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Background: Postgraduate medical education (PGME) curricula are being redesigned across the western world.

Aim: This study examined the implementation process (what works where and why) of new competency-based PGME curricula and relevant factors influencing this process.

Methods: In a nationwide project (2006–2010) in the Netherlands, competency-based PGME curricula were implemented for residents in Pediatrics and Obstetrics & Gynecology. The authors conducted 25 semi-structured interviews and used a multi-level theoretical framework to guide coding.

Results: The implementation process proved to be highly dynamic, non-linear, and influenced by many factors. These could be divided into attributes of the innovations/adopters, the implementation process, and the organization. The context determined the speed, quality, and direction of the process and how a factor affected the process …