VISIONARA - developing a concept for decentralized competency-based learning in primary health care and its proposed evaluation.

Abstract

Background: To educate high-quality medical graduates who can contribute to a resilient, primary care-based health system, medical education must shift its focus towards decentralized and curricular competency-based medical education (CBME). However, undergraduate general practice education in Germany remains fragmented: theoretical content is delivered at universities, while practical experience is confined to clerkships in community practices, which often lack sufficient didactic infrastructure. This persistent separation of theory and practice hinders the genuine transformation towards CBME. New models that embed structured teaching directly within real care environments are required to bridge this gap.

Approach: VISIOn Network of Academic Reference Practices in General Medicine (VISIONARA) introduces a novel model for decentralized competency-oriented education in general practice. By establishing academic teaching clusters within community practices, the program creates structured, contextually anchored learning environments that enable experiential learning and professional development. While the initiative aligns with the Medical Research Council (MRC) framework for complex interventions, its primary innovation lies in its design as a scalable model for competency-based learning integrated directly into real-world practice.

Methods: Following the Medical Research Council (MRC) framework, this paper reports on the first two phases: (1) concept development and (2) pilot planning. The development phase comprised a synthesis of evidence on competency-based and decentralized medical education, design of a didactic model based on Kolb's Experiential Learning Cycle, and process/outcome modelling to guide feasibility testing. The pilot phase will assess the model's feasibility, acceptability, and integration into routine general practice.

Discussion: VISIONARA seeks to bridge the gap between theoretical academic instruction and real-world healthcare in general practice education by embedding structured, competency-based learning within authentic clinical settings. The feasibility study will examine financial and personnel resource requirements, acceptance among practice staff, students, and patients. It will further assess organizational integration into routine practice workflows, and the identification of structural and logistical barriers. These findings will inform further refinement and the potential progression to a subsequent evaluation phase.