The Royal College is pleased to release the Competence by Design (CBD) Adaptations Plan resulting from an 18-month national collaborative effort that brought together a comprehensive group of medical education leads and resident representatives to adapt and improve the CBD education model. 

This national collaborative process, which culminated in the 2023-24 CBD National Summit Series, was launched to address five key challenges in CBD implementation:

• reducing the burden of assessment for residents, faculty, administrators, program directors and competence committees;
• increasing opportunities for authentic feedback and coaching interactions;
• providing clear and consistent communication about CBD and its evolution;
• revising and reconceptualizing the Royal College approach to evaluation of CBD; and
• optimizing electronic portfolio use.

Iterative discussions addressed the varied needs of the different representative groups to arrive at solutions to these five key challenges. The CBD Adaptations Plan that includes these solutions was approved by the CBD National Summit participants, CBD National Advisory Board and National CBME Leads in March 2024, by the Royal College Committee on Specialty Education in May 2024, and by Royal College Council in June 2024.

The consultation process emphasized the need for ongoing efforts to

• unify audiences around a shared understanding of CBD and clarify the requirements and flexibilities within CBD;
• develop additional support materials for CBD implementation, including a new consult service and additions to the CBD Orientation Resources; and 
• promote a culture of long-term partnership and collaboration across the representative groups that form part of the system of residency training: faculties of medicine, medical educators, residents, health care institutions and the Royal College.

Change is happening now

Local institutions and programs are currently working on CBD adaptations as needed. Postgraduate medical education offices have been granted immediate agency on acceptable local variations of CBD to better adapt it to the unique needs of different disciplines, schools and programs, and reduce the administrative burden. 

Explore the following documents to learn more about CBD adaptations: 

CBD Adaptations Executive Summary
CBD Adaptations FAQ
CBD Adaptations Plan

The Royal College is grateful to the many participants for sharing their expertise and perspectives on how we can work together to improve learning and assessment in residency.

We remain confident about the value of CBD in Canada, which we see as ultimately contributing to enhanced patient care. We are committed to its ongoing implementation across all specialties. As of July 1, 2024, 88 per cent of the 67 disciplines have implemented CBD, and the remaining 12 per cent are expected to transition by 2026. For details about CBD implementation, please visit the CBD roll out schedule.

Related: Commitment to Action | Statement on enhanced flexibility for CBD program implementation