From Time-Based to Competency-Based: A Decade-Long Transformation of Medical Radiation Technologist Education in Taiwan and Its Implications for System-Level CBME Reform

Competency-based medical education (CBME) has reshaped physician training, yet system-level implementation in allied health professions is rarely described. In this Perspective, we examine Taiwan's decade-long national reform of medical radiation technologist (MRT) education led by the Taiwan Association of Medical Radiation Technologists (TAMRT) and distill lessons for system-level CBME. Beginning in 2012, TAMRT adapted the Accreditation Council for Graduate Medical Education (ACGME) core competencies and introduced workplace-based assessments across diagnostic radiography, radiation therapy, and nuclear medicine. Early national accreditation cycles revealed persistent variability in assessment quality and highlighted the limitations of time-based advancement. TAMRT therefore shifted from adding isolated tools to building an integrated progression system. Using Van Melle's core components of CBME as a scaffold, TAMRT implemented a ``CBME trilogy'': (1) specialty milestones (107/115/125 across the three specialties) and 14 entrustable professional activities; (2) a structured national faculty development and certification program; and (3) a nationwide electronic platform supporting programmatic assessment and visualization of competency trajectories. In 2024, TAMRT launched a second-generation MRT Professional Advancement System aligned with a Dreyfus-informed, five-level framework. This case illustrates how coordinating competency frameworks, faculty capacity, and data infrastructure can enable system-level CBME in allied health professions and may provide actionable design levers for broader medical education reform.