Above: The Dominion Medical Council of Canada celebrates the establishment of national training standards for Canada’s medical institutes (November 1912, Parliament Hill, Ottawa).

Dear colleagues,

In just a few days, on July 1, medical schools across Canada will launch a new approach to medical education that is years in the making (you could even say 100 years in the making, depending on how you measure it).

It is time to start implementing our collective Competence by Design initiative. After 100 years under a time-based model, postgrad programs in Otolaryngology – Head and Neck Surgery and Anesthesiology will introduce a hybrid, outcomes-based approach to training and assessment that is more flexible and adaptable to societal change. Soon, programs in 65 more disciplines will usher in these same changes and, in time, all aspects of the learning continuum and professional development will be impacted.

Now, I deliberately emphasize this as being “our” initiative. Competence by Design may have been introduced by the Royal College, but it has only advanced this far because of the involvement, collaboration, hard work, leadership and commitment to quality improvement by our partners in Canada’s 17 medical schools, our specialty committees and staff members, and other stakeholders and contributors from the medical education community.

It seems fitting that our implementation date should fall on Canada’s 150th anniversary. This date affords us the perfect opportunity to take stock of our country’s proud heritage and, importantly, to situate this achievement alongside other important moments in the evolution of Canada’s medical education system.

In photos: milestones in Canada’s medical education system

In our 150 years as a nation, our health care system has become part of the fabric of our country and engrained in our Canadian value system. While we no doubt have our challenges – both those before us and those on the horizon – we truly do have a world-class system. We should all feel proud that Competence by Design will complement and extend this legacy — giving more support to both faculty and learners, and enabling them to better respond to the demands they face in this hectic and changing medical environment.

Together we are pioneers. While this is just the beginning of a long implementation journey, we should all take a moment to celebrate this “milestone.” Together we are shaping the next generation of physicians and surgeons. We are fashioning a reinvigorated training system. It’s ground-breaking. And while we may not recognize the full magnitude of it now, these changes are poised to have the same degree of impact as Flexner, Osler and the members of the Dominion Medical Council of Canada. Perhaps in 100 years from now, people will be talking about this moment in history.


Andrew Padmos, BA, MD, FRCPC, FACP

Chief Executive Officer