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CBME Resources

This page has been created for all things CBME. Watch this space for more information as it becomes available.

What is CBME? 

Competency-based medical education (CBME) is an outcomes-based approach to medical education. CBME responds to changes in patient and societal needs, and ensures that you receive more consistent and valuable information about your performance, allowing you to gain the skills necessary to progress through stages of training and into independent practice.  

Until now, residency programs were time-based. This meant that as a resident, you spent one full year in each Postgraduate Year (PGY) before progressing to the next level. Promotion was based on the successful completion of a year of learning comprised of thirteen equal rotation blocks, and this was the same for all residents. CBME reduces the emphasis of learning based on units of time and instead shifts the basis for promotion to the demonstration of competence.

Our residency programs have been restructured into four new phases of learning, collectively known as the Royal College Competence Continuum, each with a different focus. In each phase, you’ll have to demonstrate that you’ve achieved competency in the clinical tasks and activities expected of you. 

The Competence Continuum
The Royal College Competence by Design (CBD) Competence Continuum breaks down specialist education into a series of integrated stages, starting at the “Entry to Residency” and moving through practice. The continuum provides a quick look at the new stages of residency training that CBME follows. 

Stages in the Competence Continuum 

  1. Transition to Discipline 
  2. Foundations of Discipline 
  3. Core of Discipline 
  4. Transition to Practice 

Entrustable Professional Activities

Entrustable Professional Activities, or ‘EPAs’, are broad tasks, or units of work, that will ultimately be entrusted to you to carry out during your residency training. They are the overarching clinical tasks that must be accomplished. A series of program-specific EPAs have been developed for each stage of residency and once you can demonstrate that you’ve gained sufficient competence to successfully complete these tasks, you’ll be promoted to the next level.


Milestones are meaningful markers of progression. They reflect the abilities you need to accomplish a specific task, and many milestones are integrated into each EPA. Milestones have been developed to help teach and prepare residents to achieve the EPA.  

The Reporter, Interpreter, Manager and Educator (RIME) Model for Competence by Design (CBD) in Internal Medicine

The RIME Model for CBD in Internal Medicine

Internal Medicine Stage Specific Entrustable Professional Activities (EPAs)

Internal Medicine Stage Specific EPAs

Internal Medicine EPAs by Rotation for Each Stage of the Competence Continuum

Transition to Discipline EPAs by Rotation

Foundations of Discipline EPAs by Rotation 

Core of Discipline EPAs by Rotation

Transition to Practice EPAs by Rotation

Assessment Forms
As a resident, you are responsible for ensuring your assessment plans are completed to the best of your ability. The following outlines the basic types of assessment forms available starting in July 2017. Becoming familiar with common CBME forms will allow you to identify the best contexts for their use during training experiences. 

Clinical Assessment Form 

The Clinical Assessment Form (AKA Supervisor Form) will be used to give direct feedback on a specific EPA. The Clinical Assessment form can be initiated by either the resident or the supervisor, and can be completed at the point of encounter. Once an EPA has been selected, the form displays the relevant milestones for consideration. Supervisors indicate the resident’s progress for each milestone that was observed and can also provide a global entrustment rating. Narrative comments are also encouraged.

Field Note 

Field notes will be used when supervisors wish to leave narrative comments for a learner following a direct observation. These are linked to specific EPAs. When completing these forms supervisors will be prompted to code field notes for up to 6 contextual variables (e.g., case complexity, setting, diagnosis, etc.). This will aid in sorting field notes.

Procedure Form 

Procedure forms will be used when you are looking for direct observation feedback on a specific procedural skill. Once a procedure is selected, specific criteria will be displayed which is often (though not always) grouped by the stage of the procedure (pre/post/procedure). Some programs will be using a generic procedure form and others will use specific criteria for every procedure.

Periodic Performance Assessment (PPA)

The Periodic Performance Assessment (PPA) focusses on longitudinal learning experiences. The PPA will capture information about the consistency of resident performance over multiple encounters (a minimum of one week is recommended). Residency programs can tailor the PPA to capture specialty-specific longitudinal data on resident performance. 


Rubrics are assessment tools that have anchored descriptors of performance and often define levels of performance in terms of increasing complexity. Rubrics provide a framework for performance offering improved inter-rater reliability and validity, while also fostering learning from the resident. 

Multisource Feedback
The Multisource Feedback (MSF) tool is a structured rubric based on directly observed behaviours. MSF forms are typically completed by Allied Health Professionals (e.g. RN, RT, RD, SW), and are often based on routine performance rather than specific patient encounters. The purpose of these forms is not to assess medical knowledge; rather, it is to get a 360-degree perspective of communication, collaboration, leadership and professionalism competencies with other members of the healthcare team. Allied Health Professionals are able to provide unique and invaluable perspectives into the day-to-day operation of healthcare teams and a resident’s performance on the team.    

Assessment Expectations 

Clinical Teaching Unit (CTU)

Number of Forms       Type of Form   Frequency  
1  Clinical Assessment Form or Field Note  Weekly  
 Periodic Performance Assessment (PPA)       Bi-weekly

Inpatient/ Consult Services 

Number of Forms       Type of Form   Frequency  
1  Clinical Assessment Form or Field Note  Weekly  
 Periodic Performance Assessment (PPA)       Bi-weekly


Number of Forms       Type of Form   Frequency  
1  Clinical Assessment Form or Field Note  Per clinic day  
 Periodic Performance Assessment (PPA)       Per rotation

For more information about CBME visit: The Royal College of Physicians and Surgeons Canada
For more information about CBME at Queen's University visit: Designing Competency at Queen's University