"Entry to Residency" "Transition to Discipline" "Foundations of Discipline" "Core of Discipline" "Transition to Practice" "Advanced Expertise" "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" "As a learner in the clinical environment, demonstrate a duty of care toward patients" "Demonstrate compassion for patients" "Under supervision, demonstrate commitment and accountability for patients in their care" "Demonstrate a commitment to high-quality care of their patients " "Role-model a commitment to high-quality patient care" "1.2 Integrate the CanMEDS Intrinsic Roles into their practice of medicine" "Describe the CanMEDS Roles and explain how they relate to the practice of medicine" "Explain how the Intrinsic Roles need to be integrated into the practice of their discipline to deliver optimal patient care" "Integrate the CanMEDS Intrinsic Roles into their practice of medicine" "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" "Apply knowledge of biomedical and clinical sciences to identify, diagnose, and address common clinical problems" "Apply clinical and biomedical sciences to manage core patient presentations in their discipline" "Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in their discipline" "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" "Perform a patient assessment and provide an interpretation of the clinical situation to the supervising physician" "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" "Perform clinical assessments that address the breadth of issues in each case" "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" "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" "Recognize competing demands in professional duties and seek assistance in determining priorities" "On the basis of patient-centred priorities, seek assistance to prioritize multiple competing tasks that need to be addressed" "Maintain a duty of care and patient safety while balancing multiple responsibilities Prioritize patients on the basis of clinical presentations" "Carry out professional duties in the face of multiple, competing demands" "Teach and role-model how to prioritize professional duties" "1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice" "Recognize that there is a degree of uncertainty in all clinical decision-making" "Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making" "Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation" "Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves Seek assistance in situations that are complex or new" "Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice" "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" "Identify the concerns and goals of the patient and family* for the encounter" "Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves" "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" "Prioritize which issues need to be addressed during future visits or with other health care practitioners" "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" "Elicit a history and perform a physical exam that informs the diagnosis Develop a general differential diagnosis relevant to the patient’s presentation" "Develop a specific differential diagnosis relevant to the patient’s presentation" "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" "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" "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" "Initiate, under supervision, discussions with the patient and family about goals of care" "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" "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" "Establish goals of care in collaboration with the patient and family, which may include slowing disease progression, achieving cure, improving function, and palliation" "2.4 Establish a patient-centred management plan" "Develop an initial management plan for common patient presentations" "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" "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" "Establish a patient-centred management plan" "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" "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" "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" "Determine the most appropriate procedures or therapies for the purpose of assessment and/or management " "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" "Describe the ethical principles and legal process of obtaining and documenting informed consent" "Obtain informed consent for commonly performed procedures and therapies, under supervision" "Use shared decision-making in the consent process, taking risk and uncertainty into consideration" "Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy" "3.3 Prioritize a procedure or therapy, taking into account clinical urgency and available resources" "Recognize and discuss the importance of the triaging and timing of a procedure or therapy" "Advocate for the timely execution of a patient procedure or therapy" "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" "Prioritize a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources " "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" "Perform a simple procedure under direct supervision" "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" "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" "Competently perform discipline-specific procedures Document procedures accurately Establish and implement a plan for post-procedure care" "Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances" "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" "Describe the importance of follow-up in patient care" "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" "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" "Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation" "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" "Describe the scope and burden of health-care–related harm Define the types of patient safety incidents" "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" "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" "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" "Recognize and respond to harm from health care delivery, including patient safety incidents" "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" "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" "Describe common types of cognitive and affective bias Describe the principles of situational awareness and their implications for medical practice" "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" "Apply the principles of situational awareness to clinical practice" "Adopt strategies that promote patient safety and address human and system factors" "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"