CBD FAQ

Below are some commonly asked questions. If your question is not answered here, please do not hesitate to contact your program or email us at dom.cbd@utoronto.ca.

Q: What is CBD?

Competence-by-Design (CBD) is the Royal College’s version of Competency-Based Medical Education (CBME). CBME is an outcomes-based approach to physician development that focuses on the demonstration of core competencies required to train. CBD is a hybrid model that de-emphasizes time and emphasizes the demonstration of key skills, improved through feedback and coaching.

Q: What is the value of CBD?

CBD is a multi-benefit initiative that defines knowledge, skills, and attitudes within an organized framework, helps learners identify areas of improvement, tracks learner progress, and focuses on teaching and learning based on individual needs. It encourages direct observation of trainees and promotes in-time coaching and feedback.

Q: What are the stages of the competence continuum?

There are four developmental stages in the competence continuum: Transition to Discipline (TTD), Foundations of Discipline (FOD), Core of Disciple (COD), and Transition to Practice (TTP). Each program has outlined the length of each stage as part of their CBD curriculum.

Q: What is an EPA?

An Entrustable Professional Activity (EPA) is a key task in the clinical setting that a resident can be trusted to perform without  direct supervision, e.g. carrying out a procedure, leading a family meeting, etc. EPAs are a focal point for improved teaching, learning, and assessment and increase in complexity through the stages.

Q: What are milestones?

A milestone is a specific component of an EPA. Multiple milestones must be integrated and performed successfully in order to complete a specific professional activity. Example: taking an accurate and suitably detailed history is one requirement (a milestone) for a broader task such as assessing a patient in the emergency department.

Q: Are EPAs the only way that residents are assessed?

EPAs are one component that the Competence Committee uses to assess resident progress. Some examples of other types of assessments are OSCEs, STACERs, multisource feedback, teaching portfolios, and written examinations. Many of these are formative assessments while the end of rotation ITAR (In-training Assessment Report) is a summative review of all performance in a given rotation.

Q: Who can initiate an EPA?

Either a resident or a faculty can initiate an EPA assessment.

Note: Faculty initiating assessments require an Elentra user account.

Please contact your Program Administrator or dom.cbd@utoronto.ca if you do not have an account.

Q: How often should EPAs be completed?

Each program sets EPA targets for their residents to meet during each stage of training and are used to make progression/promotion decisions. If you have any questions, please contact your Program Director, CBME Lead, or the Program Administrator for your program.

Q: When should EPAs be completed?

It’s best to complete an EPA assessment shortly after the encounter. While it is understood that may not always be possible, EPAs must be completed within 48 hours after the encounter. EPAs posted in Elentra by a resident are taken off the system 1 week after they are initially requested.

Q: What are some tips to completing EPAs during the COVID-19 pandemic?

The health and safety of yourself and others always come first. Be mindful of passing mobile phones between the assessee and assessor.

A resident who initiates an EPA should have all contextual variables filled in so that faculty recognize which clinical encounter is being assessed. The EPA link can then be mailed to the assessor for completion later in the day. Making notes of the cases during the day and completing and submitting the form later in the day is another way to have EPAs completed.

Q: Do I need a University of Toronto user ID (UTORID) to access Elentra?

Yes, a UTORID is required to sign in to the Elentra platform. If you don’t know your UTORID, please contact your Program Administrator or dom.cbd@utoronto.ca.

Q: Is there any guidance to providing constructive feedback?

Yes, we have a brief document that provides some useful tips and a previous newsletter had a section devoted to this.