CBME Tips/FAQ's

Most of the time the resident should be initiating an EPA evaluation as residents are responsible for tracking their EPA progress and stages, although either a resident or preceptor may initiate an EPA. EPA evaluation forms should be completed as close to the time of the clinical encounter as possible (ie. right afterwards). EPA forms should not be submitted to preceptors more than 1 week after the encounter and some preceptors will decline an EPA that is sent to them more than 24hrs later. 

a) If the EPA has not been completed by the preceptor within 48 hours of sending, consider contacting the preceptor to remind them to review it (prior to the 14 day expiry).

b) If the EPA has expired after 14 days, you can re-submit the EPA form and contact the preceptor to ask them to complete it.

c) If you are aware of preceptors who commonly allow EPAs to expire, you may reach out to the Competence Committee who can explore the issue further.

In most cases, 1 clinical encounter is used for 1 EPA. Multiple EPAs should not be submitted for a single clinical encounter without the preceptor’s deliberate consent. If you are involved in a patient’s care over time, you may be part of multiple clinical encounters which could then be used for more than one EPA.

a) Transition to Discipline: TD1, Narrative.

b) Foundations of Discipline: FD3, FD7, Narrative.

c) Core of Discipline: CD2, CD3, CD7, CD10, Narrative.

No. You are not expected to obtain EPAs during Research, CanMEDs, or while on vacation. These rotations are taken into account when we determine what your expected EPA pace is.

Yes. You are still expected to attempt 3 EPAs per week while on elective, both locally and away. As CBME is Canada-wide, all preceptors working with residents will be familiar with EPAs and will understand that they are an important part of resident education and assessment. If your preceptor is not listed in CBME, you can email the EPA form to them to complete. 

This is done at the discretion of the Competence Committee (CC) when reviewers determine which EPAs have been completed. This may happen if an EPA is marked as 4 but all milestones are ‘achieved’ and/or if there are no preceptor comments for areas to improve upon. This is more likely to happen if there are multiple EPA attempts that can be reviewed, regardless of the rating, compared to a single EPA attempt that is marked as a 4. 

A ‘mix’ or ‘variety’ of cases generally means at least 3 different cases. 

a) Residents are expected to attempt 3 EPAs per week until they have completed Core of Discipline, though Competence Committee will allow a low pace for one quarter (ie. one Competence Committee meeting) in the Core of Discipline stage, as residents near the end of this stage and have only situation-specific EPAs to complete. Please see Definitions and Consequences Form for more details.

b) Once the program has determined that all Core of Discipline EPAs are completed, residents are encouraged to continue to do EPAs to obtain feedback but are not required to.

a) The most common reason is that you have not met all of the context requirements for the EPA. Many EPAs have specific context requirements, and some EPAs have multiple context requirements within them (ie. being evaluated by a staff physician vs other health care professional, certain medical conditions, ambulatory vs inpatient care). The EPA is considered completed when the required number of successful attempts also completes all context requirements.

b) Other less common reasons why an EPA may not be marked as completed include if one clinical encounter was used for multiple EPAs without clear reason, or if the clinical encounter does not match the purpose of the EPA.

a) The Competence Committee reviews each resident cohort three times throughout the year. Each resident’s EPA attempt pace, number of completed EPAs, ITERs, and other forms of assessment are reviewed. The CC then makes a decision based on the Definitions and Expectations framework. The CC makes recommendations to the Residency Program Committee (RPC) where the final decision is made on a resident’s status and if a monitoring or learning plan is implemented.

b) CIM Assessment Guidelines: Definitions & Expectations

a) EPA monitoring plans are largely for the purpose of increasing EPA completion rates in order to ensure that residents do not fall behind in their progress. EPA monitoring plans may also occur when a resident does not complete their CBD stage EPAs by the end of the stage (when a Competence Committee promotional meeting takes place). EPA monitoring plans are supervised by Academic Advisors.

b) There are two types of learning plans - minor and major learning plans.

i) Minor learning plans occur when Competence Committee and/or RDC recognize that a resident has not been progressing as expected through the CBD EPAs or if there are concerns identified on their ITERs (‘Requires Some Improvement’ to reach expected level - RSIs). Often a minor learning plan will be initiated if a resident does not increase their EPA pace after an EPA monitoring plan has already been implemented. Minor learning plans may be supervised by Academic Advisors or separate learning plan supervisors, depending on the context.

ii) Major learning plans occur when there are significant concerns raised about a resident’s progress. Most commonly this occurs if there are frequent or recurring RSI/RSigIs (Requires Some Improvement or Requires Significant Improvement) on their ITERs, professionalism concerns or failure to progress despite previous learning plans. Major learning plans are brought forward to and approved by PGME. Major learning plans have a dedicated learning plan supervisor and are also supervised by the Program Director. If a major learning plan has been put in place during your training, it may be included in your application to the CaRMS medicine subspecialty match.

c) All monitoring and learning plans have the intent of providing support and assistance to residents and are not punitive in nature.

a) The decision for a monitoring/learning plan is made by the Residency Program Committee based on recommendation from the Competence Committee. Questions or concerns about why you received a plan can be brought to your Academic Advisor. If you still have concerns, please contact the Program Director.

a) First, we encourage you to talk with your Academic Advisor about your concerns. If you still have concerns, you can begin the appeal process.   

b) According to PGME guidance, appealing assessment decisions occurs in two steps: there is an informal appeal and a formal appeal.  The informal appeal occurs as a discussion between the resident and Program Director or program designate about the concerns and reasons for appeal. If the informal appeal discussions do not resolve the matter, then the resident may submit a formal appeal to the Faculty Academic Appeals Committee (FAAC). For the formal appeal process, the appeal is submitted to the Vice Dean, Education. The FAAC does not have any jurisdiction to hear a formal appeal unless the informal appeal process has been exhausted. There needs to be ground for an appeal, and that is outlined in the PGME Academic Appeals Policy. Residents cannot appeal Competence Committee decisions about individual EPA achievement, but they may contest any decision ratified by the RPC (stage progression, promotion, readiness for exam or practice) if there are accepted grounds for appeal.