Department of Medicine

Internal Medicine - CBD

Welcome to the Internal Medicine Competence by Design page.


Competence by Design (CBD) is a Royal College of Physicians and Surgeons of Canada (RCPSC) initiative to transition postgraduate medical education and professional practice in Canada into a model of competency-based medical education.

What does that mean to you? There is a shift towards a coaching model of training in lieu of the current performance model. In the coaching model residents will be required to complete formative assessments called Entrustable Professional Activities (EPAs). EPAs are tasks of the discipline that can be delegated to a resident and observed by a supervisor. These are low-stakes assessments. You will learn more on EPAs in the Assessment Section. Here is a link to a CBD Terminology Page for more information

CBD Stages

Residency will continue being 3  years. The final stage will be part of the first year of subspecialty training. It will be split into 4 stages:

  • Transition to Discipline (TTD) 4 Blocks in PGY 1
  • Foundations of Discipline (FOD) 9 Blocks in PGY 1
  • Core of Discipline (COD) 2 years PGY 2-PGY3
  • Transition to Practice (TTP) 1 year PGY 4 (first year of subspecialty year)

The Royal College Exam will take place after the Core stage at the end of PGY3. 

Assessments, Primers and Resources

Getting Started

EPA Primers

All documents are in PDF format. 

    Core of Discipline (PGY2 & 3)

    EPA Assessments Mapped to Rotations

    EPA Primers

    Resident Primer