Resources to support competency-based medical education implementation in emergency medicine

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The implementation of competency-based medical education (CBME) is challenging for both residents and staff observers. The shift to workplace-based assessments using entrustable professional activities (EPAs) can be very helpful for getting specific feedback; however, the number and diversity of EPAs can be overwhelming for new residents and those beginning a new rotation or stage of training. It is perhaps even more challenging for observers supervising multiple residents at different stages of training. As outlined in our recent CJEM article​1​, we created practical, aesthetically pleasing resources to promote familiarity with EPAs and assist residents and observers in transitioning smoothly to a competency-based training model.

Reference Cards

Reference cards were developed to be used by residents and observers at the bedside in order to ensure that EPAs are being performed and assessed appropriately. They were designed to hang behind hospital ID badges and were color-coded by stage of training and rotation to facilitate easy access. Reference cards were divided into stage-specific cards (for use on EM rotations) and rotation-specific cards (for use on off-service rotations). The cards can be viewed and used in a variety of ways:

  • For use on rotations, they can be easily viewed on your computer or mobile phone at the website
  • For a quick review, galleries of the rotation-specific and stage-specific reference cards are featured below.
  • If you would like to create a set of cards for yourself, a downloadable PDF card package featuring all of the cards is available here and the individual images can also be downloaded from the galleries.

Stage-Specific Reference Cards

Rotation-Specific Reference Cards

Reference Card Templates

If you are interested in producing reference cards for your own program, we have developed some templates to get you started. The three Powerpoint files below are an outline of how they can be used, a vertical template, and a horizontal template. It should be fairly easy to modify the colour scheme and add logos to ensure consistency with a brand.

Curriculum Board

The curriculum board was developed in order to store and display the reference cards. The board organizes the cards by stage of training – transition to discipline, foundations, core, and transition to practice – in order to provide residents with a visual curriculum map of the rotations that they will complete throughout each stage of training. Spare cards are hung on the board via hooks. The link to the blueprint of the curriculum board is included here.

EPA Curriculum Board in use at the University of Saskatchewan


The reference cards and curriculum board were useful tools for the Royal College EM residents at the University of Saskatchewan.​1​ More information concerning the reference cards, curriculum board, and the results of the research conducted regarding the use of these resources can be found in the full article. We encourage others to replicate this innovation with necessary modifications in order to fit their needs and local context and to consider sharing their experiences with others.


  1. 1.
    Stoneham EJ, Witt L, Paterson QS, Martin LJ, Thoma B. The development of entrustable professional activities reference cards to support the implementation of Competence by Design in emergency medicine. CJEM. August 2019:1-4. doi:10.1017/cem.2019.395

Quinten Paterson

Dr. Quinten Paterson is an Emergency Medicine at the University of Saskatchewan, a Masters of Medical Education candidate through the University of Dundee, and a Clinician Educator Diploma candidate through McMaster University.

Lara Witt

Lara Witt is a medical student at the University of Saskatchewan College of Medicine.

Emily Stoneham

Emily Stoneham is a third-year medical student at the University of Saskatchewan. She is interested in Emergency Medicine, trauma, and medical education.

Lynsey Martin

Dr. Lynsey Martin is the Assistant Program Director and the CBME Lead for the Emergency Medicine Residency Program at the University of Saskatchewan.
Dr. Brent Thoma is a medical educator, blogging geek, and trauma/emergency physician who works at the University of Saskatchewan College of Medicine. He founded BoringEM and is the CEO of CanadiEM.