Competency By Design / Competency-Based Medical Education


To contribute to the success of Canadian physicians and the delivery of high-quality patient care, the Royal College of Physicians and Surgeons of Canada has embarked upon an initiative to introduce competency-based medical education (CBME) in Canadian postgraduate specialty training and in professional practice in Canada. This initiative, called Competence by Design (CBD), aims to enhance patient care by aligning medical education and lifelong learning with evolving patient needs and empowering learners to more fully engage in their education process.


CBD will use time as a framework rather than the basis for progression. It is not anticipated that the duration of training will change for the majority of trainees. Residency programs will be broken down into stages, and each stage will have a series of milestones based on required competencies. These milestones will create more targeted learning outcomes and involve more frequent, formative assessments within the clinical workplace to ensure residents are developing and receiving feedback on the skills they need.


We anticipate that Western's Emergency Medicine program (along with all others across the country) will be transitioning to Competency By Design (CBD) starting in July of 2018.


The Specialty Committee at the Royal College (including all of the program directors) have developed:


  • Entrustable Professional Activities (EPA): These are assessments based on the observation of trainee performance of cardinal tasks required to become a competent emergency physician.   EPA’s will form the basis of evaluation and promotion in the Competency Based Education Model.

  • Required Training Experiences which will help determine which rotations/experiences residents must undertake.


The new stages for residency programs under CBD are:

  • Transition to Discipline (~3 Months)

  • Foundations of Discipline (~9 Months)

  • Core of Discipline (~3 years)

  • Transition to Practice (~1 year)


Transition between stages will take place once the requisite competencies in a particular stage have been completed.


We anticipate that this change will likely result in:

  • Fewer off service rotations

  • Modifications to off service rotations to maximize the relevancy to EM

  • A program that will be more tailored to individual residents


The Exam will take place after the Core stage and time for training in an Area of Focused Competence (subspecialty training) will take place in the Transition to Practice Stage.


The exact details of what this will look like for the program are still being developed. More information will be forthcoming at the CaRMS interviews and for candidates who match to the program.