Competence Based Medical Education

What is CMBE?

CBME refers to the current nation wide transition in the way residents are trained, evaluated and promoted. It's a cooperative effort being undertaken by the Royal College of Physicians and Surgeons and medical faculties across Canada. The essence of CBME is the move away from "time-based" model of medical education, and towards assessment based on specific demonstrated competencies.

What does this mean for me?

As part of the Royal College initiative, CBME is scheduled to be rolled out for Internal Medicine by 2019. However the U of A Core Internal Medicine program began piloting many of the necessary changes in July 2016 and went live with CBME in July 2017. All residents who entered our program as of July 2016 or later will be assessed under a CBME framework.

Promotion (from R1, to R2, etc) in CBME is primarily based on demonstrated competency in the form of achieved Entrustable Professional Activities. (EPA's) EPA's can be considered the "unit" of training a CBME assessment system. An EPA refers to a clinical task that can safely be delegated to a trainee after competence has been demonstrated.

Each EPA is composed of a series of milestones. The key difference between EPAs and milestones is that an EPA is a task that must be accomplished (Eg. Manage a patient with heart failure) whereas a milestone refers to the specific abilities of an individual (Eg. Understand the role of diuretic use in heart failure). Promotion between years will be primarily based on the acquisition of the expected set of EPA's for that level.

Here is an example of a likely EPA for the foundations (i.e. junior resident) level of training:

Identifying personal learning needs while caring for patients and addressing those needs

• Reflects on strengths and weaknesses in delivering clinical care

• Identifies gaps in knowledge and abilities

• Addresses professional development needs in identified areas

• Logs professional development activities using ePortfolio (or other appropriate logging system)

So before someone can move on from Foundations to Core, they needs to demonstrate this EPA.

Short Videos to help you understand CBME

Since March 2017, we have created several videos to help residents and faculty understand and operationalize CBME. To see the full playlist, click here.

List of videos (click on title to view that one):

Video 1 - Overview and Why CBME (4:51)

Video 2 - Academic Advisors & the Competence Committee (6:52)

Video 3 - Competency Based Assessment Framework (7:56)

Video 4 - Evaluation of Clinical Preceptors (5:45)

Video 5 - How to pull up forms (7:10)

Note: what is labelled "Assessments" and "Evaluations" in the video have now been renamed as Assignments and EPAs on the system.

Video 6 - Introduction to Dash.med (7:49)

Video 7 - Planning Which EPAs to get (10:53)

Note: In this video, we show Jesse pulling up forms on the website to look at, but now you can instead pull up and look at the forms on https://cbme.med.ualberta.ca

Video 8 - How to (and how not to) get EPA forms filled (7:24)

Note: Voted one of the funniest CBME videos!

Video 9 - Transition to Discipline Overview (9:29)

Video 10 - Foundations of Discipline Walkthrough (13:41)

Video 11 - Understanding the O-Score Entrustment scale, Milestones, and Comment boxes (5:29)