General surgery programs in Canada transitioned to a Competence by Design (CBD) model in July 2020.
This model for education is based on specialty training being broken down into distinct stages with clear learning objectives for each, called Entrustable Professional Activities (EPAs). This is a combination of time-based and outcomes-based learning. During each stage residents are observed as they work towards achieving their EPAs and receive targeted feedback. A committee for your program is responsible for reviewing resident progress at multiple points throughout the year and they give recommendations on resident progression to subsequent stages as well as address any areas that may require additional attention from the resident or support from the program in order to achieve.
As a junior resident, you will work on two sets of EPAs set out by the Royal College – General Surgery and Surgical Foundations programs. These years focus on EPAs under the Transition to Disciple and Foundations of Disciple stages. In upper years, the Core EPAs make up the vast majority of general surgery training. In the final year, Transition to Practice EPAs aim to prepare residents for their transition to staff positions. EPA guides are updated by the Royal College as programs work through this transition period to CBD learning. Year to year the EPAs residents are expected to achieve may differ due to these changes so ensure you know which version of EPAs you are expected to complete. Here is an EPA tracker that reflects the Surgical Foundations Version 2.0 (2021) and General Surgery Version 1.0 (2020) EPAs. You may find this useful in keeping track of EPAs that are pending and/or completed. Please note this form was created by a resident as a way to help track their own progress during residency, and is not affiliated with the Royal College. Feel free to use this as a starting point but know that EPA requirements may change over the years and therefore this document may need to be updated periodically.
For more information on CBD learning: https://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e.
For EPA guides in general surgery and surgical foundations: https://www.royalcollege.ca/rcsite/documents/cbd/epa-observation-templates-e
Below is a flexible guideline of expectations for residents throughout the years. Please note the level of responsibility for each operation is extremely rotation/hospital/university
dependent. There will be great variability between programs in the expected timeline to achieve these operations. These are estimates only and at the end of your 5 years of training it will not make a difference in which year you became primary surgeon for any given procedure. By your PGY 5 year, you would be expected to be the main surgeon in most general surgery cases with staff assistance as needed. This would not be the expectation however for subspecialty and fellowship-level cases.
