Why Competence by Design is the right move for Canada
Dr. Viren Naik, MD, FRCPC, is the Director of Assessment at the Royal College of Physicians and Surgeons of Canada
Residency education in Canada is very good. We have graduated competent specialists from our programs to serve Canadians for many years. The global interest in our postgraduate medical education system is a tangible marker of our quality. In an era where all industries are committed to quality improvement, we have to ask ourselves if we can do even better?
Competence by Design (CBD) appreciates that our learning environment and learners have changed. In this “brave new world”, the evolution in our education will feel more pronounced in some disciplines depending on the extent to which their learning environments are different. CBD will “raise the waterline” for all programs to focus on outcomes of education. Trainees will receive regular documented feedback based on observations made by their clinician supervisors. Programs will have the necessary data to make informed decisions on a trainee’s progress.
The Royal College exams will still be an important external biopsy that a trainee has achieved the knowledge and judgment necessary for practice. The difference in CBD is that trainees will be better informed of their exam readiness from regular measurement and feedback against clinically relevant activities (EPAs and milestones). Different components of the exam will move earlier into training, no longer serving as terminal events of training. The benefit to trainees will be a meaningful period to transition to practice without the burden and stress of the exam.
Ultimately, these changes will not only benefit our learners, but our patients as we even better prepare doctors for practice in the 21st century.