Competency Based Medical Education

The Royal College of Physicians and Surgeons of Canada (RCPSC) describes Competence by Design (CBD) as an “initiative to improve physician training and lifelong learning”. The overarching mission of CBD is to “enhance patient care by improving learning across the continuum from residency to retirement to help ensure that physicians continue to demonstrate the skills and behaviours needed to meet evolving patient needs”.

CBD, the Royal College’s version of Competency-based Medical Education for specialist medical education, is designed to blend an outcomes-based education framework into a system which recognizes the importance of a time structured element to residency training and patient care.

CBD for each training program asks the question, “What abilities do physicians need at each stage of their career?” It organizes physician training around these desired outcomes and looks at the needed competencies. The deliberation and documentation of this list of necessary outcomes or tasks is undertaken by each discipline’s national Specialty Committee at the Royal College.

A major focus of the CBD curriculum is on providing consistent, detailed, and timely resident feedback and assessment at each stage of training. Central to CBD is a new concept of Entrustable Professional Activities (EPAs). These are tasks that physicians (residents and seasoned clinicians) do every day. Each Royal College Specialty Committee has identified key activities of the discipline and summarized these as EPAs.

Faculty (or senior residents and fellows) can review learner performance against these benchmarks and provide in-the-moment feedback. Multiple snapshots of each learner’s clinical work can be collated and reviewed by the program leaders (via the Competence Committee and the Residency Program Committee under the guidance of the Program Director) to make formal decisions regarding the resident’s abilities and entrustment decisions regarding specific tasks. If a resident can work on their own (under the usual faculty or senior resident supervision), they are entrustable for that EPA.