Competence by Design: The Rubber Hits the Road

Two years after our first field tests started, we’re excited to be preparing for the formal launch of Competence by Design (CBD) in the Emergency Medicine, Nephrology and Medical Oncology programs on July 1, 2018!  As we get ready for the launch, we want to update you on the progress that’s been made so far, and let you know about the people in our department who’ll be responsible for leading the implementation of CBD.

CBD is the Royal College of Physicians and Surgeons and Canada’s brand of competency-based medical education - an outcomes-based approach to the design, implementation, assessment and evaluation of an educational program using an organized framework of competencies.  Many of you have already participated in one of our field tests in CBD (thank you!) and have hands-on experience with this new educational framework.  For those of you who want to learn more about the fundamentals of CBD, you can take a look at this two-page overview, watch this short video or read Dr. Hawker’s Column from October 2016. 

Your dedication and commitment to teaching and mentoring our trainees in establishing the outstanding educational programs we have now is recognized and appreciated.  As we implement CBD in the DoM, we want to do even better and build on that excellence.
Introducing CBD will:

1. Integrate a programmatic approach to assessment, with enhanced workplace-based assessments, including direct observation and an enhanced culture of feedback.
2. Enable shared evidence-informed decision-making on residents’ progress through the use of Competence Committees.
3. Help nurture more confident, knowledgeable and engaged residents regarding their performance strengths and limitations as they complete a more outcomes-based training model, including soliciting and incorporating feedback and assistance.
4. Allow us to lead in CBD knowledge translation, scholarship and research.

During a transformational change like this, we want to make sure your concerns are addressed and your questions are answered.  You can contact us by sending your questions to our central email: dom.cbd@utoronto.ca. It’s worth taking a few minutes to review the Royal College’s concise but informative infographic (available here) that helps clarify some of the myths and misconceptions around CBD and answers many of the common questions about CBD.

Where Are We?

CBD has actually already started to roll out in our department. Medical Oncology has been field-testing since July 2016 under the leadership of Program Director Dr. Raymond Jang.  Faculty and learners in that division have already completed more than 250 entrustable professional activity (EPA) assessments.  Dr. Jeanette Goguen has led the field tests in the Internal Medicine program since July 2017, and faculty and learners have completed more than 1700 assessments (!) as they prepare for their 2019 launch.  The lessons learned in both of these programs will help improve the experience for the other programs that are preparing to launch.

Program Directors for Emergency Medicine (Dr. Nazanin Meshkat), Nephrology (Dr. Jeffrey Schiff) and Medical Oncology (Dr. Raymond Jang) are preparing for the official launch of CBD in their programs on July 1, 2018.  Dr. Tara O’Brien (Program Director, General Internal Medicine) has been working along with the initial cohort to prepare for field-testing in July 2018 and a full launch in 2019.

It’s been incredible to watch the dedication and enthusiasm of these PDs, their Program Assistants, their Residency Program Committees, as well as the faculty and learners in their divisions as they lead the implementation of CBD in our department.

The Implementation Team

We are very fortunate to have a select group of nationally and internationally recognized educational leaders in our department. Many of them have committed to ensuring the successful implementation of CBD.

Our CBD Implementation Steering Committee ensures that we have the best possible guidance on CBD implementation that is aligned with the vision and values of our department.

The CBD Implementation Steering Committee includes:

Faculty Development Leads:

Drs. Danny Panisko and Martin Schreiber

Research Lead:

Dr. Shiphra Ginsburg

In addition to serving as Research Lead on our Steering Committee, Dr. Ginsburg and Dr. Ryan Brydges are leading a DOM Competency-Based Medical Education Research Network to ensure that as we implement CBD, we lead the scholarly and critical examination the fundamental questions related to CBME/CBD.

Person-Centred Care Leads:

Drs. Ayelet Kuper and Lisa Richardson

Analytics Lead:

Dr. Rodrigo Cavalcanti 

Project Manager:

Pavi Chandrasegaram

Three other senior educational leaders in the Department round out the membership of our steering committee: Dr. Jeanette Goguen, Dr. Eric Yu (Director, Subspecialty Programs) and Dr. Arno Kumagai (Vice Chair, Education).

Where Are We Going?

The next few years will be very exciting as we work to launch CBD all of the programs in our department (final cohorts are planned for a 2022 launch) and we will be looking to you for your help and guidance. Please watch out for our upcoming newsletters, our updated website and visits from our team to keep you informed and ensure you have the resources you need as we continue our implementation.

We want to hear from you. Please contact us with any questions or comments at dom.cbd@utoronto.ca.  

Scott Berry
CBD Implementation Lead, DOM