Barriers to the implementation of competency-based education and assessment: A survey of otolaryngology program directors


  • The authors have no funding, financial relationships, or conflicts of interest to disclose.



To identify the barriers faced by otolaryngology program directors as they implement competency-based education and assessment and to identify preferred approaches to meet these challenges as suggested by program directors.

Study Design:

A national survey of otolaryngology–head and neck surgery program directors.


We developed a 20-item questionnaire that was distributed to 102 otolaryngology program directors through SurveyMonkey. Nonrespondents were reminded by follow-up email and phone calls. Results were analyzed by descriptive statistical analysis.


A total of 88 (86%) program directors responded to the survey. There was a marked discrepancy between the income received and time spent performing the duties of the program director. Program director workload was recognized as the most important barrier to the implementation of competency-based education. Creating a practical clearinghouse of existing and emerging assessment tools was given the highest rating among the approaches to meet the challenges faced by program directors.


Program directors in otolaryngology do not have sufficient financial support, protected time, and personnel to fulfill their administrative and educational responsibilities. They should be provided with additional institutional assistance to help them achieve the goals of the Accreditation Council for Graduate Medical Education outcome project.