Competency-based medical education, including the Canadian version known as Competence by Design, was built on a compelling promise: training should align tightly with the observable tasks of a discipline, and assessment should capture what trainees can actually do. Entrustable Professional Activities, or EPAs, define the essential tasks of each specialty and anchor workplace-based assessment. The framework has improved clarity, feedback, and the connection between training and independent practice. But the perspective argues that implementation has created a practical incentive with an unintended consequence: programs now prioritize settings where specialty-specific competencies can be most readily observed and documented, and off-service rotations, where such observations are harder to coordinate, become structurally vulnerable.

The technical heart of the argument lies in what the authors reviewed. They examined the Competence by Design EPAs for pediatrics, emergency medicine, and internal medicine and found that many could be achieved through specialty-specific clinical experiences alone. From an assessment standpoint, observing a trainee within her primary specialty environment is simply more straightforward than coordinating EPA observations across services. The result is a quiet restructuring of educational time: programs ask whether experiences once obtained through off-service rotations could instead be delivered within home services, simulation environments, longitudinal experiences, or academic curricula. In some cases, the authors acknowledge, such redesign genuinely improves efficiency and removes experiences no longer essential to contemporary practice. The problem is what falls through the cracks.

What falls through the cracks, the perspective contends, is a form of learning that extends well beyond discipline-specific competence. Off-service rotations were never designed only to expose trainees to additional medical content. They served as opportunities to develop broader clinical judgment, encounter uncommon clinical presentations, understand the operational realities of adjacent specialties, and build the relationships that support future collaborative practice. Evidence supports this broader view. A study by Diffley and colleagues demonstrated measurable gains in clinical understanding following a one-month off-service plastic surgery rotation, framing the allocation of resident time as a cost-benefit decision in which educational breadth must be weighed against opportunity costs. Their findings suggest that clinical exposure itself, rather than curricular content alone, drives meaningful learning and may enable knowledge transfer across specialties.

The social infrastructure of care may be the most underappreciated casualty. Research by Chan and colleagues identified familiarity as a central mechanism influencing referral and consultation interactions among residents. Familiarity emerged through repeated exposure over time: rotating through other services, shared educational experiences, collaborative patient care, and even informal interactions outside clinical work. Residents reported that knowing colleagues personally increased receptivity, empathy, and willingness to engage in discussion and debriefing after consultations. Familiarity was closely tied to trust, as repeated interactions allowed physicians to develop an understanding of one another’s practice styles and clinical reasoning. Shared experiences also created alignment of interests and improved communication efficiency during patient transfers. Off-service rotations, in this light, function not merely as educational exchanges but as mechanisms for developing the interpersonal relationships that allow healthcare systems to coordinate care effectively.

To make sense of what may be changing, the authors deploy a conceptual lens borrowed from human factors engineering: the Systems Engineering Initiative for Patient Safety, or SEIPS 3.0 framework. SEIPS conceptualizes healthcare as a system of interacting people, tasks, technologies, environments, and organizational structures that shape care processes and outcomes. Crucially, it recognizes that healthcare work occurs through interconnected physical, cognitive, and social or behavioral processes. From the physical process perspective, cross-disciplinary experiences expose residents to diverse environments, workflows, operational structures, technologies, and patterns of patient movement across the system. A resident on an off-service rotation encounters different approaches to triage, consultation, discharge planning, escalation of care, documentation, and referral, developing a broader awareness of how healthcare systems function across boundaries.

The cognitive dimension is equally consequential. Different specialties prioritize different information, operate with different thresholds for intervention, and conceptualize patient problems in distinct ways. Participating in these environments helps residents develop more flexible mental models and appreciate that similar clinical presentations can lead to different but equally appropriate approaches to care, depending on context. The social and behavioral dimension completes the picture: healthcare depends on communication, coordination, role negotiation, and shared understanding across individuals and teams. Working alongside other residents and faculty allowed trainees to become familiar with professional cultures, consultation practices, service expectations, and the day-to-day realities of adjacent specialties, shaping future interactions in subtle but important ways. The educational question, reframed through SEIPS, is whether redesign unintentionally narrows the physical, cognitive, and social processes through which residents learn to participate in complex healthcare systems.

The concern is not hypothetical. Residents within EPA-based systems have reported that predefined assessment structures may not fully capture the complexity, breadth, and contextual nature of clinical work, and have expressed worries that emphasizing specialty-specific EPAs could diminish learning opportunities occurring outside directly assessed activities. The authors also point to systems-level evidence: a study by Saffo and colleagues showed that placing an internal medicine triaging resident in the emergency department reduced preventable admissions while significantly improving trainee experiences related to patient flow and initial management. Off-service clinical roles, that work suggests, can simultaneously enhance medical training and healthcare system efficiency by fostering interdisciplinary collaboration and expanding competencies in triage and care transitions. Patients, after all, rarely experience healthcare through the boundaries of specialties; they move across services, teams, and settings throughout their care journey.

The perspective is careful to avoid arguing against competency-based training, EPAs, or educational redesign. Its constructive proposal is that programs should identify and preserve forms of learning that become less visible within outcome-based models, not because they lack value but because their outcomes are harder to document directly. The authors outline concrete opportunities: longitudinal cross-disciplinary experiences, integrated clinics, structured patient-following activities across services, joint academic half-days, cross-specialty simulation, collaborative case reviews, intentional consultation experiences, and assessment activities that explicitly recognize systems-oriented and collaborative skills. They cite a promising example from Clark and colleagues, who described recurring combined educational sessions between emergency medicine and internal medicine residents built around shared clinical problems and transitions of care. Residents valued the shared experience itself as much as the educational content, reporting increased understanding of colleagues’ working conditions, recognition of shared goals, and appreciation for opportunities to discuss common frustrations and collaboratively identify solutions.

The deeper implication reaches beyond residency offices into the architecture of medical training itself. Little empirical work has examined how off-service and cross-disciplinary experiences have actually changed following implementation of outcomes-based training models, how curricular restructuring decisions are made, or which educational outcomes may be affected by these changes. The authors, whose work was supported in part by the Social Sciences and Humanities Research Council of Canada, invite clinicians and educators to consider not whether to preserve prior rotation models, but how to preserve the elements of cross-disciplinary exposure that remain essential for preparing clinical learners for practice. As training systems evolve, educational leaders may benefit from asking not only whether competencies are achieved, but also what forms of learning become more or less available through curricular redesign. In a healthcare system where collaboration across specialties determines patient outcomes, the perspective suggests, the invisible curriculum of familiarity, trust, and systems awareness may be worth more than any single assessed task.

Subject of Research: Medical Education

Article Title: Preserving the Educational Value of Off-Service and Cross-Disciplinary Experiences in Competency-Based Residency Training

Article References: Bilgic, E., Zarandi, A., Athina (Tina) Martimianakis, M., Ngo, Q. N., Fleming, A., & Martin, L. (2026). Preserving the Educational Value of Off-Service and Cross-Disciplinary Experiences in Competency-Based Residency Training. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10808-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10808-6

Keywords: residency training, competency-based medical education, off-service rotations, cross-disciplinary learning, SEIPS framework, postgraduate medical education, Preserving, Educational, Value, Off-Service, Cross-Disciplinary, Experiences

The graduate at the center of the milestone is Matthew Grundy, a 27-year-old marketing professional who completed the degree ahead of the standard three-year timeframe by taking on additional units and studying through holiday periods. His route through the program offers a case study in how the degree operates in practice. Rather than moving through a fixed sequence of disciplinary prerequisites, Grundy navigated a curriculum built around tackling real-world projects, working alongside people from different backgrounds and exploring emerging technologies and business models. The structure deliberately mirrors the conditions of contemporary professional life, where problems rarely arrive neatly labeled by discipline and where teams are assembled from varied expertise to respond to challenges that shift as quickly as the markets they emerge from.

In remarks following the ceremony, Grundy reflected on what drew him to the program in the first place, describing the degree as different from conventional offerings because it encouraged students to think across industries rather than focusing on a single field of study. He emphasized that the curriculum rewarded creative problem solving and adaptability, and he argued that these capabilities are becoming increasingly important as industries evolve and organizations seek people who can think critically, identify opportunities and navigate uncertainty. His assessment speaks to a wider debate within higher education about whether the traditional degree structure, which has historically organized knowledge into bounded departments and majors, still serves students entering a labor market characterized by fluid career paths, technological disruption and the erosion of clearly defined job descriptions.

Curtin Vice-Chancellor Professor Harlene Hayne framed the graduation in precisely those terms, saying that Grundy’s success exemplified the curiosity, adaptability and entrepreneurial thinking the university aims to foster in every student. According to Hayne, graduates who can work across disciplines, think creatively and respond confidently to uncertainty will be essential to the future workforce as industries continue to evolve. The statement reflects a strategic bet being made by institutions around the world: that the next generation of value creation, whether in established corporations or startup ecosystems, will depend less on deep specialization in a single domain and more on the ability to synthesize insights from multiple fields, communicate across professional boundaries and translate abstract ideas into practical solutions that generate measurable outcomes.

Grundy’s own experience of the degree suggests that its lessons extended well beyond formal coursework. Balancing full-time work in marketing with a demanding study load, he said the program sparked a strong interest in growth, innovation and business development, and he now plans to continue building a career spanning strategy, marketing, innovation, organizational development and business growth. Notably, he described being the first graduate of the degree as a source of considerable pride, and he offered a perspective on innovation that pushes back against common assumptions. Innovation is frequently equated with technology, he observed, but one of the biggest lessons he took from the degree was that innovation is fundamentally about people, about solving problems and about creating value. Those skills, he argued, will remain important regardless of how industries change in the future.

That people-centered framing of innovation deserves attention, because it aligns with a growing body of thought in management and organizational research. Studies of successful innovation consistently find that technological capability alone rarely determines outcomes; instead, the decisive factors tend to be organizational culture, the willingness to experiment, the capacity to learn from failure and the ability to assemble teams whose members bring complementary perspectives. A degree that explicitly trains students to collaborate across backgrounds and to treat problem solving as a human-centered activity is, in effect, institutionalizing those findings into a curriculum. The implication is that innovation can be taught not as a body of technical knowledge but as a set of habits and dispositions, including tolerance for ambiguity, comfort with iteration and the discipline to test ideas against real constraints before scaling them.

Dr Mike Burbridge, the Bachelor of Innovation course lead at Curtin Business School, described the degree as a direct response to a job market in which career paths are changing faster than ever before. His characterization of the program’s purpose is deliberately practical: the degree, he said, gives students the skills and knowledge to tackle complex problems and the confidence to implement their solutions, whatever direction their careers ultimately take. That last clause is significant. Unlike professional degrees that prepare graduates for a defined occupation, the Bachelor of Innovation is explicitly designed to be destination-agnostic, equipping students with transferable capabilities that remain relevant as their individual paths diverge. In a labor market where analysts estimate that many of today’s school-age students will work in roles that do not yet exist, that design choice represents a conscious departure from the credentialing logic that has dominated universities for generations.

The accelerated completion of the degree also highlights questions about how flexible academic structures can be when students are motivated and institutions allow it. By taking extra units and studying through holiday periods, Grundy compressed a three-year program into a shorter span while simultaneously maintaining full-time employment. For universities, this raises the possibility that innovation-focused curricula, freed from rigid prerequisite chains, may naturally lend themselves to accelerated and part-time pathways alike, broadening access for working professionals who cannot step away from employment to study. It also suggests a model in which the boundary between study and work becomes more porous, with students applying classroom insights to professional challenges in real time and bringing workplace problems back into academic projects, creating a continuous feedback loop between theory and practice.

The graduation arrives amid broader evidence that employers increasingly prize exactly the competencies the program targets. Global surveys of hiring managers routinely place creative thinking, adaptability, complex problem solving and collaboration near the top of desired skills, often ahead of specific technical proficiencies that become obsolete within a few years. Automation and artificial intelligence are expected to absorb many routine analytical tasks, leaving human workers to concentrate on the ambiguous, judgment-heavy and interpersonal dimensions of work that resist codification. A curriculum that treats uncertainty as a subject of study rather than an inconvenience therefore positions its graduates to occupy the segments of the labor market that are likely to expand rather than contract, and the first completed cycle of the degree offers an early indication that students can emerge from such a program with a coherent professional identity rather than a diffuse set of interests.

For Curtin University, the weekend ceremony closes the loop on a bold curricular experiment and opens a new chapter in which the degree must demonstrate sustained value through the career trajectories of its graduates. Grundy’s stated ambition to build a career across strategy, marketing, innovation and business growth will be watched with interest, not as a single data point but as the first entry in what both the university and its faculty clearly hope will become a growing roster of alumni demonstrating that thinking differently can be formally taught, rigorously assessed and practically rewarded. As Professor Hayne’s remarks made clear, the university’s wager is that curiosity, adaptability and entrepreneurial thinking are not fixed traits that students either possess or lack, but capacities that can be deliberately cultivated. The first graduate of the Bachelor of Innovation now stands as living evidence that the experiment can work, and his journey from enrolment to graduation, compressed ahead of schedule and balanced against full-time work, may well become the template that future cohorts of cross-disciplinary problem solvers follow into a workforce that increasingly rewards those who can adapt faster than the world around them changes.

Subject of Research: The first graduate of Curtin University's cross-disciplinary Bachelor of Innovation degree and the design of innovation-focused higher education curricula.

Article Title: Curtin's first Innovation graduate proves the value of thinking differently

Article References: Curtin's first Innovation graduate proves the value of thinking differently. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Curtin University, Bachelor of Innovation, Matthew Grundy, Harlene Hayne, Mike Burbridge, Curtin Business School, innovation education, cross-disciplinary learning, graduate employment, creative problem solving, future workforce, higher education