Royal College of Physicians and Surgeons of Canada
The Royal College in 2018

Education and lifelong learning

CBD in 2018: Support, respond, reach out

We are gaining momentum! Eight disciplines have now launched Competence by Design (CBD) — the Royal College’s initiative to introduce competency-based learning to Canadian residency training programs. Twelve more disciplines are preparing to launch CBD in July 2019.

Why CBD is the right move for Canada,” by Dr. Viren Naik, FRCPC (CBD Community Touchpoint, Nov. 2018).

Disciplines that launched CBD in 2018

  • Emergency Medicine
  • Forensic Pathology
  • Medical Oncology
  • Nephrology
  • Surgical Foundations
  • Urology

As CBD picks up steam, there has been increased discussion about what is needed for implementation and a growing interest in understanding this change initiative.


We have been communicating with our partners and expanding our resource collection to address their needs. This includes more items on workplace-based assessment and competence committees, among others. Views to our CBD webpages have increased 150% over 2016-2017 and more than 14,000 resources were downloaded this fiscal. We now have more than 10,000 residents and faculty members using Royal College ePortfolio.


In 2018, the Fédération des médecins résidents du Québec released a report on the impact of CBD. We addressed their concerns in our response-report, Listen, Learn, Adjust. We also reviewed CBD costs in collaboration with the Committee on Health Workforce (CHW — a joint federal-provincial/territorial network of deputy ministers of health). Into 2019, we continue to work on costing with the CHW and the Association of Faculties of Medicine of Canada. We will continue to explore resource implications and local variation in CBD implementation, and to strategize appropriate responses and supports.


We spent the year assisting program directors, deans and other stakeholders who are leading the change towards CBD. We held regular meetings with resident associations and postgraduate deans, and reported on our progress. We also continued to discuss CBD at our outreach visits and hosted several teleconferences. Also in 2018, we held the first CBD summit for medical students to extend their early understanding of CBD.

Visit our refreshed CBD Resource Directory to explore newly released materials.


Dr. Jennifer Vergel de Dios wasn’t entirely sure what she’d signed up for when she agreed to a new role as Competence by Design (CBD) lead for her department. “I didn’t know much about CBD at all. But I always really enjoyed teaching, figuring out how to communicate messages in different ways.”

Dr. Vergel de Dios is an anesthesiologist at the Schulich School of Medicine & Dentistry at Western University in London, Ont. Her specialty was one of two to launch the ground-breaking Competence by Design initiative in 2017. Introduced by the Royal College in partnership with Canada’s 17 medical schools, CBD is transforming medical education nationwide.

“I soon realized how big an undertaking it was. Being the first specialty to roll out, it was very daunting.” Soon after accepting the role, she became ill, often working on the launch from home while recovering from surgeries and other treatments. “Being a patient, being on the other side of hearing bad news, going through treatments and side effects, I realized you can be an expert in your field but there is so much you can’t understand until you’ve experienced it. I try to pass that on to the residents.”

Teamwork is essential to her roles both in and out of the operating room

The frameworks, teaching models and guidelines created by Dr. Vergel de Dios and her team lead the way as other specialties and departments shift to CBD in the years ahead. To that end, she is now Schulich’s director of Competency-Based Medical Education Implementation. “My role is essentially understanding the strengths and weaknesses of each program, seeing if there are overlapping challenges or barriers, and seeing what other programs have come up with as solutions that we can share.”

From her earliest days as an anesthesiologist, Dr. Vergel de Dios loved the teamwork of the operating room. She encourages the same collegial approach in her new role. “We help each other through. I think CBD has brought a spotlight to medical education in general, to really reflect and think about what we’re doing, what we don’t want to do anymore. We can pool resources to look at different approaches in different departments.”

Seventeen Anesthesiology & perioperative medicine residents are now going through the CBD program under Dr. Vergel de Dios’s leadership. “We boil it down to the basics of coaching, feedback and a growth mindset. I think that applies even to people who’ve been practising for a long time. We all have something we could get better at. The goal is always to improve patient care.”

Re-engineering and modernizing exams — we’re working on it!

The evolution of specialty medical education to a Competence by Design (CBD) framework is changing how we will assess physicians' competence to practice. Royal College exams will contribute to a doctor's certification, but will only be one element in a multi-faceted assessment to ensure the quality of the next generation of specialists.

If anything, CBD has made a stronger case for modernizing our exams — something we have been exploring for the last several years. Nothing is off the table. We are evaluating exam blueprints, timing, processes, formats and infrastructure for exam delivery.

Computer-based examinations

Throughout 2018, we explored various software systems that might meet our particular needs for computer-based exams. We also piloted a tablet-based marking system for the spring 2018 applied examinations in Otolaryngology – Head and Neck Surgery and Nuclear Medicine.

Online Examiner Onboarding Program

We started pilot testing a new program in 2018.

New exam centre

We launched a new partnership with Touchstone Institute in Toronto. Four OSCE/oral examinations were successfully performed on location in the fall of 2018.


Written examination centres: 14 across Canada


Examiners and committee members: 1,500


Exam candidates: 2,852


Surgical Foundations candidates: 461

Assessment and accreditation

The Royal College is one of three organizations that accredit residency programs in Canada. Accreditation visits occur on a rolling basis. These “check-ups” tell us whether training programs are maintaining expected standards and adequately preparing graduates for independent practice. More importantly, it allows the programs to engage in quality improvement processes.

The system of residency accreditation in Canada is currently under transition.

These changes are to ensure the quality of residency education. This includes modernized processes and a system that can evaluate programs that have introduced competency-based learning.

As of July 1, 2019, this new system of residency accreditation — CanERA — will be fully implemented. To prepare, in 2018, we launched a full test of all components of the system as the final phase of our prototype testing implementation model, which included the regular accreditation review of Dalhousie University in November 2018 (and will also include the regular accreditation review of McGill University in March 2019).

The Canadian Accreditation Management System (CanAMS) – the digital platform that will support this new accreditation system – will be deployed to all universities by July 2019.

Did you know? We accredit simulation programs

  • In 2018, we accredited five simulation programs: two in Toronto and one each in Calgary, Ottawa and Montreal. Simulation programs accredited by the Royal College pass a rigorous peer-review process that measures their ability to meet the highest standards in administration, education and ethics.

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