Re-examining claims about competence by design (CBD) implementation success in Canadian postgraduate medical education

Introduction Competency-Based Medical Education (CBME) has transformed postgraduate medical education worldwide. In 2017, Canada adopted the Competence by Design (CBD) model. While widely promoted as a successful large-scale curricular reform, emerging critiques suggest limited empirical evidence and unintended consequences. We critically examined a recent article promoting CBD’s success via citation analysis and evidence appraisal.Methods We analyzed the article’s 169 references, categorizing each by type and empirical relevance. We synthesized Canadian-situated empirical studies on Entrustable Professional Activities (EPAs) and their role in feedback within CBD systems. Additionally, we consulted the Royal College of Physicians and Surgeons of Canada’s (RCPSC) 2024 CBD Adaptations Plan to contextualize recent developments.Results Empirical studies accounted for 49.2% of the citations, and only 59.4% of those directly addressed CBME. We observed many (25.3%) self-citations, suggesting limited diversity of perspectives. Synthesized studies revealed mixed outcomes: although EPAs aimed to enhance feedback, trainees reported increased stress, administrative burden, and inconsistent feedback quality. These challenges were largely unacknowledged in the analyzed article but were recognized in the 2024 CBD Adaptations Plan’s proposed reforms.Discussion Our findings challenge the narrative of CBD’s unequivocal success in Canada. We highlight the need for context-sensitive empirical research to guide future reforms.