Competency-Based Medical Education

What is Competency-Based Medical Education?

Competency-Based Medical Education (CBME) is the educational framework that is guiding the changes in our medical education system. CBME follows a trend already in place in other medical programs across the world, namely in the United States and in Australia. CBME is defined by the Royal College of Physicians and Surgeons of Canada (RCPSC) as, "An outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using competencies as the organizing framework."

Why are we transitioning to Competency-Based Medical Education?

The Royal College of Physicians and Surgeons of Canada (RCPSC) is currently mandating the transition of all its residency training programs towards Competency-Based Medical Education (CBME). This change is motivated by the desire to enhance the way we train future doctors. While our current medical education system is strong and reputable, the medical education community recognizes there are gaps and challenges that need to be addressed to enhance training outcomes and ultimately enhance patient care.

What are the principles of Competency-Based Medical Education?

The four principles of CBME are:

Video introduction to Competency-Based Medical Education and Competency By Design

What is Competence By Design?

Competence By Design (CBD) is the framework the Royal College of Physicians and Surgeons of Canada (RCPSC) has designed to implement Competency-Based Medical Education. Moving forward, we will think about residents within their 'stage of training' rather than year of training. These stages are: Transition to discipline (TTD), Foundations of discipline, Core of discipline, and Transition to practice (TTP). Each stage of training includes a number of clinical activities trainees will have to demonstrate competence performing before moving on to the next (higher complexity) stage of training. See figure below.

Key implications of the Competence By Design framework for our training program:

  1. Implementation of the concept of entrustment of specific clinical tasks through Entrustable Professional Activities ("EPAs")
       ​ a. EPAs are being defined by a joint effort of residency training program directors, educational leaders and the RCPSC. They are specific to a given stage of training.
        b. Milestones are components of EPAs and are based around the CanMEDS roles.
  2. Increased emphasis on direct and indirect observation
  3. Need for multiple low-stakes assessment on focused clinical tasks with documentation
  4. Emphasis on actionable, timely and concrete feedback to enhance trainee learning and progress
  5. Importance of coaching and personalized learning plans as overarching themes to points 1-4

Useful links for more information:
1) Introduction to CBME and CBD
2) Competence By Design (CBD)
3) EPAs and Milestones in teaching and assessment

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