Leveraging the 4 Disciplines of Execution to Establish Graduate Medical Education at a New Medical School

Background: Canadian residency programs are usually developed over 4 years. The Toronto Metropolitan University School of Medicine (TMU SoM) in Brampton, Ontario, Canada sought accreditation for residency programs to accommodate its first 105 residents in 14 months. Objective: To describe how the TMU SoM leadership team applied the 4 disciplines of execution to seek accreditation for a Postgraduate Medical Education (PGME) office and 17 residency programs. Methods: Between August 2023 and October 2024, the TMU PGME office utilized the methodologies described in the 4 disciplines of execution ("select a wildly important goal," "act on lead measures," "keep a compelling scorecard," and "create a cadence of accountability") to coordinate the hiring of interim program directors and the development of accreditation applications. The primary outcome was achieving accreditation status for the PGME office and residency programs. Results: The TMU SoM hired 30 interim program directors between October and December 2023. It received accreditation for its PGME office in February 2024, its first 2 residency programs in May 2024, and 14 of the remaining 15 residency programs in October 2024. One hundred five residents (2-40 residents/program) began training at TMU on July 1, 2025. The final residency program received accreditation in October 2025. Conclusions: The TMU SoM successfully utilized the 4 disciplines of execution to achieve accreditation for its PGME office and 16 residency programs in 14 months.