EPAs and Competency by Design
What Is CBD?
CBD, or Competency by Design, is a Royal College initiative to introduce Competence-Based Medical Education to Canada. It shifts the educational focus from time-based to competency-based training, ensuring residents develop the necessary skills for their practice.
Why Did We Change Our Educational Approach?
We transitioned to CBD to align education with the dynamic needs of today's workforce, emphasizing skill mastery and outcome-oriented learning. This approach addresses challenges in traditional time-based training by:
- Personalizing learning paces to accommodate skill acquisition variability.
- Concentrating on outcomes rather than solely on program duration.
- Preparing residents with practical experience for real-world challenges.
- Providing flexibility to meet individual learning needs.
- Utilizing resources more efficiently to master competencies.
- Balancing practical skills with theoretical knowledge.
- Employing diverse assessments to measure competence accurately.
- Adapting swiftly to advancements in medical practice.
CBD's learning outcomes are clear, assessments are rigorous, and learning paths are personalized, ensuring real-world relevance.
What Are The CBD Assessment Tools?
Assessment in CBD includes:
- Entrustable Professional Activities (EPAs): Tasks reflecting professional responsibilities assessed for autonomy in performance. They integrate specific skills and milestones into comprehensive assessment tools.
- End of Rotation Evaluations: Performance assessments upon rotation completion.
- General Assessment: Ongoing evaluations of a resident's performance across various competencies.
- Resident Portfolio: A comprehensive record of a resident's development and achievements.
What Are the Training Program Phases?
CBD training comprises four stages, each with specific EPAs:
- Transition To Discipline (TTD): The first four months for R1 (Oct-Jan).
- Foundation of Discipline (FOD): The remainder of the year for R1 (Feb-Sep).
- Core of Discipline (COD): Advanced training in R2 and R3.
- Transition to Practice (TTP): Final preparation for independent practice in R4.
The timelines are approximate and some residents will complete some of those stages faster or slower than others.
How Are We Keeping Track of Residents' Progress?
Progress tracking involves:
- KBIM.app Documentation: This platform maintains detailed electronic records of progression and feedback, analyzing performance data.
- Competence Committee: A dedicated group evaluating residents' development, meeting regularly for review. They make decisions on residents' progression status and subsequent recommendations based on a holistic view of their performance.
- Transparency: Residents have access to their performance data, ensuring they understand progression benchmarks.
How Does the Resident Progress to the Next Stage?
Progression criteria include:
- Holistic Review: Overall competence is considered, including medical knowledge and professional skills. Achieving EPAs is vital but not the only measure of readiness to progress. Competence captured through various assessment feedback, end-of-rotation evaluations, and the resident portfolio is also considered.
- Competence Committee Decisions: Decisions are informed by a comprehensive review of all assessments and the resident portfolio.
- Individual Learning Plans: Customized feedback is provided for targeted improvement.
- Continuous Monitoring: Ensuring residents are aware of their developmental trajectory and areas for improvement.
This approach promotes well-rounded development, preparing residents for the demands of independent practice.
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