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Competence by Design

In the early 2010s, the Royal College of Physicians and Surgeons of Canada began transitioning all Canadian specialty residency programs to a new competency-based medical education model called Competence By Design (CBD). In the CBD model, in order to graduate from a residency program, a resident must demonstrate they are able to effectively perform specific discipline-specific tasks called Entrustable Professional Activities (EPAs). The CBD model also bundles other medical education innovations with competency-based medical education, like learning through growth mindset, staged progression of training, and programmatic assessment. All PHPM residency programs in Canada are transitioning to CBD.

Continuing Professional Development

PHPM residents and physicians affiliated with any institution are welcome to access these resources, including the live continuing professional development sessions.

Online Learning

Introduction to Competence By Design

  • Non-accredited, self-directed online learning module.
  • Learning objectives: (1) Define Competence by Design (CBD); (2) Identify the stages of training in the CBD model; (3) Describe components of work-based assessment; (4) Describe features of effective feedback and coaching
  • Register here: NOSM University CEPD Learning Module

Introduction to CBME and CBD in PHPM

  • Live virtual sessions* on March 18 or March 20. Registration is now closed.
  • Speaker: Dr. Emily Groot, with opening remarks from Dr. Rob Anderson, Associate Dean, Postgraduate Medical Education, NOSM University
  • Learning objectives: (1) Differentiate between time-based and competency-based PHPM residency training; (2) Describe the key features of Competence By Design in PHPM; (3) Discuss the RCPSC’s rationale for transitioning to Competence By Design.
  • Resources: The PAPERs Podcast: Is this program competency based?(21 minutes) & ten Cate O. An updated primer on Entrustable Professional Activities (EPAs). Rev Bras Educ Med. 2019;43(1 suppl 1):712–20.

Applying the Competence Continuum in PHPM

  • Live virtual sessions* on April 8 or April 10. Registration is now closed.
  • Speaker: Dr. Emily Groot with opening remarks from Dr. Alyssa Ness, President, Public Health Physicians of Canada
  • Learning objectives: (1) Differentiate between the stages of training in CBD; (2) Classify PHPM rotations by CBD stage; (3) Apply the CBD PHPM Competencies and Training Experiences documents in developing new or updating existing PHPM rotations
  • Resources: PHPM Competencies & PHPM Training Experiences

Competence Committees and Programmatic Assessment

Workplace-Based Assessment and Entrustable Professional Activities

PHPM CBD Check-In

  • Register for the live virtual session*: October 21, 2025 @ 12 pm
  • Moderator: Dr. Emil Prikryl, PHPM CBME Lead, NOSM University
  • Learning objectives: (1) Discuss implementation of CBD in PHPM to date; (2) Contrast CBD experience in PHPM with experiences in other specialties
  • Resource: KeyLIME+ Podcast: Episodes 5-6: “The good, the bad, and the future of CBME” (Parts I & II)

 All times in EDT. The live virtual sessions are Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Continuing Education and Professional Development Office at NOSM University. You may claim a maximum of 1 hour per session attended (credits are automatically calculated).

 

Royal College Resources

Competency-Based Medical Education

Competency-based medical education (CBME) is “education that qualifies and graduates learners only if they meet the standards of knowledge, attitude, and skill needed for unsupervised practice” (ten Cate & Jarrett, 2023). CBME approaches were developed in the 1990s to address concerns that resident competence was often inferred from duration of training rather than direct assessment of knowledge and skill. In CBME, the degree to which preceptors “entrust” some or all of an EPA to a resident forms the foundation of frequent, low-stakes workplace-based assessments. Collectively, these assessments are used by a Competence Committee to determine whether a resident has the knowledge and skills necessary to take on additional responsibilities.

Staged Progression of Training

Training experiences in CBD are intentionally sequenced to support graduated responsibility and entrustment of progressively more complex EPAs. The stages of training in residency in the CBD model include:

  • Transition to discipline: This stage of training focuses on orienting residents to the program and the discipline. Residents start developing a professional identity specific to their specialty. In PHPM, this requires early interactions with PHPM preceptors and early exposure to the work of public health agencies.
  • Foundations of discipline: This stage of training focuses on competencies that may be shared across multiple specialties, but are foundational to the practice of a specific specialty. In PHPM, this includes experiences like providing care to an individual patient with an animal bite or developing critical appraisal skills in a journal club.
  • Core of discipline: This stage of training focuses on competencies demonstrated in the typical day-to-day practice of a specific discipline. In PHPM, this includes experiences like outbreak management, media communications, and health program planning.
  • Transition to practice: This stage of training focuses on refining specialty-specific knowledge and skills, extending leadership skills, and ensuring residents are ready to practice independently. By the transition stage of PHPM training, residents are expected to be able to act in a role similar to an associate medical officer of health.

Graphic showing the different stages of CBD training

Programmatic Assessment

Programmatic assessment is a comprehensive, systematic approach to resident assessment. Instead of relying on a single type of assessment or assessment at a point in time, programmatic assessment considers multiple types of assessment data over time. Different aspects of a resident’s knowledge, skills, and attitudes, as evaluated by a variety of assessors, are all considered when arriving at progression decisions. In the NOSM U PHPM Program, programmatic assessment includes consideration of rotation In-Training Assessment Reports (ITARs), EPA assessments, practice OSCEs and written exams, evaluation of a resident’s scholarly project, peer assessment of academic presentations, academic half-day attendance, resident self-reflection, regular meetings with the program director or delegate, and a 360 evaluation (a survey of individuals who have worked with a resident).

Competence Committee

A Competence Committee, as defined by the Royal College, is a group of faculty members responsible for reviewing assessment data and determining whether residents have demonstrated sufficient knowledge and skill to progress to the next stage of training. Competence Committee decisions are grounded in evidence from programmatic assessment, including workplace-based assessments.

The NOSM U PHPM Competence Committee meets quarterly to review resident portfolios.
Dr. Jessica Jackman is the chair of the NOSM U PHPM Competence Committee.
The other committee members include:

  • Dr. Laura Bourns
  • Dr. John Tuinema
  • Dr. Natalie Bocking

Group of people gathered in banquet hall
Attendees of the 2024 PHPM CBD Summit, coordinated by NOSM University

Public Health and Preventive Medicine