CBD Community Touchpoint - May 2017

Message from the CEO

Royal College CEO Andrew Padmos

Dear Colleagues,

Together with our partners, the Royal College has built a model of excellence in postgraduate medical education and resident training that is respected around the world. Together we are embarking on Competence By Design, a major project to modernize and improve the quality of our core activities, including standards, processes and tools. The end result will be excellence in patient care and population health provided by highly-qualified, dedicated and compassionate medical and surgical specialists working in interdisciplinary teams.

A key success factor for enabling Competence by Design (CBD) is for the Royal College to work closely with our partners at every step of design and implementation. While we have learned along this journey to expect the unexpected, we have also learned that our implementation plan becomes more robust when we hear all voices and consider all viewpoints.

Since we last connected on March 1, I am pleased to report that we have made steady progress working with key partners toward meeting our CBD launch date of July 1 for the first two specialties: Anesthesiology and Otolaryngology – Head and Neck Surgery.

With 60 days to go, CBD has become a reality for Anesthesiology, as you will read in our conversation with Dr. Rob Anderson (FRCPC). Dr. Anderson reports that CBD is already working better at the Northern Ontario School of Medicine (NOSM) than the time-based system that it is replacing. He likens the adoption of CBD to the cleaning out of a basement; the transition has enabled his program to jettison processes that are no longer effective, and keep its most valued processes, while also adopting new CBD-based processes that are sure to improve resident learning and assessment.

On the technology front, we are preparing to go live this summer with the Royal College’s Resident ePortfolio, which is our custom solution for tracking resident learning and assessment in line with the principles of competency-based medical education. I invite you to explore our summary about ePortfolio and listen to our webinar, which gives important details about this exciting new software.

While transitioning residents to CBD is the priority over the shorter term, the Royal College continues to move toward adopting competency based continuing professional development (CB-CPD) for all Fellows. We are still in the research and discovery phase of CB-CPD, and encourage you to explore our highlight article on CB-CPD in this issue.


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


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A conversation with Dr. Rob Anderson, FRCPC

Dr. Rob Anderson

Dr. Anderson is a Northern Ontario School of Medicine (NOSM) Associate Professor, the Postgraduate Site Director of Family Practice and FRCP Anesthesia at NOSM, and Program Director, Anesthesiology. He has been involved in the development of CBD at NOSM for four years, and has given many lectures on the details of development and implementation of CBD, including how to develop effective EPAs. We talked recently with Dr. Anderson about his experiences and challenges championing CBD for Anesthesiology, which is one of two cohorts scheduled to launch CBD July 1, 2017.

We know you’ve had a lot of success developing CBD for anesthesiology, but what have been some of the specific challenges?
The biggest difficulty has been managing uncertainty. CBD is a major change. We think we’re doing a pretty good job training residents right now and the Royal College is saying that CBD will be much better than what we currently have. I believe that to be true and I see the evidence around me. But in truth, we’re at the forefront of the biggest medical education experiment in the last 100 years. So, a major challenge is in convincing people that we need this change. I’m confident that people will be convinced once they see CBD in action.

As for specific challenges, scheduling has been a bit difficult. Anesthesiology relies on internal medicine, emergency, pediatrics and many others to determine scheduling. There are numerous scheduling pressures, including providing clinical service for patients, working with off-service rotations to get appropriate and timely training experiences and using different scheduling frameworks than other programs. While this is challenging for other programs and postgraduate departments, it is an opportunity for them to explore better ways to do things when they transition to CBD in the future.

Mainly it’s been challenging because our department is the first through the door with CBD, so we don’t have others to turn to for advice.

What are the benefits for residents learning in a CBD program?
CBD will help us better support learners who are either struggling or way ahead. For struggling learners, we’ll be able to identify their challenges more swiftly and give them a customized learning plan to overcome their issues.

But an even greater benefit will be for the rock stars who in the past we’ve thought didn’t need interventions from us. They’ve always been treated as if they’re okay and we just let them sail through the process. But CBD’s process and portfolio reviews at the competency committee level ensure that every resident gets a personalized learning plan. It’s not just about pass/fail. It’s about how can we improve your performance today. So, if a resident gets all their EPAs in the first few months, they can continue to learn and improve instead of just moving toward graduation with minimal supervision. CBD is about raising the bar for everyone.

I also see great benefits for residents in the system now who will take the competency-based approach into their professional development. We’re training our residents to learn in this new environment, so it’s all they know. My hope is that, when they graduate, the practice environment will include more authentic, real feedback for faculty members. The culture will hopefully translate through to a continuum of improved practice, and that will translate to better patient care.

What advice do you have for future cohorts going through this process, or just starting the process?
A couple things. First, at a high level, the main thing is to remain optimistic and positive about this experience. Those following you will be looking to you for that. Those who may not be as supportive are looking for any evidence that this isn’t working, which can make it hard to stay positive. But don’t give in to negativity.

Also, I think some really important advice – especially for those who may still be many months from their workshops – is to try not to drink the ocean. Go for some easy wins that will be helpful for your specialty, such as picking a couple everyday procedures that you trust your residents to do with minimal supervision. For us in anesthesiology, labour epidurals were that kind of procedure. Build an assessment around something simple and you’ll get a feel for the work. One challenge is that we want to make sure we don’t miss anything when we build our EPAs, but you need to choose just for now and get used to it.

Next, you can start to figure out how what you’re doing will fit within CBD without creating a lot of extra work. Because CBD isn’t more work, it’s better work. If there are steps in your current process that you can delete, then do that. We found we were able to protect the great things we already did – such as our excellent and very active core program – and fit it within the new paradigm of CBD. The idea is to let CBD replace what you’re already doing with something better – and preserve what you’re already doing that you find valuable.

You also need to identify champions early and get them educated in the process. Think about recruiting young educators who are motivated and looking for a home academically, such as a medical education research plan or a scholarship program. CBD is an amazing opportunity for them to get involved and help shape what people do locally.

Do you think CBD is the right move for Canada?
Competency-based medical education is absolutely the right move for Canada. As for CBD, it’s new and not perfect, but it is already better than what we are doing. We’re already seeing that. Our department implemented competency-based assessments and progression four years ago and today the approach is highly valued by residents and faculty. The process makes sense and enables us to give residents valuable feedback.

A new process is bound to be challenging at the outset and it will take 10 years to make CBD seamless. But it will happen. To get a culture shift, it takes a complete redesign – and CBD is a complete redesign. It’s like we’re cleaning out our basement that has lots of things we like and lots of things we don’t like. When we set it back up, we can’t include everything – only the things that work.


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Our unique ePortfolio enhances learning and assessment

Our unique ePortfolio enhances learning and assessment

On July 1, 2017, the Royal College’s Competence by Design (CBD) goes live for two specialties: Anesthesiology and Otolaryngology – Head and Neck Surgery. In anticipation, we have developed and field tested the Royal College’s Resident ePortfolio. Our unique ePortfolio will formally launch on May 15.

The Royal College’s Resident ePortfolio provides an enhanced method of tracking resident learning and assessment activities in line with the principles of competency-based medical education. Our ePortfolio is a dependable, continuously improving, free-of-charge service offering customized to the specifics of CBD, and it is available for all universities to adopt, if they wish.

One-of-a-kind solution
The Royal College Resident ePortfolio enables clinical experts (who we call observers) and individuals developing skills (trainees) to logon to the software and manage their interactions electronically. For example, when a trainee wishes to interact with an observer, they select a specific assessment form for a task and “push” out the request. The observer sees the task request and, if feasible, arrives to observe the learner and record their observations.

Powerful and intelligent
The Royal College’s solution moves the ePortfolio concept forward by providing information built specifically for a competency-based system. Some reports will be available at system launch, and the Royal College will increase the selection of reports as system use increases. We are working closely with other vendors, such as 145 and Entrada, to ensure the systems communicate and align.

In addition, the Royal College Resident ePortfolio uses responsive design, which means ePortfolio sizes to display appropriately on mobile devices. At present, the Royal College is creating an ePortfolio app, which will launch in July. The app will enable users to access ePortfolio when they are offline.

The Royal College’s Resident ePortfolio will:

  • Always be up to date – As CBD standards inevitably evolve, our ePortfolio will reflect the latest iteration because each change will be integrated.
  • Focus on privacy – It is critical that any ePortfolio solution meet the privacy requirements for collecting, using and disseminating learning information. The Royal College contracted a third party to analyze the Resident ePortfolio and ensure it meets the requirements for security and maintenance of privacy in Canada.
  • Continuously improve – The Royal College will continue to evolve its Resident ePortfolio, adding options for reporting, and improving the software’s functionality and interface based on feedback we receive from stakeholders. Data disclosure to the Royal College will enable automation of the credentialing process straight out of the software. No faxes or other reports will need to be produced, mailed or couriered.

Find out more
For more information and a comprehensive demonstration about how the Royal College’s residency ePortfolio works, see our webinar.

In more technical terms, here are some of the things you can do using the Royal College’s Resident ePortfolio:

  • Leverage pre-loaded, specialty-specific milestones and EPAs to support developing learning plans.
  • Track learner progress at the individual level or at the level of amalgamated data across multiple programs.
  • Inform scheduling (ePortfolio doesn't provide scheduling, but observations can be "requested" by learners with a due date) and recording of observations between learners and faculty teams.
  • Enable analysis of comparative data against the national standards to improve program quality.


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Competency-based CPD for Fellows

Competency-based CPD for Fellows

If you’ve been following the Royal College’s emerging Competence by Design (CBD) initiative, you know that July 1, 2017 is our roll-out date for the first two resident programs: Anesthesiology and Otolaryngology – Head and Neck Surgery.

CBD is the Royal College’s strategy for supporting lifelong learning, beginning with residency and continuing throughout a physician’s career. Our initial work has focused on transforming residency training to a competency-based model in partnership with the postgraduate deans, programs directors, clinical faculty and residents. In future, our focus will include how CBD can enable the transition to competency-based continuing professional development (CB-CPD) by 2020.

The vision for CB-CPD places the health needs and expectations of patients at the core of a CPD system that will use competencies as a framework to guide learning and assessment. CB-CPD promotes the pursuit of excellence throughout a physician’s professional life, whether learning or assessment occurs at the individual, group or team level.

“CB-CPD will promote collaborative learning in the workplace with peers, colleagues, health professionals and patients so that we can provide better care together,” says Craig Campbell, the Royal College’s Director of Continuing Professional Development. “The goal is to demonstrate how participation in learning and assessment is impacting our performance and health care outcomes we are striving to continuously improve”.

We want to hear from you!

We want to provide you with every opportunity to contribute your ideas for how CB-CPD can meet your needs and expectations. We need your input and feedback to ensure that the changes to come are meaningful to you.

Here are three ways you can contribute today:

  • Competency-based CPD is defined as a “CPD system that uses competencies to continuously improve specialty practice, patient outcomes and the health system.” Tell us if this vision, focused on demonstrating continuous improvement of performance, quality of care and our health systems resonates with you?
  • Go to our website and provide feedback on a series of white papers on CB-CPD.
  • Share how you or your colleagues are using external sources of data and feedback today to enhance performance or health outcomes experienced by patients!

Contact us today. We value your input and feedback.


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Accreditation reform

Accreditation reform

Residency accreditation in Canada is shifting to adopt 21st century best practices and reflect the needs of competency-based medical education. In close collaboration with accreditation stakeholders, the Canadian Residency Accreditation Consortium (CanRAC) is working to determine what should be reformed and how.

A call for change
In 2012, CanRAC interviewed Canada’s post-graduate deans to identify the strengths and challenges of the current accreditation system. Fifty percent of deans called for transformative change, identifying specific areas for improvement such as paper-based processes, episodic workload and a need for more consistent decision making.

Early discussions among the CanRAC partners culminated in a proposed new system of residency accreditation that aims to address challenges in the current system, while preserving strengths such as national standards, onsite visits conducted by peer reviewers and input from specialists.

Current System

  • Systematic rigorous process
  • Peer review
  • Manual, paper-based
  • Episodic, “snap-shot in time” site visit
  • Process-based standards
  • Opportunities to clarify decision-making processes, including resident input

Proposed System

  • Systematic, rigorous process
  • Peer review
  • Digital platform
  • More continuous cycle of accreditation
  • New, more explicit standards that align with competency-based medical education and with an increased focus on outcomes
  • Revised categories of accreditation
  • Enhanced system for resident involvement and input
  • Increased emphasis on continuous improvement and the learning environment

National consultations
More recently, CanRAC conducted national consultations with all stakeholders of the accreditation system. The consultations included a national online survey and webinars to familiarize stakeholders with the proposed changes. From this wide-reaching consultation process as well as three annual accreditation summits, CanRAC has heard much support for the changes, as well as an appreciation for the challenges ahead.

The national survey revealed that two thirds of participants (67 percent) are familiar with the proposed process changes for accreditation, and 91 percent support the changes. Participants were asked to rate the degree of implementation challenge for each proposed change. Seven of the 10 process changes were noted as “challenging” and the process change involving a move to a digital accreditation management system was noted as “very challenging”.

A need for support
The results confirm for CanRAC that universities will need a great deal of support throughout the implementation of accreditation reform. In particular, the implementation of new digital accreditation management system will include extensive testing and adjustments to ensure that all stakeholders have the capacity to use such systems. Efforts are already underway with respect to anticipating and addressing training and support required for universities, including regular communication with CanRAC, AMS training, and additional pre-survey visits.

The accreditation process remains unchanged pending full endorsement of the new system and its implementation plan by all three Colleges that make up CanRAC. To learn more about the implementation process, visit the CanRAC website’s When am I affected? section.


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More concise & easier to find: inspect our revamped CBD content

More concise & easier to find: inspect our revamped CBD content

Dr. Smith has a problem. She keeps hearing about the Royal College’s Competence by Design (CBD) initiative — she thinks she understands the basic principles of it (e.g. introducing competency-based medical education into residency programs, ePortfolio, catching struggling students sooner, new accreditation guidelines, etc., etc.); but, she can’t answer specific questions from residents and colleagues like

  • When does our specialty transition to CBD?
  • How will ePortfolio change the way we work?
  • What kinds of faculty supports are being planned?

Dr. Smith’s not even sure where to begin looking!

If you’re like Dr. Smith and want more information about CBD, you’re in luck. We just relaunched our CBD webpages to better connect you with the information you want and need, and to improve your user experience through

  • clearer, more relevant and concise content;
  • a refreshed resource section;
  • improved search capabilities;
  • updated information on ePortfolio, competency-based continuing professional development and more.

Visit www.royalcollege.ca/cbd.

Feedback is always welcome. Email cbd@royalcollege.ca.


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ICRE 2017 to include dynamic competency-based education track

ICRE 2017 to include dynamic competency-based education track

Are you thinking of attending this year’s International Conference on Residency Education (ICRE), the world’s largest conference devoted exclusively to advancing residency education? Are you looking to learn more about competency-based education from leading experts like Jason Frank, MD MA (Ed.) FRCPC and Eric Holmboe, MD FACP FRCP? Then we’ve got great news, this year’s ICRE has a special track dedicated to this emerging endeavour in medical education, which will include a thought-provoking symposium session on innovative competency-based medical education program design, plus much more! Stay tuned over the coming months as we unveil more about this exciting track.

This year’s venue: Picturesque and culturally rich

This year’s ICRE will take place from October 19 – 21, 2017, in beautiful Quebec City, Canada. Quebec City is one of North America’s oldest and most culturally rich Francophone settlements. From its picturesque location on the Saint Lawrence River, to the cobblestone streets of the Old Quebec historic district, ICRE attendees will understand quickly why Quebec’s nickname is “La belle province” (The Beautiful Province).


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