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Competence by Design

Competence by Design (CBD) is the Royal College’s initiative to improve physician training and lifelong learning. The CBD initiative will transition specialist medical education from a traditional time-based model to a hybrid form of competency-based medical education (CBME). CBD does not discount or adjust time spent in training; instead, it re-conceptualizes time as a resource for acquiring competencies.

CBD is a multi-year, transformational change initiative. It focuses on outcomes, asking the question “What abilities do physicians need at each stage of their career?” It organizes physician training around desired outcomes and looks at the needed competencies.

The greater goal of CBD is to enhance patient care by improving learning and assessment across the continuum from residency to retirement. This will ensure that physicians continue to demonstrate the skills and behaviours needed to meet evolving patient needs.

“We do a good job now, but we can do a better job, and I think that is the message — that we can always do better. We know in clinical practice we achieve a standard, but there is always a better way to do things, and I think this is a mechanism to achieve that next level of improvement.”

— James Wilson, MD, FRCSC; associate professor, Department of Urology, Queen's University; urologist, Kingston General Hospital

Re-conceptualizing time

While “pure” CBME is time-free, CBD is a hybrid model. In this model, the number of years needed to complete a residency program is not expected to change for most residents. Residents will work within the defined time frames of their residency programs, but they will be able to achieve competencies (measured by milestones/EPAs) at their own pace and in a variety of locations.

Your education. Your practice. Your change!

We can’t do this alone. The knowledge, experience and directions of Fellows, residents and the medical education community are essential. Tell us what you think. Let us know what tools you need. Get involved in shaping your medical education system.

Read about why we are doing this.

Read about how and when we are doing this.

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The Royal College can’t implement CBD without the involvement of the medical education community.