Competence-based medical education is an outcomes-based approach that involves identifying the abilities required of physicians and then designing the curriculum to support the achievement and assessment of these predefined competencies. This paradigm defies the assumption that competence is achieved based on time spent on rotations and instead requires residents to demonstrate their competence (Stodel et al., 2015).

Around the world, medical education is undergoing a major transformation. Calls for reform in how physicians are trained are longstanding (Frank et al., 2010). In many of the current systems, programs define the successful completion of training based on the length of time a trainee is in a program, assuming that trainees will develop the required competencies to practice after a predetermined amount of time. Within this paradigm, time is fixed but competence may be variable. Instead, in CBME, residents are required to demonstrate the competencies deemed necessary for patient care. Within this paradigm, competence is fixed but time for achieving them may be variable.

uOttawa is already well on the way to implementing competency-based resident education. The Department of Family Medicine implemented a Triple C competency-based program in 2014 and the Department of Anesthesiology followed suit a year later when they designed and implemented a new CBME program for their residents under the Royal College’s FIRE project. More uOttawa CBME innovations can be found in the Spotlight section.

The remaining specialty programs will be implementing Competence by Design (CBD), the Royal College’s approach to CBME, in a multiyear rollout. According to the Royal College:

CBD is a multi-year, transformational change initiative. It focuses on outcomes, asking the question “What abilities do physicians need at each stage of their career?” It organizes physician training around desired outcomes and looks at the needed competencies.

The greater goal of CBD is to enhance patient care by improving learning and assessment across the continuum from residency to retirement. This will ensure that physicians continue to demonstrate the skills and behaviours needed to meet evolving patient needs.

While “pure” CBME is time-free, CBD is a hybrid model. In this model, the number of years needed to complete a residency program is not expected to change for most residents. (Royal College)