Competence by Design (CBD)
Department of Medicine Resource Cabinet
NEWS
NEW: EPA tips for Residents video - watch this two-minute video that emphasizes how to get EPAs done in the moment and avoid expiring EPAs.
LIVE Programs
Implementation Schedule
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)
2024 or Later (TBD)
PUBLIC HEALTH AND PREVENTATIVE MEDICINE
ENDOCRINOLOGY
OCCUPATIONAL MEDICINE
*Launch Dates as of June 30*
What does CBME Look like?
What is my role in a CBD environment?
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