Department of Medicine

Internal Medicine - CBD

Welcome to the Internal Medicine Competence by Design page. 

Introduction to CBD

Dr. Jeannette Goguen
I want to first thank you for your support this past year with the Internal Medicine pilot. The Internal Medicine program will continue its field testing of Entrustable Professional Activities (EPAs) as we prepare for Competence by Design (CBD) launch in July 2019.

Phase 2 of the pilot starts on July 4th, 2018 and we will be rolling out 5 new Entrustable Professional Activity (EPAs) forms throughout the year. We expect weekly EPA forms to be completed for every PGY1, PGY2 and PGY3 resident

Finally, we now have Academic Advisors recruited to longitudinally coach the PGY1s and PGY2s and a Competence Committee to provide promotional decisions and oversee the CBD process.

Jeannette Goguen,
Internal Medicine Program Director 



Competence by Design (CBD) is a Royal College of Physicians and Surgeons of Canada (RCPSC) initiative to transition postgraduate medical education and professional practice in Canada into a model of competency-based medical education.

What does that mean to you? There is a shift towards a coaching model of training in lieu of the current performance model. In the coaching model residents will be required to complete formative assessments called Entrustable Professional Activities (EPAs). EPAs are tasks of the discipline that can be delegated to a resident and observed by a supervisor. These are low-stakes assessments. You will learn more on EPAs in the Assessment Section. Here is a link to a CBD Terminology Page for more information

CBD Stages

Residency will continue being 3  years. The final stage will be part of the first year of subspecialty training. It will be split into 4 stages:

  • Transition to Discipline (TTD) 4 Blocks in PGY 1
  • Foundations of Discipline (FOD) 9 Blocks in PGY 1
  • Core of Discipline (COD) 2 years PGY 2-PGY3
  • Transition to Practice (TTP) 1 year PGY 4 (first year of subspecialty year)

The Royal College Exam will take place after the Core stage at the end of PGY3. 

EPA 101



Academic Advisor

Academic Advisor Orientation Video Part 1 - CBD Primer (PowerPoint)


Academic Advisor Orientation Video Part 2 - Role of an Academic Advisor (PowerPoint)


Coaching and Mentorship (PowerPoint)