Dear colleagues,

I was in Montreal and Halifax earlier this month for outreach visits with medical schools. A topic of considerable interest (not surprisingly) was Competence by Design and how that work is progressing. The short answer: things are beginning to take shape.

When we started talking about competency-based medical education years ago, it was just an idea. Now, we’re seeing it move into action.

I was surprised and pleased to see so many of you indicate an interest in hearing more about competency-based medical education in our communications survey. Competence by Design (CBD) is our vehicle for introducing and implementing a competency-based approach to medical training, and eventually, continuing professional development.

I’d like to use this message to give you a brief update on this work.


The big news: A shift in our implementation timeline

We recently deferred (from July 1, 2016) the full implementation of Competence by Design for Cohort 1 disciplines: Otolaryngology – Head and Neck Surgery and Medical Oncology. Instead, both disciplines will field test aspects of Competence by Design throughout 2016.

This was an interesting case of the process mirroring the philosophy behind the initiative.

Just as CBD takes an outcomes-based approach with frequent feedback rather than our current time-based model of training; we had to reflect on our own time-based approach to introduce and implement CBD and adjust our plans.

This decision was based on feedback we heard and questions that still need to be addressed, such as faculty preparedness, assessment processes and so forth. The decision to defer the full implementation of Cohort 1 until we have had an opportunity to integrate and test components in various clinical situations and learn from these experiences, was positively-received by our partners.


With the postgraduate deans, we agreed to some next steps focusing on postgraduate education:

  1. Form advisory groups to provide advice on key areas like assessment, implementation, policy and guidelines (with PG deans and others, as appropriate).
  2. Create a Competence by Design National Advisory Committee (with sister organizations and stakeholders).
  3. Work with partners to develop a framework for a new model of implementation (to be validated by Council).

It’s important to us that all of our partners in medical education have the opportunity to influence this work. We want the end product to be something everyone is proud of and that meets their specific needs. This decision to delay implementation creates the time needed to co-create solutions and test our model in stages.


Other tangible outputs of Competence by Design:

  • We launched CanMEDS 2015 last October. I’m most proud of what that revised framework represents: successful collaboration with stakeholders, associations and members. I’m confident it will serve as a valuable guide for many years to come.
  • More groups are defining their milestones and EPAs. We’re continuing to work with more specialty groups to define their specialty-specific milestones and entrustable professional activities (EPAs). There is real excitement and energy in those workshops. People are starting to see Competence by Design become concrete and many have gained a deeper understanding of the benefits of this initiative.
  • We shared our first resources and tools. We’re committed to creating learning tools and supports to help faculties of medicine implement Competence by Design. So far, we’ve produced implementation guides, informational documents, a CBD Roadmap, The Meantime Guide and a first CanMEDS Interactive website. More resources are planned for the coming year.
  • Many other activities: If I were to write out everything we’re working on, this message would be considerably longer. I will say that we’re evaluating our plans for MAINPORT ePortfolio and beginning work on accreditation, among others.


Want regular news on Competence by Design?

If you’re interested in learning more about CBD or sharing information about this initiative within your networks, we have a lot of resources at

I’d like to highlight two in particular:

  1. CBD Community Touchpoint comes out three times a year. It’s the best way to stay informed of news specific to our work in competency-based medical education. The next issue is scheduled for mid-March. Sign up for CBD Community Touchpoint.
  2. For a basic introduction to competency-based medical education and Competence by Design, I recommend our Frequency Asked Questions document.

For CBD to be successful everyone needs a voice, everyone needs to be heard. I’m looking forward to further progress and sharing more updates with you later this year.


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


P.S. If you have a question or comment you’d like to share specific to our Competence by Design work, email



Feedback from the Emergency Medicine CBD workshop (February 2016)

Dr. Carolyn Snider, MD, FRCPC

“I really did expect this change to take a lot of time, but now I’m starting to realize that it’s not going to take as much time; it’s actually going to be better for teaching and it’s going to be much more beneficial for our residents and for myself as a teacher.”

Carolyn Snider, MD, FRCPC
Clinician-scientist, Department of Emergency Medicine, University of Manitoba

Dr. Sandy Dong, MD, FRCPC

“When we started, CBD was this big daunting task, this gargantuan mountain to climb. In the last few days, it’s been broken down into more manageable steps and the facilitators have purposefully made each day digestible.”

Sandy Dong, MD, FRCPC
Program Director, Department of Emergency Medicine, University of Alberta

Dr. Stephen Choi, MD, FRCPC

“The thing that is going to benefit patients the most is that we use competence as the benchmark and to me that is exciting because it’s so incredibly logical.”

Stephen Choi, MD, FRCPC
Program Director, Emergency Medicine, University of Ottawa

Dr. Brian R. Holroyd, MD, MBA, FACEP, FRCPC
(Source: Alberta Health Services)

“This [workshop] session has given me a chance to see how well organized the Royal College and its staff are to support the transition to CBD. I think it’s a huge change and evolution in medical education and it’s very reassuring to see the tremendous amount of planning and great organization the Royal College has to support this transition.”

Brian R. Holroyd, MD, MBA, FACEP, FRCPC
Professor and Chair, Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta

Senior Medical Director, Emergency Strategic Clinical Network, Alberta Health Services