目的：基于能力的医学教育的实施是在当地和文化背景下的社会建设过程。然而,对适应不同系统的过程知之甚少，称为“glocalization”。我们分析了一个里程碑项目的开发过程中的文档，该项目将全球标准调整为本地环境，并确定了该过程的基础框架。
方法：台湾急诊医学学会（TSEM）通过包括委员会工作在内的一系列共识方法，开发了基于ACGME版本的学习里程碑，标称组技术(NGT)，和改进的Delphi方法。我们应用定性内容分析来描述TSEM和ACGME原始里程碑文件的三个版本的演变，并探索glocalization过程所揭示的差异背后的含义。
结果：我们发现ACGME和TSEM里程碑之间存在48个差异。在这些差异中,一个是委员会的工作，44来自NGT，和3来自修改的Delphi过程。编码过程中出现了两个主题和七个子主题，以解释里程碑的上下文化过程。
结论：我们确定了一个框架，该框架将本地表达和本地需求纳入称为glocalization的过程中，通过该框架，基于能力的标准的全球模型可以在具有不同系统和文化的本地环境中最佳地实施。
OBJECTIVE: The 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.
METHODS: Taiwan 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.
RESULTS: We 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.
CONCLUSIONS: We 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.
