The American Board of Pediatrics recently announced a plan to alter pediatric subspecialty fellowship training, moving toward a competency-based framework that would, for neonatal-perinatal medicine, condense what has traditionally been a three-year fellowship into a shorter pathway. Proponents of such reforms point to workforce shortages, the financial strain of prolonged training, and evidence that clinical competence can be demonstrated and certified through entrustable professional activities rather than time served. The board’s stated goal, articulated in its 2026 announcement on ensuring readiness for practice, is to advance competency-based subspecialty training so that physicians enter independent practice sooner without sacrificing skill. For a field grappling with persistent recruitment challenges and rising demand for neonatal intensive care, the appeal is obvious.

Yet Kukora and her colleagues argue that this framing overlooks something fundamental: professional identity formation, often abbreviated as PIF in the medical education literature. Drawing on decades of scholarship, including the influential schematic model developed by Richard and Sylvia Cruess and colleagues at McGill University, the authors describe professional identity formation as the process through which trainees internalize the values, behaviors, and norms of medicine, gradually coming to think, feel, and act like the physicians they are training to become. This transformation does not occur through the mere accumulation of procedures or checklists. It unfolds within what educational theorists call a community of practice, an immersive social environment in which novices learn by participating alongside experienced mentors, absorbing not only explicit teaching but also the hidden curriculum of daily clinical life.

Neonatal-perinatal medicine presents a particularly demanding context for this transformation. Neonatologists care for infants at the very margins of viability, make life-and-death decisions under profound uncertainty, and navigate emotionally charged relationships with families in crisis. The ethical terrain is notoriously difficult: decisions about initiating, withholding, or withdrawing life-sustaining treatment; the interpretation of aggregate outcome statistics for individual counseling; and the negotiation of family-centered care in settings where evidence is often incomplete. The authors emphasize that the entrustable professional activities defined for neonatology, the specific tasks considered essential for independent practice, are themselves deeply rooted in professional identity formation. Competence in these activities presupposes mature moral reasoning, the capacity to experience and manage distress, and the resilience to sustain a career in an emotionally punishing environment.

The literature on moral distress in neonatology underscores why this matters. Studies by Prentice, Janvier, Gillam, and colleagues have documented high levels of moral distress among neonatal clinicians, the anguish that arises when providers know the ethically appropriate course of action but feel constrained from pursuing it. Repeated episodes of moral distress leave behind what Epstein and Hamric have described as moral residue, a cumulative erosion that contributes to the crescendo effect of escalating distress over time. Compassion fatigue, secondary traumatization, and burnout are well documented among neonatologists, and physician burnout has been linked in multiple studies to increased medical errors and worse patient outcomes. Professional identity formation, the authors argue, is one of the key mechanisms through which clinicians develop the meaning and purpose that buffer against these occupational hazards. Research by Toubassi and colleagues has explicitly linked professional identity formation to well-being, suggesting that a coherent sense of professional self is not a luxury but a protective factor.

Against this backdrop, the prospect of condensing fellowship raises a series of ethical concerns. First, there is the problem of time itself. Identity development is longitudinal and cannot be reliably compressed without consequence. Qualitative longitudinal research on how residents develop virtues suggests that character formation in medicine depends on sustained experience, reflection, and mentorship over time. A trainee who spends fewer months in the neonatal intensive care unit has fewer opportunities to witness and internalize how seasoned clinicians handle uncertainty, communicate bad news, repair errors, and honor the values of family-centered care. Second, the authors point to the discontinuity problem in medical education, a topic recently analyzed in the New England Journal of Medicine by Warm and colleagues. Shortened, fragmented training pathways risk disrupting the continuity of relationships, between trainees and mentors, and between trainees and the patients and families they follow over weeks and months, that make deep learning possible.

Third, the perspective highlights the hidden curriculum, the informal and often unspoken lessons trainees absorb from their environments. When institutions signal that training is primarily a throughput problem to be optimized, trainees may internalize a transactional view of their profession. Conversely, when programs deliberately protect time for reflection, ethics education, and relationship-building, trainees are more likely to develop the habits of moral attention that neonatal practice demands. Ethics education in neonatology, as recent work in NeoReviews by Sullivan and colleagues illustrates, increasingly integrates theory, multimodal teaching methods, and even artificial intelligence innovation, but it requires protected space within the training structure to take root. A compressed pathway that crowds out these formative experiences may produce technically competent graduates who are nonetheless underprepared for the ethical weight of their role.

The authors are careful to acknowledge the legitimate pressures motivating reform. The pediatric subspecialty workforce faces genuine shortages, and neonatal intensive care admissions in the United States have risen steadily, according to National Center for Health Statistics data covering 2016 through 2023. Burnout and workload concerns have prompted serious discussion of hours-based scheduling in neonatology, and some have argued in the Journal of Perinatology that the field should indeed move to two-year fellowships. A companion critical appraisal by Vergales and colleagues examined the American Board of Pediatrics’ proposed two-year pathway in detail, questioning whether the required competencies can realistically be achieved in the condensed timeframe. The debate is thus not between reform and stagnation, but between competing visions of what fellowship is ultimately for.

What distinguishes the Kukora paper is its insistence that the answer must be framed in ethical rather than merely operational terms. The authors argue that it is an ethical imperative for neonatal-perinatal medicine fellowship programs to nurture the evolving professional identities of their learners, because those learners will guide future innovation and progress in the field while providing ethical, family-centered, high-quality clinical care. If professional identity formation is foundational to every essential entrustable professional activity in neonatology, then any reform that undermines it risks compromising not only individual careers but the profession’s core mission. The stakes, in other words, are borne ultimately by newborns and their families, who depend on physicians trained not just to perform interventions but to deliberate wisely about when interventions serve the patient’s best interests.

The perspective closes with a call for the pediatrics community to take these risks seriously before implementing the new pathway. Rather than treating identity formation as an intangible byproduct of training, the authors suggest it should be treated as an explicit outcome to be protected and measured, alongside clinical competence and procedural skill. As the American Board of Pediatrics moves forward with competency-based subspecialty training, the challenge will be to design programs that achieve efficiency without hollowing out the human and moral development that makes a neonatologist more than a technician. The paper’s central message is stark: how the profession trains its future members will shape, for better or worse, the care that the smallest and most vulnerable patients receive for decades to come.

Subject of Research: Ethical implications of condensing neonatal-perinatal fellowship training for neonatologists' professional identity formation

Article Title: Threats to neonatologists’ professional identity formation: ethical implications of condensing neonatal-perinatal fellowship

Article References: Kukora, S. K., Gray, M. M., McLean, C. K., & Krick, J. (2026). Threats to neonatologists’ professional identity formation: ethical implications of condensing neonatal-perinatal fellowship. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02899-0

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02899-0

Keywords: neonatology, professional identity formation, medical education, fellowship training, American Board of Pediatrics, moral distress, medical ethics, neonatal-perinatal medicine, competency-based training, burnout, family-centered care, Journal of Perinatology

The review, published in the journal “Discov Educ,” provides a thorough analysis of existing literature and practices related to outcome-based medical education (OBME). The authors delineate a clear trajectory that outlines the origins, developments, and current applications of OBME, making a compelling case for its necessity in the context of modern healthcare training. Such frameworks establish clear competencies that medical practitioners are expected to achieve, thereby enhancing the relevance and applicability of medical education to real-world scenarios.

One of the salient features of OBME is its focus on the integration of knowledge, skills, and attitudes. This triad forms the foundation of effective medical practice and highlights the importance of not just teaching technical skills, but also cultivating the professional demeanor and ethics that students must embody. It is imperative that future doctors are not only knowledgeable but also competent in applying their knowledge in clinical settings. The review emphasizes that this holistic approach enhances patient care and ensures that graduate medical practitioners are prepared to meet the complexities of modern healthcare.

Intriguingly, the authors of the review delve into a variety of teaching methodologies that have emerged alongside the rise of OBME. Among these, problem-based learning (PBL) and simulation-based education stand out as particularly effective strategies that promote active engagement and critical thinking among students. By placing students in realistic clinical scenarios, these methods foster an environment where learners can apply theoretical knowledge to practical challenges, reinforcing the underlying principles of OBME.

The impact of OBME is not limited to individual learning experiences; it extends to the broader curriculum design and assessment strategies employed in medical schools. The review outlines how medical curricula have increasingly been structured around competencies rather than mere content delivery. This shift has profound implications for assessment, as traditional examinations may not adequately capture a student’s ability to apply knowledge in real-world conditions. Instead, performance-based assessments and competency checklists have been adopted to gauge student readiness effectively.

An important aspect highlighted in the review is the role of interprofessional education (IPE) within the OBME framework. The collaboration between medical students and those from other healthcare disciplines is underscored as a crucial element in preparing future healthcare providers for team-oriented environments. This focus on IPE ensures that students cultivate the necessary communication and collaborative skills essential for delivering high-quality care in multidisciplinary teams.

Furthermore, the review addresses the challenges faced in implementing OBME across diverse educational settings. Variability in institutional resources, faculty training, and cultural acceptance of these methodologies can hinder the effective realization of outcome-based education. The authors call for strategic investments and policy initiatives that foster a supportive environment for innovation in medical pedagogy, underscoring the need for collaborative efforts among educational institutions, policymakers, and healthcare providers.

One critical concern in the evolving landscape of medical education is the equitable access and quality of training opportunities. The review raises awareness about the disparities that exist between different regions and institutions regarding the implementation of OBME. While some medical schools have embraced these approaches, others lag due to financial, geographic, or resource constraints. Addressing these issues will be vital in ensuring that all medical students receive a robust, competency-oriented education that equips them for future challenges.

Additionally, the review emphasizes the necessity of continuous improvement and feedback mechanisms in the OBME framework. Educational institutions are encouraged to regularly assess and refine their curricula based on emerging healthcare needs, student performance, and feedback from clinical practice. This iterative process is crucial in maintaining the relevance of the education provided and ensuring that it aligns with the evolving standards of healthcare delivery.

As the review concludes, it remains optimistic about the future of competency-based medical education. It highlights the role that technology can play in enhancing educational experiences, with innovations such as virtual reality and artificial intelligence providing new avenues for immersive and adaptive learning. Incorporating these technologies into OBME promises to further engage students and provide them with rich, tailored educational experiences.

In summary, the scoping review by Alias, A.H., Ibrahim, M.S., and Abu Bakar, Y.I. serves as a comprehensive resource that sheds light on the implementation of outcome-based medical education over the last three decades. By synthesizing extensive research, the authors advocate for a transformative approach to medical training that prioritizes competencies essential for contemporary practice. Their insights offer invaluable guidance for educators and policymakers looking to develop resilient and adaptive medical education systems that can meet the demands of future healthcare environments.

The implications of this review extend beyond medical education. By fostering a more competent healthcare workforce, we can ultimately enhance patient care and safety, lead to better health outcomes, and positively impact public health on a global scale. This is a critical moment in medical education, one that necessitates collective commitment and innovation from all stakeholders involved in shaping the next generation of healthcare providers.

Subject of Research: Implementation of outcome (competency) based medical education

Article Title: Implementation of outcome (competency) based medical education: a scoping review of 30 years of evidence

Article References: Alias, A.H., Ibrahim, M.S., Abu Bakar, Y.I. et al. Implementation of outcome (competency) based medical education: a scoping review of 30 years of evidence. Discov Educ (2026). https://doi.org/10.1007/s44217-026-01132-6

Image Credits: AI Generated

DOI:

Keywords: Outcome-based medical education, competency-based education, medical training, interprofessional education, healthcare workforce

The shift from a 2+4 to a 6-Year curriculum model is not merely a structural change, but rather an ideological revolution aimed at enhancing the quality of medical education. This transition reflects the pressing need for a curriculum that not only delivers theoretical knowledge but also emphasizes continuous practical application and patient-centered care. South Korea, known for its rigorous educational landscape, is embracing this shift with the intent to produce well-rounded, competent medical professionals who can navigate the complexities of modern healthcare systems effectively.

As the authors of the study argue, the 2+4 curriculum, which typically entails two years of pre-clinical studies followed by four years of clinical training, often compartmentalizes the learning process. This segmentation can lead to gaps in knowledge retention and application. In contrast, the 6-Year continuous model integrates early clinical exposure with robust learning opportunities throughout the entire program. This integration is crucial since it allows students to apply their knowledge in clinical settings more frequently, reinforcing their educational experience and fostering essential skills such as critical thinking, communication, and teamwork.

The stakeholders’ input in this research highlights the multifaceted nature of medical education. The educators expressed a resounding need for curriculum designs that adapt to the rapid advancements in medical science and technology. Insight from administrators indicated a belief that longer curriculums could lead to greater depth and breadth of knowledge acquisition, which is essential in facing the increasing complexity of diseases and healthcare delivery. Students themselves articulated the value of extended learning periods, which can accommodate not just medical knowledge but also personal growth and resilience in the face of challenges.

Challenges do accompany this monumental transition. Financial implications are undeniable; an extended curriculum may incite concerns regarding tuition fees, funding, and potential debt burdens facing medical students. Additionally, the logistical complexities of scheduling and resource allocation come into play. However, advocates for the 6-Year curriculum argue that the return on investment, in terms of enhanced learning outcomes and better-prepared physicians, far outweighs these hurdles.

Further analysis in the article examined how comparable shifts have been approached globally. Countries such as the United States and the United Kingdom have implemented various models promoting integrated and longitudinal learning experiences within medical education. By examining these international examples, South Korea can glean valuable insights into best practices and potential pitfalls, allowing for a more tailored and effective transition.

Another compelling aspect addressed in the paper is the psychological implications of a longer curriculum on students. The authors discussed how the prolonged engagement in medical education could affect well-being, mental health, and overall student satisfaction. The increased time in training can foster deeper relationships among peers and mentors, creating support networks essential for the mental resilience often required in the medical profession. This perspective is becoming increasingly relevant as the emphasis on physician well-being becomes a priority within healthcare institutions.

The study also explores opportunities for innovation in pedagogy accompanying the new curriculum structure. Incorporating new technologies, such as virtual reality and simulation-based learning, provides fresh avenues for immersive education and skill acquisition. These modern approaches can enhance engagement, ensuring that the students are not just passive recipients of knowledge but active participants in their learning journey.

Furthermore, the expansion of the curriculum facilitates flexibility, allowing for the incorporation of interdisciplinary approaches and elective courses that were previously sidelined due to time constraints. This flexibility enables students to pursue specialties and interests that resonate with their personal and professional aspirations, thereby promoting a sense of agency in their education.

As the discussion progresses, the role of accreditation bodies and policy makers becomes paramount. The findings advocate for ongoing dialogue among all stakeholders to ensure that accreditation remains relevant and supportive of this new curriculum model. Continuous reevaluation of educational standards, coupled with stakeholder feedback, will be essential in creating a dynamic educational environment that can adapt to both local and global healthcare challenges.

The authors conclude with a call to action for educators and policymakers, imploring them to prioritize the holistic development of students in the medical field. This call resonates with the broader movement towards a more humane approach to medical education that emphasizes empathy, patient-centered care, and a commitment to continuous learning. As South Korea embarks on this educational transformation, it is poised to set a precedent that could influence global medical education standards for decades to come.

Ultimately, the transition from the 2+4 curriculum to the 6-Year model serves as a powerful reminder of the importance of adapting educational frameworks in response to the evolving demands of society. As healthcare systems become more intricate and patient needs diversify, the educational strategies employed must also evolve to ensure the next generation of physicians can rise to the occasion. The study by Lee, Shin, and Park not only sheds light on this tectonic shift but also inspires a global conversation about the future of medical education.

Subject of Research: Transition in medical curriculum structure in South Korea from 2+4 to 6-Year continuous model.

Article Title: Breaking the mould: stakeholder insights into the shift from 2 + 4 to a 6-Year continuous medical curriculum in South Korea.

Article References:

Lee, Y., Shin, JS., Park, W.B. et al. Breaking the mould: stakeholder insights into the shift from 2 + 4 to a 6-Year continuous medical curriculum in South Korea.
BMC Med Educ 25, 1399 (2025). https://doi.org/10.1186/s12909-025-07998-8

Image Credits: AI Generated

DOI:

Keywords: Medical education, curriculum development, South Korea, stakeholder insights, continuous learning.