Lost in translation? How context shapes the implementation of Competence by Design in operative settings

Abstract Background: Given the complexity of the transition to competency-based medical education (CBME) and the diversity of systems and learning contexts, the literature has acknowledged the need for principled yet contextual approaches to implementation. There is a need for research that examines these adaptations and their consequences, both intended and unintended. Methods: We performed a constructivist grounded theory study to explore how the theory of CBME translated to practice in operative settings in a Canadian approach to CBME: Competence by