A competency-based curriculum for palliative medicine in Canada

of Physicians and Surgeons of Canada (the Royal College), passed a motion approving Palliative Medicine as a Royal College Subspecialty.The entry routes to Palliative Medicine include Internal Medicine, Pediatrics, Neurology, Anaesthesia, and any other specialty, including Family Medicine, if a prerequisite of twelve months of clinical medicine with a minimum of six months at a senior level can be met. 1 Palliative Medicine is unique in being the latest subspecialty (as of Oct. 2013) to be created by the Royal College and the only subspecialty that allows entry from Family Medicine.Following the creation of the subspecialty, we formed a Palliative Medicine Working Group to establish the objectives, training requirements and specific standards for program accreditation of the discipline.With these approved, the Working Group disbanded, and we formed the inaugural Specialty Committee in Palliative Medicine in 2016. 2 Our specialty committee is made up of Palliative Medicine physicians from across Canada and is comprised of: a chair; vice-chair; representatives from set regions across Canada, community practice and a core specialty area; residency program directors from the universities with Palliative Medicine training programs; and a representative from the national specialty society, the Canadian Society of Palliative Medicine (CPSM).3 Our specialty committee is responsible for maintaining the subspecialty content expertise in the discipline and making recommendations to the Royal College on specialty-specific issues.3 Within a year of establishing our specialty committee, The University of Toronto and the University of British Columbia were accredited with new residency training programs in Palliative Medicine (Adult stream) and enrolled their first residents in July 2017. 2 We also created an Examination Committee to develop certification examinations in adult and pediatric Palliative Medicine and a Practice Eligibility Route (PER) to allow those already in practice to apply to challenge the examination.1 In September 2019, we administered the first examination in Palliative Medicine in Canada.This exam resulted in the certification of 34 Palliative Medicine physicians.As of August 2024, we have 98 Canadian exam-certified Palliative Medicine physicians, and there are also six Canadian Palliative Medicine physicians who are recognized as leaders and subspecialists within our discipline, whom have been given the designation of "Founder" by the Royal College.4 As of 2024, we have nine training programs in Adult Palliative Medicine, and four training programs in Pediatric Palliative Medicine, that have been accredited by the Royal College.5 Up until 2023, our residency programs were time- Scientific ReportsOverview of the Educational Design Process in CBD for Palliative Medicine Our discipline, Palliative Medicine, started the transition to CBD in May 2021 with the first of three workshops.We invited sixteen palliative care experts to participate in the workshops, and another nineteen invitees came from the Royal College, to help facilitate the process.The palliative care experts were members of our specialty committee for Palliative Medicine including the regional representatives, Chair, Vice-Chair and program directors, a Palliative Medicine resident trainee, a base specialty representative (Neurology), and a Canadian Society of Palliative Medicine (CSPM) representative.We also added a palliative care psychologist to support our development of competencies related to complex psychosocial suffering, a symptom that is commonly seen in palliative medicine practice.The training backgrounds of the palliative care physicians involved in the process varied, and included Internal Medicine, Neurology, Oncology, Pediatrics and Family medicine, as well as a Palliative Medicine subspecialty resident and a Palliative Medicine physician trained in the UK, where Palliative Medicine is a five-year direct entry specialty training program.As the transition to CBD started two years after our first Canadian examination was held, credentialing of the participants also varied.Of the eighteen physicians, four held Palliative Medicine Founder status at the Royal College, seven were Palliative Medicine exam certified, having come from both Royal College and Family Medicine backgrounds, seven held Certificates of Added Competence (CAC) in palliative care through the College of Family Physicians of Canada (CFPC), and one held Royal College certification in the UK.Six of the Family Medicine trained physicians were credentialed with both a Certificate of Added Competence in palliative care and an FRCPC in Palliative Medicine.All non-resident participants had spent many years working clinically in the discipline at a subspecialty-equivalent level. Workshop 1In Workshop 1, CBD was introduced, and our group started work to define the scope of practice of a Palliative Medicine subspecialist, to be included as an introduction in the Palliative Medicine Competency document.We then broke into groups, with each group assigned a stage of training to draft EPAs.Many of the Royal College EPAs were felt to be similar for Adult and Pediatric Palliative Medicine, although some important differences did exist.To help ensure the EPAs were appropriate for their patient population the

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