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[LEFT] The Dominion Medical Council of Canada celebrates the establishment of national training standards for Canada’s medical institutes in 1912 (Parliament Hill, Ottawa). [RIGHT] Over a century later, the Royal College’s Committee on Speciality Education, Otolaryngology - Head and Neck Surgery and Anesthesiology Speciality Committee Chairs, CBD Leads and postgraduate deans celebrate the decision to implement Competence by Design starting in July 2017 (Royal College, Ottawa).

On July 1, medical schools across Canada will launch a new approach to medical education that is years in the making (you could even say 100 years in the making, depending on how you measure it).

It is time to start implementing our Competence by Design initiative. After 100 years under a time-based model, postgrad programs in Otolaryngology – Head and Neck Surgery and Anesthesiology will introduce a hybrid, outcomes-based approach to training and assessment that is more flexible and adaptable to societal change. Soon, programs in 65 more disciplines will usher in these same changes and, in time, all aspects of the learning continuum and professional development will be impacted.

Now, I deliberately emphasize this as being “our” initiative. Competence by Design may have been introduced by the Royal College, but it has only advanced this far because of the involvement, collaboration, hard work, leadership and commitment to quality improvement by our partners in Canada’s 17 medical schools, our specialty committees and staff members, and other stakeholders and contributors from the medical education community.

It seems fitting that our implementation date should fall on Canada’s 150th anniversary. This date affords us the perfect opportunity to take stock of our country’s proud heritage and, importantly, to situate this achievement alongside other important moments in the evolution of Canada’s medical education system.

In our 150 years as a nation, our health care system has become part of the fabric of our country and engrained in our Canadian value system. While we no doubt have our challenges – both those before us and those on the horizon – we truly do have a world-class system. We should all feel proud that Competence by Design will complement and extend this legacy — giving more support to both faculty and learners, and enabling them to better respond to the demands they face in this hectic and changing medical environment.

Together we are pioneers. While this is just the beginning of a long implementation journey, we should all take a moment to celebrate this “milestone.” Together we are shaping the next generation of physicians and surgeons. We are fashioning a reinvigorated training system. It’s ground-breaking. And while we may not recognize the full magnitude of it now, these changes are poised to have the same degree of impact as Flexner, Osler and the members of the Dominion Medical Council of Canada. Perhaps in 100 years from now, people will be talking about this moment in history.


First Faculty of Medicine

McGill’s first medical building (built in 1872).

Canada’s first Faculty of Medicine at McGill University was founded in 1829. It is the legacy of the Montreal Medical Institution (est. in 1823 by four physicians from the Montreal General Hospital). Before 1913, eight more faculties of medicine were formed at universities in Montreal, Toronto, Quebec City, Kingston, Halifax, London, Winnipeg and Edmonton.


Osler’s “bedside training”

Dr. William Osler - popularly titled the “Father of Modern Medicine”

Dr. Osler was a key figure in the development of medical education in Canada and the United States. In 1880, he introduced the concept of “bedside training.” Prior to that, medical students in both countries were trained in laboratories before being certified as doctors. Dr. Osler ushered in a significant shift whereby training programs now emphasized a range of “patient-focused” skills, beyond the lab or science.


The Flexner Report

Cover of The Flexner Report on Medical Education in the United States and Canada, authored by Abraham Flexner in 1910.

In 1910, Dr. Flexner shook up the medical education system. Using data he collected from over 155 training institutes across North America, he showed that medical education was frighteningly inconsistent. His report led to major reforms in Canada and the United States, including provoking medical authorities in both countries to establish and adopt unified training standards across their medical education faculties.


National training standards

The Dominion Medical Council of Canada marks the establishment of national training standards across medical institutes based on the 1910 Flexner Report.

In 1912, the Dominion Medical Council of Canada established the first set of medical educational standards in the country. They were mandated for use by all Canadian universities to ensure consistency in knowledge among graduates. To this day, medical regulatory authorities audit training programs to ensure standards continue to be met.


The Royal College of Physicians and Surgeons of Canada

June 1929 - a special Act of Parliament established the Royal College of Physicians and Surgeons of Canada to oversee postgraduate medical education in Canada.

At first, the Royal College offered just two specialty qualifications: Fellowship in general medicine and Fellowship in general surgery. By 2014, the Royal College had expanded its activities to recognize 80 disciplines, granting Fellowships in 30 specialties, 35 subspecialties, three special programs and 13 Areas of Focused Competence (AFC-diplomas).

From the 1940s to the 1970s, the Royal College conducted examinations at two levels in most specialties: Fellowship, the higher qualification, or Certification, a lesser designation. In 1972, the Royal College abolished this dual standard and began to offer a single certification that continues today.


Launch of CBD



Otolaryngology – Head and Neck Surgery prepare for the transition to Competence by Design at a workshop in Ottawa in November 2014.

The implementation of Competence by Design (CBD) launches on July 1, 2017. , After years of preparation, Otolaryngology - Head and Neck Surgery and Anesthesiology will be the first two programs to usher in these changes. We expect all disciplines to transition to CBD by 2022. Find out more about CBD implementation.