Re-examining claims about competence by design (CBD) implementation success in Canadian postgraduate medical education.
Introduction: Competency-Based Medical Education (CBME) has transformed postgraduate medical education worldwide. In 2017, Canada adopted the Competence by Design (CBD) model. While widely promoted as a successful large-scale curricular reform, emerging critiques suggest limited empirical evidence a...
| Published in: | Medical Teacher Vol. 48; no. 7; pp. 1269 - 1275 |
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| Main Authors: | , , |
| Format: | review tables/charts Journal Article |
| Published: |
Taylor & Francis Ltd
Jul2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194783050&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194783050 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0142159X MCH jtl: Medical Teacher issn: 0142159X maglogo: Y pubinfo: dt: Jul2026 vid: 48 iid: 7 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 194783050 191479671 194783050 194783050 10.1080/0142159X.2026.2628089 194783050 ppf: 1269 ppct: 6 formats: tig: atl: Re-examining claims about competence by design (CBD) implementation success in Canadian postgraduate medical education. aug: au: Chainey, Jonathan Kuper, Ayelet Brydges, Ryan affil: Division of Neurosurgery, Department of Surgery, University of Montreal, Montreal, Canada sug: subj: Education, Medical Education, Masters Canada Education, Competency-Based Program Evaluation Competency Assessment Educational Measurement Implementation Science Education, Continuing Citation Analysis Canada Medical Practice, Evidence-Based Students, Medical Faculty, Medical Faculty Attitudes Professional Development Professional Competence Mentorship Curriculum Development Workload Feedback ab: Introduction: Competency-Based Medical Education (CBME) has transformed postgraduate medical education worldwide. In 2017, Canada adopted the Competence by Design (CBD) model. While widely promoted as a successful large-scale curricular reform, emerging critiques suggest limited empirical evidence and unintended consequences. We critically examined a recent article promoting CBD's success via citation analysis and evidence appraisal. Methods: We analyzed the article's 169 references, categorizing each by type and empirical relevance. We synthesized Canadian-situated empirical studies on Entrustable Professional Activities (EPAs) and their role in feedback within CBD systems. Additionally, we consulted the Royal College of Physicians and Surgeons of Canada's (RCPSC) 2024 CBD Adaptations Plan to contextualize recent developments. Results: Empirical studies accounted for 49.2% of the citations, and only 59.4% of those directly addressed CBME. We observed many (25.3%) self-citations, suggesting limited diversity of perspectives. Synthesized studies revealed mixed outcomes: although EPAs aimed to enhance feedback, trainees reported increased stress, administrative burden, and inconsistent feedback quality. These challenges were largely unacknowledged in the analyzed article but were recognized in the 2024 CBD Adaptations Plan's proposed reforms. Discussion: Our findings challenge the narrative of CBD's unequivocal success in Canada. We highlight the need for context-sensitive empirical research to guide future reforms. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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