Competence by Design (CBD) and exams

Changing exam timing

Exam timing in competency-based residency programs under Competence by Design differs from time-based residency programs.

In the current system, residents spend the last year of their programs preparing for their certification exams. This usually means they lose valuable clinical time. In time-based residency education programs, residents apply for an assessment of exam eligibility before entering their final year. The exam is written at the end of the final year of training.

In the competence by design (CBD) model, residents move through four stages where the exam becomes one of many assessments that occur throughout training.

  • Transition to Discipline (orientation and assessment)
  • Foundations of Discipline
  • Core of Discipline
  • Transition to Practice

A resident’s journey to certification
This infographic explains at-a-glance how a resident’s journey to certification changes under Competence by Design, comparing the traditional and new systems. The duration of stages may vary across specialties.

CBD Start Launch and Exam Schedule
During the approximate 30-month CBD workshop process, the specialty committees will decide the exact timing of the exams for their individual specialties. This schedule captures current exam decisions of launch cohorts and what stage they are at in the launch process.

Clarifying the Role of Mandatory Training Time in Competence by Design
Changes to exam timing under the competency-based CBD model are not intended to shorten the length of training. This policy document explains the role of time in CBD.

CBD may shift exams earlier in training — likely to the end of the core of discipline stage (the timing of the exam will be determined by the needs and context of the discipline). This way, trainees will not be lost to textbooks in their final year. Instead, they can take that year to hone their skills. As much as possible, emphasis will be placed on independent work and skills, helping physicians better prepare for independent practice.

Moving exams will not shorten residency training — successfully completing the Royal College exam will continue to be a requirement for independent practice. However, passing the exam at the end of the core of discipline stage will not lead to certification.

The Royal College will only grant certification when the resident has successfully completed the transition to practice stage and has received sign-off from the program director and the postgraduate office at their medical school.

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