About

WHAT IS CBME?

CBME (Competency Based Medical Education) refers to the current nationwide 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 IS CBD?

CBD, Competence by Design, refers to the hybrid version of CBME that the Royal College is using for implementation in Canada. The CBD model is not time free but time is re-conceptualized as a resource for learners and programs rather than as the key determinant of program requirements. CBME and CBD is often used interchangeably.

WHAT WILL CBME LOOK LIKE?

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.

AS AN ACADEMIC ADVISER

• Meet with the resident to discuss current progress

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

• Create report and make recommendations to the Competence Committee

AS A COMPETENCE COMMITTEE MEMBER

• Make decisions about competence based on data and portfolios

• Make recommendations about promotion to next stage of training

AS AN RPC MEMBER

• Make decisions about promotion to next stage of training

AS A PROGRAM COORDINATOR

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

• Support of Competence Committee

AS A PROGRAM DIRECTOR

• Observe, Coach, Document

• Guide progression from one competency level to the next

AS TEACHING FACULTY

• Observe, Coach, Document

• Guide progression from one competency level to the next