Department of Medicine

CBD: A Mid-year Review

Dec 18, 2018

We are now in Block 7 of this academic year, here is an update from the world of CBD!

Emergency Medicine, Medical Oncology and Nephrology have successfully launched. Internal Medicine, General Internal Medicine and Geriatrics are not far behind and are currently field testing in preparation for their 2019 launch. Gastroenterology and Rheumatology are also well on their way preparing for a 2019 launch.

It has been a busy year with EPA completions! Here are some quick stats on how things have been progressing:

CBD Stats from Blocks 1-6

So, how are things going? We’ve gathered and summarized some feedback from faculty and residents on what's been going well, some of the challenges they’ve faced and tips for completing EPAs.  To help address commonly asked questions by resident and faculty about CBD and EPA completion, we've also collated some Frequently Asked Questions, which you can read below.

Feedback on CBD

Here are some highlights and challenges from faculty and residents on their experiences in CBD:


What’s been going well?

  • Thinking about the learner and focusing on what they did well and what they need to work on.
  • Providing feedback is very useful for the resident and the teacher.
  • The ability to coach a trainee’s progress to the stage of autonomy
  • Opportunities to provide more in-depth and specific feedback

Where is there room for improvements?

  • Finding time to complete EPA assessment due to the pace of workflow or variable staffing
  • Finding appropriate cases for some EPAs
  • Teasing out the role of a more junior resident who is being assessed for an EPA when they are a member of a team


What’s been going well?

  • Receiving specific and actionable feedback that relates directly to their clinical practice.
  • EPA assessments make it easy to focus on a case and teach around it
  • Timely feedback in the clinic give residents time to work on the areas of improvement for the next clinic
  • Supervisors have provided very specific and actionable items for improvement that may have been missed previously (example: language use, body position, interaction with family/caregivers)

Where is there room for improvements?

  • Difficulty asking for EPA completion on a busy service or when there is a limited time
  • Assessments being focused globally based on an entire case or entire day rather than the specific elements of the EPA
  • Frustration with delays in having EPA assessments completed in a timely fashion
  • The desire to have more EPA assessments initiated by staff

Tips on EPA Completion

Some tips from faculty and residents on for smoother EPAs completion:


  • To avoid bias, select a random case at the beginning of clinical service or before interaction with a patient to complete an EPA
  • Do the assessment in real time Aim to complete an EPA shortly after the encounter to make the feedback more relevant for the resident (but also to avoid external factors influencing the assessments)
  • Pick two or three milestones to focus on. Not all milestones need to be completed on each EPA.
  • Schedule the EPAs at ad hoc


  • Inform faculty at the beginning of the rotation/week/day so they know that EPAs need to be completed
  • Pick EPAs that you want to focus on for that period and discuss with faculty
  • It will better if the resident tells the concerned staff that they would like to get the EPA filled before the resident sees the patient or the activity is performed – so that will allow the staff to also observe the resident closely in anticipation
  • Complete the EPAs in real time – and not thru email / blank email form
  • It is  helpful to specify at the beginning on the EPA(s) and backup EPA(s) that should be completed
  • Be persistent and remind faculty to complete an assessment
  • Pre-populating the demographic information helps in speeding up the EPA completion 

--  Thanks to all of the faculty and residents for taking the time to share their feedback.