Competence by Design: Geriatric Medicine

Welcome to the Geriatric Medicine Competence by Design webpage.

If you do not find what you are looking for on this page or you have any questions, please do not hesitate to contact us at geriatric.medicine@utoronto.ca.

Overview 

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).

EPAs PRIMERS: 

• TTD1A: Initiating a comprehensive geriatric assessment (CGA) and identifying common geriatric syndromes.
• TTD 1B: Initiating a comprehensive geriatric assessment (CGA) and identifying common geriatric syndromes. Part B: Performing an MMSE and MoCA
• TTD2: Assessing and proposing management for older adults with common Internal Medicine conditions
• FOD1: Performing comprehensive geriatric assessments (CGA)
• FOD2: Diagnosing and managing older patients with common medical conditions.
• FOD3:Selecting, performing and interpreting assessments of cognition
• FOD 4A: Assessing, diagnosing and managing common neuro-cognitive disorders with typical presentations Medicine condition
• FOD 4B: Assessing, diagnosing and managing common neuro-cognitive disorders with typical presentations medicine condition: communication
• FOD 4C: Assessing, diagnosing and managing common neuto-cognitive disorders with typical presentations medicine condition: management
• FOD 5A: Diagnosing and initiating management of patients in delirium
• FOD 5B: Diagnosing and initiating management of patients in delirium: communication with patient/caregiver
• FOD 5C: Diagnosing and initiating management of patients in delirium: Initiating Management
• FOD 6: Identifying issues with medication use and making suggestions for optimal prescribing
• FOD 7A: Assessing and managing patients with a fall risk: Gait and balance assessment
• FOD 7B: Assessing and managing patients with a fall risk: Falls assessment and management
• FOD 8: Teaching and supervising junior learners
• COD 1A: Managing older adults with functional decline using comprehensive geriatric assessment (CGA). Part A: Management Plan
• COD 1B: Managing older adults with functional decline using comprehensive geriatric assessment (CGA). Part B: Communication with patient and family
• COD 1C: Managing older adults with functional decline using comprehensive geriatric assessment (CGA). Part C:  Communication with referring source
• COD 2: Managing older adults with multiple co-morbidities across the spectrum of frailty
• COD 3: Determining patients’ capacity for decision-making.
• COD 4A: Assessing and managing patients with complex and/or uncommon neuro-cognitive presentations. Part A: Assessment and Management
• COD 4B: Assessing and managing patients with complex and/or uncommon neuro-cognitive presentations. Part B: Counselling and Communication
• COD 5: Assessing and managing behavioural and psychological symptoms of dementia (BPSD)
• COD 6A: Preventing and managing delirium. Part A: Preventing Delirium
• COD 6B: Preventing and managing delirium. Part B: Managing Delirium
• COD 7A: Assessing and managing older adults with uncomplicated mental health conditions: Part A: Patient interview
• COD 7B: Assessing and managing older adults with uncomplicated mental health conditions: Part B: Management
• COD 8A: Managing end-of-life care in older adults. Part A: Medical management
• COD 8B: Managing end-of-life care in older adults. Part B: Communication
• COD 9A:  Assessing and managing complex psycho-social issues unique to vulnerable older adults: Case discussion
• COD 9B: Portfolio and supervisor discussion
• COD 10: Running family and team meetings
• COD 11A: Teaching other learners. Part A: Feedback to junior learners
• COD 11B: Teaching other learners: Part B: Formal Scheduled teaching
• Transition to Practice 
• TTP - EPA #1 Managing the Geriatrician's practice
• TTP - EPA #2 Contributing to the improvement of health care delivery for older people in teams, organizations, and systems 
• TTP - EPA #3 Planning and completing personalized training experiences aligned with career plans and/or specific learning needs 

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.
• Special Assessment (SA)#1Developing and implementing a continuing personal development plan geared to setting of future practice
• Special Assessment (SA)#2 Advancing Geriatric Medicine through scholarly work