How a resident’s journey to certification changes under Competence by Design

September 20, 2019 | Author: Royal College Staff

Teachers and learners from across the country have been asking for clarity on how the journey to Royal College certification changes under Competence by Design. In response, we have developed an infographic. It maps out how the traditional model of learning compares to the new competency-based approach, highlighting key changes.

Download the infographic

Traditional journey to certification

As its core, the traditional process is highly focused on time.  A resident progresses through rotations specified by their discipline’s objectives of training. Before entering their final year, they apply to the Royal College for assessment of training and exam eligibility. Once they complete their full training and pass their exam, they are eligible for certification.

Competence by Design journey to certification

With Competence by Design, the journey moves away from being solely focused on time to one that looks at competency overall.  There are four stages of training.  Each one comprises discipline-specific entrustable professional activities (EPAs) and CanMEDS milestones. Through workplace-based assessment, residents now demonstrate their competence by accomplishing tasks.  Their progress is documented by front-line clinical teachers who also provide authentic observations and valuable feedback, to help trainees evolve.

Once they have complete all of their EPAs and CanMEDS milestones, their program deems them eligible to sit their exam(s). This occurs in the core and/or transition to practice stages of training.  Once they complete their full training and successfully complete their Royal College exam(s), they are eligible for certification.

Supporting you throughout this journey

 This is the largest change initiative the Royal College has ever undertaken and we know that at the core of its success lies our ability to openly hear from all those who are actively involved in this change.  Your feedback is invaluable. Share it with us at




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