My first six months of CBD – A resident’s perspective

January 12, 2022 | Author: Royal College Staff

PGY1 resident Jessica Tao shares her experiences and tips training under Competence by Design

Jessica Tao, MD, is currently a PGY1 Pediatrics resident at the University of Ottawa and the Children’s Hospital of Eastern Ontario (CHEO). Her July 2021 start date coincided with her immersion in Competence by Design (CBD), a time and outcomes-based approach to trainee learning that is being rolled out to all Canadian medical specialties.

We recently connected with Dr. Tao and asked about her CBD experience.

Dr. Jessica Tao (submitted photo)

What were your impressions of CBD before you started your program?

We’ve  heard about CBD throughout medical school, especially during the Pediatrics CaRMS process – how July 1 we were starting this process and how the aim is to make the transition as smooth as possible for residents.

Some of the initial reactions my peers and I had was the Pediatrics program is going to be four years instead of three, and what is this extra year of training going to mean for our future? Also, CBD might be another layer of administrative work for our staff to do when they already do so much.

Now, six months in, I see that extra training time is an opportunity to become more competent in your skills, build connections, and really think about what your dream career is going to be after you’re done residency. There were mixed feelings about this extra year, but it’s now a positive in my books.

How does CBD “show up” in your Pediatrics training?

We had a one-month orientation at the beginning explaining how to do an entrustable professional activity (EPA), communicating expectations with all staff and exploring the EPA app. We have EPA cards on our CHEO lanyards so it’s top of mind for everyone.

In my day to day, we meet with our team and talk about what happened overnight. We see our patients and relay information to their parents, the main medical team, subspecialists, and allied health.

All the while I’m proactive, thinking ‘this patient encounter would be a good opportunity for an EPA’ and communicating that with my staff and senior residents.

Can you share a time where coaching helped you learn a specific skill?

I had an opportunity to do a lumbar puncture (LP) early on in my training. During a call shift, I had a senior resident who knew there was an LP coming and she said ‘Jess, you’re going to be doing it’ and I said ‘Heck yes!’

We practise this procedure in simulation, but it was my first time doing it on a patient. Having that senior resident by my side coaching me, sharing tips, letting me do the steps and talking to her if I was unsure, was fantastic. Plus, there was a specific EPA for LPs, so I was happy to get that done as well.

Do you have any insights for residents about CBD? 

  • Know your resources: Academic advisors are there for you throughout your resident journey. They are aware of your EPAs and have your back. Use them as a resource in any capacity.
  • EPAs Part 1- Keep them top of mind: Know your EPAs and what you need to learn. Think about EPAs every day, every call shift. Completing EPAs may not happen every day but that mentality will lead you to success. EPAs shouldn’t be done last minute. The goal is to get timely feedback and show you’re progressing over time.
  • EPAs Part 2- Self-reflection: We can start our own EPA comments about what went well and what didn’t. This helps me practise positive self-reflection – what I can do better and what to work on. It’s a matter of having a senior resident or staff add on to your  reflections, and applying this feedback.
  • Not about the 5 out of 5: A lot of residents are high achieving and strive for excellence. The first time I do a LP, I’m not expecting to get that 5 out of 5 on my EPA.  It’s about training yourself to embrace the process of becoming competent.
  • Importance of feedback: This is your training, your learning, you’re living it right now. I encourage residents to speak up about what works and what doesn’t with CBD with your program. There’s always room for improvement.
Do you have CBD feedback you’d like to share with us? Contact We’d love to hear from you.


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