Implications for Competence by Design (CBD)

Special thanks to Anne Matlow, M. Sc., MD, FRCPC, for developing this content.

The essence of Competence by Design (CBD), the Royal College of Physicians and Surgeons of Canada’s outcomes-based approach to learning, is the achievement of prescribed competencies at progressive developmental stages of professional practice. The focus has shifted from ascribing competence according to the amount of time spent in training to demonstrating competence through achievement of prescribed outcomes. The following key points help our understanding of the interface between CanMEDS and CBD (adapted from 5 Key Things You Should Know about CanMEDS and Competence by Design1) and can be applied to Key Competency 3 of the Leader Role:

  1. CanMEDS continues to define physician competency outcomes: “CanMEDS competencies continue to provide clear expectations about the skills and abilities expected of a physician in all domains of their medical practice”;1 however, these expectations are now described in a progressive fashion to help situate and assess the learner on their personal journey from trainee to independent practitioner.
  2. CBD is a new process for teaching and assessing CanMEDS competencies: As primarily an outcomes-based approach to medical education, CBD introduces the concept of entrustable professional activities (EPAs) as the key outcomes to be achieved. An EPA is defined as “a stage-specific clinical task that an individual can be trusted to perform in a given health care context, once they have demonstrated sufficient competence.”
  3. Residents draw on their CanMEDS competencies to perform EPAs: “Disciplines define their own EPAs, choosing the activities that will best enable programs to ensure their residents develop the competencies needed to progress through training appropriately.”1 At any given stage of training, residents will need to perform the defined EPAs successfully to demonstrate that they have developed the competencies they need to progress to the next stage of their training. Embedded CanMEDS competencies are identified for each EPA.
  4. Workplace-based assessment and coaching help build competence across all CanMEDS Roles. As CBD focuses on workplace-based tasks, workplace-based assessment and coaching are integral components of this approach. Timely and repeated observations provide perspectives on a resident’s EPA competence that are assessed in aggregate by competency committees. They enhance the collective picture of a learner’s competence that is derived from other assessment modalities such as narrative assessments, summaries of daily clinical performance, in-training tests and objective structured clinical examinations (OSCEs).
  5. Physician competence recommendations are made through a group process. All input on a trainee’s performance is aggregated and assessed by the local specialty competence committee and evaluated by level of training to ensure that the trainee is completing the required EPAs and acquiring the necessary CanMEDS competencies.

References

  1. Royal College of Physicians and Surgeons of Canada. 5 key things you should know about CanMEDS and Competence by Design. Ottawa: Royal College of Physicians and Surgeons of Canada. www.royalcollege.ca/rcsite/documents/cbd/royal-college-canmeds-cbd-e.pdf