Effectiveness of Competency-Based Assessment versus Traditional Assessment in Postgraduate Residency Training

Abstract

Background: Assessment is an integral part in the process of post-graduate medical training, because it defines the process and readiness of the resident for independent clinical work. Traditional assessment techniques focus on written tests and viva voce/viva voce at the end of rotation while competency-based assessment focuses on multiple observations in the workplace, with structured feedback and a demonstration of pre-established clinical skills. In the postgraduate residency training program, this study examined the competency based assessment and traditional assessment methods.

Methods: A prospective comparative study was conducted at the Rawal Institute of Health Sciences, Islamabad from January 2025 to June 2025. The total number of residents included was 76, with an equal number in each group of postgraduates. Thirty-eight residents were competency assessed and 38 were traditionally assessed. The outcomes were overall assessment scores, clinical knowledge, clinical and procedural skills, communication, professionalism, clinical decision-making, patient management, competency achievement, pass rate and resident satisfaction. Data were analysed using appropriate descriptive and inferential statistical tests and a p value of < 0.05 was set as the criteria to be statistically significant.

Results: Residents assessed through the competency-based approach achieved a significantly higher mean overall score than those assessed traditionally (78.6 ± 6.9 versus 71.3 ± 7.5; p < 0.001). The competency-based group also obtained significantly higher scores in clinical skills, procedural competence, communication, professionalism, clinical decision-making and patient management. The mean improvement from baseline was 13.4 ± 5.8 points in the competency-based group and 7.1 ± 5.2 points in the traditional group (p < 0.001). Competency achievement was observed in 86.8% and 65.8% of residents, respectively (p = 0.031), while final pass rates were 92.1% and 73.7% (p = 0.034). Residents receiving competency-based assessment also reported greater satisfaction, more useful feedback and lower assessment-related stress.

Conclusion: Competency-based assessment was more effective than traditional assessment in improving clinical performance, competency achievement and residents’ learning experiences. Its implementation may strengthen postgraduate residency training, although adequate faculty preparation, time and institutional support are required.