Beyond Flexner: Critical analysis and structural challenges of Competency-Based Medical Education

Abstract

Objective: To critically analyze the transition from the traditional medical training model to Competency-Based Medical Education (CBME), evaluating its implications for assessment, quality, and clinical performance. Central analysis of the topic: Through a critical narrative review, it becomes evident that the time-based, passive Flexnerian model is insufficient for current complex healthcare demands. CBME emerges as the dominant paradigm, prioritizing observable outcomes through Entrustable Professional Activities (EPAs) and programmatic assessment. However, its implementation faces structural frictions and epistemological debates. There is a risk of falling into behaviorist reductionism that atomizes expert clinical judgment, turning CBME into a bureaucratic checklist exercise. Although empirical literature supports improvements in patient safety, the transfer of these competencies to complex autonomous practice remains heterogeneous. Institutional barriers, such as academic overload and a lack of faculty training, demand innovative solutions, including the integration of artificial intelligence to manage formative feedback. Conclusion: The transition to CBME is epistemologically necessary but unfeasible as a mere administrative change. It requires a systemic reengineering that assimilates socioconstructivism, decouples assessment from traditional high-stakes pressure, and reforms university accreditation matrices, thereby ensuring optimal professional performance.