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Competence by Design and assessment

Assessment that gives the full picture

Many of the assessment practices in Canadian medical education focus on the learner’s abilities at a particular point in time, and on individual skills. Examples of these assessment practices include objective structured clinical examinations (OSCEs), direct clinical observation, patient management discussions, in-training evaluation reports (ITERs), local evaluations, and the Royal College exams.

These assessments are valuable, but they provide piecemeal information on performance (generally at the end of training) rather than a full picture of what a resident can actually do in clinical practice.

Competence by Design (CBD) aims to reframe assessment by looking at it through a programmatic lens. The CBD model will go beyond assessment at the end of residency to create an environment where all aspects of a learner’s performance are continually evaluated.

EPAs: Driving assessment and curriculum development

Using the CanMEDS Roles as an organizing framework, CBD will break down each stage of training into milestones and entrustable professional activities (EPAs).

This process will

  • embed continual assessment and self-reflection into the learning and practice habits of specialist physicians,
  • change the “failure to fail” culture by making it easier to identify and respond to learners in difficulty early on in training,
  • allow educators to identify learners with exceptional skills and foster growth of these abilities, and
  • demonstrate the commitment of all specialists to patient safety and continuous improvement.

Taken together, milestones and EPAs will layout a clear learning plan for residents and clear teaching and assessment goals for educators. Overall, this approach will increase the number of assessments within residency; however, it will also increase the amount of valuable, practical and demonstrable data we can use to evaluate the competence of our learners and ensure they are delivering quality patient care.