The Royal College is the national professional association that oversees the medical education of specialists in Canada. We accredit the university programs that train resident physicians, and we oversee the examinations that residents must pass to become certified as specialists. Based on 10 years of collaborative research to evaluate the effectiveness of the current training system and to identify solutions for identified gaps, the Royal College saw an opportunity to lead Canada's medical education into the 21st century by shifting the current 100-year-old teaching model to meet modern-day best practices.

The introduction of Competence by Design (CBD) is a national large-scale transformative initiative and cutting-edge approach to set new standards in specialty medical training. A budget of $33 million was allocated over 11 years to fund the initiative to transform 68 medical specialities to CBD, a new medical teaching model, in a staggered approach between 2017 and 2024. Setting out to shift long-established teaching practices and traditions, explain the widespread complexities of the change, and facing a critical need for audience buy-in, CBD success is dependent on overcoming the Royal College's historic reputation of working with audiences using a top-down approach. The initiative was therefore fuelled by a communications strategy to influence a growth mindset and change culture within our audiences, by inviting individuals into the change process and building a community of champions to operate from the bottom up.

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