Competency Based Medical Education

Entrada Quick Start Guides

What is CBME?

  • Traditional medical education with a time-based emphasis has been shown to result in gaps in competence of medical students and residents [Chen], [Crosson], [Mattar].
  • CBME is a framework of education which focuses on both the process & outcomes of training.
  • Several challenges with traditional model are specifically addressed by CBME [Regehr].

Traditional vs CBME – Comparison


No good data to determine educational value of rotations

Many data points for each rotation

ITERS high stakes

Frequent low stakes assessments

Late identification of residents in difficulty

Early identification of residents who require additional support

Failure of faculty to give timely,  constructive feedback when deficiencies identified

Coaching in the moment around specific competencies

Faculty and Program expectations of residents not clear

Explicit expectations

Programs may respond to residents in difficulty with increased support or time, limited opportunity to facilitate enhanced learning for exceptional residents

More responsive educational construct to fit each resident’s unique educational trajectory.Traditional medical education with a time-based emphasis has been shown to result in gaps in competence of medical students and residents [Chen], [Crosson], [Mattar].

Competency by Design (CBD)

is the Royal College’s initiative to incorporate CBME into specialty education.  CBD incorporates frequent observations and coaching [operationalized by assessment of Entrustable Professional Activities (EPA’s)] specific to stages of residency, Required Training Experiences (RTE’s) as well as other supporting  documentation (e.g. exams).

To learn more:

The College of Family Physicians of Canada’s (CFPC) Triple C CBME Curriculum was implemented at UBC in 2012.  The curriculum is based on principles of comprehensive care, continuity of education and patient care, and Family Medicine-centered.

To date, 22 Royal College programs have launched CBME:

  • July 1, 2017 – Anesthesiology, Otolaryngology- Head and Neck Surgery
  • July 1, 2018 – Emergency Medicine, Medical Oncology, Nephrology – Adult & Pediatric, Surgical Foundations, Urology
  • July 1, 2019 – Anatomical Pathology, Cardiac Surgery, Critical Care Medicine – Adult & Pediatric, Gastroenterology – Adult & Pediatric, General Internal Medicine, Geriatric Medicine, Internal Medicine, Neurosurgery, Obstetrics & Gynecology, Radiation Oncology, Rheumatology – Adult & Pediatric
  • July1, 2020 – Cardiology – Adult & Pediatric, Clinical Immunology – Adulty & Pediatric, General Surgery, Neonatal-Perinatal Medicine, Neurology Adult & Pediatric, Orthopedic Surgery, Pediatric Surgery, Physical Medicine and Rehabilitation, Plastic Surgery, Physciatry, Respirology Adult, Vascular Surgery


CBME co-leads:
Dr. Howard Lim, Co-CBME Faculty Lead –
Dr. Parvathy Nair, Co-CBME Faculty Lead –

CBME Project Manager:
Eleni Tsakumis –

CBME Entrada Support:
Anika Sterba –

CBME Coordinator:
CBME Coordinator –


CBD Modules

CBD Resources

External Links


Chen C, Kotliar D, Drolet BC. Medical education in the United States: do residents feel prepared? Perspect Med Educ. 2015;4. DOI: 10.1007/s40037-015-0194-8. [PubMed]

Crosson FJ, Leu J, Roemer BM, Ross MN. Gaps in residency training should be addressed to better prepare doctors for a twenty-first-century delivery system. Health Affairs. 2011;30:2142–8. doi: 10.1377/hlthaff.2011.0184. [PubMed] [Cross Ref]

Mattar SG, Alseidi AA, Jones DB. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258:440–9. doi: 10.1097/SLA.0b013e3182a191ca. [PubMed] [Cross Ref]

Regehr G. What does the College Want from Us Now? Peeking Behind the Curtain of Competency-based Medical Education. UBC Department of Surgery Grand Rounds. April 19, 2017.