CBME – Competency Based Medical Education

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]:



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: http://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e

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.

July 1, 2017, CBD  was launched for Anesthesiology and Otolaryngology- Head and Neck Surgery

July 1, 2018, CBD is set to launch for Emergency Medicine, Medical Oncology, Nephrology – Adult, Nephrology – Pediatrics, Surgical Foundations and Urology. 

The CBD Discipline Launch Schedule by Year can be found here.


CBME Lead: Dr. Sonia Butterworth, MD, FRCS(C), Clinical Associate Professor, UBC

Dr. Butterworth took on the role of CBME Lead in Spring 2017.  She completed Undergrad, General Surgery and Pediatric Surgery training at UBC.  She has had roles as the Associate Program Director in General Surgery, the Program Director for Pediatric Surgery and the Program Director for Surgical Foundations.  She also served as co-Lead Simulation for PGME.

CBME Project Manager:  Eleni Tsakumis

Eleni has joined the CBME team from the Department of Surgery where she worked for 7 years as the Program Manager and prior to that, Vancouver Coastal Health for 13 years. She brings direct knowledge of the workings of a postgraduate program and will be working to help guide and support each of the Royal College programs in their CBME rollout over the next several years.

Contact: pgme.cbme@ubc.ca

CBD Module:

Competency By Design:  Resident Training & Assessment

CLICK HERE to start the module

Faculty Development Resource: Mock Competence Committee Cases for Practice Deliberation

CLICK HERE to start the module

CBD Resources

CBD Retreat Presentation-Coaching & Feedback

CBD Retreat Presentation-Resident Perspectives

CBD Retreat Presentation-PD Perspective

CBD Retreat Presentation-ePortfolio Platform

ePortfolio Test Account

Clarifying Myths, Misconceptions & Misunderstandings

The Meantime Guide

CBD Handout – FAQ Part 1 – Rationale

CBD Handout – FAQ Part 2 – Implementing CBD

CBD Handout – FAQ Part 3 – Terms

CBD Key Things Residents Need to Know

CBD Residents Guide

CBD Resource Directory

Postgraduate Medical Education – Competence Committee – Terms of Reference

External Links

CanMEDS Interactive

CanMEDS Tools Guide

Royal College of Physicians and Surgeons of Canada

Family Medicine Triple C Curriculum


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.