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MEdIC Series: Case of the Competency Conundrum – Expert Review and Curated Community Commentary


Our final case of this season, The Case of the Competency Conundrum, outlined a scenario of residency competency committee members who are divided in their approach to a superstar R4 resident, Josh, who has already completed the requirements of his training program. They struggle with competing opinions surrounding competency based medical education (CBME) early advancement principles and the importance of continued exposure/service.

This month, the MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around this case with insights from the ALiEM community. We are proud to present to you the curated community commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!

This follow-up post includes

  • Responses from our solicited experts:
    • Dr. Brent Thoma (@Brent_Thoma) is an emergency physician and trauma team leader in Saskatoon, Saskatchewan. He is the interim Director of Simulation and Program Director of the Royal College emergency medicine residency program. Brent investigates technological innovations that enhance learning with the goal of helping good people to provide exceptional healthcare. His work is online at,, and
    • Dr. Teresa Chan (@TChanMD) is an emergency physician, clinician educator and assistant professor at McMaster University, where she is also the Competence Committee chair for the Royal College Emergency Medicine training program. She is the assistant program director of the Clinician Educator Area of Focused Competence program. In her spare time she volunteers with a number of influential FOAM outlets including:,,,, International Clinician Educator blog, Emergency Medicine Cases
  • A summary of insights from the ALiEM community derived from the Twitter and blog discussions
  • Freely downloadable PDF versions of the case and expert responses for use in continuing medical education activities
Expert Response 1: The Stellar Resident: A Good Problem to Have (Dr. Brent Thoma)
Expert Response 2: The Complexities of Clinical Competency Committees (Dr. Teresa Chan)
Curated from the Community (Dr. Alkarim Velji)

Case and Responses for Download

Click here (or on the picture below) to download the case and responses as a PDF (321 kb).

Tamara McColl, MD FRCPC

Tamara McColl, MD FRCPC

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba