Updated Review of Customized Onboarding Strategies for Faculty in Competency-based Medical Education: Emerging Principles and Challenges

Abstract

Competency-based medical education (CBME) marks a paradigm shift in medical training by prioritizing outcomes over time-based progression and focusing on clearly defined competencies aligned with societal needs. Faculty serve as critical agents of this transformation, but the success of CBME implementation depends significantly on effective and sustained faculty onboarding. This narrative review examines customized onboarding strategies in CBME and explores emerging principles and challenges. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar using keywords such as CBME, faculty development, onboarding, and competency-based assessment. Articles published between 2019 and 2025 were included based on relevance, empirical content, and English language. Data from selected studies were thematically analyzed and validated through expert consultation. Findings highlight persistent challenges in onboarding, such as resistance to change, time constraints, inadequate institutional support, and variable CBME familiarity. The review outlines a phased onboarding model—from preonboarding to continuous support—emphasizing the use of online learning platforms, simulation tools, and peer mentoring to improve faculty readiness. Success metrics include faculty engagement, learner performance, and longitudinal faculty development. While evidence supports CBME’s effectiveness in improving learner outcomes, further empirical validation is warranted to evaluate the impact of tailored onboarding on faculty performance. The review underscores the need for sustainable, context-sensitive, and tech-enabled onboarding frameworks to foster institutional capacity for CBME.

Introduction

Competency-based medical education (CBME) represents a transformative shift in medical training, emphasizing the acquisition of specific competencies and milestones as the primary focus of medical education. ¹ In CBME, the traditional time-based model of medical training is supplanted by an outcomes-based approach, wherein learners progress while achieving predetermined competencies. This educational paradigm shift has garnered significant attention and interest in recent years due to its potential to enhance the quality of medical education, improve patient care, and better align training with healthcare needs. In the Indian undergraduate medical curriculum, CBME explicitly identifies pharmacology-related competencies, such as rational prescribing, medication safety, and pharmacovigilance. These competencies highlight the expectation that medical graduates should apply pharmacological knowledge in clinical decision-making and patient care, reinforcing the need for faculty who are adequately trained to teach and assess these competencies effectively. However, in recent years, since its implementation, various potential challenges have emerged, particularly concerning faculty onboarding and motivational deficits, including skill shortages, as well as the absence of a well-defined roadmap. ² The successful implementation of CBME relies heavily on faculty members, who play a pivotal role in curriculum design, assessment, and the overall support of learners. ³ Their active engagement in the CBME framework is essential to ensure the program is effective and delivers its intended outcomes. Therefore, faculty onboarding, which encompasses educators’ orientation, training, troubleshooting, and professional development, holds paramount importance in the CBME context. ⁴ In pharmacology education, CBME frameworks emphasize competencies such as rational prescribing, critical evaluation of drug literature, pharmacovigilance, and therapeutic decision-making. These competencies require the integration of pharmacological knowledge with clinical reasoning and professional judgment, highlighting the importance of faculty who are adequately trained to teach and assess these competencies within competency-based curricula. ⁵

This review is designed to comprehensively explore the evolving concept of CBME and highlight the pivotal role that effective faculty onboarding plays in its successful implementation. This effort is crucial for encouraging the embrace and enhancement of CBME in medical education, considering the knowledge gained from successful implementation strategies and triumphs. The rationale for conducting this updated review, despite several years having passed since CBME’s implementation, is multifaceted. It encompasses the need for evolving educational best practices, adapting to changing educational and healthcare needs, extracting and applying lessons from ongoing feedback and continuous improvement efforts, and filling any existing gaps in previous onboarding strategies. Additionally, the review addresses the necessity of integrating interdisciplinary approaches and responding to diverse global and cultural contexts. It underscores the importance of ensuring long-term sustainability in CBME and leveraging technological advancements. Together, these factors strongly justify the need for a fresh, in-depth examination of faculty onboarding strategies in the dynamic landscape of CBME. The aim of this review is not to delve deeply into CBME itself, but, rather, to outline a roadmap for successful implementation, taking into account previous failures and successes.

Methodology

The search strategy for this narrative review involved a comprehensive exploration of electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, using combinations of keywords such as CBME, faculty onboarding, medical education, faculty development, educational best practices, competency-based assessment, curriculum design, professional development, and implementation challenges. Studies were included if they were published in peer-reviewed journals between 2019 and 2025, focused on faculty onboarding strategies in CBME, provided empirical data, theoretical frameworks, or best practices related to faculty development, and were available in English. Exclusion criteria included studies that were not related to medical education, did not specifically address CBME, or were opinion pieces lacking empirical evidence or theoretical analysis. Data extraction was conducted independently by two reviewers, who gathered information on onboarding strategies, measured outcomes, and key findings. Following the thematic synthesis of the literature, the emerging themes were reviewed through expert consultation to enhance the interpretive validity of the findings. A small panel of medical education faculty with experience in CBME implementation and faculty development was invited to review the preliminary thematic framework. These experts had prior involvement in curriculum implementation, medical education training programs, or scholarly work related to CBME. The experts independently reviewed the thematic categories and provided feedback regarding their clarity, completeness, and applicability to real-world CBME implementation contexts. Based on this feedback, minor refinements were made to the thematic structure to ensure that the final synthesis accurately represented both the published literature and practical implementation experience.

A narrative review approach was chosen for this study because the available literature on faculty onboarding and CBME is highly heterogeneous in terms of study design, conceptual frameworks, and reported outcomes. The published evidence includes qualitative studies, institutional reports, educational frameworks, program evaluations, and descriptive studies rather than uniform experimental or comparative trials. Due to this variability, conducting a systematic review with meta-analysis was not appropriate. A narrative synthesis allowed the integration of diverse sources of evidence and enabled the identification of recurring themes related to faculty onboarding, implementation strategies, and challenges in CBME adoption. This approach is widely recommended when the objective is to synthesize conceptual developments, educational practices, and emerging implementation strategies across diverse contexts rather than to quantitatively compare intervention outcomes.

Thematic Results

Understanding Competency-based Medical Education

CBME is an approach to preparing physicians for practice that is fundamentally oriented to outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centeredness. In the context of CBME, “competence” refers to a specific set of abilities that medical students and practitioners must demonstrate to be considered capable of practicing medicine effectively. ⁶ These abilities encompass a broad range of skills, knowledge, behaviors, and attitudes essential for providing high-quality healthcare. One of the key principles of CBME is the identification and definition of clear and measurable competencies that learners are expected to achieve. ⁷ This means that educators need to define what learners should be able to do at the end of their training in concrete terms. CBME places a strong emphasis on feedback, self-reflection, and learner self-assessment, thereby fostering a continuous improvement cycle. ⁸ The transition to CBME marks a significant shift in medical education, moving away from traditional time-based models to a focus on individual competencies. CBME’s focus on learners advancing through demonstrated proficiency requires significant alterations in assessment techniques, faculty responsibilities, and curriculum structure to effectively achieve its goal of fostering skilled healthcare professionals. Understanding and adapting to the key differences between traditional and competency-based teaching by medical faculty are crucial for breaking down old habits and structures and establishing new, more effective ones (Table 1).^9–11

The adoption of CBME has significantly expanded and diversified the roles and responsibilities of medical faculty. They now play key roles in developing learner competencies, providing assessment and feedback, offering individualized coaching, designing curricula, and participating in faculty development. This broader scope of duties underlines the need for faculty to receive appropriate training and fully understand their enhanced roles in the CBME framework. ¹² A lack of faculty motivation and challenges in faculty onboarding, however, have been identified as one of the major factors affecting the overall success of this remarkable and evidence-based shift.

Table 1.

Key Differences Between Traditional Teaching and Competency-based Medical Education (CBME).

Key Element	Traditional Method	CBME
Curriculum	Fixed and Structured	Flexible and Adaptable
Focus	Transmitting knowledge from the instructor to the student.	Developing the student’s competencies, which are observable behaviors that demonstrate the student’s ability to perform a task to a defined standard.
Learning goals	Predetermined and fixed	Flexible and adaptable to individual needs.
Instructional methods and learning activities	Traditional teaching methods typically rely on lectures, textbooks, and other forms of passive learning.	CBME uses a variety of active learning methods, such as problem-based learning, case-based learning, clinical experiences, and simulation.
Clinical training	Integrated throughout the curriculum	Focused on developing clinical competencies.
Assessment	Summative assessment-traditional teaching methods typically assess students’ knowledge through exams, quizzes, and essays.	Formative assessment-CBME assesses students’ competencies through a variety of performance-based assessments, such as direct observation, portfolios, demonstrations, projects, WPBA, OSCE, mini-CEX, and standardized patients.
Student-centeredness	Traditional teaching methods are typically instructor-centered, with the instructor being the primary source of information and the student being responsible for passively receiving and memorizing that information.	CBME is student-centered, with the student taking responsibility for their own learning and the instructor playing a supportive role.
Pace of learning	Traditional teaching methods typically move at a set pace, with all students expected to learn the same material at the same time.	CBME allows students to learn at their own pace, with students progressing through the curriculum at a rate that is appropriate for them.
Feedback and reflection	Traditional teaching often provides limited opportunities for regular feedback, and self-assessment by students is often not integrated into the learning process.	CBME places a strong emphasis on feedback, self-reflection, and self-assessment by students, fostering a continuous improvement cycle
Flexibility and individualization	Traditional methods often have a fixed curriculum and pace	CBME allows for personalized learning plans, accommodating differences in learning styles and speeds.
Interprofessional collaboration	Traditional teaching puts limited emphasis on interprofessional collaboration and teamwork, with a primary focus on i ndividual discipline-specific knowledge and skills.	CBME promotes interprofessional collaboration as a core competency, recognizing the importance of working effectively within healthcare teams. Learners are exposed to collaborative experiences, fostering teamwork and communication skills.
Grading	Based on achievement of specific competencies	Based on demonstration of mastery of competencies.
Progression	Based on successful completion of the course	Based on demonstration of mastery of competencies.
Teachers’ role	Delivers content and instruction	Facilitates learning and provides feedback.
Students’ role	Passive recipients of information	Active participants in their own learning.
Outcome	Graduates with a broad knowledge of medicine	Graduates with skills and competencies to practice medicine effectively.

Note: Mini-CEX: Mini clinical evaluation exercise; OSCE: Objective structured clinical examination; WPBA: Workplace-based assessment.

Challenges in Faculty Onboarding for Competency-based Medical Education

Despite extensive efforts in faculty training, onboarding remains a major challenge in CBME. Understanding the reasons behind this is crucial for new institutions and those struggling with implementation to ensure a smoother transition and more successful outcomes in the future (Figure 1). ¹³ Figure 1 illustrates that faculty onboarding in CBME is hindered by multiple intertwined issues—including resistance to change, limited CBME expertise, competing time demands, resource constraints, insufficient institutional support, and low motivation—creating a complex environment that ultimately impedes effective adoption of competency-based education. These challenges support the need for targeted strategies specific to facilitate faculty onboarding, beginning from preonboarding to continuous support, mentorship, and reinforcement of working strategies.

Figure 1.

Challenges in Faculty Onboarding for Competency-based Medical Education (CBME).

Designing an Effective Faculty Onboarding Program

Given the evolving roles of medical educators in CBME and the implementation challenges faced by institutions, clearly defined objectives for Faculty Development Programs (FDPs) are essential to support effective CBME training.^13–15

Effective onboarding includes structured orientation sessions that introduce CBME principles, institutional goals, assessment strategies, and faculty roles, alongside discussions on the benefits and challenges. ¹⁶ Workshops and training modules should focus on practical areas such as competency-based assessment, feedback methods, and curriculum alignment with CBME standards. Mentorship and peer support are vital, enabling new faculty to learn from experienced colleagues and fostering collaborative learning communities.^15–17 In pharmacology education, recent CBME curriculum reforms have incorporated competency-oriented teaching strategies, such as rational prescription writing exercises, drug-information evaluation tasks, and therapeutic decision-making scenarios. These approaches help align pharmacology teaching with real-world prescribing competencies and enable faculty to assess learners’ ability to apply pharmacological knowledge in clinical decision-making contexts. ¹⁸

Onboarding must be tailored to varying levels of faculty experience with CBME. Preassessments can identify baseline knowledge, guiding targeted interventions. Disciplinary differences also matter—clinical faculty may need help designing performance-based assessments, while basic science faculty may need support with competency framing. To accommodate diverse learning styles and interests, programs should incorporate hands-on workshops, online modules, mentoring, and self-directed learning opportunities. Such customized onboarding enhances faculty readiness and supports institution-wide CBME success. ¹⁹

Implementation Strategies for Faculty Onboarding for Competency-based Medical Education

Timeline and Phases of Onboarding

The onboarding process for faculty in CBME should be well-structured, with clear timelines and phases to ensure a smooth transition. These phases may include (Figure 2).

Figure 2.

Timeline and Phases of Faculty Onboarding for Competency-based Medical Education (CBME).

The Preonboarding Phase focuses on introducing faculty to the onboarding process and its objectives. This stage may include conducting preassessment surveys or needs assessments to gauge existing knowledge and identify individual faculty needs.

In the Orientation Phase, faculty are introduced to the basic principles of CBME and the specific framework adopted by the institution. This includes familiarizing them with the curriculum structure, assessment plans, and key practices related to assessment within CBME.

The Training and Development Phase provides focused capacity building through workshops, seminars, and hands-on sessions in areas like curriculum design, competency-based assessment methods, and feedback strategies. Faculty should also receive feedback on their own CBME teaching and assessment practices to foster continuous improvement.

The Mentoring and Peer Support Phase emphasizes ongoing guidance by pairing new faculty with experienced mentors. Establishing peer networks or communities of practice helps promote knowledge exchange and collaborative problem solving.

Finally, the Assessment and Evaluation Phase involves faculty participation in assessing learners using CBME-aligned methods. This includes observing assessments, providing structured feedback to learners, and ensuring that their evaluation practices are consistent with CBME standards.

When designing the timeline and phases for faculty onboarding in CBME, it is essential to align the program with the institution’s broader CBME implementation plan to ensure faculty are adequately prepared to integrate CBME into their teaching. The onboarding process should also be responsive to faculty needs and interests, taking into account their prior experience with CBME, teaching discipline, and preferred learning styles. Additionally, the program must be planned realistically, considering the resources available within the institution, to ensure feasibility and sustainability. ²⁰

Resources and Tools for Effective Onboarding

To facilitate effective onboarding in CBME, faculty should be equipped with a variety of resources and tools to support their understanding and implementation of CBME principles. These include comprehensive handbooks or guides outlining CBME frameworks, assessment methods, and best practices. Online learning platforms or learning management systems (LMS) can host these materials, enabling flexible, self-paced access. Providing faculty with assessment templates and feedback tools specifically designed for CBME can further enhance their ability to evaluate learners effectively. Additionally, real-world case studies and practical examples demonstrating the application of CBME concepts can help faculty translate theory into practice. ²¹ Contemporary pharmacology education has evolved from traditional lecture-based approaches toward active learning strategies, such as case-based learning, simulation-based training, and objective structured clinical examination (OSCE)-based prescribing assessments, reflecting the broader transition toward competency-based educational frameworks. ²²

Leveraging Technology in Faculty Onboarding

Technology plays a pivotal role in enhancing faculty onboarding in CBME. Online modules and resources enable faculty to engage in self-paced learning, accessing onboarding content at their convenience. Virtual workshops and webinars provide interactive learning experiences, overcoming geographical barriers. The use of LMS helps centralize onboarding materials, assessments, and communication, ensuring easy access and organization. ²³ Additionally, simulation-based tools and virtual patient encounters offer faculty hands-on practice in CBME assessments. Online communities further foster collaboration and peer learning, providing a platform for resource sharing and mutual support. Leveraging data analytics allows the tracking of faculty engagement, monitoring of progress, and identifying areas needing targeted interventions for continuous improvement.^{24, 25}

Continuous Support and Professional Development

Sustaining faculty engagement and growth in CBME requires continuous support and structured professional development strategies. Regular workshops and updates should be conducted to keep faculty abreast of evolving CBME practices and innovations. Establishing peer communities and online forums provides faculty with a platform to exchange experiences, seek guidance, and collaborate on CBME-related challenges. Regular performance evaluations, coupled with constructive feedback, help faculty refine their teaching and assessment skills. Additionally, encouraging faculty participation in CBME-related research and scholarly activities not only fosters academic growth but also promotes their active contribution to the advancement of medical education. ²⁶

Assessing Faculty Onboarding for Competency-based Medical Education Effectiveness

Effective assessment of faculty onboarding for CBME requires well-defined metrics, continuous feedback mechanisms, and the adoption of evidence-based best practices. This ensures that faculty are not only equipped to implement CBME effectively but also remain engaged and supported in the long term. Effective faculty onboarding in pharmacology departments is essential to ensure that educators are able to teach and assess competencies related to rational prescribing, medication safety, and therapeutic decision-making, which are central to safe clinical practice.

Metrics for Success in Faculty Onboarding

Clear key performance indicators (KPIs) should be established to assess the success of faculty onboarding in CBME. These may include faculty competency development, wherein faculty members are expected to demonstrate a sound understanding of CBME principles, curriculum design, teaching-learning methods, and assessment strategies, along with the confidence to implement these effectively in their teaching practices. Additionally, their satisfaction with the onboarding process, in terms of content, structure, and delivery, is an important measure. Learner outcomes, reflected in the improved performance and achievement of competencies by students under the guidance of onboarded faculty, further serve as a vital metric. Faculty retention and engagement postonboarding, including their active participation in CBME initiatives and continued professional development, are essential indicators of sustained effectiveness. Moreover, feedback from learners regarding the quality of faculty teaching, assessment practices, and mentorship provides valuable insights into the success of the onboarding process. Finally, periodic reviews of assessment data to ensure alignment with CBME principles and to ascertain the reliability and consistency of faculty-conducted assessments complete the framework for evaluating onboarding effectiveness. ²⁷

Adopting Evidence-based Best Practices for Assessing Effectiveness

Adopting evidence-based best practices is essential for assessing the effectiveness of faculty onboarding in CBME. A mixed-methods approach that combines quantitative methods, such as knowledge tests and skill assessments, with qualitative inputs, like interviews and focus group discussions, ensures a comprehensive evaluation of onboarding outcomes. Involving faculty directly in the assessment process by engaging them in the design of assessment tools, data collection, and analysis promotes ownership and relevance. ²⁸

Establishing peer learning communities provides a platform for faculty to regularly exchange insights, discuss challenges, and share strategies related to CBME implementation. Structured mentoring and coaching networks, where experienced faculty guide and support newly onboarded colleagues, foster continuous development and confidence. Additionally, documenting and disseminating successful onboarding experiences through case studies, workshops, webinars, and publications enables cross-learning and helps build a repository of practical strategies that can benefit other faculty and institutions implementing CBME. Despite widespread implementation efforts, is there evidence from the literature or expert consensus indicating that CBME is truly achieving its intended outcomes?

Is There Any Evidence Demonstrating the Effectiveness of Competency-based Medical Education?

Several recent studies have provided compelling evidence-based objective measurements of CBME’s effectiveness. For instance, a study published in the Journal of Postgraduate Medicine in 2023 found that CBME graduates exhibited significantly better performance on standardized exams compared to their non-CBME counterparts. Additionally, a 2022 study published in Medical Teacher demonstrated that CBME graduates were more confident in their clinical skills and had a greater understanding of patient care principles. These findings are corroborated by a growing body of research that consistently highlights the positive impact of CBME on student outcomes. Studies evaluating competency-based pharmacology teaching have demonstrated improvements in rational drug selection and therapeutic reasoning. Training students in structured frameworks such as the personal drug (p = drug) selection approach enhances their ability to apply pharmacological knowledge to clinical prescribing decisions. ²⁹ Studies have shown that CBME can lead to improved patient satisfaction, increased graduation rates, and a stronger commitment to lifelong learning among medical graduates.^30–32

Future Directions for Enhancing Onboarding

Technology can be used to make onboarding more efficient, effective, and accessible. For example, institutions can use online modules, video conferencing, and online communities to support faculty onboarding. There are going to be several potential benefits of using artificial intelligence in medical education. Institutions can use data and analytics to personalize onboarding for each faculty member. This will help ensure that faculty members receive the most relevant and targeted support. They can create opportunities for faculty members to collaborate during the onboarding process. This will help build a community of support and learning. ³³

Strengths and Limitations of the Review

The study offers an in-depth analysis of CBME, effectively covering its core principles, implementation strategies, and the essential role of faculty onboarding. It brings attention to faculty onboarding as a critical yet often underexplored element of CBME. The review is well-supported by existing literature, lending credibility to its recommendations. It provides practical, actionable suggestions for designing onboarding programs, utilizing technology, and fostering continuous faculty development. The emphasis on feedback mechanisms for ongoing improvement further enhances its relevance to medical education practice. However, the study is limited by its reliance on secondary data, with no original empirical evidence provided. The interpretation and synthesis of literature may carry inherent author bias. The applicability of its recommendations may vary across institutions, depending on local contexts and available resources. While challenges in faculty onboarding are acknowledged, a more detailed exploration of ground-level barriers would have added value. Inclusion of case studies or real-world examples of successful CBME implementation could have further strengthened the practical relevance of the review.

Conclusion

Effective faculty onboarding for CBME should include providing faculty with the knowledge and skills necessary to develop and implement CBME curricula, assessments, and teaching activities. It should also support faculty in their transition to CBME by providing access to resources and support networks, as well as offering opportunities for faculty to share their experiences and learn from each other. Technology can be leveraged to support faculty onboarding for CBME by providing faculty members with self-paced learning opportunities, connecting them with experienced CBME faculty mentors, and creating online communities where they can share resources and learn from each other. The field of medical education is constantly evolving, and onboarding practices should evolve accordingly. Within pharmacology education, structured faculty onboarding is particularly important to ensure effective teaching of competencies such as rational prescribing, pharmacovigilance, and therapeutic decision-making within CBME curricula.