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Competence by Design and exams

Changing exam timing

In the current system, residents spend the last year of their programs preparing for their certification exams. This usually means they lose valuable clinical time. In the Competence by Design (CBD) model, residency has four stages:

  • Transition to Discipline (orientation and assessment)
  • Foundations of Discipline
  • Core of Discipline
  • Transition to Practice

CBD will shift exams earlier in training — likely to the end of the Core of Discipline stage (the timing of the exam will be determined by the needs and context of the discipline). This way, trainees will not be lost to textbooks in their final year. Instead, they can take that year to hone their skills. As much as possible, emphasis will be placed on independent work and skills, helping physicians better prepare for independent practice.

Moving exam will not shorten residency training

Successfully completing the Royal College exam will continue to be a requirement for independent practice. However, passing the exam at the end of the Core of Discipline stage will not lead to certification.

The Royal College will only grant certification when the resident has successfully completed the Transition to Practice stage and has received sign-off from the program director and the postgraduate office at their medical school.