Medical Oncology - CBD

What is CBD? 

  • Overview
  • CBD Stages


  • Entrustable Professional Activities (EPAs) and other assessments
  • Entrustment Scale
  • Elentra (assessment platform)
  • EPA Completion Guides
  • Competence Committee

Dr. Raymond Jang


Competence by Design (CBD) is here! As of July 2018 all Medical Oncology PGY4/5 residents will be immersed in CBD. The residents who entered residency before 2018 will not be in the CBD stream. 


I thank all the faculty and residents who have participated in our program’s pilot testing of different components of CBD in the past two years. 

If you have any questions or comments, please send them to

Dr. Raymond Jang, Program Director

What is CBD? 


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 for more information

CBD Stages

Residency will continue being 2 years. It will be split into 4 stages:

●    Transition to Discipline (TTD) 2 blocks in PGY 4
●    Foundations of Discipline (FOD) 5 blocks in PGY 4
●    Core of Discipline (COD) 15 blocks in PGY 4/5
●    Transition to Practice (TTP) 4 blocks in PGY 5

The RCPSC will be providing more information in the coming years about any possible changes to the date of the Medical Oncology Exam.


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 Medical Oncology 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 of all the EPAs across each stage.  You will notice a number of milestones under each EPA. We will not be using the milestones for assessment purposes, but you can refer to them should you need more information. 

Other assessments include “Notes to File” and “Professional Behavioural Monitoring Form”. You can use these documents to provide information and feedback on resident performance that is not captured in the EPAs. “Notes for File” are confidential and are only shared with the PD and Competence Committee. 

The assessments above will be completed on the Elentra e-platform, and can be initiated by you or the resident.
The Elentra platform is replacing the ‘Portfolio’ that residents had to keep in order to document non-medical expert CanMEDs roles.  Currently, Journal Club assessments and Teaching Assessments can be completed on Elentra.

Entrustment Scale

EPAs are assessed using the Entrustment Scale. We expect that most EPAs will be given an “Intervention”, “Direction” and “Support” category, and only a few will be given “Competent” and “Proficient” especially in the early phase of a stage and in early years of residency. 

Elentra (assessment platform)

Here is a link to the Elentra Login page: . Please note that you will need to log in with your UTORID.  

EPA Primers

1. TTD Primers
2. FOD Primers 
3. COD Primers
4. TTP Primers

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, and is chaired by the PD.  They use all the assessments described above (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 4 times per year.  The CC provides their overall assessment and recommendations to the Residency Program Committee and PD.