Guide

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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