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Competence by Design: The rationale for change

Over time, the demands on, and expectations of, specialists have changed significantly. But the medical education system has remained relatively unchanged over the past 100 years.

The current system assumes that the more time a learner spends on an activity, the more the learner absorbs and excels. While our system continues to produce excellent physicians, evidence suggests that our methods of training and lifelong learning can be improved.

“The reality is that our existing training model is very old. The depth and breadth of information and skills that we expect our residents to learn now is much more substantial.”

Erin D. Wright, MDCM, MEd, FRCSC; member of the Royal College Specialty Committee in Otolaryngology — Head and Neck Surgery; professor, Department of Surgery, University of Alberta

We need a system that responds to specialists who

  • graduate with knowledge gaps and feel unprepared for independent practice,
  • feel that existing methods of assessment and feedback are ineffectual,
  • lack a clear understanding of the learning objectives of their program,
  • lose needed clinical practice time to exam preparation, or
  • find it difficult to determine when new abilities/skills are needed in practice.

We need a system that helps educators who

  • struggle with inefficient and ineffective in-training assessment tools,
  • struggle to focus teaching activities in the absence of clear learning objectives,
  • feel unprepared to provide meaningful and targeted assessment, or
  • find it difficult to determine or demonstrate when a learner is falling behind.

We need a system that enables educators/learners to

  • identify the competencies needed at all stages of training and practice,
  • set up/follow a transparent learning plan to achieve these competencies,
  • adjust learning to individual needs and abilities and consistently track progress,
  • pinpoint areas where learners may be struggling and respond accordingly,
  • provide/receive meaningful assessments against competencies,
  • determine when and how new skills should be incorporated into practice, and
  • ensure a national baseline of competence across all specialties in Canada.

The move toward Competence by Design (CBD) will also reflect the recommendations of the Future of Medical Education in Canada Postgraduate (FMEC-PG) Project.