• Franziska Miller, Sarah Wood, and Patricia Livingston.
• Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada. fr429747@dal.ca.
• Can J Anaesth. 2024 Feb 1; 71 (2): 254263254-263.

PurposeCanadian specialist residency programs are in the process of transitioning to a hybrid time and competence model, Competence by Design (CBD), developed by the Royal College of Physicians and Surgeons Canada. Although there is extensive literature around competency-based medical education (CBME), few studies have evaluated the experience of residents after CBME implementation. The purpose of this study was to obtain a rich perspective on the lived experience of residents.MethodsWe designed a qualitative study with inductive thematic analysis of semistructured interview data. The study population was residents in CBD postgraduate training programs in anesthesiology, internal medicine, or surgery (including all surgical subspecialties) at Dalhousie University (Halifax, NS, Canada).ResultsResidents identified the following benefits of their programs and CBD: supportive peers and clinical supervisors, a roadmap for residency, formalized feedback opportunities, and program evolution. Resident-identified drawbacks of CBD included: a lack of transparency around CBD, CBD not as advertised, a lack of buy-in, increased administrative burden, difficulties obtaining evidence for entrustable professional activities (EPAs); the onus for CBD on residents, inconsistent feedback, cumbersome technology, and significant psychological burden. Resident-suggested improvements were reducing the number of EPAs, streamlining EPA requirements, increasing transparency and communication with competence committees, providing incentives and continuous education for clinical supervisors, improving on existing electronic interfaces, and developing technology better suited to the needs of CBD.ConclusionThis study highlights that the significant administrative and psychological burden of CBD detracts from clinical learning and enthusiasm for residency. Future research could explore whether overcoming the identified challenges will improve residents' experiences.© 2023. Canadian Anesthesiologists' Society.

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