Competency Based Medical Education

Competence by Design

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.

Competence by Design Cohorts

As the CBD programs across a given specialty are launched at the same time nationally and the lead up to starting the CBD curriculum is complex, CBD is being initiated across multiple years. The following is the schedule of program launches from information available as of July 2020.

Cardiology 2021 PGY4
Clinical Immunology and Allergy 2021 PGY4
Clinical Pharmacology & Toxicology 2021 PGY4
Dermatology 2022 PGY1
Emergency Medicine 2018 PGY1 - PGY2 - PGY3 - PGY4
Endocrinology & Metabolism TBD  
Gastroenterology and Hepatology 2019 PGY4 - PGY5
General Internal Medicine 2019 PGY4 - PGY5
Geriatric Medicine 2019 PGY4 - PGY5
Hematology 2022 PGY4
Infectious Diseases TBD  
Internal Medicine: Core 2019 PGY1 - PGY2 - PGY3
Medical Oncology 2018 PGY4 - PGY5
Nephrology 2018 PGY4 - PGY5
Neurology 2020 PGY1 - PGY2
Occupational Medicine TBD  
Palliative Medicine TBD  
Physical Medicine and Rehabilitation 2020 PGY1 - PGY2
Respirology 2021 PGY4
Rheumatology 2019 PGY4 - PGY5


1. DOM CBD Related Meetings 2021-2022 Academic Year

  • To be added soon


    2. CBD Tool Box for Program Directors and Competence Committees

    • Program Directors and Competence Committee members have access to the CBD Tool Box, a centralized document repository for CBD resources. Please email to request access.


    3. Elentra Essentials

    All programs will be using Elentra as the CBD assessment platform. Please note that you will need to use your UTORid and password to login to Elentra.

         For Assessors

         For Learners


    4. How to Complete an EPA Assessment


    5. Faculty Resources

         Selected References for Competency-based Medical Education

         Selected References for Giving Feedback

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