Internal Medicine — Program Information

Curriculum & Study Plan

The KBIM program uses the Core Internal Medicine curriculum from the Royal College of Physicians of Canada. There are two kinds of items that residents should be aware of regarding the curriculum:

  1. Competencies— this is a list of all the things that residents need to be capable of doing by the end of the program. For example, a resident should be able to "Prioritize issues to be addressed in a patient encounter"

  2. EPAs— those are specific tasks that a resident should be able to perform independently, without supervision. An example is "Performing histories and physical exams, documenting and presenting findings, across clinical settings for initial and subsequent care".

As residents go through the different stages of training, they'll be tested in different and increasingly more advanced EPAs. We recommend starting by skimming all of the EPAs required to get a sense of the kinds of tasks you'll be expected to master.

You will also see the details of how you'll demonstrate this mastery. Every EPA has a number of requirements, such as a minimum number of times you receive an entrustment level of "Competent" or a minimum number of different tutors who give you this entrustment level.

For each stage of training, we have a list of rotations suitable for that stage and for within each rotaiton we specify the EPAs you should work on. You can find this information in the Curriculum page, under each Stage. The procedures you're expected to master in the program are listed in EPA C5.

In addition, you can look at the detailed mapping for each Teaching Activities (e.g., Rotation, Lecture, Workshop, etc). This mapping includes both the EPAs as well as the Competencies expected to be covered for each activity. At the start of each Rotation, make sure you go through the Curriculum page for the Rotation and create a study plan to cover all of the competencies.

Finally, you can see the entire list of all competencies in the Competencies section in the Detailed Curriculum Map page. This way you can have a sense of everything you're expected to be capable of by the end of the program.

There are many sources to read from, including websites, textbooks, guidelines, review articles, and original journal articles. It's important to realize that as a resident specializing in Internal Medicine, the expectations will be significantly higher than what's expected from a medical student for example. You'll be expected to know the details and the nuance. You should therefore pick your study materials accordingly. Ask your tutors for recommendations on the most important guidelines to cover for each subspecialty.

Study Plan

A common practical question about the curriculum is where to study from and how to incorporate studying into your days. While there are many ways to study, here's one suggested study plan.

UpToDate— for every patient you admit, read the UpToDate article on their condition. You can read the same article multiple times and start expanding into adjacent articles. For example, if you admit a patient with Asthma, you can read the article on the initial management of Asthma then expand into diagnostic criteria, long-term management, biologics, etc.

In addition to reading about every admission, make sure you cover all the competencies for each rotation well, as described earlier.

If you read 5 articles per week for 40 weeks of the year (I.e., average 1 article per weekday with 12 weeks off during vacations, etc.), you'll have read 200 articles in the year. Every article you read, UpToDate will give you 0.5 CME points. If you're following this plan, you should be accruing 100 CME points per year. This should be a minimum. Some residents accrue 200+ CME points per year.

Guidelines— guidelines contain highly condensed summaries of the literature with best practices recommendations. You need to know everything in them very well, including all the small details and nuanced points. For every rotation you go through, make sure you cover the top guidelines related to the specialty. Ask your tutors to help you make a list of guidelines to read from.

We follow North American guidelines. If there are American and Canadian guidelines on the same topic and they are both recent, you can usually pick either of the two. We try to avoid asking questions that would have different "correct answers" by different guidelines. Even if that happens, it's a rare occurrence and won't be the reason why someone passes or doesn't pass an exam. A much more common reason for struggling is wasting time arguing about which guidelines to read and ending up reading neither. Do not do that.

MKSAP— this is a high-quality practice question bank that gets regularly updated. It contains 1200+ questions. We recommend that you go through all of the questions at least twice. If you plan to do that within the first two years of residency, before your Part 1 exam, you'll need to cover 100 questions per month. The digital version of MKSAP will automatically track your progress and let you know how many questions you've attempted so far. Use that to be honest with yourself.

In the first two years of our program, we expect our residents to focus on gaining as much medical knowledge as possible. Our specialty is expansive and very dependent on knowledge. By building a strong base from the beginning, you'll be able to focus on developing your team management, research, quality improvement, and leadership skills in later years, rather than worrying about missing a diagnosis or not remembering the first line therapy for a medical condition. As a registrar, you will be receiving a constant flood of cases and without that knowledge at your fingertips, your task will be significantly more difficult.

Next: EPAs and Competency by Design