Competence by Design (CBD)

NEPHROLOGY (2018)

CORE INTERNAL MEDICINE (2019)

GASTROENTEROLOGY (2019)

GENERAL INTERNAL MEDICINE (2019)

GERIATRIC MEDICINE (2019)

RHEUMATOLOGY (2019)

NEUROLOGY (2020)

PHYSICAL MEDICINE & REHABILITATION (2020)

CARDIOLOGY (2021)

RESPIROLOGY (2021)

DERMATOLOGY (2022)

HEMATOLOGY (2022)

INFECTIOUS DISEASES (2024)

PUBLIC HEALTH AND PREVENTATIVE MEDICINE (2025)

ENDOCRINOLOGY (2025)

2024 or Later (TBD)

OCCUPATIONAL MEDICINE

*Launch Dates as of June 30*

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 need to demonstrate this EPA.

Academic Advisors

• Meet with the resident to discuss current progress

• Review data (assessments, narrative, direct observations) on a regular basis

• Create reports and make recommendations to the Competence Committee

Competence Committee Members

• Make decisions about competence based on data and portfolios

• Make recommendations about promotion to next stage of training

RPC Members

• Make decisions about promotion to next stage of training

Program Coordinators

• Continued support to the residency program (scheduling, non-EPA assessments, RPC, rotating learners, etc)

• Support of Competence Committee

Program Directors

• Observe, Coach, Document

• Guide progression from one competency level to the next

General Teaching Faculty

• Observe, Coach, Document

• Guide progression from one competency level to the next