Competency-based education (CBE) is an educational approach based on the application of specific knowledge, skills and attitudes, replacing traditional education based on the delivery of theoretical contents. This is a student-centered approach that places the responsibility of learning on the students, who are required to demonstrate their ability to perform and apply competencies successfully.1,2

Remote learning, facilitated by emerging technologies, is an efficient modality that students can adapt to their own needs.3 In 2013, the Asociación Española de Pediatría (AEP, Spanish Association of Pediatrics) launched Continuum, an e-learning platform based on CBE. It hosts numerous educational activities designed to develop the competencies (knowledge, skills and attitudes) that pediatricians need in their daily practice. The available contents are structured into various activities (“Training Courses”, “New in the Literature”, “Highlighted Articles”, “Image of the Week”, “Interactive Clinical Cases”, “Learning Capsules”, “Tools”). They are articulated as educational modules developed to cover a predefine spectrum of skills that, together, have allowed the development of a matrix or framework underpinning the educational structure of Continuum.

The Continuum competency matrix was developed based on the collection of documents published by the Global Pediatrics Education Consortium (GPEC).4 This consortium is composed of leaders of 20 national, regional or international organizations devoted to education, training and accreditation in the field of pediatrics. At the same time, it assesses their efficacy with the aim of guaranteeing high-quality learning at the global level. The Continuum competency matrix is an original and standalone database. It holds more than eight thousand elements assigned to a hierarchical coding system to facilitate the management of the competencies involved in each learning activity. This design helps avoid the confusion and aimless rambling that can occur when attention is focused on process without first defining a clear destination or outcome.5

In this original article, we present and describe the CPEC pediatric competencies on which training and education is offered through the Continuum e-learning platform since its inception. The aim was to estimate the coverage of the GPEC curriculum overall and by type of activity and knowledge area. We also sought to describe the profile of the platform users and the rate of engagement and completion for the offered activities.

We conducted a cross-sectional and descriptive study of the training activities and competencies offered and delivered through the Continuum platform in the 2011–2024 period. A full description of the platform is available in previous publications.6–8

During the study period, Continuum, the online education platform of the AEP, offered 1118 activities to 22 342 users. A total of 5718 competencies were covered, enabling the development of more than two-thirds of the competencies proposed by the GPEC curriculum standards.4 To understand the magnitude of this figure, we must consider the large number of competencies proposed by the GPEC, many of which are repeated or diversified in different content areas (specialties) and types of competencies (history, physical examination, diagnosis, management plan). In comparison, other training curricula for general pediatrics, such as those developed by The Royal College of Paediatrics and Child Health or the American Board of Pediatrics, have far fewer elements.10–13

It is known that e-learning can complement formal in-person education during medical school,14 specialty training or clinical practice,15 especially in areas that tend to not be covered in depth16 or that are highly specialized.17,18 It is also useful for clinical scenarios that require standardized management, as it can improve the confidence of residents and adherence to clinical practice guidelines.19,20 In spite of this, there is still little objective evidence on the potential advantages of remote learning. Its effectiveness and impact on the performance of health care professionals and, to the extent possible, the impact on patient outcomes, all need to be evaluated.3

Based on our findings, it is reasonable to state that Continuum, built on the foundation of its matrix of competencies, enables and facilitates online learning of pediatrics competencies. More than two thirds of pediatrics competencies have been covered by the platform in its first decade in operation. At the same time, the platform hosts and organizes the training portfolios of the users, providing them with logging and tracking tools. Thus, the training portfolio becomes more than a mere collection of evaluations and attendance certificates. It turns into an actual résumé that defines the strengths and weaknesses of both the user’s training and the platform itself.

In addition, the aforementioned transition to competency-based education includes additional evidence through practical assessments within a progressive, inquiry-based and demonstrably competency-based learning plan.21 The Continuum competency matrix implements international standards for planning and implementing educational activities or courses. It promotes self-led learning, the development of clinical skills and critical thinking. There have been few previous similar experiences. Among them, we ought to highlight that of the Royal College of Paediatrics and Child Health, which has proven effective in the integration of standard curricula in e-portfolio training logs.10,21

The main challenge in covering the competencies of the GPEC syllabus lies in their uneven development across different areas of learning. This means that areas with more detailed competencies that break into a larger total number of competencies which, therefore, require a larger number of specific training activities to cover them. This makes it difficult for the platform to homogeneously cover all the skills and specialties within pediatrics; a lower percent coverage of an area’s competencies does not necessarily signal neglect of that particular area. To minimize this issue, Continuum structures and offers educational activities based on the different subspecialties of pediatrics.22–24

This probably gives rise to some of the heterogeneity in the coverage of competencies. The diverse profiles of the authors, combined with the variable contribution of the different committees and societies of the AEP, has influenced the achievements made in training. Thus, as would be expected, there is a correlation between the offered training courses and the degree of coverage of the competencies in their respective areas.

The content areas with the highest coverage (>90%) include “professionalism”, “patient safety and quality improvement”, “musculoskeletal disorders”, “allergy”, “dermatology” and “nutrition”. These cross-cutting general competencies apply to different areas of pediatrics knowledge, which is why their coverage predominates. Since the platform does not have a permanent team of instructors, at the outset, the development of educational activities was not planned to follow a uniform distribution by content area. However, after periodic reviews of the platform’s performance, it is possible to approach the development of new courses to cover underrepresented areas moving forward. The findings of our study can guide the optimization of the offered educational activities to learning areas that have not been covered yet.

We found differential behavior in activities such as “New in the literature” or “Highlighted articles”. These were influenced by the recent publications in the medical literature. On the other hand, the “Image of the week” and “Interactive clinical case” authors were sporadic collaborators not affiliated with Continuum. Both of these sections directly reflect clinical practice (“submitting what is managed in the real-world care setting”). Their contents, which align with the digital format with the use of cutaneous or radiological images, contribute to increasing the coverage of diagnostic competencies.

This study has some limitations. Although the results of the analysis show the competencies that can be acquired through the activities on our platform, it was not possible to estimate with certainty the actual learning of our students. Completing any activity requires an assessment test, but this does not guarantee an actual clinical impact on patient care. Assessing this impact is one of the challenges we should undertake in the future. On the other hand, given the observational nature of the study and the design of the matrix, we were unable to consider aspects such as whether the acceptance of training options is modified or influenced by the assigned competencies. We also could not infer whether students changed their training choices based on the absence or presence of specific competencies in their training portfolio.

In conclusion, the Continuum e-learning platform has made it possible to acquire more than two thirds of the competencies required for the practice of pediatrics based on the GPEC curriculum. Thus, the platform offers a broad range of educational activities that contributes to the development of an important part of the professional competencies in pediatric care and that support and facilitate continuing education. Still, we found imbalances in coverage between different content areas. These imbalances need to be considered to prioritize access to the underrepresented competencies in the future development of educational strategies.

This research project did not receive specific financial support from funding agencies in the public, private or not-for-profit sectors.

All authors contributed to the study concept and design. Materials were prepared and data collected and analyzed by all authors. Carlos Ochoa Sangrador and Carmen Villaizán Pérez wrote the first draft of the manuscript and all authors commented on this and subsequent versions of the draft. All authors read and approved the final manuscript.