CBD Community Touchpoint - March 2017

Working together to implement CBD

Royal College CEO Andrew Padmos

Dear Colleagues,

We are now exactly four months from the implementation of Competence by Design (CBD).

As I shared with you in our December newsletter, Canada’s 17 medical schools and the Royal College made an agreement in November to implement CBD starting July 1, 2017. The first two disciplines to launch their residency training under a new competency-based approach are Anesthesiology, and Otolaryngology – Head and Neck Surgery.

Our agreement is the result of committed action and engagement across the medical community. And that engagement continues. Since the November announcement, the Royal College has worked closely with the universities, specialty committees and resident groups, building readiness checklists so we know precisely what needs to be in place before we move forward on our first implementation. This work has been meticulous and highly productive. The cycle of input and feedback in recent months shows just how much can be achieved when we work together.

As a deliverable coming out of our November meeting, we are also in the process of establishing a committee to work with all our stakeholders, including residents, to determine precisely how assessment data will be handled and where it will be stored. We will find a solution that is agreeable to everyone.

Working together to implement CBD
Between now and July, we will meet with department chairs at the universities, and with the specialty committees, hospital executives and other key stakeholders, to build understanding about CBD, as well as how it will affect their work and the resident workforce. We will continue a productive series of workshops where the specialty committees come together with the Royal College to co-create the overall composition of CBD. A CBD national advisory committee will also begin to meet in the coming weeks with the goal of convening representatives from all stakeholder groups as we refine a strategy for rolling out CBD more widely.

It has been an extraordinary – and sometimes taxing – journey toward CBD implementation, and I want to thank everyone who has contributed to where we are today. We have made great progress by working together with our partners toward this important common goal. We are nearly there. And we are well positioned, with a solid plan of action, to implement CBD on schedule.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer


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Medical Oncology field test yields encouraging results

Medical Oncology field test yields encouraging results

Field tests are an effective way to gather quick, real-time data that help the Royal College improve how it’s working with stakeholders to implement Competence by Design (CBD). The lessons learned in field tests help us fine-tune elements of our design that will ensure CBD is usable and practical in the real world.

Medical Oncology is scheduled for a July 2018 CBD implementation. To prepare, starting in July 2016, 15 Medical Oncology programs across Canada went through several months of voluntary field testing.

A focus on observation
The field test focused on the fact that competency-based medical education (CBME) puts special emphasis on teachers observing a resident’s work – and then giving the resident direct feedback. This element of CBME distinguishes CBD from the current, time-based approach to residency education. A key question, therefore, is: How well does direct observation and feedback work?

“We wanted to know what impact direct observation has on the quality of feedback residents are getting,” says Elaine Van Melle, PhD, Education Scientist at the Royal College. “Is direct observation feasible in a clinical setting? Does it enhance the quality of feedback? And what do we need to do for Medical Oncology – its program directors, faculty and residents – so they feel completely prepared to implement CBD?”

Medical Oncology found answers by field testing the direct observation method for six of its entrustable professional activities (EPAs), which are tasks in the clinic setting that a supervisor delegates to a resident who has demonstrated sufficient competence. Results from the field test came from surveying teachers and learners once a week and interviewing program directors and other leaders.

Direct observation works well
Results showed that teachers generally agreed they could easily use direct observation in clinical settings – especially during longer consultations where teachers had little trouble integrating feedback into the allotted time.

However, teachers ran into challenges in busy clinics, where feedback following a relatively brief consultation caused delays. Some Medical Oncology program directors plan to us these results to adapt their clinics to accommodate direct observation – for example, in some cases by creating designated teaching teams.

Residents expressed a variety of opinions. Some found direct observation challenging because one patient interaction is never a “perfect” interaction. They expressed the feeling that no task could ever be “complete.” Others found direct observation helpful because it enabled teachers to spot major omissions in a resident’s performance. If no major omissions were identified by the teacher, the resident’s confidence increased.

Context is important
Medical Oncology reported that the Royal College’s support strategies for implementation helped facilitate the field test. The process benefitted from engaged leadership at the Royal College and readily available support resources. At the same time, the implementation plan lacked clarity, which Medical Oncology identified as a barrier.

“The message here is about the importance of context,” says Van Melle. “Every school does its work a little differently, so CBD implementation has to be contextualized clearly for the schools’ various resources, conditions and requirements.”

Van Melle added that one program director said that the field test was highly successful because it showed in a safe environment what worked and what didn’t. “The feeling was that fields tests are a low-stakes environment where we get a chance to experiment. And the outcomes can be highly valuable.”

The Royal College applauds Medical Oncology for the critical leadership role that they have played in moving CBD forward.


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CBD Readiness Checklist: Mapping out our strategy for the next four months

CBD Readiness Checklist: Mapping out our strategy for the next four months

We are now only four months away from implementing Competence by Design (CBD), and the Royal College has been working closely with our medical school partners, specialty committees, CBD leads and residents to finalize preparations for the July 1, 2017 launch. Check out the high-level CBD readiness checklist – developed collaboratively with our partners that highlights key implementation activities.

CBD Readiness Checklist


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Learning from CBD stakeholders

Learning from CBD stakeholders

Since our journey toward CBD began, the Royal College has focused on working closely with the organizations and individuals the changes will affect most so that CBD will be enhanced by the collective wisdom of multiple stakeholders.

We’ve worked closely with specialty committees, post graduate deans, CBD leads at hospitals, and provincial and territorial ministries to prepare for implementation. More recently, we’ve built closer relationships with resident organizations to make sure their concerns and suggestions are heard and considered. Our experiences have shifted how we form relationships and build dialogue.

“This experience has involved a widespread multi-stakeholder engagement process” says Rhonda St. Croix, Change Initiative Advisor in the Royal College’s Office of Specialty Education. “And we continue to reach out to stakeholders to build the relationship and dialogues we need most. We’ve done this in full knowledge that we must get their insights, guidance and practical help to improve and implement CBD.”

January – March Calendar of Stakeholder Engagement

  • Jan 14 – Meet with FMRQ resident group in Québec
  • January 24 –Change leadership session with Queens CBME resident sub-committee
  • Jan 26 – Quarterly Queens CBME workshop, including leadership team, program directors, faculty and residents
  • Jan 27 – Regular call with Ontario hospital executives
  • Jan 27 – Bi-monthly call with post graduate managers
  • Jan 30 – Bi-weekly call with CBME national faculty leads
  • Jan 31 – Resident online town hall
  • Jan 31 – Meeting with AFMC deans
  • Feb 2 – Regular call with the CB-CPD National Advisory Committee
  • Feb 3 – CBD outreach visit with Manitoba, including PGME stakeholders, Manitoba Health the Regional Health Authorities of Manitoba
  • Feb 3 – Program Administrator National Advisory Cte meeting
  • Feb 5 – Meeting with Association of Canadian University Departments of Anesthesia
  • Feb 16-18 CBME summit at Western
  • Feb 23 – uOttawa post-graduate deans retreat
  • March 16 – CBD outreach visit with Memorial University of Newfoundland MUN
  • March 29 – McMaster University program director retreat
  • March 30 – Program Director National Advisory Cte meeting


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Faculty Development: Supporting you in CBD implementation

Faculty Development: Supporting you in CBD implementation

The Royal College recognizes that faculty development is a critical piece to the CBD implementation puzzle. As we approach our July 1, 2017 launch date, we continue to work with key stakeholder to create educational and faculty development resources that support disciplines as they incorporate competency-based medical education into their programs.

Resources designed specifically to support CBD implementation

We are also committed to ensuring these resources directly align with the needs of our Fellows and key stakeholders. For several years the Royal College has been working closely with the early cohort disciplines, CBD Leads, PG Deans and others to prioritize the College’s faculty development efforts.

We currently have a wealth of Faculty Development resources on our website, including videos, handouts, FAQs and more. In the coming months we will unveil a number of additional resources that address key topics identified by those directly on the ground, including: Coaching for Excellence, Specialty Committee Implementation Guide and Meantime Guide.

Competence committees: A critical component of competency-based assessment

In this edition of CBD Touchpoint, we also want to draw your attention to a series of resources that can be used to support local Competence Committee development and operations. Competence Committees are a critical component of competency based medical education, and while there is no single way to design and operationalize a Competence Committee, we do offer guidelines and resources that can help busy programs get started on their own plans.


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Have questions about Accreditation Reform? This resource is for you!

Have questions about Accreditation Reform? This resource is for you!

Check out "Your Guide to Accreditation Reform" for more information on what CanRAC is, what the proposed changes are, and an overview of the 10 reforms.

Your guide to accreditation reform [link to PDF]

What is CanRAC?

CanRAC is the Canadian Residency Accreditation Consortium, which is comprised of the three certification colleges in Canada: the Collège des médecins du Québec, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada.

The three colleges partnered in 2013 to evaluate the current accreditation system. They recognized the opportunity to improve the system and to align residency accreditation with 21st century best practices — including supporting the shift towards competency-based medical education (CBME).

10 Reforms

  1. New standards
  2. New evaluation framework
  3. New progressive accreditation cycle supported by data monitoring
  4. New digital Accreditation Management System
  5. Emphasis on continuous quality improvement
  6. Enhanced onsite review processes
  7. A new institutional review process
  8. Emphasis on the learning environments
  9. New decision categories
  10. A new approach to evaluation and research

Proposed changes

Clearer expectations

  • New standards more focused on outcomes

Go digital

  • No more printing big binders and starting from scratch every cycle

More CQI

  • Less punitive and more focused on continuous quality improvement

Less Episodic

  • Less of a rush, more digestible workload

Your guide to accreditation reform [link to PDF]


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