Competence-By-Design

Banner for CBDThe Royal College of Physicians and Surgeons of Canada (RCPSC) has mandated a transition in residency training to Competence-By-Design (CBD), which is the RC’s version of competency-based medical education (CBME). CBD promotes greater accountability, flexibility and learner centeredness – residents will play a greater and more active role in their learning.  

The greater goal of CBD is to enhance patient care by improving learning and assessment across the continuum from residency to retirement, fostering lifelong learning. This will ensure that physicians continue to demonstrate the skills and behaviours needed to meet evolving patient needs. The RCPSC website provides a comprehensive description of Competence-By-Design (CBD).  

CBD is proposing a hybrid of the traditional time-based training model with an approach that “organizes physician training around desired outcomes and looks at the needed competencies” (RCPSC). This means that while the OBGYN residency program will continue to span five years, the focus will shift from thinking simply in terms of time spent to ensuring each resident acquires the necessary competencies before they progress through each of four stages: 

  1. Transition to Discipline (TTD) – roughly three months 
  2. Foundations of Discipline (FOD) – roughly 21 months 
  3. Core of Discipline (COD) – roughly 30 months 
  4. Transition to Practice (TTP) – roughly six months 

Roll-out of CBD for all Obstetrics and Gynaecology programs across Canada commenced on July 1, 2019. This includes our PGY1 residents, as well as a soft-launch for our PGY2 residents.  

Quick links 

The University of Toronto PGME website provides many useful resources on CBME/CBD including: 

Entrustable Professional Activities (EPAs)

EPA Tips for Residents

EPA Tips for Assessors

Tips for EPA Entrustment

EPAs are activities that physicians do every day that the OBGYN Royal College Subspecialty Committee has identified as key tasks of the discipline. Teachers already make entrustment decisions, but CBD takes this one step further by making these types of decisions more explicit and formalized. Faculty will now be completing EPA forms when opportunities for observation and feedback arise throughout the rotation.  

EPAs are designed to be developmental and progress from basics tasks to complex tasks as trainees move through the stages of training. The Obstetrics and Gynaecology EPAs by stage can be found in the following attachment – EPA Map (by stage). 

Within each EPA are a number of milestones. These are individual skills that are needed to accomplish the EPA. You will recognize the language around milestones, as it is derived from the RC’s CanMEDS framework (e.g. medical expert, communicator, collaborator, leader, etc.).  

See our recent articles in the OBGYN Newsletter on: 

Training Experiences (TEs)

Training Experiences (TEs) include both mandatory and recommended training opportunities and activities. TEs support a trainee's acquisition of competence and include both clinical (inpatient care, ambulatory clinics, performance of technical procedures) and non-clinical (simulation exercises, scholarly projects, journal clubs, etc.) activities. TEs replace the “rotation” in traditional residency education; TEs are the activities or settings in which trainees have experiences that enable them to achieve competence in their EPAs.   

CBD in OBGYN Newsletters

Our most recent departmental newsletters can be found on our website here. Information on CBD has been featured in a number of our editions, including the below:

Useful Links