Competence By Design: Gastroenterology & Hepatology

Welcome to the Gastroenterology & Hepatology Competence by Design webpage. If you have any questions or comments, please send them to


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. In this model, residents will be required to complete Entrustable Professional Activities (EPAs), which are tasks that can be delegated to a resident and observed by a supervisor. These are low-stakes assessments. 

CBD Stages

Residency will continue being two years. It will be split into four stages:

●    Transition to Discipline (TTD) - PGY4 Blocks 1 & 2
●    Foundations of Discipline (FOD) - PGY4 Blocks 3-8
●    Core of Discipline (COD) - PGY4 Blocks 9-13 and PGY5 Blocks 1-11
●    Transition to Practice (TTP) - PGY5 Blocks 12&13

It is anticipated that in the future the specialty exam will be administered near the end of the Core stage.

Assessments, Primers, and Resources

Entrustable Professional Activities

Each stage of CBD has Entrustable Professional Activities (EPAs), which are made up of several “elements” called milestones. EPAs are tasks; milestones are the skills needed to perform the task. For a list of all EPAs, the milestones associated with each, and the number of entrustments required, please refer to the EPA Primer document.


All programs will be using Elentra as the CBD assessment platform. Please note that you will need to use your UTORid and password to login to Elentra.