CBD Community Touchpoint - October 2017

Message from the CEO

Royal College CEO Andrew Padmos

Dear Colleagues,

We’ve come a long way in a few short summer months! On July 1 we celebrated the launch of Competence by Design (CBD) for Anesthesiology and Otolaryngology-Head and Neck Surgery. Since then, everyone has worked tirelessly to lay the foundation for next year, and beyond, as we set our sights on the other disciplines to implement CBD.

Next year, medical school and academic health centres will potentially implement CBD in another 10 specialties. The sheer number of disciplines to roll out CBD in 2018 will test everyone’s preparation and readiness efforts. We owe it not only to residents, but to all patients to be ready.

The Royal College is taking the time to learn what it can from the first wave of CBD implementation. Taking a true measurement of our progress thus far is not only necessary, but it sets the compass on the next phase. In our regular exchanges with post-graduate deans and the greater specialty medical education community, what we hear is that it’s no longer about why CBD is here, rather those specific things medical programs need to know before they roll out CBD.

Change can be daunting, and we know there will be growing pains. We’ve certainly had our own. But the College will be here every step of the way to see this through, as this is all about supporting one another.

One of the vivid lessons learned thus far is actually more of a realization – the specialty medical education community is committed, talented, and willing to help. I am confident that we will all unite, as we have so many times in the past, and take CBD to the next level.


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


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faces of CBD

The faces of CBD

Early insights: implementing CBD

Interview with
Dr. Brian W Rotenberg MD MPH FRCSC

Residency Program Director
Department of Otolaryngology - Head & Neck Surgery
Western University

“One of the most surprising realities has been the sheer excitement and positivity that many of the staff have displayed toward CBD and its processes.”

With the first two disciplines launching their Competence by Design (CBD) programs on July 1, 2017, we are pleased to offer a glimpse into the first few months of the CBD experience. In this edition, we profile Residency Program Director, Brian Rotenberg to discuss how things are going with the implementation of CBD in the Otolaryngology – Head & Neck Surgery (OTO-HNS) Department at Western University.

Program directors are involved in every step of designing the new CBD program for their discipline, in addition to working with colleagues at their home faculties to prepare for implementation. Dr. Rotenberg is an enthusiastic supporter of a competency-based medical education (CBME) approach to residency education.

After only a few months with CBD in place, we asked him to reflect on learnings so far regarding implementing CBD.

What do you see as the real advantage of CBD for the modern physician?

“By nature, we doctors are empirical people and this bodes well when you introduce a system that responds directly to the needs of the changing times and changing learners too. Under CBD, we can address specific issues in a real-time way and add detail to the way the learner acquires strength in one area of specialty.

There’s much more conversation about learning happening under CBD, which targets areas of improvement and identifies areas of strength very specifically. This efficiency makes CBD a natural evolution for time-crunched physicians today.”

Describe the role of the Program Director (PD) in implementing CBD.

”The PD has a role to play in making sure CBD unfolds as planned. PDs have significant conversations with their staff about CBD. We play a persuading role and while there is sometimes resistance from staff, they need to be able to align everyone in one direction. Ultimately CBD is the way to go, so if anyone has a fundamental problem with it, it does fall on the PD to make tough decisions about who should be on the educational team. PDs also create enthusiasm, generate interest and harness positive contributions from all participants. This is critical. In the end, the single most important factor to the success of CBD will have been communications.

PDs are hands on, they watch and they are the symbol that residents emulate. Under CBD, the role of the PD has in fact never been more important. With the introduction of EPAs and other measurable achievement milestones, the frequency and regularity of exchanges between mentor and mentee has increased exponentially, improving overall learning.”

"With Competence by Design, the job of Program Director is like that of an Orchestra Conductor. All the parts of the ensemble have to come together in harmony for the symphony to work. Brian brings those acute management tools to the table, and exemplifies the drive and passion that is needed to truly affect change.

What unexpected challenges did you encounter?

“One of the challenges has been making this smooth within a team that is not familiar with CBD. In particular, when OTO-HNS students rotate into a non-CBME specialty, there is often a lot of questions asked by the supervisors from those specialties as how to evaluate the OTO-HNS trainees, as they have no knowledge of CBD. This makes for an awkward reality in the field. Currently there is no bridge built that provides an easy solution for this reality.”

Any surprises?

“One of the most surprising realities has been the sheer excitement and positivity that many of the staff have displayed toward CBD and its processes. When asked to be guinea pigs for a new program, they put their hands up and said “sign me up coach!” It’s very pleasant to see young, bright people come out and say that they like the frequency and quality of the exchanges with their mentor which has contributed to a general happiness among the staff. Junior staff have also brought forward many amazing suggestions to make CBD even better at our school. We have communicated these to the Royal College and have always been well received."

What is important to keep in mind about the CBD implementation process?

Dr. Rotenberg cautions anyone who thinks CBD will look exactly as predicted in the end. CBD affects everyone in the medical education continuum, from residents, to Program Administrators, to PDs, the Royal College and so on.

“Given the sheer variety of people impacted by CBD and the different points of views that come with it, it would be unreasonable to assume the CBD program will look exactly as predicted 10 years down the line.”

If you could tell a program director in another medical specialty one thing about preparing to implement CBD, what would that be?

“Don’t underestimate the amount of organization involved in rolling out CBD in your program. While the College will provide guidelines, milestones and all other blueprint materials, you, the program director, will need to put this into practice and this is no small feat. One of the most underestimated criteria in selecting a program director is the need to have someone who is organized and can lead a project. Having someone who is not organized or inclined to plan can be a huge detriment to the success of CBD in your program.”

“Remember, the Royal College provides the blueprints, but programs build the house.”


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Faculty development resource of the month

New work-based assessment resources

Competence by Design (CBD) involves familiar, but also evolving, views of resident learning, teaching and assessment. These three new complimentary resources on work-based assessment (WBA) can help to support the change. Have you seen them?

CBD Mockup

  1. Presentation Summary

    If you’re curious about WBA and want a high-level overview of what’s ahead, take 30 seconds to review the 2-page presentation summary.

  2. Reference Guide

    Those of you in a leadership role may want a deeper understanding of how WBA will impact your program. Why not take a few minutes to review the 10-page reference guide?

  3. Customizable Slide Deck

    Do you need to explain WBA to others? Save yourself some time and use or adapt this customizable slide deck.

Assessment is essential to CBD’s successful implementation.

Download the resources


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Pocket full of Change

Rhonda St. Croix

Part 1 in a series of reflections on change and its impact on organizations and people

Welcome to A Pocket Full of Change, a new Touchpoint series that will explore the transformation that is Competence by Design (CBD) and its impact on the people that make up medical education in Canada.

As the Change Advisor on the Competence by Design Initiative at the Royal College of Physicians and Surgeons, my role here is to build bridges with our partners, keep an ear to the ground, watch for signs of strain and empower people to rally behind our common purpose.

So the medical education world was rocked on July 1, 2017, with the official start of CBD implementation in Canadian medical schools. Since the two “pioneer” programs have started to share their experience with CBD thus far, there is no better time for a reality check on what it will take to usher in the new era in medical education and make it sustainable.

Let’s get something out there right now - change is not a linear process and is more like white water rafting than rowing in a regatta. You often take 2 steps forward, 1 step sideways, 1 step back, then mistakes, obstacles, risks, discomfort, disappointment, misunderstandings and vulnerability. And CBD is not immune to this reality either!

Change is often referred to as something you “roll out” and we all use terminologies that imply that control, that somehow we are all the drivers and managers of change and think it can happen our way and on our schedule. In fact, change is not a one-time roll-out, rather a people-driven endeavour.

As we all move forward with CBD, we are learning that the real work is to involve people, each other, in order to build readiness and co-create shared solutions. Capturing the minds and hearts of intelligent people comes down to a few simple (not easy) things. It gets messy, especially for us perfectionist types who want to make change happen on our timelines.

And ultimately, it’s all about energy and good will.

On the practical side, as we go back to our routines, I would like to share some “calls to action” from successful change practice experts. I hope these can help YOU become a catalyst for change for CBD. Lend these qualities to your work, and let me know how it goes! I would be happy to hear from you.

Create that empowering CBD environment with these change management tips!

Share purpose

Co-create a powerful story that captures the goal and what people want. As CBD champions, we all have a role to play in helping others see it, feel it and believe it.

Build energy and readiness for change

  • Work with people, start small and grow a community for the change. To this end, imagine a snowball rolling down hill and gathering momentum as it goes.
  • Know where people are at by asking, listening and understanding levels of support and resistance.
  • Build trust by involving people. No involvement means no commitment. Give people a stake in it and a hand in shaping the future. The more complex the change the more involvement is required.
  • Connect and influence. It's the community being built as a result of our CBD efforts that will determine success, relevance and sustainability.

Don’t go for perfect. Get started.

  • Start with early adopters who will take the time to learn about it, take the risk to try it, take their peers’ time to tell them about it and model it.
  • Make it less onerous by focusing on the elements that will make the greatest difference.
  • Involve others to create the new behaviours, roles and habits.
  • Habits are the building blocks of behavioural change. All change is behavioural.

Achieve real results

  • Share tools and a story. Enable people.
  • Go for progress not perfection. Make progress visible for all to see.

Provide support and learn together

  • Learn together and leverage learning in the community. Adjust and reset as needed. We learned this first hand. There was resistance to the original dataset to be collected by the College. We listened to concerns and are working with partners to develop an alternative solution.

Develop ourselves as change agents

  • Leading change requires more than subject matter knowledge and technical expertise. It demands capacity to deal with interpersonal, relational and group dynamics.
  • Trust is a precondition for change. People need to trust in change leaders to follow their change agenda. Leaders often overestimate support. This is due to the intention-action gap since we assume that if we have good intentions people will trust and follow us. Not so. Concerns about data access are a prime example of an issue that became top of mind for the College and its partners as the first wave of CBD implementation was initiated. We have been working hard to build trust with key stakeholders and to involve others in shaping the solution.

If you have any questions or comments on the above, feel free to reach me at any time. In fact, I hope this column inspires us all to build our empowering CBD community!

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3 Questions: Shaping the future of CPD in a CBME world

The Rationale for Change.

The principles of competency-based medical education (CBME) have the potential to revolutionize Continuing Professional Development (CPD) but the process of transitioning to competency-based CPD must be meaningful to Fellows, CPD providers, regulators, health care institutions and patients.

The Royal College has brought together Fellows and multiple stakeholder organizations to discuss how to create a CPD system that enables specialists to continuously improve their practice and contribute to enhancing patient outcomes.

From these conversations, a series of peer-reviewed White Papers were written and are one way you as a Fellow of the Royal College can provide feedback. The first white paper examines The Rationale for Change and poses three questions for your consideration:

Can a competency-based CPD System…

  1. Address areas for improvement in our current system?

    The requirements to participate in, reflect on and record the self-reported outcomes from formal and informal learning and assessment activities have been a focus of frustration by Fellows as either a ‘tick-box’ exercise that does not demonstrate their competence or the quality of care they provide to patients. This white paper explores whether a CPD system that links competencies to address patient and population health needs would have the potential to focus on the outcomes our current CPD system was not designed to address. What do you think of this idea?

  2. Link CPD activities to continuous improvement of practice?

    Feedback from Fellows indicates that they engage in CPD activities to enhance their performance and improve patient outcomes. Without requiring a daunting infrastructure to implement, we are exploring ways a new competency-based CPD program could support specialists to continuously improve their practice and patient outcomes over time. How could a CPD system promote the role of CPD in enabling specialists to address the areas they have already identified for improvement?

  3. Enable access to relevant data & feedback?

    Using data and feedback to inform where learning for continuous improvement can be best focused is a strategy that makes sense to many Fellows. But how can health care institutions, data administrators and other medical community partners collaborate to support specialists to access relevant and meaningful practice data and receive feedback to translate data into actionable practice improvement plans?

We invite you now to READ the white paper on the rationale, CONSIDER these questions and COMMENT on what resonates with you or concerns you about the strategic directions for this transition. We need to hear from you. Make your opinion heard.

Read “The Rationale”

Email icon  I’m Ready to Comment Now!



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ICRE 2017

Simulation Summit