• Fremen Chihchen Chou, Cheng-Ting Hsiao, Chih-Wei Yang, and Jason R Frank.
• Center for Faculty Development, Department of Education, China Medical University Hospital, Taichung City, Taiwan; School of Medicine, China Medical University, Taichung City, Taiwan; Department of Emergency Medicine, China Medical University Hospital, Taichung City, Taiwan.
• J Formos Med Assoc. 2022 Aug 1; 121 (8): 1523-1531.

Background/PurposeThe implementation of competency-based medical education is a social construction process within a local and cultural context. However, little is known about the process of adaptation to different systems, known as "glocalization". We analyzed the documents in the development of a milestone project from adapting global standards into a local context and identified a framework underlying this process.MethodsTaiwan Society of Emergency Medicine (TSEM) had developed learning milestones based on the ACGME's version through series of consensus methods including committee work, nominal group technique (NGT), and a modified Delphi method. We applied qualitative content analysis to characterize the evolution of the three versions of TSEM and the original ACGME milestones documents and to explore the meaning behind the differences revealed by the glocalization process.ResultsWe found 48 differences between ACGME and TSEM milestones. Among these differences, one was made by committee work, 44 came from NGT, and 3 were from the modified Delphi process. Two themes and seven sub-themes emerged from the coding process to explain the contextualization process of the milestones.ConclusionWe identified a framework that incorporates local expression and local needs into the process called glocalization through which global models of competency-based standards could be optimally implemented in a local context with different systems and cultures.Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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