Competence by Design: Geriatric Medicine

Competency By Design: Geriatric Medicine

Welcome to the Geriatric Medicine Competence by Design webpage.

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Competence by Design (CBD) is a Royal College of Physicians and Surgeons of Canada (RCPSC) initiative to transition postgraduate medical education and professional practice in Canada into a model of competency-based medical education.  In this model,  residents will be required to complete Entrustable Professional Activities (EPAs),  which are tasks that can be delegated to a resident and observed by a supervisor. These are low-stakes assessments. 

Competency-Based Medical Education (CBME) Terminology Reference Sheet

Competence Committee

The Competence Committee (CC) is responsible for making overall assessments for each resident, and recommendations regarding promotion, coaching and remediation, at multiple time points throughout residency (CC Terms of Reference).  The committee is made up of faculty members from each of the core sites. The PD also sits on this committee. They use all the assessments (e.g. EPAs, ITARs, exams, notes to file etc.), as well as other relevant criteria (e.g. attendance records, emails to the PD), to make decisions.  Every resident will be reviewed by the CC at least two times per year.  The CC provides their overall assessment and recommendations to the RPC and PD. The PD will meet with the resident (after the CC meeting) to review these recommendations.


Entrustable Professional Activities(EPAs) and other assessments.

Entrustable Professional Activities (EPAs) are a CBD requirement. Each stage has specific EPAs that are assigned to it (determined by the Royal College Geriatric Medicine Specialty Committee), and successful completion at each stage will be required to move from one stage to another. Here is a link to the Royal College document for a detailed breakdown. You will notice a number of milestones under each EPA. 

CBD Stages 

The residency will continue being 2 years. It will be split into 4 stages: Transition to Discipline (TTD), Foundations of Discipline (FOD), Core of Discipline (COD) and Transition to Practice (TTP).


The assessments above will be completed on the Elentra e-platform and can be initiated by you or the resident. 

Elentra (login page)

Tipsheet on how to complete an EPA

Special Assessments are non-EPA assessments that are a requirement

  • For each rotation, an In-training Assessment of Resident (ITAR) will be completed
  • For electives, it is the responsibility of the resident or fellow to ensure he/she has sent the Program Director a set of learning objectives agreed upon with the elective supervisor.