CBME in the Canadian Context
The scope of medical education in Canada
The Canadian medical education system is structured by a logical progression from breadth to depth of knowledge and training. As such, Canadian medical education has traditionally followed a pre-planned course of training where a student moves across a continuum that is grounded on time-based curricula and final assessments prior to entering a less structured and longer phase of learning in practice.
While to some extent dependent on individual and program, the training pathway typically follows the phased journey as follows:
2-4 years University Undergraduate
3-4 years Medical School
2-5 Years Residency (post-MD)
Following residency, learners also have the option to complete subspecialty training (typically 1-3 years) and/or complete training in an Area of Focused Competency (AFC).
Key valued features of the Canadian medical education system (To maintain)
Canada has an international reputation for producing competent and highly skilled physicians. An examination of the medical education system in Canada must acknowledge and respect the many successes of the current system of training. There are several key valued features of the system, including:
- High quality training built on comprehensive national standards;
- Innovations such as the CanMEDS Framework
- Development and use of multi-source feedback instruments for high-quality assessment;
- Certification examinations that contribute to the public’s trust in the profession;
- Deployment of modern technologies, such as simulation methods;
- Unique and enabling university infrastructure fostering leadership in programs across Canada;
- High quality accreditation systems.
Contemporary pressures of the Canadian medical education system (To improve)
The contemporary medical education system in Canada is the product of a series of developments and major changes throughout history. However, since the early 20th century, few major revolutions in the medical education system had been enacted. The system is facing a number of contemporary pressures. New demands are emerging, owing to the increased complexity of the society that the system serves.
The section below details current pressures on the Canadian medical education system, the impact, as well as the desired state moving forward.
Exponential increase in knowledge required to train and practice
Exponential increase in the wealth of knowledge required by trainees and practicing professionals alike.
- Significant demands on the medical education system and the system of specialization.
- A thoughtful articulation of the system of specialty medicine, clear routes to training, and a focus on the desired outcomes – i.e. orienting principally around the question of: “what are the skills trainees need to meet societal health needs?”
Increasing need to provide preventative care and care for complex, chronic illness
The health care system is increasingly pressured to provide preventative care and care for complex, chronic illness.
- The health care system was initially designed for the handling of acute illness, rather than chronic care, leading to deficits in the training of professionals. Professionals increasingly need skills to manage complex, chronic diseases – skills that are not necessarily being taught in a consistent fashion, owing to the origins of the system.
- Professionals who are well-equipped to optimally address the realities of today’s health care system and the patients who require care from that system.
The rise of the interprofessional health care team
The health care system is increasingly team-based and interprofessional, but our training systems are not.
- Professionals increasingly need skills to work within a complex, interprofessional and team-based care environment in order to optimize patient care and continuity of care.
- Professionals who are trained to work seamlessly in interprofessional and contemporary health care environments.
An era of fiscal restraint
An era of fiscal restraint, which is experienced both in terms of staffing constraints and limited budgets.
- Increased demand for efficiencies in an era where the demands on the health care system are significant, owing to demographic changes and changes in the nature of care provision.
- Operational and service requirements often dictate educational experiences, leading to deficits in the exposure of trainees.
- A training model that is built “by design” rather than built in an extemporaneous fashion, such that careful consideration can be granted to the priorities of the training environment and the experiences needed by trainees to ensure well-rounded training exposure.
Canadian adaptations of CBME
Traditional models of medical education are built to prepare health care professionals for the health care systems of the past. The implementation of CBME programs offers the ability to adjust and focus training curricula based on the current and evolving needs of the population. Such an update is essential to ensure this fundamentally important system is positioned to keep pace with the dramatic evolutions of our contemporary society.
The list below illustrates several adaptations of CBME in various Canadian contexts.
- College of Family Physicians of Canada – Triple C Competency Based Curriculum
- Royal College of Physicians and Surgeons of Canada – Competence by Design
- Competency-based Medical Education at Queen’s University
- Competency-based Medical Education at the University of Toronto – Orthopaedic Division