CBD 101

The current model of medical education has been founded on a time based framework of learning where it is assumed that competence is achieved as a result of the amount of time residents spend in specific rotations. However this focus on time can leave significant gaps in the knowledge and skills that a resident is supposed to have acquired and lead to learners in difficulty being identified late in their training when a formal remediation is needed instead of smaller corrective action.

If outcomes can replace time as the focus of learning then medical educators can base their teaching and assessment around the achievement of the outcome of competency. In this model of competency based medical education, there are explicit expectations of the outcomes or competencies that residents need to achieve and they cannot move further into their training until they have demonstrated their achievement. 

Competence By Design (CBD) is The Royal College of Physicians and Surgeons of Canada’s enactment of CBME. The Royal College describes (CBD) as “a multi-year change initiative launched by the Royal College of Physicians and Surgeons of Canada. CBD will introduce a competency –based medical education (CBME) model to learning and assessment in residency and specialty practice across the country, helping to prepare physicians for practice that is:

  • geared towards patient needs and excellent care;
  • structured to support continuous learning and enhanced skills and abilities;
  • based on the needs of  the leaner, with more accountability; and
  • focused on demonstrating skills and performance, instead of time-spent in training.1

Resources

The resources below have been compiled to help you learn more about the CBME Model and its basic constructs:

Introduction to CBME and CBD (video)

Understanding Entrustable Professional Activities (EPAs)

  1. Competence by Design Cheat Sheet
  2. CBD Frequently Asked Questions
  3. Clarifying Myths, Misconceptions & Misunderstandings

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  1. The Royal College of Physicians and Surgeons of Canada. (2015). Competence by Design. Retrieved from http://www.royalcollege.ca/rcsite/cbd/rationale-why-cbd-e