1 year trial in Switzerland: A mobile app for tracking competency-based urology skills

In Switzerland, specialist training typically lasts five years, but trainees often take eight years to complete, highlighting the limitations of this model. Traditional programmes also lack consistent feedback mechanisms. Evaluations are often sporadic and vary significantly across supervisors and settings, leading to inconsistent assessments and potential skill gaps. In busy clinical environments, tracking each trainee’s development is challenging, making it difficult to ensure timely progress toward independent practice. Additionally, modern healthcare demands residents to master diverse skills, from technical expertise to patient communication, which traditional models may not fully address.

Competency-Based Medical Education (CBME)

CBME shifts the focus from time-based progression to demonstrated competence in defined activities. It ensures residents advance based on mastery, providing regular, formative feedback tied to specific competencies2. A core feature of CBME are “Entrustable Professional Activities” (EPAs)—supervisable medical tasks such as specific interventions or communication3,4. EPAs are assessed on a five-step scale, from "observation" to "supervise others," reflecting the level of supervision required rather than a pass/fail outcome. This allows supervisors and trainees to actively monitor progress in real-time, fostering accountability and timely interventions.

Application for progress tracking

To address these challenges, our institution introduced a smartphone-based application for evaluating urology specific EPAs. A set of 46 EPAs, encompassing core urology tasks, was defined by a consultant working group at our institution.  After completing an EPA - whether procedural (e.g., TURB) or non-procedural (e.g., communication) - the trainee and supervisor assess the task’s complexity and supervision level using a five-step scale. This process, completed in under a minute, compares ratings from both parties, facilitating discussions on discrepancies. 

The app saves ratings in the trainee’s account, generating a competency profile that tracks individual progress. It supports continuous monitoring, fosters trainee-supervisor discussions, and helps ensure readiness for independent practice. If a trainee transfers institutions, as is common in Switzerland, their profile can be shared, giving new employers insight into their skills and competencies.

Several mobile applications for implementing CBME and skills tracking have been evaluated and shown to be effective across various medical specialties in previous studies5–9. However, these evaluations primarily focused on technical aspects and outcomes, often overlooking the individual user experience. In the section below, we present the perspectives of both a trainee and a supervisor using the application, highlighting its benefits and challenges. 

A trainee’s perspective 

Dr. Nicola Di Nardo, 3-PGY resident: “As a resident, I often wondered how much time and practice are needed to perform a procedure safely and independently. The truth is, this varies, but the introduction of the app has accelerated the learning process, helping to determine when full autonomy is reached, both from my own and my supervisor's perspective.”

“The evaluation process is quick and takes less than a minute. After performing a procedure, I open the app, select the procedure, and a QR code is generated for my supervisor to scan. We then assess the procedure's complexity and assign an autonomy level from five options: "Observe," "Direct supervision," "Indirect supervision," "Distant supervision," and "Supervise others." This mutual evaluation facilitates discussion and allows both of us to clarify the reasoning behind each judgment.”

“The app’s main advantage is the ability to provide immediate feedback, enabling ongoing discussion and advice on improving techniques. Over time, both my supervisor and I gain a clear overview of my progress and competence. Additionally, the system benefits supervisors. In the case of an urgent procedure the supervisor can assess whether I need assistance by reviewing my competency summary in the app. This allows them to decide whether to come in or trust me to handle the situation based on my recent performance and feedback.”

“The introduction of CBME and the app benefits both trainees and consultants. The app is regularly updated and enables the evaluation of both "hard skills" (e.g., surgical procedures) and "soft skills" (e.g., clinical reasoning and patient counselling). I believe this application has the potential to enhance the evaluation process, shifting from simply completing a minimal number of procedures to ensuring that residents can independently perform all necessary tasks to become certified specialists.”

A supervisor’s perspective 

Consultant urologist, Dr. Marko Kozomara: “As a supervisor, you are undoubtedly aware of the critical role that high-quality feedback plays in optimising operational performance and daily practice. Similarly, during our own professional development, individualised feedback from senior physicians has been a pivotal factor in shaping our current clinical competencies, even if not often received.”

“As a senior physician, you possess a comprehensive perspective on the proficiency levels of individual trainees. However, due to the frequent rotation of trainees across various hospitals and in the clinic itself, it is often challenging to consistently monitor their ongoing learning progress.”

“This highlights the importance of incorporating CBME not only during medical school but also throughout specialist training. It should be stressed that, in addition to surgical skills, competencies such as interpersonal communication, patient interaction, diagnostic procedures, and differential diagnosis should be equally emphasised.” 

“In our trial phase, the EPAs employed proved to be overly detailed. As a result, evaluations predominantly focused on repetitive procedural tasks, while essential soft skills, as outlined earlier, were significantly underassessed. This imbalance may be attributed to the structural and procedural workflow within our hospital or our medical system.”

“At this stage, a definitive evaluation may not be made based on the one-year pilot. It is likely that the full impact and effectiveness of CBME will only become clear over the coming years, or even decades. However, if a standardised set of a few relevant EPAs were defined and implemented across all urological training programmes within a country, it would significantly streamline the recruitment of new trainees. This approach would allow new trainees to be more rapidly integrated into clinical tasks, as they would already be familiar with the standardised expectations and requirements.”

“In addition, a combination of both quantitative and qualitative assessment methods may be necessary to capture a comprehensive evaluation of trainees’ competencies. Ultimately, only through continuous evaluation and reassessment of the current training program can we determine whether the chosen path is effective and aligned with the goals of medical education. Reflecting on the past year following the introduction of the new EPAs, I can affirm that the feedback was highly valued and positively received by the trainees.”

You can learn more here: Mobile-based assessment of entrustable professional activities in urology training: implementation and outcomes - European Urology Open Science.