W39 – The Future of Medical Education: Opportunities and Challenges After the Implementation of Competence by Design (CBD) in Psychiatry

W39 – The Future of Medical Education: Opportunities and Challenges After the Implementation of Competence by Design (CBD) in Psychiatry

Saturday, Oct. 29
10:45 – 11:45 (1 hr)
Meeting Room: Sheraton Hall B (Lower Concourse)
Joseph Sadek*, MD, FRCPC, DABPN; Leon Tourian, MD, FRCPC; Catherine Hickey, MD, FRCPC; Hillary Bohler, MD, FRCPC; Harry Karlinsky, MD, MSc, FRCPC;Jaqueline Paquet, MD; Carla Garcia, MD, FRCPC; Michael Mak, MD, FRCPC; Adrienne Tan, MD, FRCPC; Michael Harrington, MD, FRCPC
Supported by the Education Committee

CanMEDS Roles:

  1. Medical Expert
  2. Collaborator
  3. Health Advocate

At the end of this session, participants will be able to: 1) Explain what CBD is, the rationale for its use in psychiatric training and describe the CBD approach during training in psychiatry; 2) List the perceived challenges and opportunities identified by the program directors and supervisors regarding the implementation of CBD; and 3) List some resources to help clinicians become more familiar with CBD.

Competence by Design (CBD) is the Royal College of Physicians and Surgeons of Canada’s major change initiative to reform the training of medical specialists in Canada. It is based on competency-based medical education (CBME). The objective of CBD is to ensure physicians graduate with the competencies required to meet local health needs. It aims to enhance patient care by improving learning and assessment in residency and transforms specialty medical education from a time-based to an outcome-based approach.

CBD is a multi-year, transformational change initiative in specialty medical education focused on the learning continuum from the start of residency to retirement. CBD enables our medical education system to ensure competence and support physicians’ skills and abilities. It responds to changing patient and societal needs; addresses gaps in the current system, reduces burden on faculties, promoting smoother credentialing and accreditation. It also increases accountability and promotes transparency in training. There are four stages of residency under CBD, including transition to discipline, foundations of discipline, core of discipline and transition to practice. Each stage of CBD has what are called entrustable professional activities, or EPAs, and milestones. CBD has an impact on postgraduate accreditation, the practicing physicians, exams and credentialing, resident coaching and feedback, and faculty development. There is a common problem in curriculum redesign, as what is intended, what is delivered and what is experienced may differ significantly. CBD is a dynamic process which will require ongoing surveillance, refinement, and resolution of challenges. It is vital that psychiatrists become familiar with the new opportunities and challenges with CBD.


  1. Horak H, Englander R, Barratt D, et al. Entrustable professional activities: a useful concept for neurology education. Neurology 2018;90:326–32.
  2. Carraccio C, Englander R, Gilhooly J, et al. Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med 2017;92:324–30.