Dear Colleagues,

A year ago, I sent you a message about the Royal College’s plans to develop and implement a new competency-based medical education or CBME approach to medical education. I explained that the Royal College had produced a series of white papers to inform the Future of Medical Education in Canada Postgraduate Project, the overarching goal of which was to ensure that physicians practising in Canada continue to acquire the education and skills they need to serve their communities.

Members were generous in contributing to the white paper series and the exercise yielded a number of recommendations. We have been implementing many of these recommendations through our emerging Competence by Design (CBD) initiative, the vehicle through which the Royal College’s is introducing CBME to specialty training and practice.

Many of you took the time to provide comments on the CBD initiative, requesting more details on the implementation plan and expressing a need to ensure that changes would be guided by evidence and shared practical experience.

I am pleased to announce today our two early adopters that will allow us to partner with our Fellows in defining the new education and assessment processes, and supporting tools for a CBME approach to continuous learning:

  • Medical Oncology (Subspecialty), and
  • Otolaryngology – Head and Neck Surgery (Specialty)

Early adopters – enabling a practical and relevant approach

The competency milestones are still in generic form because we recognize there is no one-size fits all approach to CBD. We are committed to providing all schools, disciplines and faculties with the time and tools they need to effectively integrate competency-based practices. At the other end of the continuum, we heard Fellows clearly ask for a competency-based approach to their continued learning that is grounded in relevance and practicality. Piloting CBD will help ensure that we get it right when we move to full-scale implementation across all specialties.

This fall we will begin our implementation process with Medical Oncology and Otolaryngology, with the initial focus on residency education. We have envisioned an iterative process for our pilot projects in which these two early adopters, supported by the Royal College, will initiate the creation, refinement, integration, implementation and assessment of specialty-specific milestones into their residency training programs. Together we will collaborate on all aspects of CBD as it relates to the Royal College’s business processes, from credentialing through to assessment and accreditation. As this multi-year initiative continues to evolve, their actions and learning will also help to inform changes in continuing professional development that are usable and practical in a real-world environment.

I would like to take this opportunity to thank the energetic physicians who are spearheading this important work on behalf of their specialties and to share with you some of their comments and observations about the importance of integrating CBD into their programs. Tamara Shenkier MD, FRCPC is a member of the Medical Oncology Specialty Committee and is a medical oncologist at the BC Cancer Agency. She said, “When I think of the future, I want a physician who is knowledgeable, self-reflective and self-motivated, adept with technology tools, a good communicator and an advocate for my needs; that’s the kind of doctor I want looking after me and my family. CBD will help educators incorporate these competencies into the intrinsic roles and expertise of physicians of the future.”

Erin D. Wright MDCM, MEd, FRCSC, is a member of the Otolaryngology–Head and Neck Surgery Specialty Committee and a professor in the University of Alberta’s Department of Surgery. His opinion reinforces a widely held perception that CBD is needed to usher in an era of modernization in medical education. “The reality is that our existing training model is very old. It worked great in the past, but times have changed. The depth and breadth of information and skills that we expect our residents to learn now is much more substantial. I’m not confident that the traditional model is able to keep up with what is expected of today’s trainees.”

CanMEDS 2015 is a foundational project for CBD.

By 2015, we will release an updated CanMEDS Physician Competency Framework that leaves the seven CanMEDS Roles largely intact, but that is aligned with CBME and creates new competency milestones under each Role. CanMEDS 2015 continues to move forward on schedule, and we will launch the final Framework, with milestones, in October 2015 at the International Conference on Residency Education in Vancouver, B.C.

As always, we are looking to our members for input and feedback on the work we have accomplished to date. Shortly, we will release the Draft CanMEDS 2015 Framework, Series II,which is anchored in a set of generic competency milestones for CBD. (In February, we released the Draft CanMEDS 2015 Framework – Series I, which is still available for review and feedback.) I invite you to view the Nine Expert Working Groups (EWG) Reports, the 2013 Consultation Report called “Reaffirming our Directions, Setting the Stage,” and a special, CanMEDS 2015-focused issue of Dialogue.

New and updated tools to support CBD

As we continue to develop CBD, we will work to provide a more personalized learning experience for residents and Fellows. CBD’s ePortfolio project will develop an expanded version of our current MAINPORT ePortfolio that will provide residents and Fellows with a space to develop, plan, reflect, assess and document their learning.

As CBD moves forward and the ePortfolio continues to mature, we will integrate competency milestones into the system, enabling residents and Fellows to link their achievements to the CanMEDS 2015 milestones online. This will build a foundation for demonstrating the ways in which specialists have sustained and progressed in their competence within their defined scopes of practice.

Participate in the process.

Competence by Design is a major undertaking of the Royal College to align medical education with the realities of today’s practice. Its success and ultimate quality depend on active support and involvement from our Fellows, partners and others who have a stake in Canada’s health care system. I invite you all to provide your thoughts and insights on the progress we have made so far using the commenting functionality below and by joining in the conversation on Twitter or LinkedIn.

I also urge you to participate directly in the process and learn more by attending a CBD/CanMEDS 2015 webinar, and/or taking part in the CanMEDS 2015 ePanels.

I look forward to your comments and further engagement.

Warm wishes and kind regards,
Andrew Padmos, MD, FRCPC, FACP
Chief Executive Officer