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The CanMEDS 2015 Milestones Guide | Selected milestones

Editors: Jason R. Frank, Linda S. Snell, Jonathan Sherbino

In the progression through a physician’s career, competencies acquired at a given stage are sustained and developed further through subsequent stages. Where a specific milestone for the acquisition of an enabling competency is not specified for a given stage, it should be assumed that earlier milestones for that competency still apply.

Throughout the CanMEDS 2015 Framework and Milestones Guide, reference to the patient’s family are intended to include all those who are personally significant to the patient and are concerned with his or her care, including, according to the patient’s circumstances, family members, partners, caregivers, legal guardians, and substitute decision-makers.

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Health Advocate

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	Entry to Residency	Transition to Discipline	Foundations of Discipline	Core of Discipline	Transition to Practice	Advanced Expertise
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	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	Analyze a given patient’s needs for health services or resources related to the scope of their discipline	Demonstrate an approach to working with patients to advocate for health services or resources	Facilitate timely patient access to health services and resources	Work with patients to address the determinants of health that affect them and their access to needed health services or resources	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	Describe the value and limitations of promoting healthy behaviours Describe the principles of behaviour change	Identify resources or agencies that address the health needs of patients	Select patient education resources related to their discipline Educate the patient and family about information and communication technologies to improve health	Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours	Work with the patient and family to increase opportunities to adopt healthy behaviours	Create health promotion and education resources
1.3 Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients	Describe the processes of disease prevention, health promotion, and health surveillance		Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection	Evaluate with the patient the potential benefits and harms of health screening	Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients	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	Describe the health care system, identifying communities or populations facing health inequities		Identify communities or populations they serve who are experiencing health inequities	Analyze current policy or policy developments that affect the communities or populations they serve	Work with a community or population to identify the determinants of health that affect them	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		Participate in health promotion and disease prevention programs relevant to their practice	Identify patients or populations that are not being optimally served in their clinical practice	Report epidemics or clusters of unusual cases seen in practice, balancing patient confidentiality with duty to protect the public's health	Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities	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			Partner with others to identify the health needs of a community or population they serve	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	Contribute to a process to improve health in the communities or populations they serve	Partner with others to support, plan, or lead the implementation of a program to improve the health of the communities or populations they serve