From leadership research to district action: The Wicked Problem of Selection and Competency-Based Education: Applying TRIZ Inversion to the Graduate Medical Education Selection Process

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Introduction: Graduate medical education (GME) selection processes may pose significant barriers to implementing competency-based health professions education (CBHPE). Current selection metrics are largely nonpredictive of future success, and the removal of clerkship grades has given rise to a shadow economy of effort focused on publications, research hours, and other activities that detract from clinical training. This misalignment between selection practices and CBHPE principles constitutes a wicked problem that requires innovative approaches to develop new solutions. Methods: We conducted a TRIZ (Theory of Inventive Problem Solving) exercise, a Liberating Structure that challenges assumptions by asking what would make a process fail spectacularly. Eight participants representing three countries, two continents, and four medical specialties convened via video conference in October 2025. Participants served as proxies for key stakeholder groups (students, program directors, medical school leadership, and patients/society), identified elements of the worst-possible selection system, compared them to current practices, and proposed solutions. Results: Participants identified numerous elements characterizing suboptimal selection systems, including inequitable and biased processes, arbitrary decision-making, gaming of metrics, resource-intensive processes that fail to differentiate candidates, misinformation from training sites, and prioritization of self-interest over patient needs. Many of these elements were recognized as present in current GME selection systems worldwide. Discussion: Recommendations to align selection with CBHPE included embedding social accountability throughout selection, leveraging coproduced competency frameworks, prioritizing workforce diversity, ensuring equity in assessment and selection, incentivizing a growth mindset through a transparent learner handover, and implementing structural innovations, including preference signaling or potentially lottery systems, to better align CBHPE and selection.

Study methods

Wicked problems cannot be solved using traditional methods. They are different from traditional problems in that they are: 1) defined differently from multiple perspectives; 2) appear differently in each different context, but follow consistent patterns wherever they appear; and 3) can never be completely solved [910]. The issue of selection in medical education, particularly in light of the adoption of CBHPE, falls clearly into this category. While the literature on wicked problems is more nuanced, we provide this abbreviated working definition for this manuscript to frame our thinking as it evolved over several meetings discussed below. Given that the problem cannot be completely solved, the temptation is to give up hope and stop trying altogether. To combat that, we chose an alternative approach.

Limitations

We performed TRIZ with the authors acting as, or “wearing the hat” of, the various interest-holder groups. The small sample size of eight participants and a single 60-minute TRIZ exercise, while exhaustive of the ideas of those present, does not fully represent the breadth of what could have been generated with iterative sessions and varied groups of participants.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Holly A. Caretta-Weyer; Ming-Ka Chan; Mary Ellen J. Goldhamer; Alan Schwartz; Teresa M. Chan; Lalena M. Yarris; Ian W. Incoll; Arvin Damodaran; H. Carrie Chen; As members of the International Competency-Based Health Professions Educators Collaborative. The Wicked Problem of Selection and Competency-Based Education: Applying TRIZ Inversion to the Graduate Medical Education Selection Process. Perspectives on Medical Education (2026-09-29). https://doi.org/10.5334/pme.2596

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.