Internal Medicine - CBD
Welcome to the Internal Medicine Competence by Design page.
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.
What does that mean to you? There is a shift towards a coaching model of training in lieu of the current performance model. In the coaching model residents will be required to complete formative assessments called Entrustable Professional Activities (EPAs). EPAs are tasks of the discipline that can be delegated to a resident and observed by a supervisor. These are low-stakes assessments. You will learn more on EPAs in the Assessment Section. Here is a link to a CBD Terminology Page for more information
CBD Stages
Residency will continue being three years. The final stage will be part of the first year of subspecialty training. It will be split into four stages:
- Transition to Discipline (TTD) 2 Blocks in PGY 1
- Foundations of Discipline (FOD) 11 Blocks in PGY 1
- Core of Discipline (COD) 2 years PGY 2-PGY3
- Transition to Practice (TTP) 1 year PGY 4 (first year of subspecialty year)
The Royal College Exam will take place after the Core stage at the end of PGY3.
Assessments, Primers and Resources
CPSO Professional Responsibilities in PGME
Elentra Guides
Accessing Elentra & Resources - IM CBD (PowerPoint presentation)
Elentra Procedure Log User Guide
EPA Primers
All documents are in PDF format.
Transition to Discipline Primers (PGY1 Blocks 1-2):
EPA Assessments Mapped to Rotations
EPA Primers
- TTD1 PEFORMING HISTORIES AND PHYSICAL EXAMINATIONS, documenting and presenting findings, across clinical settings for initial and subsequent care
- TTD2 Identifying and Assessing UNSTABLE PATIENTS, Providing Initial Management and Obtaining Help
Resident Primer
Foundation of Discipline Primers (PGY1 Blocks 3-13)
EPA Assessments Mapped to Rotations
EPA Primers
- FOD1 Assessing, Diagnosing and Providing Initial Management for Patients with Common ACUTE MEDICAL
- FOD2A Managing patients admitted to ACUTE care settings with common medical problems and advancing their care plans: PATIENT ASSESSMENT & MANAGEMENT
- FOD2B Managing patients admitted to acute care settings with common medical problems and advancing their care plans Part B: Communication with Patient/Family
- FOD2C Managing patients admitted to acute care settings with common medical problems and advancing their care plans: HANDOVER
- FOD3 CONSULTING SPECIALISTS and other health professionals, synthesizing recommendations, and integrating these into the care plan
- FOD4 Formulating, communicating, and implementing DISCHARGE PLANS for patients with common medical conditions in acute care settings
- FOD5 Assessing UNSTABLE PATIENTS, providing targeted treatment and consulting as needed
- FOD6 Discussing and establishing patients’ GOALS OF CARE
- FOD7 Identifying PERSONAL LEARNING NEEDS while caring for patients, and addressing those needs
Resident Primer
Core of Discipline (PGY2 & 3)
EPA Assessments Mapped to Rotations
EPA Primers
- COD1 - Assessing, diagnosing, and managing patients with COMPLEX OR ATYPICAL ACUTE medical presentations
- COD2A - Assessing and managing patients with COMPLEX CHRONIC CONDITIONS: Assessment, Diagnosis, and Management
- COD2B - Assessing and managing patients with complex chronic conditions: PATIENT EDUCATION Communication
- COD3A - Providing internal medicine CONSULTATION to other clinical services: PATIENT ASSESSMENT AND DECISION-MAKING
- COD3B - Providing internal medicine CONSULTATION to other clinical services: WRITTEN COMMUNICATION
- COD3C - Providing internal medicine CONSULTATION to other clinical services: ORAL COMMUNICATION
- COD4A - Assessing, resuscitating, & managing UNSTABLE CRITICALLY ILL PATIENTS - PATIENT CARE
- COD4B - Assessing, resuscitating, and managing unstable and critically ill patients: INTERPROFESSIONAL CARE
- COD5 - Performing the PROCEDURES of Internal Medicine
- COD6 - ASSESSING CAPACITY for medical decision making
- COD7 - DISCUSSING SERIOUS and/or COMPLEX ASPECTS OF CARE with patients, families, and caregivers
- COD8 - Caring for patients who have experienced a PATIENT SAFETY INCIDENT (adverse event)
- COD9A - Caring for patients at the END OF LIFE – SYMPTOM MANAGEMENT in End of Life Care
- COD9B - Caring for patients at the END OF LIFE – DISCUSSION ABOUT TRANSITION away from disease modifying
- COD10 - Implementing HEALTH PROMOTION STRATEGIES in patients with/at risk for disease
- COD11A - Supervising junior learners in the clinical setting: TEACHING
- COD11B - Supervising junior learners in the clinical setting RUNNING THE TEAM
Resident Primer
Transition to Practice (PGY4)
EPA Primers
- TTP1A - Managing an INPATIENT medical service: OVERALL PATIENT CARE
- TTP1B - Managing an INPATIENT medical service: INTERPROFESSIONAL CARE
- TTP2A - Managing LONGITUDINAL aspects of care in a medical clinic: OVERALL PATIENT CARE
- TTP2B - Managing LONGITDUINAL aspects of care in a medical clinic: COLLABORATION AND EFFICIENCY
- TTP3 - Assessing and managing patients in whom there is UNCERTAINTY IN DIAGNOSIS AND/OR TREATMENT
- TTP4 - Providing consultation to OFF-SITE HEALTH CARE PROVIDERS
- TTP5 - Initiating and facilitating TRANSFERS OF CARE through the health care system
- TTP6 - Working with other physicians and healthcare providers to develop COLLABORATIVE PATIENT CARE PLANS
- TTP7 - Identifying learning needs in clinical practice, and addressing them with a PERSONAL LEARNING PLAN
- TTP8 - Identifying and analyzing SYTEM-LEVEL SAFETY, QUALITY, OR RESOURCE STEWARDSHIP CONCERNS in healthcare delivery
Resident Primer
Rotation Cards
| Rotation | Transition to Discipline | Foundation of Discipline | Core of Discipline | Transition to Practice |
| Cardiology | Click here | Click here | N/A | N/A |
| CCU | N/A | N/A | Click here | N/A |
| Clinical Immunology & Allergy | N/A | N/A | Click here | N/A |
| Clinical Pharmacology & Toxicology | N/A | N/A | Click here | N/A |
| Critical Care Medicine (MS-ICU) | N/A | N/A | Click here | Click here |
| Dermatology | N/A | N/A | Click here | N/A |
| Endocrinology | Click here | Click here | Click here | N/A |
| Gastroenterology | Click here | Click here | Click here | N/A |
| Geriatric Medicine | Click here | Click here | Click here | N/A |
| GIM - Ambulatory | N/A | N/A | Click here | Click here |
| GIM - Community | N/A | N/A | Click here | Click here |
| GIM - Community Elective | N/A | N/A | N/A | Click here |
| GIM - CTU | Click here | FOD - Early in the stage FOD - Late in the stage | COD - Early in the stage COD - Late in the stage | N/A |
| GIM - ED Admit | N/A | N/A | Click here | N/A |
| GIM - Internal Medicine THP | N/A | N/A | Click here | N/A |
| GIM - Medical Consults | N/A | N/A | Click here | Click here |
| Haematology | Click here | Click here | Click here | N/A |
| Infectious Diseases | Click here | Click here | Click here | Click here |
| Longitudinal Clinic | N/A | N/A | N/A | Click here |
| Medical Oncology | Click here | Click here | Click here | N/A |
| Nephrology | Click here | Click here | Click here | N/A |
| Neurology | Click here | Click here | Click here | Click here |
| Obstetrical Medicine | N/A | N/A | Click here | Click here |
| Palliative Medicine | N/A | N/A | Click here | N/A |
| PGY4 Lead Competence Committee | N/A | N/A | N/A | Click here |
| QI Project | N/A | N/A | N/A | Click here |
| Respirology | Click here | Click here | Click here | N/A |
| Rheumatology | Click here | Click here | Click here | N/A |
Rotation Plans
| Rotation | Plan |
| Cardiology | Click here |
| CCU | Click here |
| Clinical Immunology & Allergy | Click here |
| Clinical Pharmacology & Toxicology | Click here |
| Critical Care Medicine (MS-ICU) | Click here |
| Dermatology | Click here |
| Elective | Click here |
| Emergency Medicine | Click here |
| Endocrinology | Click here |
| Gastroenterology | Click here |
| Geriatric Medicine | Click here |
| GIM - Community | Click here |
| GIM - CTU - Junior | Click here |
| GIM - CTU Senior / Consults Experience | Click here |
| GIM - ED Admit / Ambulatory | Click here |
| GIM - Hospitalist | Click here |
| GIM - Internal Medicine THP | Click here |
| GIM - Medical Consults | Click here |
| Haematology | Click here |
| IM4 Ambulatory | Click here |
| IM4 Critical Care | Click here |
| IM4 GIM Community | Click here |
| IM4 Infectious Diseases | Click here |
| IM4 Longitudinal Clinic | Click here |
| IM4 Medical Consults | Click here |
| IM4 Neurology | Click here |
| IM4 Obstetrical Medicine | Click here |
| Infectious Diseases | Click here |
| Medical Oncology | Click here |
| Nephrology | Click here |
| Neurology | Click here |
| Obstetrical Medicine | Click here |
| Palliative Care | Click here |
| Research | Click here |
| Respirology | Click here |
| Rheumatology | Click here |