CBD Community Touchpoint - September 2016

Learning and improving with voluntary CBD field tests

Learning and improving with voluntary CBD field tests

Dear colleagues,

I am pleased to report progress in making our huge project, Competence By Design, (CBD), a reality.

Over the next several months, Medical Oncology and Otolaryngology – Head and Neck Surgery programs across Canada will participate in voluntary field tests to evaluate elements of the CBD assessment strategy including specialty-specific entrustable professional activities (EPAs), assessment tools and the new MAINPORT ePortfolio (Residency Prototype 1).

These field tests are designed to provide quick, real time data to help us improve the CBD implementation model and check for any unintended consequences. The lessons learned from each testing experience will help us fine tune our design and make sure CBD is usable and practical in the real world. 

Included in this issue are details about the field testing process, including what’s being tested, how the tests will occur and our commitment to keeping all resident data private and secure.

Ken Harris, Executive Director of Specialty Education, and I would be happy to hear your comments and suggestions about improving CBD implementation or anything else about postgraduate medical education and specialty residency training. Please contact us at cbd@royalcollege.ca.

Yours Sincerely,

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


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Medical Oncology: Field tests to focus on EPAs, observation tools and process

Medical Oncology: Field tests to focus on EPAs, observation tools and process

Field testing for CBD will focus on the relevance and usability of six EPAs, which have been developed by the Medical Oncology specialty committee.

EPAs in Foundations of Discipline stage (PGY 4)

  • Providing initial consultations (uncomplicated patients)
  • Providing assessment and management for ongoing care (uncomplicated patients)
  • Discussing serious news

EPAs in Core of Discipline stage (PGY 5)

  • Perform initial consultations (full range of patients)
  • Providing assessment and management for ongoing care (full range of patients)
  • Transitioning care away from disease modifying therapies

We have designed new observations tools to accompany EPAs. The tests will look at the functionality of these new tools. We’ll hear directly from teachers and learners and determine if the tools can be completed without significantly interrupting clinical workflows, and if they provide learners with useful feedback.

For field testing purposes, the new (EPA specific) Royal College observation tools are accessible in paper-format and via the newly launched MAINPORT ePortfolio (Residency Prototype 1). Faculties can choose to use the Royal College observation tools to evaluate the EPA (in either paper or electronic format), or they can choose to use their own local tools.

Observation Tool

Royal College paper-based observation tool
Accessible via printable forms on the website.

Royal College ePortfolio observation tool
Accessible via MAINPORT ePortfolio (Residency Prototype 1).

Local university observation tool
Accessible via local university electronic platform.

Field test process

As mentioned, the field tests are completely voluntary. We’ve reached out to the Postgraduate (PG) Deans and invited them to work with their Medical Oncology Program Directors (PD) to determine if they’d like to participate in field testing.

Interested PG Deans and PDs will work together to

  1. choose the EPAs they’d like to test,
  2. determine which observation tool they’d like to use to evaluate the EPA,
  3. determine how they will access their chosen observation tool, and
  4. invite teachers and learners in Medical Oncology to participate in field testing.

Teachers and learners invited to participate in voluntary field tests

Once the logistics of the field tests have been determined, the PG Deans will share a letter of information with all teachers and learners in the first year of Medical Oncology, inviting them to participate in voluntary field testing activities.

Teachers and learners who choose to participate will work together to set-up their own observation schedule and will take part in EPA observation encounters at their own pace.  Following an observation encounter, both teachers and learners will complete a short survey to assess the validity of the EPA, the observation tool used and the process overall.  

Participation in EPA-based observations will not replace the traditional Medical Oncology observations at this time. Existing assessment activities, such as In-Training Evaluation Reports (ITERS) and Final-In Training Evaluation Reports (FITERS), will continue for Medical Oncology learners regardless of their involvement in field testing. By participating in field testing activities, learners and teachers have the opportunity to contribute their valuable input and guidance to the CBD assessment process.

Participation in field testing will not affect learner progression

The privacy and security of resident data is of upmost importance to the Royal College. All data gathered by the Royal College during field testing will be de-identified.  Paper forms will not be sent to the Royal College, and when reviewing the ePortfolio content, it will be impossible to connect results back to a specific teacher or learner.

Furthermore, the Royal College will not use the completed observation forms to assess learner performance in any way. In fact, we’ll only be able to access forms completed using the MAINPORT ePortfolio (Residency Prototype 1) – we will never see the paper-based or local university forms. Most importantly, all data (including the survey data) will be purged within one year of completion of the field test.  Data gathered will be used by the Royal College for CBD improvement purposes only.

Let us know what you think of our field testing process by emailing cbdfieldtest@royalcollege.ca For more information about CBD, please visit www.royalcollege.ca/cbd or email cbd@royalcollege.ca.


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One step closer to a competency-based approach to lifelong learning

One step closer to a competency-based approach to lifelong learning

It was a packed house at the 2nd Invitational Summit on Competency-Based Continuing Professional Development (CB-CPD), as more than 140 representatives from all areas of healthcare came together to continue the discussions on creating a competency-based approach to lifelong learning.

Dr. Craig Campbell, MD, FRCPC, Director, Continuing Professional Development opened the Summit by sharing feedback from Fellows which

  • highlighted the importance of scope of practice when assessing in-practice performance, and
  • indicated that patients have a strong role to play in overall practice assessments.

Patient involvement and scope of practice key to successful lifelong learning

These themes continued throughout the event, as participants identified the following considerations as being important for the development of a competency-based lifelong learning model that is practical and relevant to all areas of specialty practice:

  1. Assessment must be patient-focused.
  2. Assessment strategies (including the process, tools, data and feedback mechanisms) must be supported and enabled by all organizations that physicians interface with in practice, and align with competency frameworks that focus on individual and collective competence. 
  3. Assessment “for learning” must align performance data with continuous quality improvement of practice.
  4. Assessment must ultimately achieve meaningful impacts on the quality and outcomes of health care.
  5. Assessment that is contextually relevant and societally responsive requires all stakeholders to contribute to a change in culture.
  6. Assessment in practice must promote continuous improvement and the pursuit of excellence.

How important are these considerations to you?

Let us know your level of agreement with the top considerations that were identified by the summit participants as being important.

Take our poll.

Competency-based lifelong learning: Our next steps

Competency-based lifelong learning: Our next steps

Over the next several months these considerations will contribute to

  • Developing and validating a vision for competency-based lifelong learning.
  • Based on the vision of CB-CPD, develop a competency-based lifelong learning strategy that aligns with Competence by Design.
  • Designing a program of assessment  that describes  the data specialists will  need to
    • assess their individual performance,
    • assess the collective competence of their group or team, and
    • drive performance to continuously enhance the quality of patient care
  • Determining the educational support strategies needed to implement a competency-based lifelong learning model that is specialty and practice specific. 
  • Creating a National Advisory Committee on competency-based lifelong learning with members from across all areas of specialty medicine, continuing professional development and health care.

A smooth transition to a competency-based model for lifelong learning will require careful consideration, coordination and collaboration. The Royal College will continually share information and seek guidance and feedback from you throughout the design and development phase. We want to ensure that we move forward with a model that meets the needs and expectations of each specialty and the public.

For more information about our approach to competency-based education, please visit www.royalcollege.ca/rcsite/cbd/cbd-tools-resources-e or email us at cbd@royalcollege.ca.


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Sneak peek of MAINPORT ePortfolio (Residency Prototype 1)

Sneak peek of MAINPORT ePortfolio (Residency Prototype 1)

As part of the Competence by Design (CBD) field tests, Postgraduate (PG) Deans, Program Directors (PD), Program Administrators (PA), teachers and learners who choose to participate in Medical Oncology field tests will soon have access to the MAINPORT ePortfolio (Residency Prototype 1).

MAINPORT is the Royal College’s existing ePortfolio which Fellows and in-practice physicians use to report and track participation in the Maintenance of Certification (MOC) Program. The Residency Prototype 1 is the first iteration of a competency-based version of the system which supports planning, learning and assessment from residency to retirement.

This first prototype focuses on residency training and will allow PG Deans, PDs, PAs, teachers and residents to track and record learning, assessments and progress. The prototype will be available only to individuals involved in field testing – all other Fellows and practicing physicians will not see a change to their MAINPORT ePortfolio accounts.

MAINPORT ePortfolio, a valuable learning tool provided by the Royal College, will support competency-based assessment. To get an idea of how MAINPORT ePortfolio (Residency Prototype 1) will work, check out these slides.

The Royal College knows that many of our university partners have systems in place to record, assess and access resident data. MAINPORT ePortfolio will not be mandatory for any universities or programs field testing or adopting CBD.

The MAINPORT ePortfolio (Residency Prototype 1) will showcase the data entry processes and assessment workflows so our partners can see how CBD assessment and tracking might work within their schools.

As we move forward with field testing, we will work with our partners to leverage existing technology and develop data integration and transfer solutions both within and beyond MAINPORT ePortfolio.

For more information on MAINPORT ePortfolio development, please contact cbd@royalcollege.ca.


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CBD Progress: March 2016 to July 2016

CBD Progress: March 2016 to July 2016

Over the last several months, we’ve spoken to many of our partners to discuss Competence by Design (CBD) and continue to dialogue on how we can improve the initiative.

WORD CLOUD: Fellows, Program Directors, College of Physicians and Surgeons of Ontario (CPSO), Deans, Speciality Societies, Faculties of Medicine, Department Chairs, Chiefs, Postgraduate Deans, University of Montreal, Western University, Competency-Based Medical Education, Urologists, Council of Psychiatric Continuing Education, PG Deans, Medical Oncology, General Internal Medicine, Emergency Medicine, Cardiac Surgery, Anesthesiology, Internal Medicine, Forensic Pathology, Gastroenterology, Surgical Foundations, Anatomical Pathology, Radiation Oncology, Nephrology, Emergency Medicine, Cardiac Surgery and CanRAC Summit

New Resources and Tools

CBD Progress - Next Steps

Next Steps

  • Support Medical Oncology as they begin field testing CBD entrustable professional activities (EPAs) and assessment processes.
  • Share field test outcomes. Field test data will be used to refine and adapt CBD assessment processes and implementation activities only.
  • Provide opportunities to discuss and debate CBD and the associated accreditation changes at the 2016 International Conference on Residency Education (ICRE).
  • Work with earlier adopters to finalize the terms of reference and guidelines for the development of Competence Committees
  • Continue share and demo the MAINPORT ePortfolio (Residency Prototype 1) and work with stakeholders to create future iterations of the system.
  • Foster dialogue and develop action items for consideration around the creation of a competency-based CPD model


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Understanding Competence Committees

Understanding Competence Committees

One of the key tenets of Competence by Design (CBD) is the focus on continuous and programmatic assessment. Within a CBD world, residents will experience regular, low stakes observations based on the entrustable professional activities (EPAs) determined for their stage of training. These regular and targeted assessments accompanied by feedback will help foster a culture of “assessment for learning” and provide residents with the concrete feedback they need to improve.

As part of this new culture of assessment, the Royal College has proposed the introduction of a body called the Competence Committee. The Competence Committee assesses the progress of trainees and indicates when they have achieved their EPAs. The group also approves the progress of each learner from one stage of training to the next and signals that the resident is ready to write the Royal College exam.

Promoting a robust and transparent review process

The overall goal of the Competence Committee is to ensure that every learner in a discipline achieves their requirements through a group assessment process, rather than a summative review. To do this, we envision a system where the Committee will meet regularly to review trainee performance and make decisions about progression through the stages of training (data reports provided by MAINPORT ePortfolio (Residency Prototype 1) or university specific tools). Using the qualitative and quantitative assessment data provided, the Committee then approves changes to learner stats and provides recommendations on future learning activities.

For more information about Competence Committees, check out our video “Understanding Entrustable Professional Activities (EPAs)” or email cbd@royalcollege.ca.


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Conjoint Residency Accreditation Summit

Conjoint Residency Accreditation Summit

This past June, the Canadian Residency Accreditation Consortium (“CanRAC”) convened the third annual conjoint residency accreditation summit focused on the future of residency education accreditation in Canada. CanRAC is a conjoint partnership between the Royal College of Physicians and Surgeons of Canada (Royal College), the College of Family Physicians of Canada (CFPC), and the Collège des médecins du Québec, with the mandate of developing and overseeing the reform of residency education accreditation in Canada.

Postgraduate deans (or their respective PGME office delegate), were invited to attend the 2016 accreditation summit. PG Deans, along with many other stakeholders were brought together to discuss the recent advances for residency accreditation reform in Canada as the first point of consultation on standards and process in preparation for national consultation anticipated to begin in fall 2016.

The reaction of the summit participants with respect to the proposed process components and draft new residency education accreditation standards was positive, with general endorsement to move forward with national consultation and further development of both the standards and proposed process components. 


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