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Medical Expert
1 Practise medicine within their defined scope of practice and expertise
1.1 Demonstrate a commitment to high-quality care of their patients
Entry to Residency

As a learner in the clinical environment, demonstrate a duty of care toward patients

Transition to Discipline
Foundations of Discipline

Demonstrate compassion for patients

Core of Discipline

Under supervision, demonstrate commitment and accountability for patients in their care

Transition to Practice

Demonstrate a commitment to high-quality care of their patients

Advanced Expertise

Role-model a commitment to high-quality patient care

1.2 Integrate the CanMEDS Intrinsic Roles into their practice of medicine
Entry to Residency

Describe the CanMEDS Roles and explain how they relate to the practice of medicine

Transition to Discipline

Explain how the Intrinsic Roles need to be integrated into the practice of their discipline to deliver optimal patient care

Foundations of Discipline
Core of Discipline
Transition to Practice

Integrate the CanMEDS Intrinsic Roles into their practice of medicine

Advanced Expertise

Teach and assess the application of the CanMEDS Competency Framework to medical practice

1.3 Apply knowledge of the clinical and biomedical sciences relevant to their discipline
Entry to Residency

Apply knowledge of biomedical and clinical sciences to identify, diagnose, and address common clinical problems

Transition to Discipline
Foundations of Discipline

Apply clinical and biomedical sciences to manage core patient presentations in their discipline

Core of Discipline
Transition to Practice

Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in their discipline

Advanced Expertise

Teach aspects of their discipline to other physicians and health care professionals

Provide expert opinion to advise government or other organizations or to provide expert legal testimony

1.4 Perform appropriately timed clinical assessments with recommendations that are presented in an organized manner
Entry to Residency

Perform a patient assessment and provide an interpretation of the clinical situation to the supervising physician

Transition to Discipline
Foundations of Discipline

Perform focused clinical assessments with recommendations that are well-documented

Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance immediately

Core of Discipline

Perform clinical assessments that address the breadth of issues in each case

Transition to Practice

Perform appropriately timed clinical assessments addressing the breadth of the discipline with recommendations that are well organized and properly documented in written and/or oral form

Advanced Expertise

Develop system-level processes to facilitate appropriately timed clinical assessments

Teach colleagues how to perform consultations

Use technology to facilitate consultation for patients who may have limited or delayed access to care

1.5 Carry out professional duties in the face of multiple, competing demands
Entry to Residency

Recognize competing demands in professional duties and seek assistance in determining priorities

Transition to Discipline
Foundations of Discipline

On the basis of patient-centred priorities, seek assistance to prioritize multiple competing tasks that need to be addressed

Core of Discipline

Maintain a duty of care and patient safety while balancing multiple responsibilities

Prioritize patients on the basis of clinical presentations

Transition to Practice

Carry out professional duties in the face of multiple, competing demands

Advanced Expertise

Teach and role-model how to prioritize professional duties

1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
Entry to Residency

Recognize that there is a degree of uncertainty in all clinical decision-making

Transition to Discipline

Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making

Foundations of Discipline

Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation

Core of Discipline

Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves

Seek assistance in situations that are complex or new

Transition to Practice

Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice

Advanced Expertise

Teach about complexity and clinical care

2 Perform a patient-centred clinical assessment and establish a management plan
2.1 Prioritize issues to be addressed in a patient encounter
Entry to Residency

Identify the concerns and goals of the patient and family* for the encounter

Transition to Discipline
Foundations of Discipline

Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves

Core of Discipline

Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during the current encounter or during future visits or with other health care practitioners

Transition to Practice

Prioritize which issues need to be addressed during future visits or with other health care practitioners

Advanced Expertise
2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion
Entry to Residency

Elicit a history and perform a physical exam that informs the diagnosis

Develop a general differential diagnosis relevant to the patient’s presentation

Transition to Discipline
Foundations of Discipline

Develop a specific differential diagnosis relevant to the patient’s presentation

Core of Discipline

Select and interpret appropriate investigations based on a differential diagnosis

Synthesize patient information to determine a diagnosis

Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements

Transition to Practice

Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion

Advanced Expertise

Conduct a clinical assessment in challenging or unusual situations

Conduct a clinical assessment when a second opinion is requested or when a high degree of diagnostic uncertainty has already been established

2.3 Establish goals of care in collaboration with patients and their families, which may include slowing disease progression, treating symptoms. achieving cure, improving function, and palliation
Entry to Residency

Initiate, under supervision, discussions with the patient and family about goals of care

Transition to Discipline
Foundations of Discipline

Work with the patient and family to understand relevant options for care

Address with the patient and family their ideas about the nature and cause of the health problem, fears and concerns, and expectations of health care professionals

Core of Discipline

Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes

Share concerns, in a constructive and respectful manner, with the patient and family about goals of care that are not felt to be achievable

Transition to Practice

Establish goals of care in collaboration with the patient and family, which may include slowing disease progression, achieving cure, improving function, and palliation

Advanced Expertise
2.4 Establish a patient-centred management plan
Entry to Residency

Develop an initial management plan for common patient presentations

Transition to Discipline
Foundations of Discipline

Develop and implement initial management plans for common problems in their discipline

Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines

Discuss with the patient and family the degree of uncertainty inherent in all clinical situations

Core of Discipline

Develop and implement management plans that consider all of the patient’s health problems and context in collaboration with the patient and family and, when appropriate, the interdisciplinary team

Develop, in collaboration with the patient and family, a plan to deal with clinical uncertainty

Transition to Practice

Establish a patient-centred management plan

Advanced Expertise

Establish management plans in patient encounters when there are significant disagreements about what is achievable

3 Plan and perform procedures and therapies for the purpose of assessment and/or management
3.1 Determine the most appropriate procedures and therapies
Entry to Residency
Transition to Discipline
Foundations of Discipline

Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy

Describe to patients common procedures or therapies for common conditions in their discipline

Core of Discipline

Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches

Integrate planned procedures or therapies into global assessment and management plans

Transition to Practice

Determine the most appropriate procedures or therapies for the purpose of assessment and/or management

Advanced Expertise

Develop a novel procedure or therapy while respecting ethical standards for experimentation

3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
Entry to Residency

Describe the ethical principles and legal process of obtaining and documenting informed consent

Transition to Discipline
Foundations of Discipline

Obtain informed consent for commonly performed procedures and therapies, under supervision

Core of Discipline

Use shared decision-making in the consent process, taking risk and uncertainty into consideration

Transition to Practice

Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy

Advanced Expertise
3.3 Prioritize a procedure or therapy, taking into account clinical urgency and available resources
Entry to Residency
Transition to Discipline

Recognize and discuss the importance of the triaging and timing of a procedure or therapy

Foundations of Discipline

Advocate for the timely execution of a patient procedure or therapy

Core of Discipline

Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Transition to Practice

Prioritize a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Advanced Expertise

Triage and schedule procedures in complex situations, demonstrating a collaborative approach when competing for limited resources

3.4 Perform a procedure in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
Entry to Residency

Perform a simple procedure under direct supervision

Transition to Discipline

Demonstrate effective procedural preparation, including the use of a pre-procedure time-out or safety checklist as appropriate

Set up and position the patient for a procedure

Foundations of Discipline

Perform common procedures in a skilful, fluid, and safe manner with minimal assistance

Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered

Core of Discipline

Competently perform discipline-specific procedures

Document procedures accurately

Establish and implement a plan for post-procedure care

Transition to Practice

Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

Advanced Expertise

Perform specialized procedures that extend beyond routine practice in the discipline

Teach the procedures of the discipline to others

4 Establish plans for ongoing care and, when appropriate, timely consultation
4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation
Entry to Residency

Describe the importance of follow-up in patient care

Transition to Discipline
Foundations of Discipline

Coordinate investigation, treatment, and follow-up plans when multiple physicians and health care professionals are involved

Ensure follow-up on results of investigation and response to treatment

Core of Discipline

Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Determine the necessity and appropriate timing of consultation

Transition to Practice

Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

Advanced Expertise

Develop a novel system of follow-up that is flexible and adaptable to patients, families, and community resources

5 Actively contribute, as an individual and as a member of a team providing care, to the continuous improvement of health care quality and patient safety
5.1 Recognize and respond to harm from health care delivery, including patient safety incidents
Entry to Residency

Describe the scope and burden of health-care–related harm

Define the types of patient safety incidents

Transition to Discipline

Recognize the occurrence of a patient safety incident

Differentiate outcomes of medical conditions and diseases from complications related to the inherent risks of treatments and from patient safety incidents

Foundations of Discipline

Prioritize the initial medical response to harmful patient safety incident to mitigate further injury

Incorporate, as appropriate, into a differential diagnoses, harm from health care delivery

Core of Discipline

Report patient safety incidents to appropriate institutional representatives

Recognize near-misses in real time and respond to correct them, preventing them from reaching the patient

Identify potential improvement opportunities arising from harmful patient safety incidents and near misses

Participate in an analysis of patient safety incidents

Transition to Practice

Recognize and respond to harm from health care delivery, including patient safety incidents

Advanced Expertise

Teach how to respond to harm from health care and improve bedside care

5.2 Adopt strategies that promote patient safety and address human and system factors
Entry to Residency

Describe the individual factors that can affect human performance, including sleep deprivation and stress

Describe system factors that can affect patient safety, including resource availability and physical and environmental factors

Transition to Discipline

Describe common types of cognitive and affective bias

Describe the principles of situational awareness and their implications for medical practice

Foundations of Discipline

Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Describe strategies to address human and system factors on clinical practice

Core of Discipline

Apply the principles of situational awareness to clinical practice

Transition to Practice

Adopt strategies that promote patient safety and address human and system factors

Advanced Expertise

Evaluate the impact of system changes on the provision of patient care

Design safety initiatives, including those that incorporate needs and metrics identified by patients and their families

Communicator
1 Establish professional therapeutic relationships with patients and their families
1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
Entry to Residency

Describe the key components of a patient-centred approach to medical care

Outline the evidence that effective physician–patient communication enhances patient and physician outcomes

Transition to Discipline

Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion

Foundations of Discipline
Core of Discipline
Transition to Practice
Advanced Expertise

Teach and assess the patient-centred approach to communication

1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
Entry to Residency

Describe elements of the physical environment that affect patient comfort, dignity, privacy, engagement, and safety

Transition to Discipline

Mitigate physical barriers to communication to optimize patient comfort, dignity, privacy, engagement, and safety

Foundations of Discipline

Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety

Core of Discipline
Transition to Practice
Advanced Expertise

Participate in institutional/system initiatives to improve the physical environment for patients

1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
Entry to Residency

Describe how patient and physician values, biases, and perspectives can affect clinical encounters

Transition to Discipline
Foundations of Discipline
Core of Discipline

Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly

Transition to Practice
Advanced Expertise

Teach learners to recognize situations in which patient and physician values, biases, or preferences may threaten the quality of care, and how to modify the approach to patient care

1.4 Respond to a patient’s non-verbal behaviours to enhance communication
Entry to Residency

Identify non-verbal communication from a patient and family and its impact on physician–patient communication

Describe how to utilize non-verbal communication to build rapport

Transition to Discipline

Identify, verify, and validate non-verbal cues on the part of patients and their families

Use appropriate non-verbal communication to demonstrate attentiveness, interest, and responsiveness to the patient and family

Foundations of Discipline
Core of Discipline

Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication with patients

Transition to Practice
Advanced Expertise

Demonstrate advanced non-verbal communication skills in difficult situations

1.5 Manage disagreements and emotionally charged conversations
Entry to Residency

Describe physician, patient, and contextual factors that lead to strong emotions

Describe how strong emotions may affect the patient–physician interaction

Critically reflect upon emotional encounters and identify how different approaches may have affected the interaction

Transition to Discipline
Foundations of Discipline

Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state

Core of Discipline

Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

Establish boundaries as needed in emotional situations

Transition to Practice

Manage disagreements and emotionally charged conversations

Advanced Expertise

Teach others to anticipate, recognize, and manage emotions in routine clinical encounters

1.6 Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances
Entry to Residency

Describe models of decision-making along the spectrum from “paternalistic” to “shared” to “autonomous”

Describe the importance of capacity assessment

Assess and appropriately address the patient’s preferred involvement in decisions about care

Transition to Discipline
Foundations of Discipline

Assess a patient’s decision-making capacity

Core of Discipline

Tailor approaches to decision-making to patient capacity, values, and preferences

Transition to Practice

Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances

Advanced Expertise

Teach others to tailor approaches to decision-making to patient capacity, values, and preferences

2 Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families
2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
Entry to Residency

Describe the basic elements of the patient-centred interview

Conduct a patient-centred interview under supervision, gathering relevant biomedical and psychosocial information in the context of an uncomplicated presentation of a common medical problem

Transition to Discipline
Foundations of Discipline

Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial information

Core of Discipline

Actively listen and respond to patient cues

Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview

Transition to Practice

Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information

Advanced Expertise

Intervene when, during the patient interview, a learner or health care professional ignores the patient’s beliefs, values, preferences, context, or expectations

2.2 Provide a clear structure for and manage the flow of an entire patient encounter
Entry to Residency

Conduct a patient encounter using an organizing framework

Transition to Discipline
Foundations of Discipline

Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses

Core of Discipline

Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

Transition to Practice

Provide a clear structure for and manage the flow of an entire patient encounter

Advanced Expertise
2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
Entry to Residency

Describe potential sources of information that may assist in a given patient’s care

Transition to Discipline
Foundations of Discipline

Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent

Core of Discipline
Transition to Practice
Advanced Expertise
3 Share health care information and plans with patients and their families
3.1 Share information and explanations that are clear, accurate, and timely, while checking for patient and family understanding
Entry to Residency

Describe the ethical principles of truth-telling in the physician–patient relationship

Transition to Discipline

Communicate the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and family

Recognize when to seek help in providing clear explanations to the patient and family

Foundations of Discipline

Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan

Core of Discipline

Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner

Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Transition to Practice

Communicate clearly with patients and others in the setting of ethical dilemmas

Advanced Expertise
3.2 Disclose harmful patient safety incidents to patients and their families accurately and appropriately
Entry to Residency

Describe the ethical, professional, and legal obligations, and policies for, disclosure and reporting of patient safety incidents

Transition to Discipline

Describe the steps in providing disclosure after a patient safety incident

Foundations of Discipline
Core of Discipline

Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents

Apologize appropriately for a harmful patient safety incident

Transition to Practice

Disclose patient safety incidents to the patient and family accurately and appropriately

Plan and document follow-up to harmful patient safety incident

Advanced Expertise

Lead disclosure teams

Conduct peer review and practice assessments related to unexpected clinical outcomes and patient safety incidents

Contribute to the improvement of the system of disclosure for patient safety incidents

4 Engage patients and their families in developing plans that reflect the patient’s health care needs and goals
4.1 Facilitate discussions with patients and their families in a way that is respectful, non-judgmental, and culturally safe
Entry to Residency

Describe the principles of cross-cultural interviewing

Demonstrate interviewing techniques for encouraging discussion, questions, and interaction

Conduct culturally safe interviews with close supervision

Describe steps for conducting an interview with a translator

Transition to Discipline

Conduct an interview, demonstrating cultural awareness

Foundations of Discipline

Explore the perspectives of the patient and others when developing care plans

Communicate with cultural awareness and sensitivity

Core of Discipline
Transition to Practice

Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

Advanced Expertise

Teach others and assess their ability to engage patients in a way that is respectful and non-judgmental and that provides cultural safety

4.2 Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health
Entry to Residency

Describe the various technologies and information sources available to enhance patients’ understanding and management of their health care

Transition to Discipline
Foundations of Discipline
Core of Discipline
Transition to Practice

Assist the patient and family to identify, access, and make use of information and communication technologies to support care and manage health

Advanced Expertise

Contribute to the development of communication resources and technologies to enhance patient care and medical knowledge

4.3 Use communication skills and strategies that help patients and their families make informed decisions regarding their health
Entry to Residency

Describe elements of informed consent

Transition to Discipline

Demonstrate steps to obtaining informed consent

Foundations of Discipline

Answer questions from the patient and family about next steps

Core of Discipline
Transition to Practice

Use communication skills and strategies that help the patient and family make informed decisions regarding their health

Advanced Expertise
5 Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy
5.1 Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements
Entry to Residency

Describe the functions and principal components of a medical record

Describe the regulatory and legal requirements, including privacy legislation, for record keeping

Identify potential difficulties and errors in medical record keeping that have a negative impact on patient care or patient safety

Document the essential elements of a clinical encounter using a structured approach

Include as appropriate in the medical record the patient’s narrative* of the illness experience

Transition to Discipline

Organize information in appropriate sections within an electronic or written medical record

Maintain accurate and up-to-date problem lists and medication lists

Foundations of Discipline

Document information about patients and their medical conditions in a manner that enhances intra-and interprofessinal care

Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Core of Discipline

Adapt record keeping to the specific guidelines of their discipline and the clinical context

Identify and correct vague or ambiguous documentation

Transition to Practice

Document clinical encounters in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements

Advanced Expertise

Teach or conduct peer review and practice assessment regarding record keeping practices

Use medical record review to assess trainee clinical reasoning and their understanding of their patients as persons

5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
Entry to Residency
Transition to Discipline
Foundations of Discipline

Demonstrate reflective listening, open-ended inquiry, empathy, and effective eye contact while using a written or electronic medical record

Core of Discipline

Adapt use of the health record to the patient’s health literacy and the clinical context

Transition to Practice

Communicate effectively using a written health record, electronic medical record, or other digital technology

Advanced Expertise

Teach others how to effectively communicate with patients while using a medical record

Build reminders and clinical practice guidelines into the health record to enhance care

5.3 Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding
Entry to Residency

Describe the principles and legal requirements for privacy and confidentiality of written and electronic communication

Describe the different levels of written and electronic health literacy of patients and their implications for patient care

Describe the advantages, limitations and risks of using electronic communication directly with patients (including telehealth) and strategies to reduce these risks

Transition to Discipline

Assess patients’ needs and preferences with respect to methods of information sharing

Foundations of Discipline
Core of Discipline

Adapt written and electronic communication to the specificity of the discipline and to the expectations of patients

Transition to Practice

Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding

Advanced Expertise

Teach others, including patients, how to use electronic communication effectively and safely to protect confidentiality

Collaborator
1 Work effectively with physicians and other colleagues in the health care professions
1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions to support relationship-centred collaborative care
Entry to Residency

Describe relationship-centred care

Identify the stages of group development in health care settings

Introduce themselves and their role to physicians and other health care professionals

Identify opportunities for collaboration among health care professionals along the continuum of care

Transition to Discipline

Compare and contrast enablers of and barriers to collaboration in health care

Foundations of Discipline

Respect established rules of their team

Receive and appropriately respond to input from other health care professionals

Differentiate between task and relationship issues among health care professionals

Core of Discipline

Anticipate, identify, and respond to patient safety issues related to the function of a team

Transition to Practice

Establish and maintain healthy relationships with physicians and other colleagues in the health care professions to support relationship-centred collaborative care

Advanced Expertise

Analyze interactions among health care professionals to provide feedback to optimize the performance of a team for the benefit of patients

Advocate for organizational structures that support relationship-centred collaborative care

Contribute to policy discussions related to collaborative care

Teach, assess, or develop the relationship-centred model of collaborative care

1.2 Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care
Entry to Residency

Describe the importance of professional role diversity and integration in high-quality and safe patient care

Transition to Discipline

Discuss the role and responsibilities of a specialist in their discipline

Foundations of Discipline

Describe the roles and scopes of practice of other health care professionals related to their discipline

Core of Discipline

Consult as needed with other health care professionals, including other physicians

Transition to Practice

Negotiate overlapping and shared care responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care

Advanced Expertise

Teach and assess the negotiation of role overlap and shared responsibilities with other health care professionals

1.3 Engage in respectful shared decision-making with physicians and other colleagues in the health care professions
Entry to Residency

Describe strategies to promote the engagement of physicians and other colleagues in the health care professions in shared decision-making

Transition to Discipline

Discuss with the patient and family any plan for involving other health care professionals, including other physicians, in the patient’s care

Foundations of Discipline

Integrate the patient’s perspective and context into the collaborative care plan

Core of Discipline

Communicate effectively with physicians and other colleagues in the health care professions

Provide timely and necessary written information to colleagues to enable effective relationship-centred care

Transition to Practice

Engage in respectful shared decision-making with physicians and other colleagues in the health care professions

Use referral and consultation as opportunities to improve quality of care and patient safety by sharing expertise

Advanced Expertise

Integrate feedback into shared decision-making processes as part of a quality improvement initiative

Analyze, for the purposes of teaching others, shared decision-making processes in a given patient’s care

Use technology to enhance collaboration in health care

2 Work with physicians and other colleagues in the health care professions to promote understanding, manage differences, and resolve conflicts
2.1 Show respect toward collaborators
Entry to Residency

Respect the diversity of perspectives and expertise among health care professionals

Transition to Discipline

Convey information thoughtfully

Respond to requests and feedback in a respectful and timely manner

Foundations of Discipline

Actively listen to and engage in interactions with collaborators

Core of Discipline

Delegate tasks and responsibilities in an appropriate and respectful manner

Transition to Practice

Show respect toward collaborators

Advanced Expertise
2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
Entry to Residency

List factors that contribute to misunderstandings, differences, and conflicts in the health care setting

Describe different approaches to promote understanding and manage differences

Transition to Discipline
Foundations of Discipline

Identify communication barriers between health care professionals

Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts

Listen to understand and find common ground with collaborators

Core of Discipline

Gather the information and resources needed to manage differences and resolve conflicts among collaborators

Analyze team dynamics

Gain consensus among colleagues in resolving conflicts

Transition to Practice

Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture

Advanced Expertise

Act as a consultant to physicians and other health care professionals in the promotion of a culture of collaboration

Teach conflict resolution in health care

3 Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care
3.1 Determine when care should be transferred to another physician or health care professional
Entry to Residency

Describe how scope of practice can trigger transfer of care

Describe common transitions in health care and the process of safe transfer of care

Transition to Discipline
Foundations of Discipline

Identify patients requiring handover to other physicians or health care professionals

Core of Discipline
Transition to Practice

Determine when care should be transferred to another physician or health care professional

Advanced Expertise
3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care
Entry to Residency

Describe a structured framework for transfer of care that ensures the patient, physicians, and other health care professionals understand and agree with all aspects of the care

Transition to Discipline

Describe specific information required for safe handover during transitions in care

Foundations of Discipline

Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Communicate with the patient’s primary health care professional about the patient’s care

Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues

Core of Discipline

Organize the handover of care to the most appropriate physician or health care professional

Analyze gaps in communication between health care professionals during transitions in care

Recognize and act on patient safety issues in the transfer of care

Transition to Practice

Demonstrate safe handover of care, both verbal and written, during patient transitions to a different health care professional, setting, or stage of care

Advanced Expertise

Teach effective handover, including structured frameworks for safe and effective transfer of care

Analyze local handover practices and contribute to process improvements to enhance the safety and effectiveness of transfer of care

Leader
1 Contribute to the improvement of health care delivery in teams, organizations, and systems
1.1 Apply the science of quality improvement to contribute to improving systems of patient care
Entry to Residency

Describe the relevance of system theories in health care

Describe a patient’s longitudinal experience through the health care system

Describe the domains of health care quality

Transition to Discipline

Describe quality improvement methodologies

Foundations of Discipline

Compare and contrast the traditional methods of research design with those of improvement science

Compare and contrast systems theory with traditional approaches to quality improvement

Seek data to inform practice and engage in an iterative process of improvement

Core of Discipline

Analyze and provide feedback on processes seen in one’s own practice, team, organization, or system

Participate in a patient safety and/or quality improvement initiative

Transition to Practice

Apply the science of quality improvement to contribute to improving systems of patient care

Advanced Expertise

Lead quality improvement initiatives

Design processes to mitigate the impact of human and system factors on performance

Apply the science of complexity to the improvement of health care

Teach quality improvement science

Engage physicians and other health care professionals to collaborate in improving systems of patient care

1.2 Contribute to a culture that promotes patient safety
Entry to Residency

Describe the features of a “just culture” approach to patient safety

Transition to Discipline
Foundations of Discipline
Core of Discipline

Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations

Engage patients and their families in the continuous improvement of patient safety

Model a just culture to promote openness and increased reporting

Transition to Practice

Contribute to a culture that promotes patient safety

Advanced Expertise

Promote a health care culture that enhances safety and quality

Evaluate the culture of an institution or group with respect to patient safety and health quality

Champion a just culture to enhance patient safety

1.3 Analyze safety incidents to enhance systems of care
Entry to Residency

Describe the elements of the health care system that facilitate or protect against patient safety incidents

Transition to Discipline

Describe the available supports for patients and health care professionals when patient safety incidents occur

Foundations of Discipline
Core of Discipline
Transition to Practice

Analyze harmful patient safety incidents and near misses to enhance systems of care

Advanced Expertise

Implement systems-level improvements in processes for identification of and response to patient safety hazards and patient safety incidents

1.4 Use health informatics to improve the quality of patient care and optimize patient safety
Entry to Residency
Transition to Discipline

Describe the data available from health information systems in their discipline to optimize patient care

Foundations of Discipline
Core of Discipline

Map the flow of information in the care of their patients and suggest changes for quality improvement and patient safety

Use data on measures of clinical performance during team discussions and to support team decision-making

Transition to Practice

Use health informatics to improve the quality of patient care and optimize patient safety

Advanced Expertise

Participate in systems-based informatics development and improvement

Engage others in the adoption and refinement of health information technology for quality improvement

Compare service delivery data to accepted targets or goals

2 Engage in the stewardship of health care resources
2.1 Allocate health care resources for optimal patient care
Entry to Residency

Describe the differences between cost, efficacy, and value with respect to health care delivery

Describe the ethical issues related to resource stewardship in health care

Analyze how practice-related decisions affect service utilization and health-system sustainability

Transition to Discipline

Describe the costs of common diagnostic and therapeutic interventions relevant to their discipline

Foundations of Discipline

Describe models for resource stewardship in health care used at the institutional level

Consider costs when choosing care options

Core of Discipline

Use clinical judgment to minimize wasteful practices

Develop practice-based and system-based rules for resource allocation

Transition to Practice

Allocate health care resources for optimal patient care

Advanced Expertise

Assess performance of learners in providing high-value care

Experiment with care delivery models that may improve care, value, or efficiency

2.2 Apply evidence and management processes to achieve cost-appropriate care
Entry to Residency

Discuss strategies to overcome the personal, patient, and organizational factors that lead to waste of health care resources

Describe how evidence-informed medicine can be applied to optimize health care resource allocation

Transition to Discipline
Foundations of Discipline

Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Core of Discipline

Determine cost discrepancies between best practice and their current practice

Optimize practice patterns for cost-effectiveness and cost control

Transition to Practice

Apply evidence and management processes to achieve cost-appropriate care

Advanced Expertise

Compare utilization data within and outside their institution to revise processes that are inefficient or unnecessary

Engage health care administration and leadership to reduce waste

Analyze a proposed practice innovation to determine its cost impact in the clinical microsystem

3 Demonstrate leadership in professional practice
3.1 Demonstrate leadership skills to enhance health care
Entry to Residency

Describe leadership styles as they relate to health care

Describe how self-awareness, self-reflection, and self-management are important to developing leadership skills

Transition to Discipline

Analyze their own leadership styles, including strengths, weaknesses, and biases

Foundations of Discipline
Core of Discipline

Contribute to a health care change initiative

Transition to Practice

Demonstrate leadership skills to enhance health care

Advanced Expertise

Provide mentorship and guidance to help others develop leadership skills

3.2 Facilitate change in health care to enhance services and outcomes
Entry to Residency

Compare and contrast the Canadian health care system with other models around the world

Describe the key issues regarding the need to improve health care delivery and the role of physician leadership in this improvement

Describe a recent local or national health system change and the basis for acceptance or resistance to this change

Transition to Discipline
Foundations of Discipline

Analyze patient feedback to help improve patient experiences and clinical outcomes

Describe key health policy and organizational issues in their discipline

Core of Discipline

Develop a strategy for implementing change in health care with patients, physicians, and other health care professionals

Analyze ongoing changes occurring in health care delivery

Transition to Practice

Facilitate change in health care to enhance services and outcomes

Advanced Expertise

Lead a multidisciplinary team to implement a change in health care delivery

Provide consultative advice from a physician perspective to institutional managers and policy-makers

4 Manage their practice and career
4.1 Set priorities and manage time to integrate practice and personal life
Entry to Residency

Reflect on and set personal, educational, and professional goals

Demonstrate time management skills

Transition to Discipline

Align priorities with expectations for professional practice

Foundations of Discipline

Build relationships with mentors

Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

Core of Discipline
Transition to Practice

Set priorities and manage time to integrate practice and personal life

Advanced Expertise

Adjust priorities to enable participation in clinical care, the profession, and institutional, provincial, national, or international activities

Teach and assess time and personal management skills

Mentor others

4.2 Manage career planning, finances, and health human resources in a practice
Entry to Residency

Prioritize career path options on the basis of personal strengths and goals, the needs of society, and current and projected workforce needs

Transition to Discipline

Review opportunities for practice preparation, including choices available for further training

Maintain a portfolio and reflect professional development

Foundations of Discipline

Examine personal interests and seek career mentorship and counselling

Core of Discipline

Reconcile expectations for practice with job opportunities and workforce needs

Adjust educational experiences to gain competencies necessary for future independent practice

Describe remuneration models as they pertain to their discipline

Plan practice finances, considering short- and long-term goals

Transition to Practice

Manage a career and a practice

Advanced Expertise

Teach others about career and financial planning

Hire health care professionals according to defined capabilities

Align practice with career goals and opportunities

4.3 Implement processes to ensure personal practice improvement
Entry to Residency

Manage a personal schedule using tools and technologies

Transition to Discipline

Describe how practice standardization can improve quality of health care

Foundations of Discipline
Core of Discipline

Improve personal practice by evaluating a problem, setting priorities, executing a plan, and analyzing the results

Transition to Practice

Implement processes to ensure personal practice improvement

Advanced Expertise

Engage regulatory bodies, medical associations, and specialty societies to improve standards of practice

Engage others to develop a culture of continuous practice improvement

Solicit feedback and external practice audits to drive practice improvement

Develop systems to optimize practice management, including the use of checklists, prompts, and standard operating procedures

Health Advocate
1 Respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment
1.1 Work with patients to address determinants of health that affect them and their access to needed health services or resources
Entry to Residency

Describe the role of physicians and other health care professionals in patient advocacy

Define determinants of health and explain their implications

Describe the health care system, identifying obstacles patients and families face in obtaining health care resources

Transition to Discipline

Analyze a given patient’s needs for health services or resources related to the scope of their discipline

Foundations of Discipline

Demonstrate an approach to working with patients to advocate for health services or resources

Core of Discipline

Facilitate timely patient access to health services and resources

Transition to Practice

Work with patients to address the determinants of health that affect them and their access to needed health services or resources

Advanced Expertise

Advocate to administrative or governing bodies on behalf of patients

Champion the development, implementation, and promotion of health advocacy teaching

1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours
Entry to Residency

Describe the value and limitations of promoting healthy behaviours

Describe the principles of behaviour change

Transition to Discipline

Identify resources or agencies that address the health needs of patients

Foundations of Discipline

Select patient education resources related to their discipline

Educate the patient and family about information and communication technologies to improve health

Core of Discipline

Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours

Transition to Practice

Work with the patient and family to increase opportunities to adopt healthy behaviours

Advanced Expertise

Create health promotion and education resources

1.3 Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients
Entry to Residency

Describe the processes of disease prevention, health promotion, and health surveillance

Transition to Discipline
Foundations of Discipline

Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection

Core of Discipline

Evaluate with the patient the potential benefits and harms of health screening

Transition to Practice

Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients

Advanced Expertise

Champion education programs for disease prevention, health promotion, and health surveillance

2 Respond to the needs of the communities or populations they serve by advocating with them for system-level change in a socially accountable manner
2.1 Work with a community or population to identify the determinants of health that affect them
Entry to Residency

Describe the health care system, identifying communities or populations facing health inequities

Transition to Discipline
Foundations of Discipline

Identify communities or populations they serve who are experiencing health inequities

Core of Discipline

Analyze current policy or policy developments that affect the communities or populations they serve

Transition to Practice

Work with a community or population to identify the determinants of health that affect them

Advanced Expertise

Contribute to policy discussions relevant to the determinants of health

Engage the communities or populations they serve about ways to improve health

2.2 Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities
Entry to Residency
Transition to Discipline

Participate in health promotion and disease prevention programs relevant to their practice

Foundations of Discipline

Identify patients or populations that are not being optimally served in their clinical practice

Core of Discipline

Report epidemics or clusters of unusual cases seen in practice, balancing patient confidentiality with duty to protect the public's health

Transition to Practice

Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities

Advanced Expertise

Collaborate with organizations and surveillance programs to identify populations in need

2.3 Contribute to a process to improve health in the community or population they serve
Entry to Residency
Transition to Discipline
Foundations of Discipline

Partner with others to identify the health needs of a community or population they serve

Core of Discipline

Appraise available resources to support the health needs of communities or populations they serve

Distinguish between the potentially competing health interests of the individuals, communities, and populations they serve

Transition to Practice

Contribute to a process to improve health in the communities or populations they serve

Advanced Expertise

Partner with others to support, plan, or lead the implementation of a program to improve the health of the communities or populations they serve

Scholar
1 Engage in the continuous enhancement of their professional activities through ongoing learning
1.1 Develop, implement, monitor, and revise a personal learning plan to enhance professional practice
Entry to Residency

Describe the principles of effective learning relevant to medical education

Describe learning opportunities, learning resources, and assessment and feedback opportunities relevant to the clinical setting

Transition to Discipline

Describe physicians’ obligations for lifelong learning and ongoing enhancement of competence

Foundations of Discipline

Create a learning plan in collaboration with a designated supervisor identifying learning needs related to their discipline and career goals

Use technology to develop, record, monitor, revise, and report on learning in medicine

Demonstrate a structured approach to monitoring progress of learning in the clinical setting

Core of Discipline

Review and update earlier learning plan(s) with input from others, identifying learning needs related to all CanMEDS Roles to generate immediate and longer-term career goals

Transition to Practice

Develop, implement, monitor, and revise a personal learning plan to enhance professional practice

Advanced Expertise

Develop a plan to enhance competence across all CanMEDS Roles and update it regularly

Coach others to enhance their own learning plans for practice

1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources
Entry to Residency

Identify and prioritize, with guidance, personal learning needs based on formal curriculum learning objectives

Define reflective learning as it relates to medicine

Use exam results and feedback from teachers and peers to enhance self-assessment and improve learning

Compare, with guidance, self-assessment with external assessments

Transition to Discipline
Foundations of Discipline

Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

Core of Discipline

Seek and interpret multiple sources of performance data and feedback, with guidance, to continuously improve performance

Transition to Practice

Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources

Advanced Expertise

Access and summarize sources of performance data applicable to a scope of practice

Use practice performance data in dialogue with a peer or mentor to inform a personal performance improvement plan for ongoing learning

Revise and monitor a performance improvement plan on the basis of changes to scope of practice

1.3 Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice
Entry to Residency

Contribute to collaborative group learning

Define a community of practice as it relates to medicine

Transition to Discipline
Foundations of Discipline

Identify the learning needs of a health care team

Core of Discipline
Transition to Practice

Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice

Advanced Expertise

Lead learning activities of a team

2 Teach students, residents, the public, and other health care professionals
2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners
Entry to Residency

Describe the link between role-modelling and the hidden curriculum

Transition to Discipline
Foundations of Discipline

Identify behaviours associated with positive and negative role-modelling

Core of Discipline

Use strategies for deliberate, positive role-modelling

Transition to Practice

Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners

Advanced Expertise

Address systemic issues that contribute to the hidden curriculum

Apply strategies to mitigate the tensions between formal, informal, and hidden curricula

2.2 Promote a safe learning environment
Entry to Residency

Describe factors that can positively or negatively affect the learning environment

Describe strategies for reporting and managing witnessed or experienced mistreatment

Transition to Discipline
Foundations of Discipline

Explain how power differentials between learners and teachers can affect the learning environment

Core of Discipline
Transition to Practice

Ensure a safe learning environment for all members of the team

Advanced Expertise

Address systemic or institutional processes that may compromise the safety of the learning environment

Coach others about optimizing learning environments

2.3 Ensure patient safety is maintained when learners are involved
Entry to Residency

Speak up in situations in the clinical training environment where patient safety may be at risk because of learner involvement

Transition to Discipline
Foundations of Discipline

Identify unsafe clinical situations involving learners and manage them appropriately

Core of Discipline

Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed

Balance clinical supervision and graduated responsibility, ensuring the safety of patients and learners

Transition to Practice

Ensure patient safety is maintained when learners are involved

Advanced Expertise

Contribute to guidelines on the supervision of learners with regard to patient safety and quality improvement

2.4 Plan and deliver a learning activity
Entry to Residency

Describe the characteristics of effective teachers in medicine

Transition to Discipline
Foundations of Discipline

Demonstrate basic skills in teaching others, including peers

Core of Discipline

Describe how to formally plan a medical education session

Describe sources of information used to assess learning needs

Define specific learning objectives for a teaching activity

Describe clinical teaching strategies relevant to their discipline

Transition to Practice

Plan and deliver a learning activity

Advanced Expertise

Integrate formal and informal methods of needs assessment to guide the development and/or modification of learning activities

Teach the public and other health care stakeholders

Use relevant learning theories to enhance the learning of others

Coach others to enhance their teaching

2.5 Provide feedback to enhance learning and performance
Entry to Residency

Describe the features of effective feedback and its importance for teaching and learning

Transition to Discipline
Foundations of Discipline

Provide written or verbal feedback to other learners, faculty, and other members of the team

Core of Discipline
Transition to Practice

Provide feedback to enhance learning and performance

Role-model regular self-assessment and feedback-seeking behaviour

Advanced Expertise

Help learners and teachers manage the emotional impact of giving and receiving feedback

Work with recipients of feedback to develop plans for improvement

2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner
Entry to Residency

Assess teachers in an honest, fair, and constructive manner

Evaluate programs in an honest, fair, and constructive manner

Contribute to the assessment of other learners

Transition to Discipline
Foundations of Discipline
Core of Discipline

Appropriately assess junior learners

Transition to Practice

Assess and evaluate learners, teachers, and programs in an educationally appropriate manner

Advanced Expertise

Plan systematic approaches to the assessment of learners or evaluation of programs

Develop a new assessment tool or process

3 Integrate best available evidence into practice
3.1 Recognize practice uncertainty and knowledge gaps in clinical and other professional encounters and generate focused questions that can address them
Entry to Residency

Describe the different kinds of evidence and their roles in clinical decision-making

Transition to Discipline
Foundations of Discipline

Recognize uncertainty and knowledge gaps in clinical and other professional encounters relevant to their discipline

Core of Discipline

Generate focused questions that address practice uncertainty and knowledge gaps

Transition to Practice
Advanced Expertise
3.2 Identify, select, and navigate pre-appraised resource
Entry to Residency

Describe the advantages and limitations of pre-appraised resources

Select appropriate sources of knowledge as they relate to addressing focused questions

Transition to Discipline
Foundations of Discipline

Contrast the various study designs used in medicine and the quality of various pre-appraised resources

Core of Discipline
Transition to Practice

Identify, select, and navigate pre-appraised resources

Advanced Expertise

Coach others to find and select sources of evidence for a given practice-related question

3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature
Entry to Residency

For a given practice scenario, formulate a well-structured question using a specific framework

Identify appropriate sources that answer a practice question

Transition to Discipline
Foundations of Discipline

Interpret study findings, including a critique of their relevance to their practice

Determine the validity and risk of bias in a source of evidence

Core of Discipline

Evaluate the applicability (external validity or generalizability) of evidence from a resource

Describe study results in both quantitative and qualitative terms

Transition to Practice

Critically evaluate the integrity, reliability, and applicability of health-related research and literature

Advanced Expertise
3.4 Integrate evidence into decision-making in their practice
Entry to Residency

Use evidence, as appropriate, during decision-making

Describe the principles of knowledge translation and the knowledge-to-action framework

Transition to Discipline
Foundations of Discipline

Discuss the barriers to and facilitators of applying evidence into practice

Describe how various sources of information, including studies, expert opinion, and practice audits, contribute to the evidence base of medical practice

Core of Discipline

Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services

Transition to Practice

Integrate best evidence and clinical expertise into decision-making in their practice

Advanced Expertise

Teach physicians and other health care professionals to effectively integrate evidence into decision-making in their practice

4 Contribute to the creation and dissemination of knowledge and practices applicable to health
4.1 Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health care
Entry to Residency

Describe the basic scientific principles of research and scholarly inquiry

Describe the role of research and scholarly inquiry in health care

Transition to Discipline
Foundations of Discipline
Core of Discipline

Contribute to a scholarly investigation or the dissemination of research findings in their discipline

Transition to Practice

Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health care

Advanced Expertise

Supervise a research project or scholarly inquiry

Teach the principles of research and scholarly inquiry to others

4.2 Identify ethical principles for research and incorporate them into obtaining informed consent, considering potential harms and benefits, and considering vulnerable populations
Entry to Residency

Describe the ethical principles applicable to research and scholarly inquiry

Transition to Discipline
Foundations of Discipline

Discuss and provide examples of the ethical principles applicable to research and scholarly inquiry relevant to their discipline

Core of Discipline
Transition to Practice

Identify ethical principles for research and incorporate them into obtaining informed consent, considering harm and benefits, and considering vulnerable populations

Advanced Expertise

Serve as a member on a research ethics board

4.3 Contribute to the work of a research program
Entry to Residency
Transition to Discipline
Foundations of Discipline

Compare and contrast the roles and responsibilities of members of a research team and describe how they differ from clinical and other practice roles and responsibilities

Core of Discipline

Actively participate as a research team member, balancing the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician

Transition to Practice

Contribute to the work of a research program

Advanced Expertise

Create and lead research teams

Serve as a research mentor

4.4 Pose questions amenable to scholarly inquiry and select appropriate methods to address them
Entry to Residency

Describe the characteristics of a well-constructed research question

Discuss and critique the possible methods of addressing a given scholarly question

Transition to Discipline
Foundations of Discipline

Describe and compare the common methodologies used for scholarly inquiry in their discipline

Core of Discipline

Select appropriate methods of addressing a given scholarly question

Transition to Practice

Pose medically and scientifically relevant and appropriately constructed questions amenable to scholarly inquiry

Advanced Expertise

Coach others to pose relevant, appropriately constructed questions that are amenable to scholarly inquiry

4.5 Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry
Entry to Residency
Transition to Discipline
Foundations of Discipline

Summarize and communicate to peers the findings of applicable research and scholarship

Core of Discipline
Transition to Practice

Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry

Prepare a manuscript suitable for publication in a peer-reviewed journal

Advanced Expertise

Formally present research and scholarly inquiry findings, including presentations at meetings, and in print and digital media

Professional
1 Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards
1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, demonstrating honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality
Entry to Residency

Exhibit honesty and integrity with patients, peers, physicians, and other health care professionals

Demonstrate caring and compassion

Recognize and respect boundaries

Demonstrate sensitivity to issues concerning diversity with respect to peers, colleagues, and patients

Consistently maintain confidentiality in the clinical setting, while recognizing the special limitations on confidentiality

Transition to Discipline

Consistently prioritize the needs of patients and others to ensure a patient’s legitimate needs are met

Demonstrate punctuality

Complete assigned responsibilities

Foundations of Discipline

Independently manage specialty-specific issues of confidentiality, intervening when confidentiality is breached

Core of Discipline

Manage complex issues while preserving confidentiality

Intervene when behaviours toward colleagues and learners undermine a respectful environment

Transition to Practice

Exhibit appropriate professional behaviours and relationships in all aspects of practice, reflecting honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality

Advanced Expertise

Lead and advise on professionalism and professional behaviour

Lead initiatives that promote respectful work environments

Demonstrate special expertise in issues of confidentiality and serve as a resource for others

1.2 Demonstrate a commitment to excellence in all aspects of practice
Entry to Residency

Reflect on experiences in the clinical setting to identify personal deficiencies and modify behaviour accordingly

Transition to Discipline
Foundations of Discipline
Core of Discipline

Analyze how the system of care supports or jeopardizes excellence

Transition to Practice

Demonstrate a commitment to excellence in all aspects of practice

Advanced Expertise

Systematically address barriers to excellence in clinical care

1.3 Recognize and respond to ethical issues encountered in practice
Entry to Residency

Describe principles and theories of core ethical concepts

Identify appropriate ethical concepts to address ethical issues encountered during clinical and academic activities

Transition to Discipline
Foundations of Discipline
Core of Discipline

Manage ethical issues encountered in the clinical and academic setting

Transition to Practice

Recognize and respond to ethical issues encountered in independent practice

Advanced Expertise

Advise on complex ethical issues in practice

Teach and assess the management of ethical issues in clinical practice

1.4 Recognize and manage conflicts of interest
Entry to Residency

Describe the implications of potential personal, financial, and institutional conflicts of interest, including conflicts of interest with industry

Recognize personal conflicts of interest and demonstrate an approach to managing them

Transition to Discipline
Foundations of Discipline
Core of Discipline

Proactively resolve real, potential, or perceived conflicts of interest transparently and in accordance with ethical, legal, and moral obligations

Transition to Practice

Recognize and manage conflicts of interest in independent practice

Advanced Expertise

Advise on conflicts of interest in practice and in institutions

1.5 Exhibit professional behaviours in the use of technology-enabled communication
Entry to Residency

Explain the potential abuses of technology-enabled communication and their relation to professionalism

Describe policies related to technology-enabled communication

Use technology-enabled communication, including their online profile, in a professional, ethical, and respectful manner

Follow relevant policies regarding the appropriate use of electronic medical records

Transition to Discipline
Foundations of Discipline
Core of Discipline

Intervene when aware of breaches of professionalism involving technology-enabled communication

Transition to Practice

Exhibit professional behaviours in the use of technology-enabled communication

Advanced Expertise

Develop standards and/or policies incorporating the principles of professionalism related to the use of technology-enabled communication

2 Demonstrate a commitment to society by recognizing and responding to societal expectations in health care
2.1 Demonstrate accountability to patients, society, and the profession by responding to societal expectations of physicians
Entry to Residency

Describe the social contract between the profession of medicine and society

Explain physician roles and duties in the promotion of the public good

Describe the levels of reciprocal accountability of medical students, physicians, and the medical profession in relation to individual patients, society, and the profession

Transition to Discipline
Foundations of Discipline

Manage tensions between societal and physicians’ expectations

Describe the tension between the physician’s role as advocate for individual patients and the need to manage scarce resources

Core of Discipline

Demonstrate a commitment to the promotion of the public good in health care, including stewardship of resources

Demonstrate a commitment to maintaining and enhancing competence

Transition to Practice

Demonstrate accountability to patients, society, and the profession by recognizing and responding to societal expectations of the profession

Advanced Expertise

Influence the profession’s response to issues of societal accountability

Advise institutions on social accountability and the profession

2.2 Demonstrate a commitment to patient safety and quality improvement
Entry to Residency

Describe the link between professionalism and a commitment to patient safety and quality improvement

Transition to Discipline
Foundations of Discipline

Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

Monitor institutional and clinical environments and respond to issues that can harm patients or the delivery of health care

Core of Discipline
Transition to Practice

Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment

Advanced Expertise
3 Demonstrate a commitment to the profession by adhering to standards and participating in physician-led regulation
3.1 Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing practice
Entry to Residency

Describe the regulatory structures governing physicians and the profession

Transition to Discipline
Foundations of Discipline
Core of Discipline

Describe how to respond to, cope with, and constructively learn from a complaint or legal action

Demonstrate accountability to the profession and society with regard to the impact of decisions that are made

Describe the relevant codes, policies, standards, and laws governing physicians and the profession including standard-setting and disciplinary and credentialing procedures

Transition to Practice

Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing practice

Advanced Expertise

Contribute to the development of professional and ethical codes, standards, or laws governing practice

3.2 Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions
Entry to Residency

Describe and recognize key behaviours that are unprofessional or unethical

Transition to Discipline

Respond to peer-group lapses in professional conduct

Foundations of Discipline
Core of Discipline

Describe and identify regulatory codes and procedures relevant to involving a regulatory body in a case of serious unprofessional behaviour or practice

Transition to Practice

Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions

Advanced Expertise

Lead systematic initiatives to minimize unprofessional and unethical behaviours in colleagues

3.3 Participate in peer assessment and standard-setting
Entry to Residency

Describe the principles of peer assessment

Transition to Discipline
Foundations of Discipline
Core of Discipline

Participate in the review of practice, standard setting and quality improvement activities

Participate in the assessment of junior learners

Prepare a morbidity and mortality report or chart review

Transition to Practice

Participate in peer assessment and standard-setting

Advanced Expertise

Participate in the regulatory procedures that govern the profession

Lead a debrief of a difficult clinical interaction

4 Demonstrate a commitment to physician health and well-being to foster optimal patient care
4.1 Exhibit self-awareness and manage influences on personal well-being and professional performance
Entry to Residency

Describe how physicians are vulnerable to physical, emotional, and spiritual illness

Use strategies to improve self-awareness to enhance performance

Describe the connection between self-care and patient safety

Transition to Discipline
Foundations of Discipline

Manage the impact of physical and environmental factors on performance

Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

Core of Discipline

Integrate skills that support adaptation and recovery in challenging situations

Transition to Practice

Exhibit self-awareness and effectively manage influences on personal well-being and professional performance

Advanced Expertise

Role-model and teach self-regulation

Advise on strategies to mitigate the negative effects of physical and environmental factors on physician wellness and practice performance

Role-model and coach others in resilience

4.2 Manage personal and professional demands for a sustainable practice throughout the physician life cycle
Entry to Residency

Identify strategies to support personal well-being, a healthy lifestyle and appropriate self-care, with the help of friends, family and a primary health professional.

Describe the transitions through a physician’s life cycle, including periods of vulnerability

Seek appropriate health care for their own needs, which could include consultation with a therapist and/or spiritual advisor

Use strategies to mitigate stressors during transitions and enhance professional development

Incorporate self-care into personal and professional routines

Seek mentorship to address professional development needs

Transition to Discipline

Recognize evolving professional identity transitions and manage inherent stresses

Foundations of Discipline

Describe the influence of personal and environmental factors on the development of a career plan

Core of Discipline

Manage competing personal and professional priorities

Transition to Practice

Manage personal and professional demands for a sustainable practice throughout the physician life cycle

Advanced Expertise

Role-model and teach the management of competing personal and professional priorities

Eliminate system barriers to physicians seeking care

Advocate for learning and work environments that provide opportunities for a healthy lifestyle

Coach physicians in the transition out of professional practice (retirement)

4.3 Promote a culture that recognizes, supports, and responds effectively to colleagues in need
Entry to Residency

Describe the multiple ways in which poor physician health can present, including disruptive behaviour, and offer support to peers when needed

Describe the importance of early intervention for colleagues in need of assistance, identify available resources, and describe professional and ethical obligations and options for intervention

Transition to Discipline
Foundations of Discipline

Use strategies to mitigate the impact of patient safety incidents

Core of Discipline

Support others in their professional transitions

Transition to Practice

Promote a culture that recognizes, supports, and responds effectively to colleagues in need

Provide mentorship to colleagues

Advanced Expertise

Role-model and teach learners and colleagues about personal and professional choices to effectively manage their practice

Establish a mentorship program

Teach and positively influence the behaviour of others to promote a culture of wellness