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In Canada, family physicians may pursue extended training for added competence in areas such as Palliative Care or Emergency Medicine by applying to Enhanced Skills (ES) programmes. Despite the increasing popularity of ES programmes, there are no studies that examine trends in applications to ES programmes before and after the introduction of family medicine focused competency-based curricula at individual universities. Additionally, there is a scarcity of research examining factors common among applicants to ES programmes. We undertook a retrospective observational study using secondary data analysis of archived resident files from a large Canadian family medicine residency programme. The proportion of applicants to ES programmes decreased since implementation of a competency-based curriculum in the subject programme. Older, male, and Canadian medical graduates (CMGs) applied to ES programmes more often than their respective counterparts. Residents in a family medicine competency-based curriculum may be less inclined to extend their training by applying to ES programmes. This is remarkable considering that the Canadian residency programme is the shortest among high-income countries. Further studies are needed to investigate the role of competency-based medical education programmes in enabling shortening residency training around the world.

Importance: Competency-based medical education is now established in health professions training. However, critics stress that there is a lack of published outcomes for competency-based medical education or competency-based assessment tools., Objective: To determine whether competency-based assessment is associated with better identification of and support for residents in difficulty., Design, Setting, and Participants: This cohort study of secondary data from archived files on 458 family medicine residents (2006-2008 and 2010-2016) was conducted between July 5, 2016, and March 2, 2018, using a large, urban family medicine residency program in Canada., Exposures: Introduction of the Competency-Based Achievement System (CBAS)., Main Outcomes and Measures: Proportion of residents (1) with at least 1 performance or professionalism flag, (2) receiving flags on multiple distinct rotations, (3) classified as in difficulty, and (4) with flags addressed by the residency program., Results: Files from 458 residents were reviewed (pre-CBAS: n = 163; 81 [49.7%] women; 90 [55.2%] aged >30 years; 105 [64.4%] Canadian medical graduates; post-CBAS: n = 295; 144 [48.8%] women; 128 [43.4%] aged >30 years; 243 [82.4%] Canadian medical graduates). A significant reduction in the proportion of residents receiving at least 1 flag during training after CBAS implementation was observed (0.38; 95% CI, 0.377-0.383), as well as a significant decrease in the numbers of distinct rotations during which residents received flags on summative assessments (0.24; 95% CI, 0.237-0.243). There was a decrease in the number of residents in difficulty after CBAS (from 0.13 [95% CI, 0.128-0.132] to 0.17 [95% CI, 0.168-0.172]) depending on the strictness of criteria defining a resident in difficulty. Furthermore, there was a significant increase in narrative documentation that a flag was discussed with the resident between the pre-CBAS and post-CBAS conditions (0.18; 95% CI, 0.178-0.183)., Conclusions and Relevance: The CBAS approach to assessment appeared to be associated with better identification of residents in difficulty, facilitating the program's ability to address learners' deficiencies in competence. After implementation of CBAS, residents experiencing challenges were better supported and their deficiencies did not recur on later rotations. A key argument for shifting to competency-based medical education is to change assessment approaches; these findings suggest that competency-based assessment may be useful.