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Alignment of Learning Objectives in Canadian Plastic Surgery Residency Programs
Cameron J Leong1, Stephanie Cooper2,3, Rebecca Courtemanche2,3
1Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Plastic Surgery (Oakville, Ont.)
|May 15, 2026
Summary
Plastic surgery residents and attendings largely agree on learning priorities for Entrustable Professional Activities (EPAs). Competence by Design (CBD) has perceived benefits but faces challenges in implementation and evaluation.
Area of Science:
- Medical Education
- Surgical Training
- Competency-Based Education
Background:
- Competence by Design (CBD) is a Royal College of Physicians and Surgeons of Canada initiative shifting residency training from time-based to outcomes-based education.
- CBD focuses on Entrustable Professional Activities (EPAs), which are essential tasks within a medical discipline.
- Discrepancies in educational priorities between instructors and trainees can compromise learning and patient care quality.
Purpose of the Study:
- To compare the learning priorities of plastic surgery residents and attending surgeons regarding EPA milestones.
- To explore the perceptions and experiences of plastic surgery trainees and faculty with the Competence by Design (CBD) framework.
Main Methods:
- An online survey was distributed to plastic surgery residents and attendings across Canada.
- Participants ranked EPA milestones by learning priority using a 5-point Likert scale.
- Qualitative thematic analysis was employed to examine participant opinions on CBD and EPA implementation.
Main Results:
- A total of 76 participants (25 residents, 51 attendings) completed the survey, yielding a 15% response rate.
- Residents rated 'gathering a relevant clinical history' as less important than attendings (OR=0.38, P=.049); other EPA milestone rankings showed high concordance.
- Thematic analysis indicated that while CBD is viewed favorably for trainees, concerns include administrative burden and subjective evaluations; attendings showed inconsistencies in EPA utilization and scoring.
Conclusions:
- This study demonstrates strong agreement between plastic surgery residents and attendings on the prioritization of EPA milestones.
- Perceived advantages and disadvantages of CBD in plastic surgery align with findings in other medical specialties.
- A significant portion of attending surgeons exhibit knowledge gaps regarding the effective implementation of EPA evaluations.
