Download DEPARTMENT OF FAMILY MEDICINE COMPETENCY FRAMEWORK

DEPARTMENT OF
FAMILY MEDICINE
COMPETENCY
FRAMEWORK
DECEMBER 2015
TABLE OF CONTENTS
Organizational Acronyms.................................................................................................. 3
Goal of the University of Manitoba Family Medicine Residency Program.................. 4
Organizational Acronyms
CFPC
College of Family Physicians of Canada DFM
Department of Family Medicine
RCPSC Royal College of Physicians and Surgeons of Canada
SOGC The Society of Gynaecologists of Canada
Four Principles of Family Medicine.................................................................................. 6
CanMEDS............................................................................................................................ 8
Acknowledgments
A Competency-Based Residency Program....................................................................... 9
We would like to thank colleagues from the Departments of Family Medicine at the Universities of Ottawa,
Toronto, Calgary, Edmonton and British Columbia for generously sharing their expertise and materials. Their
works have greatly inspired our framework.
Family Medicine Foundational Competencies.............................................................. 10
Maternal Care Competencies.......................................................................................... 34
Care of Children and Adolescents Competencies......................................................... 43
Care of Adults Competencies.......................................................................................... 57
Care of the Elderly Competencies................................................................................... 69
Palliative Care Competencies...........................................................................................74
Care of First Nations, Inuit, and Métis Populations Competencies............................ 80
Care of Vulnerable and Underserved Populations Competencies............................... 84
Behavioural Medicine Competencies............................................................................. 87
Milestones and Entrustable Professional Activities...................................................... 94
Curricular Grid............................................................................................................... 152
Appendix A - CFPC Core Topics.................................................................................. 155
Appendix B - CFPC Core Procedures .......................................................................... 157
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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Goal of the University of Manitoba
Department of Family Medicine Residency Program
Introduction
A broad knowledge base and clinical skill sets enable family physicians to work in diverse
settings such as patients’ homes, outpatient clinics, emergency departments, labour and delivery
suites, hospital wards, and nursing homes. Family medicine often serves as the main entry point
to the health care system and the hub that provides continuity of care throughout the life cycle.
As such, family medicine is the central medical discipline. The importance of primary care in
quality of health and the value Canadian society places on family physicians in the delivery of
this care are well known. 1 2
In response to changes in accreditation standards in family medicine, the program has engaged in a process
to review and modify its curriculum to ensure it meets the goals of the CFPC’s Triple C Curriculum 5– a
competency-based curriculum that is:
The goal of the University of Manitoba Department of Family Medicine Residency Program
is to train family physicians who are able to provide comprehensive, high quality, continuous
care in urban, rural, or remote settings.
• Comprehensive
• Focused on Continuity of education and patient care
• Centred in Family Medicine
On completion of their program, family physicians trained by our residency program will
demonstrate the abilities to:
This document is a guide to the development of specific and necessary competencies, all of which are
critical for a resident’s development as a competent physician. For individual learners this competencybased approach provides a clear guide to necessary behaviours, skills, knowledge, and practices that
will enable their development over time into a compassionate, comprehensive, and competent
family physician.
• Respond to the needs of their communities by providing comprehensive, high quality,
continuous health care to their patients and families across the life cycle (including
prevention, acute and chronic illness management), in a variety of care settings, and to a
broad base of patients, including those from underserved and marginalized populations.
The competencies are organized family medicine which are generic competencies of the graduating
practice-ready family physician. The foundational competencies are complemented by domain-specific
competencies, which are compentencies specifically related to an area of clinical care. Domains are
organized in terms of life cycle or special topics:
• Recognize that the patient-physician relationship is central to their practice and strive to
communicate effectively with patients.
Life cycle
Maternal care
Special topics
Palliative care
• Collaborate with other physicians, health professionals, patients, and their families to
optimize patient care.
Care of children and adolescents
• Mobilize the resources of the community to improve the health care delivery system.
Care of adults
Care of First Nations, Inuit, and Métis
populations
• Take an active role in improving the safety and quality of health care.
Care of elderly
• Engage in lifelong learning.
Behavioural medicine
• Demonstrate professional behaviours in all aspects of practice.
The College of Family Physicians of Canada (CFPC) has adopted a competency approach to
the accreditation of training programs for family physicians in Canada. The model is referred to
as the CanMEDS-FM framework 3 , which is modified from the CanMEDS model 4 of the Royal
College of Physicians and Surgeons of Canada (RCPSC).
1
Care of vulnerable and underserved
populations
The development of rotation-specific learning outcomes is based on foundational and domain-specific
competencies. The competencies have been constructed with the four principles of family medicine in
mind and organized under CanMEDS roles.
J. Macinko, B. Starfield, L. Shi, The Contribution of Primary Care Systems to Health Outcomes Within Organization for Economic Cooperation
and Development (OECD) Countries, 1970–-1998, Health Services Research 38, 3 (June 2003): pp. 831–-865.
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2
B. Starfield, Is Primary Care Essential? Lancet 344, 8930 (Oct. 22, 1994): pp. 1129–-1I33.
3
College of Family Physicians of Canada. CanMEDS-Family Medicine: A framework of competencies in Family Medicine (Oct 2009)
4
Royal College of Physicians and Surgeons of Canada. CanMEDS Framework (2005)
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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College of Family Physicians of Canada. Triple C Competency-based Curriculum (March 2011)
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Four Principles of Family Medicine 6
The family physician is a skilled clinician
Family physicians demonstrate competence in the patient-centred clinical method; they
integrate a sensitive, skillful, and appropriate search for disease. They demonstrate an
understanding of patients’ experience of illness (particularly their ideas, feelings, and
expectations) and of the impact of illness on patients’ lives.
Family physicians use their understanding of human development and family and other social
systems to develop a comprehensive approach to the management of disease and illness in
patients and their families.
Family physicians are also adept at working with patients to reach common ground on the
definition of problems, goals of treatment, and roles of physician and patient in management.
They are skilled at providing information to patients in a manner that respects their autonomy
and empowers them to take charge of their own health care and make decisions in their best
interests.
Family physicians have an expert knowledge of the wide range of common problems
of patients in the community, and of less common, but life threatening and treatable
emergencies in patients in all age groups. Their approach to health care is based on the best
evidence available.
Family medicine is a community-based discipline
Family practice is based in the community and is significantly influenced by community
factors. As a member of the community, the family physician is able to respond to people’s
changing needs, to adapt quickly to changing circumstances, and to mobilize appropriate
resources to address patients’ needs.
The family physician is a resource to a defined practice population
The family physician views his or her practice as a population at risk, and organizes the practice to ensure
that patients’ health is maintained whether or not they are visiting the office. Such organization requires
the ability to evaluate new information and its relevance to the practice, knowledge and skills to assess
the effectiveness of care provided by the practice, the appropriate use of medical records and/or other
information systems, and the ability to plan and implement policies that will enhance patients’ health.
Family physicians have the responsibility to advocate public policy that promotes their patients’ health.
They accept their responsibility in the health care system for wise stewardship of scarce resources.
Family physicians consider the needs of both the individual and the community.
The patient-physician relationship is central to the role of the family physician
Family physicians have an understanding and appreciation of the human condition, especially the nature of
suffering and patients’ response to sickness. They are aware of their strengths and limitations and recognize
when their own personal issues interfere with effective care.
Family physicians respect the privacy of the person. The patient-physician relationship has the qualities of a
covenant—a promise, by physicians, to be faithful to their commitment to patients’ well-being, whether or
not patients are able to follow through on their commitments. Family physicians are cognizant of the power
imbalance between doctors and patients and the potential for abuse of this power.
Family physicians provide continuing care to their patients. They use repeated contacts with patients to
build on the patient-physician relationship and to promote the healing power of interactions. Over time, the
relationship takes on special importance to patients, their families, and the physician. As a result, the family
physician becomes an advocate for the patient.
Clinical problems presenting to a community-based family physician are not pre-selected
and are commonly encountered at an undifferentiated stage. Family physicians are skilled
at dealing with ambiguity and uncertainty. They will see patients with chronic diseases,
emotional problems, acute disorders (ranging from those that are minor and self-limiting to
those that are life threatening), and complex bio-psychosocial problems. Finally, the family
physician may provide palliative care to people with terminal diseases.
The family physician may care for patients in the office, the hospital (including the emergency
department), other health care facilities, or the home. Family physicians see themselves as
part of a community network of health care providers and are skilled at collaborating as
team members or team leaders. They use referrals to specialists and community resources
judiciously.
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College of Family Physicians of Canada. The Four Principles of Family Medicine
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CanMEDS
A Competency-Based Residency Program
Medical Expert
As medical experts, physicians integrate all of the CanMEDS roles, applying medical
knowledge, clinical skills, and professional values in their provision of high quality and safe
patient-centred care. Medical expert is the central physician role in the CanMEDS framework
and defines the physician’s clinical scope of practice.
The program has identified family medicine foundational and domain-specific competencies that the
resident will achieve by the end of their residency. These have been organized under CanMEDS roles with
consideration of the new CanMEDS 2015 framework.7
Communicator
As communicators, physicians form relationships with patients and their families that facilitate
the gathering and sharing of essential information for effective health care.
The following section outlines the key competencies required of all trainees in the program. The term ‘Key
competency’ is used to designate an overarching competency. All key competencies are further defined by
a set of enabling competencies.
Further detail on key and enabling competencies, including mapping to specific CanMEDS competencies,
99 core topics 8 and core procedures 9 is provided in links embedded in the curricular grid.
Collaborator
As collaborators, physicians work effectively with other health care professionals to provide
safe, high quality, patient-centred care. Collaboration is essential for safe, high quality, patientcentred care, and involves patients, their families, physicians, other colleagues in health care
professions, community partners, and health system stakeholders.
Leader* / Manager
As leaders/managers, physicians engage with others to contribute to a vision of a high quality
health care system, and take responsibility for the delivery of excellent patient care through
their activities as clinicians, administrators, scholars, or teachers.
Health Advocate
As health advocates, physicians contribute their expertise and influence as they work with
communities or patient populations to improve health. They work with those they serve to
determine and understand needs, speak on behalf of others when required, and support the
mobilization of resources to effect change.
Scholar
As scholars, physicians demonstrate a lifelong commitment to excellence in practice through
continuous learning and by teaching others, evaluating evidence, and contributing to
scholarship.
Professional
As professionals, physicians are committed to the health and well-being of individual patients
and society through ethical practice, high personal standards of behaviour, accountability to
the profession and society, physician-led regulation, and maintenance of personal health.
* Under the the CanMEDS 2015, the ‘Manager ‘role has been re-titled ‘Leader’
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Royal College of Physicians and Surgeons of Canada. CanMEDS 2015 Framework (2015)
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College of Family Physicians of Canada. Defining competence for the purposes of certification by the College of Family Physicians of Canada: The evaluation
objectives in family medicine. Report of the Working Group on the Certification Process (October 2010)
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College of Family Physicians of Canada. Defining competence for the purposes of certification by the College of Family Physicians of Canada: The evaluation
objectives in family medicine. Report of the Working Group on the Certification Process (October 2010)
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Family Medicine Foundational Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
The role of the family physician
FAM1 – Practice within the full scope
of family medicine
1.1 Quality care: Demonstrate a commitment
to high quality care and to the four principles of
family medicine.
• The family physician is a skilled clinician
Domain-specific content
regarding knowledge and skills is
provided in Life Cycle and Special Topics
sections
• Family medicine is a community-based
discipline
• The family physician is a resource to a defined
practice population
• The patient-physician relationship is central to
the role of the family physician
1.2 Range of competencies: Use the
competencies of a family physician across the
life cycle and in different practice settings.
1.3 Knowledge and skills: Demonstrate
knowledge of sufficient breadth and depth to
practice family medicine.
1.4 Primary care in the health system:
Demonstrate the range of duties performed by
the family physician in the health care system.
1.5 Balancing competing demands: Carry
out professional duties in the face of multiple,
competing demands.
1.6 Complexity and uncertainty: Recognize
and respond to the complexity, uncertainty, and
ambiguity inherent in medical practice.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Key CompetencyEnabling Competency
Clinical care
FAM2 – Perform a patient-centred 2.1 Prioritizing: Effectively and selectively identify, assess, and
clinical assessment with the goal of prioritize main presenting symptom(s) in a patient encounter.
establishing a management plan
2.2 Establishing urgency: Recognize a patient with a serious
acute, urgent, emergent, potentially life threatening condition
and act promptly.
Domain-specific content
regarding common (key)
conditions, urgent/emergent
conditions, and undifferentiated
symptoms is provided in Life Cycle
and Special Topics sections
2.3 Assessment: Elicit a history, perform a physical exam, select
appropriate investigations and interpret results for the purpose
of diagnosis.
• History: Take an appropriately focused history regarding the
presenting problem
• Red flag: Elicit pertinent associated symptoms, red flags, and
risk factors
• Physical: Perform an appropriately thorough physical
examination in a timely manner
• Differential diagnosis: Construct an appropriately thorough
differential diagnosis that is congruent with data generated by
the history and physical, and that considers not only prevalence
of the condition in the population, but also serious or life
threatening conditions
• Selecting investigations: Select investigations based on
consideration of prevalence, evidence of benefit and risk,
patient’s wishes, and cost
• Interpreting results: Interpret the test results promptly
and correctly
• Communicating results: Communicate results in a
timely fashion
2.4 Patient perspective: Solicit the patient’s perspective
and establish goals of care in collaboration with patients and
their families.
• IFFE: Solicit patient’s ideas, feelings, impact on function, and
expectations
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Key CompetencyEnabling Competency
Clinical care
FAM2 – Perform a patient-centred
clinical assessment with the goal
of establishing a management
plan (cont’d)
Key CompetencyEnabling Competency
Clinical care
2.5 Management plan: Establish a patient-centred
management plan.
• Prescribing: Plan and arrange pharmacologic
treatments that address key principles of good
prescribing practice
• Non-pharmacologic interventions: Integrate
non-pharmacologic interventions into
management plans
• Follow up: Establish an appropriate schedule for
reassessment of the condition
FAM4 – Demonstrate an effective
approach to the ongoing care of
patients with chronic conditions
and/or to patients requiring
regular follow up
Domain-specific content regarding
chronic conditions and
conditions regarding regular follow
up is provided in Life Cycle and Special
Topics sections
4.1 Screening: Screen for and identify patients with
chronic disease.
4.2 Monitoring: Monitor for complications of common
chronic diseases.
4.3 Patient perspective: Solicit the patient’s perspective and
establish goals of care in collaboration with patients and
their families.
4.4 Patient education: Educate the patient about their chronic
disease and empower patient to take some ownership of
the disease.
4.5 Management plan: Establish a patient-centred management
plan that integrates an interprofessional approach.
FAM3 – Provide comprehensive
preventative care throughout the
life cycle, incorporating strategies
that modify risk factors and detect
disease in early treatable stages
Domain-specific content regarding
preventative care and periodic
health exams is provided in Life
Cycle and Special Topics sections
3.1 Screening and prevention: Apply current
evidence-based guidelines for health promotion,
screening, and disease prevention for different
groups of patients by age and sex.
3.2 Health promotion: Work with patients and
their families to increase their opportunities
to adopt healthy behaviours (e.g., exercise,
healthy eating).
3.3 Risk reduction: Recognize modifiable risk
behaviours and provide advice on risk reduction.
• Targets: Report the correct treatment targets for common
chronic diseases as recommended by the most relevant clinical
practice guidelines
• Prevention: Integrate health promotion and prevention into a
management plan
• Pharmacotherapy: Recommend pharmacotherapy when
appropriate for alleviating symptoms, achieving treatment
targets, or preventing complications
• Lifestyle interventions: Propose that the patient set small,
achievable lifestyle goals to maximize their ability to control
their disease
• Interprofessional care: Work with other health professionals
to integrate care for individual patients or groups of patients
3.4 Periodic health examination (PHE):
Perform all components of a complete periodic
health examination.
• Adapting PHE: In a proactive or opportunistic
manner, selectively adapt the periodic
health examination to the patient’s specific
circumstance(s)
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Key CompetencyEnabling Competency
Coordination of patient care
Clinical care
FAM5 – Perform family medicine
specialty-appropriate procedures
to meet the needs of individual
patients.
A complete list of family medicine
specialty-specific procedures is
provided in Appendix B
Key CompetencyEnabling Competency
5.1 Selection: Determine the most appropriate
procedures.
• Contraindications: Identifies contraindications
to procedure.
• Own skill level: Recognizes own skill level in
performing procedure and refers if procedure
exceeds skill set
5.2 Consent: Obtain and document informed
consent, explaining the risks and benefits of, and the
rationale for, a proposed procedure.
5.3 Prioritize: Prioritize a procedure, taking into
account clinical urgency and the available resources.
FAM6 – Establish patient-centred
care plans that include the
patient, their family, other health
professionals, and consultant
physicians
6.1 Patient-centred care plans: Implement patient-centred care
plans that support ongoing care, follow up on investigations,
response to treatment, and further consultation or referral.
• Consultation & referrals: When indicated, make timely,
complete, and clear consultation requests or referrals to
colleagues
• Team-based care: Establish the roles and contributions of
physicians, other health care professionals, the patient, and his/
her family in the provision of patient-centred care plans that
support ongoing care, including follow up on investigations,
response to treatment, and further consultation
Patient safety
FAM7 – Actively participate, as
an individual or as a member of a
team providing care, in ensuring
and improving patient safety
7.1 Patient safety: Recognize and respond to harm from health
care delivery, including patient safety incidents.
7.2 Human and system factors: Adopt strategies that promote
patient safety and address human and system factors.
5.4 Performance: Prepare and perform procedures
in a skillful and safe manner, adapting to
unanticipated findings or changing
clinical circumstances.
5.5 Aftercare: Develop a plan with the patient
for aftercare and follow up after completion of
a procedure.
5.6 Complications: Describe the normal
postoperative healing course and recognize and
manage common post-operative complications.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
COMMUNICATOR
Communication with patients and their families
Communication with patients and their families
FAM8 – Establish effective
professional relationships with
patients and their families (cont’d)
FAM8 – Establish effective
professional relationships with
patients and their families
8.1 Patient-centred approach: Communicate
using a patient-centred approach that
encourages patient trust and autonomy,
and is characterized by empathy, respect,
and compassion.
• Children: Adapt communication methods based on the age of
the child
• Elderly: Adapt interviews with elderly patients by adapting
personal communication style, the interview environment, and
visit content
8.2 Environment: Optimize the physical
environment for patient comfort, dignity, privacy,
engagement, and safety.
• Language barriers: Use appropriate strategies, including
use of translators, to minimize communication barriers
related language
8.3 Patient perspective: 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.
8.4 Non-verbal communication: Employ
non-verbal communication strategies to enhance
communication
8.5 Disagreements: Manage disagreements and
emotionally charged conversations.
8.6 Adapting communications: Adapt to the unique needs and
preferences of each patient and to his or her clinical condition
and circumstances.
• Low literacy: Use appropriate strategies to minimize
communication barriers in patients with low literacy (both
reading and numeracy literacy)
• Developmental delay: Identify specific communication
barriers in developmentally delayed populations and work
to reduce these
FAM9 – Elicit and synthesize
accurate and relevant information,
incorporating the perspectives of
patients and their families
9.1 Patient-centred interviewing: Use patient-centred
interviewing skills to effectively gather relevant biomedical and
psychosocial information.
9.2 Interview structure: Provide a clear structure for and manage
the flow of an entire patient encounter.
9.3 Corroborating information: Seek and synthesize relevant
information from other sources, including the patient’s family or
caregivers, with the patient’s consent.
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Key CompetencyEnabling Competency
Communication with patients and their families
FAM10 – Share health care
information and plans with
patients and their families
10.1 Sharing information: Share information
and explanations that are clear, accurate, and
timely, while checking for patient and
family understanding.
Key CompetencyEnabling Competency
Medical records
FAM12 – Document and share
written and electronic information
about the medical encounter to
optimize clinical decision-making,
patient safety, confidentiality,
and privacy
10.2 Disclosure: Disclose patient safety incidents
to patients and their families accurately and
appropriately.
FAM11 – Engage patients and their
families in developing plans that
reflect the patient’s health care
needs and goals
11.1 Facilitating communication: Facilitate
discussions with patients and their families in a way
that is respectful, non-judgmental, and culturally
safe.
11.2 Supporting decision making: Assist patients
and their families to identify, access, and make use
of information and communication technologies to
support their care and manage their health.
12.1 Documentation requirements: Document clinical
encounters in an accurate, complete, timely, and accessible
manner, in compliance with regulatory and legal requirements.
12.2 Record formats: Communicate effectively using a
written health record, electronic medical record, or other
digital technology.
12.3 Information sharing: Share information with patients
and others in a manner that respects patient privacy and
confidentiality and enhances understanding.
COLLABORATOR
Team-based care
FAM13 – Work effectively with
physicians and other colleagues in
the health care professions
13.1 Relationship: Establish and maintain positive relationships
with physicians and other colleagues in the health care
professions to support relationship-centred collaborative care.
• Own role: Clearly describe their roles and responsibilities to
other professionals
• Others’ roles: Clearly describe the roles and responsibilities of
other professionals within a health care team
11.3 Common ground: Use communication skills
and strategies that help patients and their families
make informed decisions leading to a shared plan
of care.
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• Team leader: Participate in a collegial process to designate
appropriate team leadership roles and, where appropriate,
demonstrate leadership in the health care team
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Key CompetencyEnabling Competency
FAM13 – Work with physicians and
other colleagues in health care
professions
13.2 Roles: Negotiate overlapping and shared
responsibilities with physicians and other colleagues
in health care professions in episodic and ongoing
care.
• Own role
• Others’ roles
• Team leader
Key CompetencyEnabling Competency
LEADER/MANAGER
Quality improvement
FAM15 – Contribute to the
improvement of health care
delivery in teams, organizations,
and systems
15.2 Culture of safety: Contribute to a culture that promotes
patient safety.
13.3 Team communication: Demonstrate clear and
effective communication (both written and verbal)
with physicians and other colleagues in health care
professions.
13.4 Shared decision making: Engage in respectful
shared decision making with physicians and other
colleagues in the health care professions.
FAM14 – Hand over the care of
a patient to another health care
professional to facilitate
continuity of safe patient care
14.1 Timing of transfers: Determine when care
should be transferred to another physician or health
care professional.
14.2 Safe transfers: Demonstrate safe hand over of
care, using both verbal and written communication,
during a patient transition to a different health care
professional, setting, or stage of care.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
15.1 Application of quality improvement: Apply the science
of quality improvement to contribute to improving systems of
patient care.
15.3 Adverse events: Analyze adverse events and near misses
to enhance systems of care.
Informatics
FAM16 – Organize and manage
patient information in an EMR to
manage individual patient and
practice population care
16.1 EMR in the office visit: Effectively integrate the electronic
medical record (EMR) into the office visit.
• Impact of EMRs on communication: Demonstrate how
EMRs can support effective communication while recognizing
and self-correcting usage that negatively impacts on the
doctor-patient relationship
16.2 EMR and individual patient care: Use appropriately
organized information in the EMR to plan individual
patient care.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Informatics
Leadership
FAM16 – Organize and manage
patient information in an EMR to
manage individual patient and
practice population care (cont’d)
16.3 EMR for care of populations:
Demonstrate how data can be extracted and
used to improve the management of a practice
population.
FAM18 – Demonstrate leadership
in professional practice
• Meetings: Chair or participate effectively in committees
and meetings
• Administrative roles: Participate in relevant administrative
roles related to clinical care
• Practice profile: Define the nature of one’s
clinical population through the use of various
electronic data sources
• Comparing: Use informatics tools to reflect
on and evaluate one’s practice population and
practice activities in comparison to evidence
and practice norms
18.1 Leadership: Demonstrate leadership skills to enhance
health care and/or health education.
18.2 Facilitating change: Facilitate change in health care to
enhance services and outcomes.
Career and practice
Resources
FAM17 – Engage in the
stewardship of health care
resources
17.1 Resource allocation: Allocate health
care resources for optimal patient care, including
referral to other health care professionals and
community resources.
FAM19 – Manage practice and
career effectively
19.1 Setting priorities: Set priorities and manage time to
integrate practice and personal life.
19.2 Practice management: Manage career planning, finances,
and human resources in a practice.
• Insurance needs
17.2 Cost-appropriate: Apply evidence and
management processes to achieve costappropriate care.
• Finance and debt management
• Cost-appropriate investigations
• Legal issues
• Cost-appropriate referrals
• Practice options
• Cost-appropriate prescribing
• Income streams and billing
• Accounting support
• Overhead requirements
• Medical record options
• Office set up
• Human resource plan
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Key CompetencyEnabling Competency
Career and practice
FAM20 – Implement processes
to ensure personal practice
improvement
Key CompetencyEnabling Competency
Advocacy for patients and communities
20.1 Practice improvement: Participate in
implementing personal practice improvement
processes to achieve the goals of the CFPC Patient
Medical Home. 10
FAM22 – Respond to the needs
of the communities they serve
by advocating with them for
system-level change in a socially
accountable manner
22.1 Determinants of health of communities: Work with their
community to identify vulnerable or marginalized populations
and the determinants of health that affect them, including
barriers to accessing care and resources.
• Communities served: Describe the practice communities they
serve and their specific needs
• Aboriginal populations: Identify Aboriginal populations they
serve and their specific needs
• Vulnerable populations: Identify vulnerable or marginalized
populations they serve and their specific needs
HEALTH ADVOCATE
Advocacy for patients and communities
FAM21 – Respond to an individual
patient’s health needs by
advocating with the patient
within and beyond the clinical
environment
21.1 Determinants of health of individuals:
Work with patients to address determinants of
health that affect them and their access to needed
health services or resources.
• Community resources: Demonstrate awareness
of community resources to help support patients;
recognize the indications for these services and
advocate effectively
• Barriers to care: Identify barriers that prevent
patients from accessing health care, including
financial, cultural, or geographical
10
22.2 Improving health of communities: Contribute to a process
to improve health in the community or population they serve.
• Advocacy: Identify opportunities for advocacy, health
promotion, and disease prevention in the communities they
serve and respond appropriately
• Approaches to change: Describe approaches to implementing
changes in the determinants of health of the population served
and points of influence within the health care system
• Policy: Describe how public policy, health care delivery and
health care financing impact access to care and the health of
the population served
• Role of the profession: Describe the role of the medical
profession in advocating collectively for health and
patient issues
• Ethical issues in advocacy: Describe ethical and professional
issues inherent in health advocacy (altruism, social justice,
autonomy, integrity, idealism) and the possibility of conflict
inherent in the role of health advocate and that of manager
College of Family Physicians of Canada. A Vision for Canada: Family Practice - The Patient’s Medical Home. Position Paper. September
2011. Share 2011 Sep - See more at: http://www.cfpc.ca/A_Vision_for_Canada/#sthash.xR0hOd0a.dpuf
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Key CompetencyEnabling Competency
Best evidence
SCHOLAR
Lifelong learning
FAM23 – Engage in the continuous
enhancement of their professional
activities through ongoing
learning and reflection
Key CompetencyEnabling Competency
23.1 Personal learning plan: Develop, implement,
monitor, and revise a personal learning plan to
enhance professional practice.
• Principles of CPD: Describe principles of
continuous professional development (CPD) and
the CFPC Mainpro+ framework
• Selecting objectives: Set SMART (specific,
measurable, attainable, relevant, time-bound)
objectives to address identified learning needs
FAM24 – Integrate best available
evidence, contextualized to
specific situations, into real time
decision making
24.1 Identifying learning gaps: Recognize practice uncertainty
and knowledge gaps in clinical (and other professional)
encounters, and generate focused questions that can
address them.
24.2 Pre-appraised information: Demonstrate proficiency in
identifying, selecting, and navigating pre-appraised resources.
• Accessing information: Access and navigate scholarly sources
of information
• Knowledge management: Develop a system to store and
retrieve relevant educational material
• Selecting and engaging in activities: Select and
engage in learning activities
• Scanning: Use evidence alerting services or electronic
knowledge dissemination services
• Integration of learning: Integrate new learning
into practice
24.3 Selecting sources of information: Select and critically
evaluate the integrity, reliability, and applicability of healthrelated research and literature.
• Reflection: Reflect on the impact of learning
• Asking good questions: Formulate a well-structured question
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23.2 Assessing performance: Identify
opportunities for learning and improvement by
regularly assessing their performance using various
internal and external data sources.
• Selecting information: Select sources of information
23.3 Collaborative learning: Engage in
collaborative learning to continuously improve
personal practice and contribute to collective
improvements in practice.
24.4 Integrating evidence: Integrate evidence into decision
making in their practice.
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
• Interpreting findings: Interpret study findings, assess validity
and study design
• Applicability: Evaluate applicability
• Guidelines: Review and appropriately apply guidelines from
organizations such as Health Canada, CFPC, and relevant
specialty societies
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Research
Teaching
FAM25 – Contribute to the
creation, dissemination,
application, and translation of
new knowledge and practices
25.1 Principles of research: Demonstrate an
understanding of the scientific principles of research
and scholarly inquiry, and the role of research
evidence in contemporary family medicine.
FAM26 – Facilitate the learning of
26.1 Role modelling: Recognize the power of role modelling.
students, residents, the public,
and other health care professionals
26.2 Learning environment: Promote a safe
learning environment.
25.2 Ethical principles: Describe ethical principles
for research in family medicine.
26.3 Identifying learning needs: Collaboratively identify
learning needs and desired learning outcomes.
25.3 Research concepts: Describe the approach to
research methods and outline statistical concepts
and epidemiological concepts used in family
medicine research.
25.4 Engaging in scholarly activities:
Apply research concepts in the process of
engaging in quality improvement.
25.5 Communicating findings: Summarize and
communicate the findings of relevant research and
scholarly inquiry.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
26.4 Ethics in teaching: Describe the principles of ethics with
respect to teaching, and ensure that patient safety is maintained
when learners are involved.
26.5 Teaching activities: Demonstrate effective learner-centred
teaching and reflect on the teaching encounter.
26.6 Feedback: Provide effective feedback to enhance learning
and performance.
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Key CompetencyEnabling Competency
Key Competency Enabling Competency
PROFESSIONAL
PROFESSIONAL
Commitment to patients, society, and the profession
Commitment to patients, society, and the profession
FAM27 – Demonstrate a
commitment to patients by
applying best practices and
adhering to high ethical
standards
27.1 Professional behaviours: Exhibit appropriate
professional behaviours and relationships in all aspects
of professional practice, reflecting honesty, integrity,
commitment, compassion, respect, altruism, respect for
diversity, and maintenance of confidentiality.
FAM27 – Demonstrate a
commitment to patients by
applying best practices and
adhering to high ethical
standards (cont’d)
• Care and compassion: Demonstrate a caring and
compassionate manner
27.5 E-communication: Exhibit professional behaviours in the
use of technology enabled communication.
• Respect of colleagues: Engage in respectful
shared decision making with physicians and other
colleagues in the health care profession
• Reliability: Ensure day-to-day behaviour reassures
one that the physician is responsible, reliable, and
trustworthy
27.3 Ethical issues: Recognize and respond to ethical issues
encountered in practice.
27.4 Conflicts of interest: Recognize and manage conflicts
of interest.
• Respect for patients and boundaries: Demonstrate
respect for the patient and ensure an appropriate
respect for boundaries at all times
• Comfort and dignity: Take steps to ensure patient
comfort and dignity at all times during exams or
procedures
27.2 Excellence: Demonstrate a commitment to excellence, and
be guided by evidence in all aspects of practice.
FAM28 – Demonstrate a
commitment to society by
recognizing and responding to
societal expectations in
health care
28.1 Accountability: Demonstrate accountability to patients,
communities, society, and the profession by responding to
societal expectations of physicians.
• Flexibility: Demonstrate a flexible, openminded approach that is resourceful and deals with
uncertainty
• Confidence: Evoke confidence without arrogance,
and do so when needing to obtain further
information or assistance
• Knowing limits: Recognize his/her limits of clinical
competencies and seeks help appropriately
• Confidentiality: Demonstrate adherence to
confidentiality constraints and Manitoba’s Personal
Health Information Act (PHIA)
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Key CompetencyEnabling Competency
Commitment to patients, society, and the profession
FAM29 – Demonstrate a
commitment to the profession
by adhering to standards and
participating in physician-led
regulation
29.1 Adherence to codes: Fulfill and adhere to the
professional and ethical codes, standards of practice,
and laws governing practice.
29.2 Professional behaviour: Engage in respectful
and collegial relationships with collaborators.
29.3 Unprofessional behaviour: Recognize and
respond to unprofessional and unethical behaviour
in physicians or other colleagues.
29.4 Peer assessment: Participate in peer
assessment and standard setting.
FAM30 – Demonstrate a
commitment to physician health
and well-being to foster optimal
patient care
30.1 Well-being: Exhibit self-awareness and
manage influences on personal well-being and
professional performance.
• Know limits: Recognize one’s own limits and seek
help appropriately
• Mindful approach: Understand how one’s
attitudes impact interactions
• Reflect on practice events: Reflect on practice
events to deepen self-knowledge
30.2 Work/life balance: Manage personal and
professional demands for a sustainable practice
throughout the physician life cycle.
30.3 Supporting colleagues: Promote a culture
that recognizes, supports, and responds effectively
to colleagues in need.
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Maternal Care Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
Pre-conception and prenatal care
FAMILY MEDICINE EXPERT
Pre-conception and prenatal care
MAT1 – Provide pre- and early
pregnancy counselling
1.1 Pre-conception counselling: Provide care
for pre-pregnancy planning, including addressing
issues such as lifestyle, exercise, dietary options/
suggestions (e.g., folate, vitamin D, multivitamin
use), environmental factors (e.g., smoking, pets,
infectious diseases, alcohol, radiation, or chemical
exposures), teratogenic medications (including
isotretinoin, angiotensin converting enzyme
[ACE] inhibitors, misoprostol/diclofenac) and antiepileptic medications.
1.2 Pre-conception vaccination: Offer prepregnancy immunizations (e.g., measles-mumpsrubella for non-immune women, influenza
vaccination to protect women when pregnant).
1.3 Work issues relevant to pregnancy: List
exposures (work/home toxins, mutagens,
infections e.g., parvovirus) needing to be
managed and employment and maternity
leave issues pertinent to patients who intend to
become pregnant or who are pregnant.
1.4 Infertility and repeat pregnancy loss:
Provide support and perform initial investigation
regarding infertility and repeat pregnancy losses.
MAT2 – Confirm and date
pregnancies
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Key CompetencyEnabling Competency
2.1 Confirmation and dating: Confirm and date
pregnancies accurately, and if dates are uncertain,
consider ordering an early dating ultrasound.
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
MAT3 – Perform early pregnancy
counselling
3.1 Family structure and dynamics: Assess family structure,
family dynamics (including between partners), and stresses and
support facing the pregnant patient.
3.2 Pregnancy desirability: Establish the desirability of the
pregnancy in a patient with suspected or confirmed pregnancy.
Ascertain whether the pregnancy is planned or unplanned.
3.3 Pregnancy options: Demonstrate an open-minded and
non-judgmental attitude when discussing all pregnancy options,
including pregnancy termination and adoption.
MAT4 – Plan comprehensive
prenatal care to low-risk female
patients
4.1 Prenatal visits (schedule, purpose): Plan an appropriate
prenatal visit schedule for a pregnant patient, and outline the
purpose of each visit.
4.2 Common prenatal office-based manoeuvres: Perform
and interpret key pregnancy-related office-based screening
questions, examination techniques, and investigations to screen
for conditions relevant to maternal and fetal well-being, including
fetal movement counts, symphysis fundal height, maternal
weight, and use of Doppler to assess fetal heart rate.
4.3 Pregnancy risk stratification: Describe maternal and fetal
criteria for a pregnancy to be considered “low risk,” and criteria for
pregnancy to be considered “high risk” and requiring obstetrical
specialty consultation.
4.4 Prenatal screening: Counsel patients on common tests
ordered in pregnancy including Integrated Prenatal Screening
(IPS) tests, genetic screening, ultrasounds, and other screening
tests including laboratory investigations.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Pre-conception and prenatal care
Pre-conception and prenatal care
MAT5 – Manage concurrent
medical conditions in pregnant
patients
MAT6 – Identify, evaluate, and
manage early pregnancy
problems
5.1 Manage chronic concurrent medical
conditions in pregnancy: Appropriately manage
ongoing medical issues (e.g., diabetes, hypertension,
hypothyroidism, asthma, inflammatory bowel
disease, epilepsy, cardiac conditions, and
depression) whose management may affect or
be affected by pregnancy. Refer to specialist
colleagues as appropriate.
6.1 Nausea and vomiting of pregnancy: Assess
and manage nausea and vomiting of pregnancy.
6.2 Ectopic pregnancy: Identify ectopic pregnancy
and appropriately refer for management.
6.3 First trimester bleeding: Diagnose and
manage first trimester bleeding appropriately
(including threatened and missed abortions).
For patients who experience miscarriage, offer
empathic, supportive counselling, advice, and
management plan.
6.4 Rh status: Diagnose Rh status and counsel
women on role of Rh status. Manage Rh-negative
status including discussion of benefits and risks of
RhoGAM or WinRho.
MAT7 – Identify, evaluate, and
manage late pregnancy problems
7.1 Abnormal lie: Describe and diagnose an
abnormal lie (including transverse lie). Propose
appropriate management plan for abnormal lie.
7.2 Breech presentation: Describe management
plan for breech presentation.
MAT7 – Identify, evaluate, and
manage late pregnancy problems
(cont’d)
7.3 IUGR: Describe characteristics of Intrauterine Growth Retardation
(IUGR), its diagnosis, prevention, and management.
7.4 Gestational hypertension: Describe approach to diagnosis
and management of gestational hypertension/pregnancy-induced
hypertension, including pre-eclampsia.
7.5 Placenta position: Recognize significance, including risks of
placenta and placenta previa, and describe approaches to counselling
and managing these patients.
7.6 GDM: List risk factors for Gestational Diabetes Mellitus (GDM). Order
screening tests for GDM, and list implications (for mother and baby) of
GDM in the long-term care of the patient and postpartum follow-up of
affected individuals.
7.7 Manage acute maternal infections during pregnancy: Describe
key infections that might affect the pregnancy (e.g., TORCH infections
[toxoplasmosis, other – syphilis, varicella-zoster, parvovirus B19, rubella,
cytomegalovirus, herpes infections], listeria, influenza, varicella, urinary tract
infections, bacterial vaginosis, and Group B strep infections), how to prevent
these infections, and how to appropriately manage the infections when
they are acquired.
7.8 STIs in pregnancy: Screen, diagnose, and manage sexually transmitted
infections (STIs) in pregnancy.
7.9 Antepartum hemorrhage (APH): Recognize, diagnose, and manage
antepartum hemorrhage appropriately and in a timely fashion.
7.10 Premature rupture of the membrane (PROM): Describe approach
to diagnosis and management of premature rupture of membranes.
7.11 Preterm labour: Counsel patients on preterm labour and how to
recognize and manage this appropriately.
7.12 Post-dates: Describe an approach to managing postdate pregnancies,
including indications for fetal assessment and induction.
7.13 VBAC: Counsel patients on vaginal birth after cesarean section and
refer when indication
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Intrapartum
Intrapartum
MAT8 – Confirm, monitor, and
manage labour
8.1 Stages of labour: List and describe different
stages of labour.
MAT10 – Manage obstetrical
emergencies
8.2 Fetal membranes: Assess for spontaneous
rupture of membranes.
10.2 Nuchal cord: Recognize and manage a nuchal cord at
delivery.
8.3 Cervical assessment: Perform vaginal
examination for cervical status (position,
effacement, cervical dilation), fetal station, and
position.
10.3 Prolapsed umbilical cord: Describe an approach to
recognizing and providing emergency management for a
prolapsed umbilical cord.
10.4 Intrapartum fever and infection: Choose appropriate
cultures to perform, and manage acutely and empirically
if necessary. Manage prolonged rupture of membranes
appropriately.
8.4 Analgesia during labour: Describe different
forms of pharmacologic (including epidural) and
non-pharmacologic means to control pain and
discomfort during labour and delivery.
10.5 Retained placenta: Recognize retained placenta and
describe techniques to remove a retained placenta (including
manual removal). Perform manual removal of placenta
(ADVANCED)
8.5 Fetal surveillance: Perform basic fetal
surveillance, including intermittent auscultation
and electronic fetal monitoring, including scalp
electrode placement. Recognize concerning
patterns and respond appropriately to these.
10.6 Postpartum hemorrhage (PPH): Describe risk factors
and approach to diagnosis, prevention, and management of
immediate and later postpartum hemorrhage.
8.6 Failure to progress: Describe risk factors for an
abnormal or difficult childbirth or labour. Recognize
failure to progress and, when appropriate, treat
by non-pharmacologic means and pharmacologic
means (with consultation - BASIC, independantly ADVANCED).
8.7 Induction: Manage induction for ruptured
membranes at term or postdates including the use
of cervical ripening, amniotomy, and oxytocin (with
consultation - BASIC, independantly - ADVANCED).
MAT9 – Manage spontaneous
vaginal delivery
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10.1 Shoulder dystocia: Recognize and manage shoulder
dystocia (including request for assistance).
9.1 Manage delivery: Manage spontaneous
term singleton vertex delivery and immediate
care and aftercare of mother and baby.
VBAC delivery (with consultation - BASIC)
Twin delivery (with consultation -ADVANCED)
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
10.7 Breech management: Recognize and manage pre-partum
breech presentation with appropriate referral. Explain the
management of an emergency vaginal breech presentation.
10.8 Support of newborn: Anticipate and prepare for the at-risk
or depressed newborn.
MAT11 – Perform episiotomy and
perineal repair
11.1 Episiotomy: Describe the indications for an episiotomy and
perform one as required.
11.2 Perineal injury: Assess the degree of perineal injury.
11.3 Repair: Repair an uncomplicated 1st or 2nd degree
laceration, or episiotomy (BASIC). Repair a 3rd degree tear
(ADVANCED)
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Intrapartum
MAT14 – Engage patients and their 14.1 Birth plans: Understand the role of “birth plans,” review with
families in developing birth plans
patients, and communicate it to other health care team members.
that reflect the patient’s health
14.2 Cultural safety: Facilitate discussions with patients and
care needs and goals
their families in a way that is respectful, non-judgmental, and
culturally safe.
MAT12 – Participate in operative
delivery
12.1 Assisted vaginal delivery: Describe
indications and contraindications for use of an
outlet vacuum or forceps assistance for a low
assisted vaginal delivery. Perform vacuum assisted
delivery as indicated (BASIC). Perform outlet forceps
delivery (ADVANCED)
12.2 Caesarian section: Describe indications for
Caesarian section. Provide assistance at Caesarian
section.
Postpartum
MAT13 – Provide basic postpartum 13.1 Anticipatory guidance: Provide anticipatory
care in both hospital and office
guidance regarding common maternal concerns.
environments
13.2 Breastfeeding: Encourage breastfeeding,
develop strategies to promote this, prevent
breastfeeding difficulties, and help women with
breastfeeding difficulties.
14.3 Information technology and decision making: Assist
patients and their families to identify, access, and make use of
information and communication technologies to support their
care and manage their health.
14.4 Consumer health information: Analyze consumer health
information that is evidence-based. Be able to review such
information with patients.
14.5 Common ground: Use communication skills and strategies
that help patients and their families make informed decisions
leading to a shared plan of care.
13.3 Postpartum medical complications:
Diagnose and manage key maternal postpartum
complications, including pain, fever, urine retention,
bleeding, delayed hemorrhage, infections, uterine
rupture.
13.4 Postpartum visits: At postpartum visits,
demonstrate an organized approach to following up
maternal complications during the pregnancy and
providing preventative care.
13.5 Mood postpartum: List risk factors for
postpartum depression. Screen for, assess, and
manage postpartum support and depression (using
common tools such as depression screening scales).
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Care of Children and Adolescents Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
Neonatology
COC1 – Demonstrate an approach
to neonatal resuscitation
1.1 Neonatal distress: Recognize newborns requiring respiratory
support, and other serious conditions that require higher level
neonatal support.
1.2 APGAR: Determine APGAR (appearance, pulse, grimace,
activity, respiration) score.
1.3 NPR (Neonatal Resuscitation Program): Perform basic
neonatal resuscitation.
COC2 – Perform a comprehensive
assessment of the newborn
2.1 Neonate common physical findings: Recognize common
physical findings or congenital abnormalities in the newborn (e.g.,
cardiac murmur, un-descended testes, hypospadias, ambiguous
genitalia, benign neonatal rashes, congenital skin lesions, hip
abnormalities, genitor-urinary tract abnormalities, absent red
reflex).
2.2 Neonatal jaundice: Demonstrate a logical approach to the
diagnosis and management of jaundice in the newborn.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Neonatology
Children
COC2 – Perform a comprehensive
assessment of the newborn
(cont’d)
2.3 Serious neonate conditions: Diagnose,
investigate, and manage (including arrangement
of timely referral) for common and serious neonatal
conditions.
• hypoglycemia
• respiratory distress
• small for gestational
age (SGA)
• vomiting in newborn
period
• large for gestational
age (LGA)
• sepsis
• infants born to febrile
mother
• infants born to GBS
positive mother
• infants born to
hepatitis B positive
mother
• hypotonia
• failure to thrive/
dehydration
• neonatal abstinence
syndrome
• temperature instability
COC3 – Provide periodic health
exams and preventative care to
infants and children
3.1 Screening: Demonstrate skill in the use of common
preventative screening tools.
3.2 Growth curves: Collect, record, and interpret biometric
measures for newborns, children, and adolescents.
3.3 Nutrition: Assess and screen for appropriate nutritional intake
and intervene appropriately.
3.4 Development: Provide effective advice to parents to
encourage motor, language, and social development.
3.5 Prevention: Develop and demonstrate practical approaches
to delivering rapid, effective, and evidence-based preventative
care advice and guidance on the following topics:
• car seat use
• coping with crying
• bicycle safety
• sleep advice and night
wakening
• burn and injury prevention
• drowning
2.4 Routine newborn discharge issues:
Demonstrate appropriate routine neonatal care
and discharge instructions (e.g., breastfeeding
advice, neonatal screening including hearing, sleep
position, and safety, monitoring hydration/weight
gain, vitamin D supplementation, car seats), and
recommend timely and adequate post-discharge
care.
• choking prevention
• discipline and parenting/
discipline
• sleep position
• toilet training
• second-hand smoke effects
• sun protection
• ankyloglossia (tongue tie)
• pacifier use
• positional (occipital)
plagiocephaly
• tooth eruption schedule and
dental care advice
2.5 Transferring neonates: Demonstrate an
understanding of the principles of stabilizing and
preparing a neonate for transport.
• colic
• fever assessment and
management
• prevention of shaken baby
syndrome
• firearm safety
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• swaddling
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
• crib safety
• use of insect repellants
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Key CompetencyEnabling Competency
Children
COC3 – Provide periodic health
exams and preventative care to
infants and children (cont’d)
3.6 Physical activity: Recommend a safe and
effective stage-specific exercise program for
children.
3.7 Screening lab tests: Describe common
screening tests performed in newborns and
children, their rationale, and implications for parents
and children tested.
3.8 Immunization: Administer an organized
vaccination program within family practice,
including routine vaccinations and those for travel
and special populations.
3.9 History and physical examination of children:
Perform an age appropriate newborn and well
child exam.
Key CompetencyEnabling Competency
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions
5.1 Fever and infection in children: Describe a family medicinecentred approach to fever and diagnose and manage key
pediatric infectious conditions.
a) Approach to fever: Describe an age-specific approach to
diagnosing fever in children and appropriate use of anti-pyretics.
b) Key infectious conditions: Describe an approach to the
diagnosis and management of infectious conditions in children.
• gastroenteritis
• pertussis
• chicken pox
• varicella
• fifth disease
• otitis
• hand, foot, and mouth
disease
• pneumonia
• measles
• conjunctivitis
• rubella
Adolescents
• strep throat
COC4 – Provide periodic health
exams and preventative care to
adolescents
• scarlet fever
4.1 Physical changes of adolescence:
Appropriately assess the physical development of
adolescents (Tanner staging).
4.2 Teen risk behaviours and teens at risk: Assess
risk behaviours in teens (HEADSSS approach - home,
education, alcohol, drugs, smoking,
sex, suicide).
• cellulitis
• lice
• scabies
• warts
• pinworms
c) Infections and daycare exclusion: For infectious conditions,
develop an awareness of routes of transmission, periods of
contagion, and appropriate period of school/daycare exclusion.
d) Reportable conditions: Demonstrate strategy of referring
reportable diseases to public health officials.
4.3 Adolescents preventative advice: When caring
for adolescents, actively inquire about and counsel
regarding substance abuse, peer issues, bullying,
home environment, diet/eating disorders, academic
performance, social stress/mental illness, sexuality,
STIs, contraception, and sexual orientation.
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Key CompetencyEnabling Competency
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions (cont’d)
5.2 Allergies in children: Diagnose and manage
key pediatric allergy conditions.
• food allergies
• environmental allergies
• drug allergies
• anaphylaxis
• allergic rhinitis
• allergic conjunctivitis
Key CompetencyEnabling Competency
COC5 – Perform patient-centered
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions
5.4 Head and neck conditions in children: Diagnose and
appropriately manage key pediatric head and neck conditions.
• dental problems
• epistaxis
• hearing loss
• stomatitis
• otitis externa
• pharyngitis
• otitis media
• mononucleosis
• foreign body ear/nose
• cerumen
• serous otitis media
• plagiocephaly
• sinusitis
5.3 Skin conditions in children: Diagnose and
manage key pediatric skin conditions.
5.5 Eye conditions in children: Diagnose and manage key
pediatric eye conditions.
• conjunctivitis
• seborrheic dermatitis
• candidiasis
• corneal abrasion
• cradle cap
• impetigo
• decreased visual acuity
• erythema toxicum
neonatorum
• cellulitis
• strabismus
• milia
• plantar warts and
common warts
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• naso-lacrimal duct
obstruction
• preorbital and orbital
cellulitis
• urticaria
• erythema multiforme
• petechiae
5.6 Endocrine conditions in children: Diagnose and manage key
pediatric endocrine conditions.
• diaper dermatitis
• purpura
• type 1 diabetes
• adrenal insufficiency
• atopic dermatitis
• erythema nodosum
• early type 2 diabetes
• obesity
• acne
• erythema migrans
• diabetic ketoacidosis
• pubertal disorder
• viral exanthems
• cafe au lait spots
• hypothyroidism
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions (cont’d)
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions (cont’d)
5.7 Respiratory conditions in children: Diagnose
and manage key pediatric respiratory conditions.
• upper respiratory tract infections
5.9 Gastrointestinal concerns in children: Diagnose and
manage key pediatric gastrointestinal conditions.
• abdominal pain
• pyloric stenosis
• vomiting
• Meckel’s diverticulum
• bronchiolitis
• diarrhea
• hernias
• post-viral cough
• rectal bleeding
• constipation
• pneumonia
• failure to thrive
• encopresis
• asthma
• volvulus
• celiac disease
• obstruction
• gastroesophageal reflux
• appendicitis
• lactose intolerance
• intussusception
• colic
• croup
5.8 Cardiovascular concerns in children: Diagnose
and manage key pediatric cardiac conditions.
• innocent murmurs
• valvular disorders
• acyanotic health disease (VSD, PDA, coA)
• acyanotic heart disease/CHF
• arrhythmia
• hypertension
5.10 Renal, urologic, and genitourinary issues in children:
Diagnose and manage key pediatric renal, urologic, and
genitourinary conditions.
• urinary tract infections
• testicular torsion
• vulvo-vaginitis
• labial adhesions
• enuresis
• balanitis
• phimosis/paraphimosis
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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Key CompetencyEnabling Competency
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions (cont’d)
5.11 Neurologic conditions in children: Diagnose
and manage key pediatric neurologic conditions.
• headaches
• febrile seizures
Key CompetencyEnabling Competency
COC5 – Perform patient-centred
clinical assessment and manage
children and adolescents
presenting with common (key)
conditions
5.14 Sexuality, contraception issues in children: Develop an
approach to issues related to child and adolescent sexuality and
contraception counselling.
5.15 Abuse in children: Recognize signs of physical, sexual, and
emotional abuse in children.
• epilepsy
• concussion
a) Domestic violence and children: Recognize the impact of
domestic violence on children and adolescents, and recognize
the signs and symptoms of abuse in children (including sexual,
emotional, and physical abuse).
5.12 Hematological conditions in children:
Diagnose and manage key pediatric hematological
conditions.
b) Child protection: Demonstrate knowledge of child protection
issues including identification and management of suspected
and confirmed child abuse. Describe a doctor’s responsibility of
reporting to child protection services.
• anemia
• sickle cell anemia
• ITP
• bleeding disorders
5.13 Musculoskeletal conditions in
children: Diagnose and manage key pediatric
musculoskeletal conditions.
• limp
• intoeing
• scoliosis
• joint instability
• congenital hip
dislocation
• juvenile rheumatoid
arthritis
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• Henoch Schonlein
purpura
• septic arthritis
• fractures
• dislocations
• ligamentous tears
• sprains
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
COC6 – Diagnose and manage key
pediatric mental health issues
6.1 Context: Inquire about a child’s context (home, school,
recreational environments) and its effect on his or her mental
health, assess the child’s supports and stressors (such as bullying),
and intervene appropriately.
6.2 Parent-child problems: Recognize parent-child problems
and develop patient-centred approaches to dealing with
these conflicts.
6.3 Mood, psychotic, and other disruptive disorders: Diagnose
and manage mood disorders (anxiety, depression, obsessive
compulsive disorder), psychotic disorders (schizophrenia),
and conditions such as oppositional defiant disorder, conduct
disorder, and separation anxiety disorder, and treat and refer
appropriately.
6.4 Antidepressants: Develop awareness of controversies about
use of some antidepressants in children (e.g., suicide risk).
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Key CompetencyEnabling Competency
COC6 – Diagnose and manage
key pediatric mental health
issues (cont’d)
6.5 Substance use: Assess for alcohol, drug, and
tobacco use in teens.
6.6 Attention deficit disorder in children:
Diagnose and manage attention deficit
hyperactivity disorder (ADHD) in collaboration with
the child, parents, schools, and other professionals
(e.g., psychologists) as appropriate.
Key CompetencyEnabling Competency
COC7 – Recognize and
appropriately respond to
emergent conditions in
children and adolescents
7.1 Decreased level of consciousness: Assess decreased level
of consciousness using age appropriate tools (such as pediatric
Glascow Coma Scale), consider broad differential diagnosis
(infections, toxic ingestions, Diabetic Keto-Acidosis, other
metabolic problems, and non-accidental trauma), and manage
appropriately.
7.2 Poisoning: Demonstrate knowledge of the risks of child
poisoning, access to poison control and other information
databases, and recognize when urgent action must be taken.
6.7 Learning concerns: Address signs and
symptoms of developmental or behavioural
concerns.
7.3 Dehydration: List signs and symptoms of different stages of
dehydration, and how this differs over different child ages. Treat
appropriately with both oral and parenteral fluid resuscitation.
• developmental coordination disorder
7.4 Life threatening illnesses: Distinguish illness acuity and
identify and manage patients with life threatening illnesses such
as meningitis or sepsis.
• global developmental delay
• language delay
• learning disorder
• autism spectrum disorder
• fetal alcohol spectrum disorder
• ADHD (attention deficit hyperactivity disorder)
• cerebral palsy
COC8 – Assess, manage, and
follow up patients presenting
with undifferentiated symptoms
8.1 Undifferentiated illness in children: Describe how the
presentation and management of disease in children differs
from adults, specifically in diagnosis and management of nonspecific and undifferentiated complaints in children, such as
behaviour disturbance, sleep disturbance, failure to thrive, chronic
abdominal pain, and change in level of activity.
6.8 Eating disorders in children: Recognize the
high prevalence of eating disorders in adolescents
and diagnose and manage appropriately.
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Care of Adults Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
ADU1 – Perform adult periodic
health examinations that address
health promotion, screening, and
disease prevention
1.1 Screening, prevention: Apply current evidence-based
guidelines for health promotion, screening, and disease
prevention for different groups of patients by age and sex.
1.2 Periodic health examination (PHE): Perform all components
of a complete periodic health examination, including a review of
the patient’s profile (past medical history, family history, allergies,
medications, lifestyle issues such as exercise, alcohol, smoking,
and drugs), appropriate history, examination, counselling for
health promotion and disease prevention, screening manoeuvres,
and investigations by age and sex group.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
Adults
ADU2 – Assess, manage, and
follow up patients presenting with
undifferentiated symptoms
2.1 Patient-centred approach for
undifferentiated complaints: Recognize the
importance of using patient-centred interviewing
for all patients, especially those with common
undifferentiated complaints.
2.2 Approach to chest pain: Describe an
appropriate primary care approach to chest pain
that incorporates a system-based approach (i.e.,
musculoskeletal, cardiovascular, pulmonary,
gastrointestinal, neurogenic, psychiatric) and rules
out serious pathologies.
2.3 Approach to fatigue: Demonstrate an
appropriate approach to the diagnosis and
management of fatigue.
2.4 Approach to dizziness and vertigo:
Demonstrate an appropriate approach to the
diagnosis and management of dizziness
and vertigo.
2.5 Approach to cough: Demonstrate an
appropriate approach to the diagnosis and
management of cough.
2.6 Approach to unexplained weight loss:
Demonstrate an appropriate approach to the
diagnosis and management of unexplained
weight loss.
2.7 Approach to abdominal pain: Demonstrate
an appropriate approach to the diagnosis and
management of abdominal pain.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
ADU3 – Recognize and respond
appropriately to urgent and
emergent conditions in adults
3.1 Cardiac arrest: Demonstrate Advanced Cardiac Life
Saving (ACLS) skills and awareness of current resuscitation
recommendations. Using current protocols, promptly manage
a compromised airway, serious arrhythmias, and other acute
cardiovascular compromise. Participate in, and be prepared to
lead a patient’s resuscitation.
3.2 Acute coronary syndromes: Recognize typical and atypical
presentations of acute coronary syndromes (ACS), interpret
electrocardiograms and other investigations appropriately,
display knowledge of various treatments for ACS, and manage the
conditions acutely and in a timely fashion, while watching for and
responding to complications of the condition and the treatment.
3.3 Respiratory failure: Recognize, assess, and promptly manage
patients presenting with respiratory failure.
3.4 Anaphylaxis and allergic reactions: Recognize and
promptly manage an allergic reaction, including anaphylaxis.
3.5 Major burns: Describe the initial approach to the patient
presenting with major burns.
3.6 Seizures and status epilepticus: Recognize, assess, and
promptly manage the patient presenting with seizures, including
status epilepticus.
3.7 Dehydration and electrolyte disturbances: Recognize
the signs and symptoms of dehydration, assess the degree of
dehydration, and manage appropriately. Manage associated
electrolyte and acid-base disorders.
3.8 Shock: Recognize the signs and symptoms of shock and
initiate management.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
Adults
ADU3 – Recognize and respond
appropriately to urgent and
emergent conditions in adults
(cont’d)
3.9 Limb threatening injuries: Diagnose a fracture
or joint dislocation by examination and appropriate
use of diagnostic imaging, rule out life threatening
or limb threatening complications, provide
adequate analgesia, and appropriately immobilize
and/or reduce the fracture/dislocation in a timely
manner.
3.10 Altered mental status: Investigate loss of
consciousness to exclude serious and potentially
lethal causes by interviewing the patient and
witnesses, performing an appropriate physical
examination, and laboratory/diagnostic imaging
tests. Demonstrate an approach to loss of
consciousness that considers disorders of vascular
tone or blood volume, cardiovascular disorders, and
cerebrovascular disorders. Manage life threatening
causes and complications when appropriate, and
arrange for appropriate follow up.
3.11 Poisoning and toxin exposure: Recognize
cases of intentional and unintentional poisoning
caused by medication toxicity, chemical exposure
(including household and agricultural chemicals),
heavy metal poisoning, alcohol poisoning, common
herbal ingestions, and carbon monoxide toxicity.
Arrange appropriate investigations, monitoring,
and poison/toxicology treatment. Use resources
available (e.g., poison control centre, toxicology
management supports) and collaborate with
others (including dialysis teams, pharmacists) when
appropriate.
3.12 Stabilizing ill patients: Stabilize and
appropriately immobilize a victim of trauma and
prevent decline in a proactive way.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
ADU3 – Recognize and respond
appropriately to urgent and
emergent conditions in adults
(cont’d)
3.13 Prepare for transport: Recognize signs or symptoms when
a patient should be transported to another facility (by land or air),
manage patients with advice from specialists at a distance, and,
where appropriate, coordinate transfer and adequately stabilize
and prepare the patient for transport.
ADU4 – Perform patient-centred
clinical assessment and manage
adults presenting with common
(key) conditions
4.1 Fever and infectious conditions: Describe an approach to
fever and diagnose and manage key infectious conditions.
• fever of unknown origin
• cystitis and pyelonephritis
• pneumonia
• human immunodeficiency
virus (HIV)
• meningitis
• upper respiratory tract
infections
• appendicitis
• cholecystitis
• diverticulitis
• infectious diarrhea
• hospital acquired infections
• sexually transmitted
infections
• prostatitis
• epidymiditis
• soft tissue infections
• tuberculosis
4.2 Allergic conditions: Diagnose and manage key adult
allergy conditions.
• angioedema
• urticaria
• allergic rash
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
Adults
ADU4 – Perform patient-centred
clinical assessment and manage
adults presenting with common
(key) conditions (cont’d)
4.3 Skin conditions: Diagnose and manage key
skin conditions.
4.6 Endocrine conditions: Diagnose and manage key
endocrine conditions.
• type 1 diabetes
• cellulitis
• purpura
• contact dermatitis
• erythema nodosum
• early type 2 diabetes
• urticaria
• erythema migrans
• diabetic ketoacidosis
• erythema multiforme
• burns
• hypothyroidism
• petechiae
• skin ulcers
• adrenal insufficiency
4.4 Head and neck conditions: Diagnose and
manage key head and neck conditions.
• acute dental pain
• stomatitis
• acute hearing loss
• pharyngitis
• otitis externa
• epistaxis
• otitis media
• eye trauma
• serous otitis media
• vertigo
• sinusitis
4.5 Eye conditions: Diagnose and manage key
eye conditions.
• conjunctivitis
• strabismus
• acute glaucoma
• preorbital and orbital
cellulitis
• decreased visual
acuity
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ADU4 – Perform patient-centred
clinical assessment and manage
adults presenting with common
(key) conditions (cont’d)
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
4.7 Respiratory conditions: Diagnose and manage key
respiratory conditions.
• upper respiratory tract infections
• COPD and COPD exacerbations
• post-viral cough
• pneumonia
• asthma
4.8 Cardiovascular conditions: Diagnose and manage key
cardiac conditions.
• hypertensive emergencies
• ischemic heart disease
• PVT/PE
• arrhythmia
• congestive heart failure
• aortic aneurysm and
dissection
• acute coronary syndrome
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
Adults
ADU4 – Perform patient-centred
clinical assessment and manage
adults presenting with common
(key) conditions (cont’d)
4.9 Gastrointestinal conditions: Diagnose and
manage key gastrointestinal conditions.
ADU4 – Perform patient-centred
clinical assessment and manage
adults presenting with common
(key) conditions (cont’d)
4.11 Neurologic conditions: Diagnose and manage key
neurologic conditions.
• headaches
• syncope
• CVA/TIA
• meningitis
• epilepsy
• intra-cranial hemorrhage
• acute abdominal pain
• bowel perforation
• vomiting
• hernias
• gastroenteritis
• constipation
• gastrointestinal
bleeding
• inflammatory bowel
disease
4.12 Hematological conditions: Diagnose and manage key
hematological conditions.
• jaundice
• pancreatitis
• anemia
• volvulus
• gastroesophageal
reflux
• neutropenia
(febrile neutropenia)
• obstruction
• appendicitis
• biliary colic
• diverticulitis
• hepatitis
• peptic ulcer disease
4.10 Renal, urologic, and genitourinary
conditions: Diagnose and manage key renal,
urologic, and genitourinary conditions.
4.13 Musculoskeletal conditions: Diagnose and manage key
musculoskeletal conditions.
• septic arthritis
• ligamentous tears
• fractures
• sprains
• dislocations
• back pain/sciatica
• urinary tract infections
• testicular torsion
4.14 Oncologic conditions: Diagnose key oncologic conditions.
• sexually transmitted
infections
• renal colic
• brain tumours
• acute renal failure
• lung cancer
• urinary retention
• breast cancer
• urologic cancer (kidney,
bladder)
• liver cancer
• skin cancer
• pancreatic cancer
• bone metastases
• bowel cancer
• hypercalcemia
• vulvo-vaginitis
• vaginal bleeding
• hematuria
• gynecologic cancers (ovary,
uterus, cervix, vagina)
• prostate cancer
4.15 Emergency contraception issues: Develop an approach to
emergency contraception.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
Adults
ADU5 – Plan and arrange
pharmacologic treatments that
address key principles of good
prescribing practice
5.1 Rational prescribing (general): Prescribe
with consideration of the four steps to rational
prescribing: efficacy, toxicity, cost, and convenience.
5.2 Provincial medication payment programs:
Counsel patients about programs available to help
patients pay for medication (e.g., Pharmacare)
and mechanisms to access medication free of
charge (e.g. SOGC Compassionate Access to
Oral Contraceptive programs, manufacturer’s
compassionate use programs).
5.3 Monitoring: List medications that require
close monitoring or that have a narrow therapeutic
index (e.g.; digoxin, theophylline, aminoglycosides,
vanocmycin, amiodarone).
5.4 Prolonged QT interval: List medications that
can prolong QT interval.
5.5 Electrolyte imbalances: Alter prescriptions,
prescribe new medications or supplements to
address common electrolyte (e.g., potassium,
magnesium, calcium, phosphorus, sodium)
abnormalities.
5.6 Herbal treatments: List evidence-based
resources or references explaining herbal/
complementary/alternative medication uses
and interactions.
5.7 Post-marketing adverse effects: Report postmarketing drug adverse effects online to Health
Canada. Subscribe to email alerts from Health
Canada to stay abreast of post-marketing adverse
effects for commonly prescribed medications.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
ADU5 – Plan and arrange
pharmacologic treatments which
address key principles of good
prescribing practice (cont’d)
5.8 Medications (new to the market): Critically appraise new
medications available and consider the potential role of these
new treatments. Critically appraise landmark randomized
controlled trials and other studies that may lead to a change in
prescribing patterns. Recognize that new chemical entities lack
robust safety data when choosing therapy.
5.9 Medications and liver or kidney disease: Describe
medications that are contraindicated or whose dose needs to
be adjusted in renal failure, as well as liver failure.
5.10 Medications in pregnancy, lactation: Identify medications
that are contraindicated in pregnancy and when breastfeeding,
and identify evidence-based sources of information about
prescribing in these contexts, as well as reputable information
sources for prescribing to children.
5.11 Provincial formulary: Determine formulary status of drugs,
identify those that require Pharmacare approval, and complete
an application for individual clinical review for patients receiving
benefits under Pharmacare.
5.12 Medication (do not crush): Recognize medications and
formulations that should not be crushed or split.
5.13 Medication (adverse effects): List common or important
medication-related adverse effects and medication interactions.
Use informatics (including software and print sources) to
identify potential medication interactions, and collaborate with
pharmacist colleagues to screen for serious interactions and to
assess their clinical relevance. Appropriately counsel, warn, and
advise patients about common, important, or serious adverse
effects of medications being prescribed, and monitor for the
adverse effects.
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Care of the Elderly Competencies
Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Adults
ADU5 – Plan and arrange
pharmacologic treatments which
address key principles of good
prescribing practice
(cont’d)
By the end of the program, the resident shall:
5.14 Medication (allergies): Screen and review
routinely for medication allergies, including
when medications are prescribed. Recognize
potential drug reactions in patients taking related
medications (e.g., sulfa reactions), and monitor for
intended and adverse effects if drugs prescribed.
Properly differentiate between drug allergies and
sensitivities, and assess their clinical relevance to
individual scenarios.
FAMILY MEDICINE EXPERT
COE1 – Provide periodic health
1.1 Common changes of aging: Demonstrate an understanding
assessments and preventative care of the physiological and psychosocial changes associated with
adapted to the needs of the elderly aging and how they relate to the importance of a comprehensive
approach to care.
1.2 Health promotion in elderly: Counsel elderly patients
about lifestyle factors that promote healthy living, such as
smoking cessation, moderation of alcohol consumption, eating a
balanced diet, aerobic and resistance exercise, immunization, and
optimizing socialization opportunities.
5.15 Medication (interactions): List common,
clinically relevant, pharmacodynamic interactions
(additive effects), and pharmacokinetic interactions
(of absorption, distribution, metabolism, and
elimination).
1.3 Prevention and early detection in elderly: Identify
conditions that are appropriate for screening in the older
patient, including assessment of falls, vision, hearing, and
blood pressure screening, immunizations, and cancer screening
(in select groups).
ADU6 – Demonstrate an effective
approach to patients presenting
with surgical concerns
1.4 Adapted periodic health exam: Selectively adapt the
periodic health exam to suit a given patient’s circumstances
(personal health goals, age, gender, medical comorbidities, and
family history)
6.1 Pre-operative assessment: Perform
appropriate pre-operative assessment, identifying
potential surgical risk.
6.2 Pre-operative consults: Facilitate referral prior
to surgery when risks identified.
6.3 Surgical assistance: Participate effectively
when assisting in the operating room.
6.4 Post-operative assessment: Perform
appropriate post-operative assessment through
a focused history, physical examination, and
investigations.
COE2 – Provide comprehensive
care to elderly patients using
a functional approach that is
adapted to the patient’s physical
and cognitive capacity
2.1 History taking in the elderly, with a focus on functional
assessment: In the course of history taking, physical exam, and
treatment planning, assess the impact of problems on a patient’s
independence and ability to function.
2.2 Physical examination of the elderly: Perform an appropriate
and adapted physical examination of elderly patients.
6.5 Post-operative complications: Initiate
management of common post-operative
complications.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Care of the elderly
Care of the elderly
COE3 – Perform a patient-centred
clinical assessment, and manage
and follow up patients presenting
with common (key) conditions in
the care of the elderly
3.1 Cognitive decline and dementia: Demonstrate
an approach to diagnosing declining cognition
(develop a differential diagnosis for cognitive
impairments). Use appropriate cognitive assessment
tests (and screening tests where appropriate), and
initiate appropriate investigation, management,
supports, and care plans for patients with
cognitive decline.
3.2 Delirium: Promptly diagnose and manage
delirium in the elderly.
3.3 Mood disorders in the elderly: Recognize
the manifestations of depression in the elderly, the
potential for suicide, and diagnose and manage
mood disorders in the elderly.
3.4 Falls and mobility difficulty: Screen for falls
appropriately. Implement rehabilitation and other
resources to improve mobility and prevent falls.
COE3 – Perform a patient-centred
clinical assessments, and manage
and follow up patients presenting
with common (key) conditions in
the care of the elderly (cont’d)
3.9 Constipation in the elderly: Describe constipation risk
factors, manifestations, diagnosis, and management in
the elderly.
3.10 Fitness to drive in the elderly: Assess an elderly patient’s
fitness to drive and complete mandatory reporting requirements.
3.11 Capacity issues in the elderly: Assess a patient’s capacity
to make informed decisions about health and planning for
the future.
3.12 POA: Initiate a discussion about advanced directives and
specific wishes with regard to decisions around health and health
care. Describe the differences between a power of attorney
(POA) for personal care and a POA for finances. Assist patients in
establishing a POA and seek additional supports (e.g., social work)
if required.
3.13 Elder abuse and neglect: Identify risk factors for elder
abuse. List signs of elder abuse and neglect, and list avenues for
reporting.
3.5 Fracture risk in the elderly: Assess risk
factors for increased risk of fractures, including
osteoporosis-related fractures and reduced bone
mineral density (BMD). Prevent and treat fractures
(including rehabilitation) where indicated.
3.6 Urinary incontinence in the elderly: Identify,
classify (i.e., stress, urge, mixed, overflow, functional),
and manage different types of urinary incontinence.
3.7 Malnutrition and depleted nutritional status:
Identify and manage risk factors for weight loss and
malnutrition in the elderly.
3.8 Pain in the elderly: Develop an approach to
diagnosis and management plan for pain in the
elderly that takes into consideration issues relevant
to the elderly.
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Key CompetencyEnabling Competency
Care of the elderly
COE4 – Understand key issues
in drug therapy for the elderly,
demonstrating an appropriate use
of medications
4.1 Safe prescribing in the elderly: Demonstrate
awareness of medications to be used with caution
and use a safe approach to drug dosing, including
required adjustments in renal impairment. Safely
stop commonly used drugs and monitor for signs of
withdrawal (e.g., SSRIs, benzodiazepines).
4.2 Polypharmacy in the elderly: Recognize
polypharmacy and effectively monitor for hazardous
drug-drug interactions, prescribing cascades, and
drug-disease interactions.
4.3 Use of non-pharmacological alternatives in
the elderly: Use non-pharmacological alternatives
to drug therapy wherever appropriate.
4.4 Treatment adherence in the elderly:
Recognize potential barriers to medication
adherence (such as low literacy, poor vision, poverty,
poor executive functions) and adapt approach to
prescribing to accommodate for these. Recognize
the importance of monitoring and optimizing
adherence to treatment, using strategies such as
collaborating with the community pharmacist on
dosette or bubble pack systems and medication
home delivery.
4.5 Medication cessation: Demonstrate awareness
of when cessation of medications may be
appropriate (i.e., primary prevention in the very
elderly or other medications near end-of-life).
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Palliative Care Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
Palliative care
2.1 Discussion of advance care plans: Initiate
advance care planning discussions with patients
and families. Participate in the development of
highly specific and detailed advance care plan
documents that clearly outline the patient’s wishes
and will serve to direct care in the event of certain
clinical conditions.
2.2 Quality of life: Identify the elements that define
quality of life for an individual patient living with
advanced disease.
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3.1 Patient feelings: Discuss and address the patient’s feelings,
impact on function, ideas, fears, and expectations about their
illness, dying, and palliative care.
3.2 Values: Determine patient and family values, wishes, needs
(physical, spiritual, emotional, and psychosocial), and how this
may impact decisions regarding end-of-life care.
1.1 Identification: Identify opportunities for
advance care planning discussions, whether
or not a patient has a life threatening or life
limiting illness.
1.2 Initiate a palliative care approach:
Initiate a “palliative care approach” early in
the illness trajectory.
PAL2 – Demonstrate an
effective approach to advance
care planning
Palliative care
PAL3 – Establish the patient’s
goals of care and needs (spiritual,
emotional, and psychosocial)
FAMILY MEDICINE EXPERT
PAL1 – Identify patients who might
benefit from a palliative approach
and initiate this early in the
disease trajectory
Key CompetencyEnabling Competency
3.3 Conflict: Identify potential goal conflicts between the patient
and others, and seek to resolve them.
PAL4 – Assess function and
symptoms using palliative
care tools
4.1 Tools: Demonstrate appropriate use of standard symptom
assessment and communication tools (e.g., Edmonton Symptom
Assessment Scale, Palliative Performance Scale).
4.2 Resources: Use evidence-based palliative symptom
management resources (including educational resources,
books, and tools) to support patients.
PAL5 – Assess and manage pain
by multiple modalities and
delivery systems
5.1 Assessing pain: Perform a comprehensive assessment of pain
and non-pain symptoms.
2.3 Differing opinion: Appreciate that family
members may differ in opinion from the patient
when prioritizing elements of quality of life.
5.2 Approach to pain: Develop an approach to pain
management using key principles (including a consideration
of pain patho-physiology, the World Health Organization pain
ladder), and include a role for opioids, adjuvant medications, and
non-pharmacological tools.
2.4 Legal definitions: Describe the elements of
substitute decision making, power of attorney, and
living wills.
5.3 Opioid prescribing: Prescribe opioids effectively, including
proper initiation, dosage, titration, rotation, breakthrough dosing,
side effect prevention, and use of oral, parenteral routes.
2.5 Consultation: Refer for consultation (specialty
or ethics) those patients with complex issues.
a) Opioid toxicity: Describe and manage the clinical presentation
of opioid neurotoxicity.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Palliative care
Palliative care
PAL5 – Assess and manage pain
by multiple modalities and
delivery systems (cont’d)
5.4 Adjuvant treatment: Integrate adjuvant
therapy in the management of pain.
a) Pharmacological adjuvants: Select appropriate
medication from commonly used adjuvants in the
management of pain (NSAIDS, anti-convulsants,
tricyclic antidepressants).
PAL7 – Recognize and
appropriately address
palliative emergencies
b) Non-pharmacological adjuvants: Use
non-pharmacological adjuvant therapies when
appropriate (radiotherapy, surgery, splinting,
physiotherapy, transcutaneous electrical nerve
stilulation [TENS]).
PAL6 – Assess and manage
common non-pain symptoms
in the last year of life
6.1 Common end-of-life (EOL) symptoms:
Prevent, identify, and manage common EOL
symptoms.
• nausea
• anxiety
• vomiting
• fatigue
• constipation
• anorexia
• bowel obstruction
• cachexia
• urinary retention
• oral problems
• urinary incontinence
• wounds
• dyspnea
• ascites
• cough
• edema
• delirium
7.1 Palliative care emergencies: Recognize and address the
following palliative care emergencies.
• spinal cord compression
• urinary obstruction
• malignant bowel obstruction
• hemorrhage
• SVC syndrome
• hypercalcemia
• cardiac tamponade
• opioid-induced neurotoxicity
• seizures
7.2 Refer: Refer appropriately for specialty consultation.
PAL8 – Provide care during the
actively dying phase across
multiple settings:
hospital, hospice, care facility,
home
8.1 Last hours: Plan for and manage the care of the dying patient
during the last hours of life.
a) Impending death: Recognize signs and symptoms of
impending death.
8.2 Setting: Recognize and access the differing resources
in different palliative care settings: patients’ homes, hospice,
nursing/retirement/long-term care home, specialized palliative
care environment, or in hospital.
a) Home care: Access home care resources appropriately,
identifying unique aspects of caring for the dying patient in
the home.
8.3 Death certification: Pronounce death and conduct death
certification. Identify situations in which the coroner must be
contacted.
a) Anticipation of death at home: Complete required
documentation for patients planning to die at home.
6.2 Palliative sedation: Describe the use of
palliative sedation for the purpose of symptom
management.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
COMMUNICATOR
PROFESSIONAL
Palliative care
Palliative care
PAL9 – Demonstrate an effective
approach to conveying bad news
and discussing prognosis
9.1 Breaking bad news: Demonstrate sensitivity,
compassion, empathy, and respect when
conveying difficult news to patients.
9.2 Prognosis: Inform patients and families of
the diagnosis of life threatening or life limiting
illness or change in trajectory of chronic illness.
Inform patients of progression of disease and
complications.
PAL11 – Recognize ethical
challenges in providing palliative
care and demonstrate the use of
an ethical framework for
decision making
11.1 Ethical framework: Employ ethical frameworks or tools
for decision making in common end of life situations as they arise
in any environment.
11.2 Decision makers: Describe a sound ethical and legal
approach to obtaining informed consent, assessment of capacity,
and substitute decision making.
11.3 Physician assisted suicide: Distinguish between physician
assisted suicide and euthanasia.
11.4 Withdrawal of treatment: Consider ethical issues related to
withholding and withdrawing of active interventions.
PAL10 – Communicate with
patient, families, and care team
about palliative and end-of-life care
10.1 Communicating with families: Identify
situations that may benefit from a family meeting
and facilitate these meetings.
10.2 Supporting families: Support patients and
families coping with loss and bereavement, grief
(including anticipatory grief), and risk factors
for atypical grief. Develop an awareness of local
resources to assist families through this process.
PAL12 – Demonstrate skills in
self-reflection on the personal
impact of patient’s illness, dying,
and death
12.1 Discomfort: Recognize personal comfort or discomfort in
responding to patient and family spiritual issues.
12.2 Personal experience: Recognize how personal life
experiences may affect interactions with patients and
their families.
12.3 Sharing: Identify a colleague or resource with whom to
share discomforts or challenges.
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Care of First Nations, Inuit, and Métis Populations
Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
FNIM1 – Demonstrate
compassionate, culturally safe,
relationship-centred care for First
Nations, Inuit, and Métis patients,
their families, and communities
1.1 Context: Describe the connection between
historical and current government practices
toward First Nations, Inuit, and Métis peoples
(including, but not limited to, colonization,
residential schools, treaties, bills, land claims,
segregation, and Indian hospitals), and the
resultant intergenerational health outcomes.
1.2 Service delivery: Describe the various
health care services that are delivered to First
Nations, Inuit, and Métis peoples, and the
historical basis for the systems as they pertain
to these communities.
Key CompetencyEnabling Competency
Care of First Nations, Inuit, and Métis populations
FNIM2 – Describe specific
health problems in Aboriginal
populations including First
Nations, Inuit, and Métis
COMMUNICATOR
FNIM3 – Demonstrate effective
and culturally safe communication
with First Nations, Inuit, and Métis
patients, their families, and peers
1.3 Diversity: Demonstrate an understanding
of the cultural diversities of Indigenous peoples
that result in a variety of perspectives, attitudes,
beliefs, and behaviours.
1.4 Determinants of health: Articulate how the
various medical, social, and spiritual determinants
of health and well-being for First Nations, Inuit,
and Métis peoples impact their health.
1.5 Health practices: Identify and describe
the range of healing and wellness practices
(traditional and non-traditional) present in local
First Nations, Inuit, and Métis communities.
2.1 Morbidity and mortality patterns: Compare patterns of
mortality and morbidity of the Aboriginal population (on and
off reserves) with that of the general Canadian population, and
describe factors that contribute to these patterns.
3.1 Communication with the individual: Demonstrate
cultural safety as it pertains to individual First Nations, Inuit,
and Métis patients.
3.2 Communication with communities: Establish positive
therapeutic relationships with First Nations, Inuit, and Métis
patients and their families. Effective and culturally safe
communication encourages reciprocity, equality, trust, respect,
honesty, and empathy.
COLLABORATOR
FNIM4 – Demonstrate effective
collaboration with both
Indigenous and non-Indigenous
health care professionals in
the provision of effective
health care for Indigenous
patients/populations
4.1 Traditional medicine providers: Describe types of Aboriginal
healers/traditional medicine people and health care professionals
working in local First Nations, Inuit, and Métis communities, and
how they are viewed in the community.
4.2 Inquiring about traditional medicine: Demonstrate how
to appropriately inquire whether a First Nations, Inuit, or Métis
patient is taking traditional herbs or medicines to treat their
ailment, and how to integrate that knowledge into their care.
4.3 Planning care: Describe a process to effectively assess, plan,
provide, and integrate care for different Indigenous patients/
populations appropriate to the patient’s home environment/
locale (e.g., urban, reserve, northern).
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
LEADER/MANAGER
SCHOLAR
Care of First Nations, Inuit, and Métis populations
Care of First Nations, Inuit, and Métis populations
FNIM5 – Describe approaches to
optimizing First Nations, Inuit, and
Métis health through a just allocation
of health care resources, balancing
effectiveness, efficiency, and access,
employing evidence-based and
Indigenous best practices
FNIM7 – Contribute to the
dissemination of knowledge/
practices related to the
improvement of First Nations,
Inuit, and Métis health in Canada
5.1 Jurisdictional issues: Describe the
complexity of providing health care in
context to jurisdictional areas and local
health service models.
5.2 Engaging community: Describe the
concepts of community development, ownership,
engagement, empowerment, capacity-building,
reciprocity, and respect in relation to health care
delivery in and by First Nations, Inuit, and
Métis communities.
5.3 Community contacts: Identify and describe
key First Nations, Inuit, and Métis community
contacts, resources, and support structures in the
provision of effective health care.
5.4 Approaches to improving care: Describe
successful approaches that have been
implemented to improve the health of First
Nations, Inuit, and Métis peoples, either locally,
regionally, or nationally.
HEALTH ADVOCATE
FNIM6 – Identify the determinants
of health of Aboriginal populations
and use this knowledge to promote
the health of individual First Nations,
Inuit, and Métis patients and
their communities
6.1 Inequities: Demonstrate an understanding
of the inequity of access to health care/health
information for First Nations, Inuit, and Métis
peoples, and factors that contribute to it.
Demonstrate effective sharing and promotion of population
health strategies and health information with First Nations, Inuit,
and Métis patients/populations.
PROFESSIONAL
FNIM8 – Demonstrate a
commitment to engage in
dialogue and relationship
building with First Nations,
Inuit, and Métis peoples to
improve health through
increased awareness of and
insights into First Nations, Inuit,
and Métis peoples, cultures,
and health practices
8.1 Reflecting on one’s attitudes: Identify, acknowledge, and
analyze one’s own considered emotional response to the many
histories and contemporary environment of First Nations, Inuit,
and Métis peoples, and offer opinions respectfully.
8.2 Recognizing own limitations: Acknowledge and analyze
the limitations of one’s own knowledge and perspectives, and
incorporate new ways of seeing, valuing, and understanding with
regard to First Nations, Inuit, and Métis health practice.
8.3 Respect: Respectfully engage with and give back to First
Nations, Inuit, and Métis communities as a health professional.
8.4 Support: Demonstrate authentic, supportive, and inclusive
behaviour in all exchanges with First Nations, Inuit, and Métis
individuals, health care workers, and communities.
6.2 Government policies: Demonstrate an
understanding of the impact of government
policies on the health care of First Nations, Inuit,
and Métis communities.
6.3 Addressing inequities: Identify ways of
redressing inequity of access to health care with
First Nations, Inuit, and Métis populations.
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Care of Vulnerable and Underserved Populations
Competencies
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
UND1 – Provide care to vulnerable
and underserved populations, while
demonstrating an awareness of
the special or unique health risks
and health problems facing specific
groups
1.1 Illnesses in other countries: Recognize the
potential health risks facing travellers to and
from specific destinations, particularly migrants
returning to visit friends and relatives; reduce
risks and manage these health problems if
they occur.
1.2 Migrant health: Acquire knowledge of the
key health risks and health promotion needs of
immigrants to Canada (immigrant/refugee).
1.3 Health problems in the homeless and
those living in inner cities: Demonstrate
awareness of common medical issues found
amongst homeless and marginally housed
patients, and issues affecting inner
city populations.
1.4 LGBTT*Q health: Demonstrate knowledge
and skills necessary to meet the specific health
needs of the Lesbian, Gay, Bisexual, Two-spirit,
Transgender and Queer communities.
Key CompetencyEnabling Competency
Care of vulnerable and underserved populations
UND2 – Recognize social
determinants of health, health
inequity, barriers to good health
for vulnerable populations, and
advocate for correction of
these inequities
2.1 Health inequities in Canada: Describe social determinants
of health and health inequities that exist in Canada, and direct
attention to health inequities in all clinical and teaching duties
(migrants, disabilities, homeless, people with low incomes, global
populations, and individual communities in other countries).
2.2 Determinants of health for global populations:
Demonstrate knowledge of the social determinants of health
worldwide and their impact on disease.
2.3 Migrant determinants of health: When caring for a patient
who is a refugee or immigrant to Canada, describe specific
determinants of health for this patient.
2.4 Homeless determinants of health: When caring for a
patient who is homeless or marginally housed, describe specific
determinants of health for this patient.
2.5 Determinants of health for patients with disabilities:
Recognize the impact of disabilities on a patient’s health.
1.5 Health problems in individuals who
are disabled or have developmental delay:
Recognize the particular importance of providing
screening and preventative care to patients with
developmental delay and disability, whose needs
in this area are often traditionally overlooked.
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Behavioural Medicine Competencies
Key CompetencyEnabling Competency
Care of vulnerable and underserved populations
UND3 – Describe health care
systems and how they contribute
to or help to reduce barriers
to good health for vulnerable
populations
3.1 International health infrastructure:
Demonstrate a basic understanding of the
international health infrastructure, particularly the
role of the World Health Organization and
United Nations.
3.2 Health systems and resources for vulnerable
populations in general: Explain how health
systems and specific resources can improve the
health of vulnerable populations in general.
By the end of the program, the resident shall:
Key CompetencyEnabling Competency
FAMILY MEDICINE EXPERT
BEH1– Integrate psychosocial and
cultural aspects of normal human
development into family practice,
with special regard for knowledge
of family systems, life cycle, and
relationship dynamics
3.3 Health systems and resources for global
populations: Explain how health systems and
specific resources can improve the health of global
populations.
1.2 Family life cycle and dynamics: Explain concepts of
family life cycle and family dynamics, and their impact on the
management of health and illness. Employ family interviewing
skills to elicit relevant and useful family information.
1.3 Cultural and gender sensitivity: Demonstrate cultural and
gender sensitivity when interviewing patients.
1.4 Sexual history: Take a sexual history and elicit relevant chief
concerns, to include bio-psychosocial and cultural perspectives.
1.5 Patient resilience and coping with stress: When patients
present with crisis, and/or when duress of acute or chronic
medical condition is evident, assess patient resilience and
strategies for coping with stress, to include personal and social
coping strategies.
3.4 Health systems and resources for migrants:
Describe elements of the health care system that
can improve the care of migrant patients.
3.5 Health systems and resources for patients
with disabilities, including developmental
delay: Describe elements of the health care
system that can improve the care of patients with
developmental delay.
1.1 Genograms: Explain how a genogram clarifies family
structure, membership, life cycle, relationships, and significant
events. Construct a genogram for the medical chart, employing
standard symbols.
BEH2 – Recognize and diagnose
mental health problems commonly
co-existing with health issues
2.1 Mental health problems underlying somatic complaints:
Recognize how common somatic complaints (e.g., abdominal
pain and bowel upset, atypical pain presentation, dizziness,
palpitations and paresthesias, headache, fatigue, insomnia)
can have underlying mental health causes.
2.2 Organic conditions underlying mental health complaints:
Recognize how mental health complaints can have underlying
organic causes and selectively arrange investigations to rule out
these conditions (e.g., medication, drug or alcohol use, metabolic,
endocrine, malignant, infectious or ischemic causes of fatigue,
depressed mood, insomnia, pain, depression, confusion,
or delirium).
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Behavioural medicine
Behavioural medicine
BEH2 – Recognize and diagnose
mental health problems commonly
co-existing with health
issues (cont’d)
2.3 Mental health comorbidities: Recognize
increased prevalence of comorbid physical health
problems (including smoking, substance abuse,
obesity, and anorexia) experienced by those with
underlying mental health problems, and screen and
case-find appropriately.
2.4 Mental health conditions and physical
illness: Recognize increased prevalence of mental
health conditions such as depression, anxiety,
and post-traumatic stress disorder( PTSD) among
those experiencing a variety of acute and chronic
physical health problems (including cancer, heart
disease, stroke, endocrine disorders, disabling and
disfiguring conditions), and screen and
case-find appropriately.
BEH3 – Recognize and provide
care to patients presenting with a
history of abuse (cont’d)
3.4 Elder abuse: Facilitate support and safety in the case of elder
abuse. Know when and how to report elder abuse if the patient is
in a long-term care setting (e.g., Protection for Persons in
Care Office).
BEH4 – Describe specific
approaches to screening for,
recognizing, diagnosing, and
managing common (key) mental
health conditions.
4.1 Mental health conditions in children/adolescents: Screen
for, recognize, diagnose, and manage common mental health
conditions in children/adolescents.
• anxiety
• depression
• attention deficit hyperactivity
disorder
• eating disorders
• autism and Asperger’s
spectrum disorders
BEH3 – Recognize and provide
care to patients presenting with a
history of abuse
3.1 Domestic violence: Recognize risks of intimate
partner violence (e.g., pregnancy) and screen for
abuse and domestic violence appropriately. Assess
the level of risk for all members of the household,
and appropriately refer to child protection services
(e.g., Child and Family Services) as required.
3.2 Sexual abuse: Identify sexual abuse, rape, or
incest. Consider query of sexual abuse in patients
who present with chronic pain, somatization, PTSD,
depression, anxiety, substance abuse, cluster B traits,
or sexual history that raises concerns for patient’s
welfare, such as evidence of prostitution.
3.3 Child abuse: Identify child abuse, whether
physical, sexual, or emotional abuse. Assess the level
of risk for other members of the household, and
appropriately refer to child protection services (e.g.,
Child and Family Services) as required.
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• conduct disorder
• enuresis
• learning disorders
• oppositional defiant disorder
4.2 Mental health conditions in adults: Screen for, diagnose,
and manage common mental health condition in adults.
• adjustment disorders
• depression and dysthymia
• attention deficit hyperactivity
disorder
• malingering
• alcohol and drug abuse/
dependence
• anxiety disorders
• bipolar spectrum disorders
• dementia
• Munchausen
• personality disorders
• schizophrenia and psychotic
illness
• somatoform disorders
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Behavioural medicine
Behavioural medicine
BEH4 – Describe specific
approaches to screening for,
recognizing, diagnosing, and
managing common (key) mental
health conditions.
4.3 Screening: Employ psychometric investigations
designed for or amenable to primary care to
diagnose, rule out, screen for, or case-find
specific conditions.
4.4 Mental status: Assess and document a patient’s
mental status, including relevant psychosocial
context, stresses, and supports, and document
appropriately.
4.5 Suicide risk: Assess patient’s suicide or
homicide risk and determine if patient requires
involuntary admission.
4.6 Risk to others: Identify and manage patients at
risk to themselves or others.
4.7 Involuntary admission: State criteria for
involuntary admission.
4.8 Select management approach: Use a patientcentred, multi-disciplinary, multi-faceted general
approach to management and follow up of patients
regardless of their mental health condition.
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BEH5 – Prescribe appropriate
psychopharmacology for common
psychiatric conditions
5.1 Psychotropic classes effects and adverse effects:
Demonstrate knowledge of drug classes, indications and
contraindications, side effects, toxicity, common interactions, and
discontinuation strategies for medications used in mental health
conditions. Demonstrate knowledge of monitoring requirements,
laboratory tests, and therapeutic levels.
5.2 Choosing and monitoring psychotropics: Select and
manage psychotropic medication based on specific psychiatric
target symptoms. Monitor response of target symptoms
to treatment using functional benchmarks, adjusting and
augmenting as clinically indicated.
5.3 Counselling patients: Counsel patients regarding side effects
and profiles of their psychotropic medication.
5.4 Addiction and dependence: Counsel regarding potential
addiction to certain prescription medications, such as
benzodiazepines. Manage addiction and dependence when
it arises.
5.5 Medication review: Incorporate comprehensive medication
reviews in the ongoing management of chronic mental illness.
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Key CompetencyEnabling Competency
Key CompetencyEnabling Competency
Behavioural medicine
Behavioural medicine
BEH6 – Become familiar with and
employ specific primary care
counselling skills that have either
been designed for or are useful in a
family practice setting
6.1 Motivational interviewing: Employ
motivational interviewing techniques to help
patients consider or commit to behaviour change.
6.2 Sexual health counselling: Understand normal
sexual development and how to address specific
sexual concerns.
6.3 Crisis intervention: Apply the BATHE
(background, affect, trouble, handle, empathy)
technique for crisis intervention, initial screen for
psychosocial or psychosomatic concerns, and as a
general approach to psychotherapy in primary care.
BEH7 – Provide care to patients
with substance abuse problems
7.1 Screening for addiction: Routinely perform screening for
patients with substance abuse problems.
7.2 Screen for sequelae: Screen patients for sequelae of
substance abuse (liver disease, infections).
7.3 Stages of change: Identify the patient’s current stage in the
Stages of Change Model.
7.4 Intoxication/withdrawal: Identify common intoxication and
withdrawal symptoms.
7.5 Counselling: Provide simple and bridging psychosocial
interventions for patients with substance abuse.
6.4 Suicide intervention: Identify and address the
issue(s) that contribute to a patient’s risk. Develop a
plan for safety with the patient.
7.6 Acute withdrawal: Demonstrate an approach for acute
management for alcohol, nicotine, benzodiazepine, and narcotic
withdrawal, including pharmacological approaches.
6.5 Cognitive behavioural therapy: Practice
evidence-based skills in primary care of cognitive
behavioural therapy (CBT) and begin to use these
techniques to help patients with problems such as
depression and anxiety.
7.7 Weaning: Demonstrate an approach for weaning of
benzodiazepines and opioids.
7.8 Referral: Demonstrate knowledge of community resources
for management of addictions.
6.6 Relaxation techniques: Describe when
relaxation therapy may be useful. Demonstrate
techniques for relaxation training (e.g., breathing,
imagery, mindfulness, progressive muscle
relaxation).
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Milestones and Entrustable Professional Activities
The University of Manitoba Department of Family Medicine Residency program introduces
two new concepts to its competency framework: Milestones and Entrustable Professional
Activities (EPAs).
The key difference between EPAs and milestones is that EPAs are the tasks or activities that
must be accomplished, whereas milestones are the abilities of the individual. The relationship
between competencies, entrustrable professional activities, and milestones can be illustrated
as shown below.
A milestone is an observable marker of an individual’s ability along a developmental
continuum. Milestones for each of the foundational family medicine competencies are
described in this section and are articulated based on entry to the program (T0), at 6 months
(T6), 12 months (T12), 18 months (T18) and on exit (T24). The milestones are based on work
completed by the Royal College of Physicians and Surgeons (Competency by Design) 11, as
well as the American Board of Family Medicine (Family Medicine Milestone Project). 12
An EPA is a task in the clinical setting that may be delegated to a resident by their supervisor
once sufficient competence has been demonstrated. Typically, each EPA integrates multiple
competencies and milestones. EPAs are used for overall assessment.
EPAs have the following characteristics:
• Authentic – occur commonly in the clinical setting
• Complex – integrate multiple CanMEDS roles and multiple competencies
• Prototypical – have typical qualities
• Contextualized – occur in a specific clinical context
• Evaluable – realized in a defined period of time, are observable and appreciated by their
process and result
• Delegable – can be delegated to qualified resident
The EPAs provide the clinical context for the competencies. As such, each EPA can be mapped
to the competencies that are critical to making an entrustment decision. Each competency,
then, has milestones associated with it that represent behavioural markers of increasing levels
of performance. Thus, an EPA is directly related to the milestones for those competencies that
are critical to entrustment decisions for that EPA.
For ease of use, a narrative for each EPA of the expected behaviours for pre-entrustable and
entrustable learners based on the milestones has been developed.
11
Royal College of Physicians and Surgeons of Canada. Competence by Design (CBD): Moving towards competency-based medical
education. 2015
12
Accreditation Council for Graduate Medical Education & Americal Board of Family Medicine. The Family Medicine Milestone Project. July
2015
94
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Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
Medical Expert Milestones
Medical Expert Milestones
FAM1
Practice within the full scope of family medicine
FAM2 Perform a patient-centred clinical assessment with the goal of establishing a management plan
1.1
Demonstrate a
commitment to high
quality care and to the
four principles of Family
Medicine
While engaging as a learner in the clinical environment, demonstrate a duty of
care toward patients
1.2
Use the competencies of
the family
physician across the life
cycle and in
different practice
settings
Describe the CanMEDS roles and explain
how they relate to the practice of
medicine
Demonstrate medical
knowledge of
sufficient breadth and
depth to practice family
medicine
Apply knowledge of biomedical
sciences and clinically relevant skills to
identify, diagnose, and
address common clinical problems
Demonstrate the range
of duties performed by
the family physician in
the health care system
Describe the variety of clinical activities
provided by family physicians
1.3
1.4
Describe the multiple settings in which
family physicians practice
Perform an assessment of a patient and
provide an interpretation of the clinical
situation to the supervising physician
1.5
1.6
96
Carry out professional
duties in the face of
multiple, competing
demands
Recognize and
respond to the complexity,
uncertainty, and
ambiguity inherent in
medical practice
Demonstrate compassion for
patients
Explain how the intrinsic
roles need to be integrated
in practice of their discipline
to deliver optimal patient
care
Recognize that there is a degree of uncertainty in all clinical decision making
Practices patient-centered
continuous and comprehensive care
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
Perform focused clinical
assessments with
recommendations that are
well-documented
Describe the non-direct
patient care activities
that family physicians are
engaged in
Recognize urgent problems
that may need the
involvement of more senior
colleagues and engage them
immediately
Identify clinical
situations in which complexity, uncertainty, and
ambiguity may play a role
in decision making
Demonstrate a
commitment to high
quality care and to the
four principles of Family
Medicine
Demonstrates committment to the holistic role of the
Family Physician
Describe the role of the
family physician within
their community and within
the health care system
Recognize competing demands in
professional duties and seek
assistance in determining priorities
Under supervision,
demonstrate commitment and
accountability for patients in
their care
Consider the activities and
services that he/she will provide
and practice settings in which they
plan to work
Demonstrate the ability to
practice in the full scope
of the family
physician, across multiple
settings
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
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
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 evolve
Carry out professional duties in the face of multiple,
competing demands
Prioritize patients on the basis of
clinical presentations
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Recognize and respond to
the complexity,
uncertainty, and ambiguity inherent in medical
practice
2.1
Effectively and selectively identify, assess,
and prioritize main
presenting symptom(s)
in a patient encounter
Identify the concerns and
goals of patients and their
families* for the encounter
2.2
Recognize a patient with
a serious acute, urgent,
emergent, potentially
life threatening condition and act promptly
Recognize the signs of
potentially urgent
conditions
Elicit a history,
perform a physical
exam, select
appropriate
investigations and
interpret results for the
purpose of diagnosis
Elicit a history and
perform a physical exam that
informs the diagnosis
Solicit the patient’s perspective and establish
goals of care in collaboration with patients and
their families
Initiate discussions with
patients and their
families, under
supervision, about goals
of care
2.3
2.4
2.5
Establish a patientcentred management
plan
Prioritize urgent situations
over less urgent situations
T18
T24
Able to effectively and selectvely
identfy, assess and prioritize the
main presenting symptoms in collaboration with the patient
Identify and prioritize which issues
need to be addressed during future
visits or with other health care
practitioners
Iteratively establish
priorities, considering the
patient’s and/or caregiver’s
perspective (including
values and preferences)
as the
patient’s situation evolves
Recognizes and
appropriately responds to urgent
and emergent conditions
Prioritize conditions
requiring assessment based on their
morbidity and patient/
family expectations
Prioritize unstable patients
when several urgencies
present
simultaneously
Select and interpret
appropriate investigations
based on a differential
diagnosis
Gathers relevant information and
uses that information to generate
appropriate differencital diagnoses
Focus the clinical encounter,
performing it in a timely 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
Work with patients and their
families to
understand relevant options
for care
Address the patient’s and his or her
family’s ideas about the nature and
cause of the health problem, their
fears and concerns, and their expectations of health care professionals
Share concerns, in a constructive and
respectful manner, with patients
and their families about their goals
of care when they are not felt to be
achievable
Establish goals of care in
collaboration with patients
and their families, which
may include slowing disease
progression, achieving cure,
improving function, treating
symptoms, and palliation
Develop and implement
management plans that consider all
of the patient’s health
problems and context in
collaboration with patients and their
families and, when appropriate, the
interdisciplinary team
Establish patient-centred
management plans for all
patients in a practice
Adequately assess unstable
patients
Actively seek to identify
high-risk situations
Develop a general
differential diagnosis relevant
to the patient’s presentation
Solicit the patient’s ideas,
feelings, impact on
function and expectations
Address the impact of the
medical condition on the patient’s
ability to pursue life goals and
purposes
Develop an initial
management plan for common patient
presentations
Develop and implement initial
management plans for common
problems in their discipline
Ensure that patients and their
families are informed about the risks
and benefits of each
treatment option in the context of
best evidence and guidelines
Discuss with patients and their
families the degree of
uncertainty inherent in all
clinical situations
Develop, in collaboration with the
patient and his or her
family, a plan to deal with
clinical uncertainty
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Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
Medical Expert Milestones
T0
T6
T12
T18
Medical Expert Milestones
FAM3
Provide comprehensive preventative care throughout the life cycle, incorporating strategies that modify risk factors and detect disease in early treatable stages
FAM4
Demonstrate an effective approach to the ongoing care of patients with chronic conditions and/or patients requiring regular follow-up
3.1
Apply current evidencebased guidelines for
health promotion,
screening, and disease
prevention for
different groups of
patients by age and sex
4.1
Screen for and identify
patient with chronic
disease
Demonstrate an awareness of recommendations for screening guidelines
developed by various organizations
Incorporate disease preventions and health promotion
into practice
Collect family, social, and
behavioural history with the goal of risk
stratification
Explain the basis of health
promotion and disease
prevention
recommendations to patients
with the goal of shared decision making
Track and monitor disease prevention and health
promotion for the practice
population
Integrate practice and
community data to improve population health
Integrate disease prevention and health promotion
seamlessly in the ongoing
care of all patients
Describe the risks, benefits,
costs, and alternatives related
to health promotion and disease prevention activities
Mobilize team members and
link patients with
community resources to
achieve health promotion and
disease prevention goals
3.2
Work with patients and
their families to increase
their
opportunities to adopt
healthy
behaviours (e.g.,
exercise, healthy eating)
Identify the roles of behaviour, social
determinants of health, and
genetics as factors in health
promotion and disease prevention
Partner with the patient and
family to overcome barriers
to disease
prevention and health
promotion
Track and monitor disease prevention and health
promotion for the practice
population
Partner with the
community to improve
population health
3.3
Recognize modifiable
risk behaviours and
provide advice on risk
reduction
Collect family, social, and
behavioural history with the goal of
identifying modifiable risk factors
Counsel patients on lifestyle
changes
Integrate risk reduction strategies
Integrate behavioural
modification strategies
into lifestyle counselling
strategies
3.4
Perform all
components of a
complete periodic
health exam
Demonstrate an awareness of recommendations for health maintenance
developed by various organizations
98
T24
Reconcile
recommendations for health
maintenance and screening
guidelines developed by
various organizations
Adapt the periodic health
exam based on individual
patient factors
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Accurately document a clinical encounter on a patient with a chronic condition
and generate a problem list
Collect, organize, and
review relevant clinical
information
List screening and case-finding
recommendations for early detection of
asymptomatic chronic disease
Incorporate disease preventions and health promotion
into practice
Understand the role of
registries in managing patient
and population health
Track and monitor disease prevention and health
promotion for the practice
population
Use registries in managing
patient and population
health
Integrate disease prevention and
health promotion
seamlessly in the ongoing care of
all patients
4.2
Monitor for
complications of
common chronic
diseases
Recognize common complications
of commonly encountered chronic
diseases
Recognize variability and
natural progression of
chronic conditions and
adapt care accordingly
Manage the conflicting needs
of patients with multiple
chronic conditions or multiple
comorbidities
4.3
Solicit the patient’s perspective and establish
goals of care in collaboration with patients and
their families
Initiate discussions with patients and
their families, under
supervision, about goals of care
Assess the social impact
of chronic disease on
individual patients
Clarify goals of care for the
patient across the course of the
chronic condition
Share concerns, in a
constructive and respectful
manner, with patients and their
families about their goals of
care when they are not felt to be
achievable
Establish goals of care
in collaboration with
patients and their
families, which may
include slowing disease
progression, achieving
cure, improving
function, treating symptoms, and
palliation
4.4
Educate the patient
about their chronic
disease and empower
patient to take some
ownership of the disease
Recognize the central role of the patient
in chronic disease
management
Engage the patient in the
self-management of his or her
chronic condition
Facilitate patients’ and families’
efforts at self-management of
chronic conditions,
including the use of
community resources and services
Partner with the
community to improve
population health
4.5
Establish a patientcentred
management plan,
which integrates an
interprofessional approach
Develop an initial management plan for
common chronic
conditions
Apply appropriate clinical
guidelines to the treatment
plan of the patient with
chronic conditions
Lead care teams to consistent
and appropriate management of
patients with chronic
conditions and comorbidities
Personalize the care of
complex patients with
multiple chronic
conditions and
comorbidities to help
meet the patient’s goals
of care
Solicit the patient’s ideas, feelings,
impact on function and
expectations
Develop a
management plan that
includes appropriate clinical
guidelines
Use quality markers to
evaluate care of patients
with chronic conditions
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Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
T18
Medical Expert Milestones
Medical Expert Milestones
FAM5
Perform family medicine specialty-appropriate procedures to meet the needs of individual patients and demonstrate an understanding of procedures performed
by other specialists to guide their patients’ care
FAM6
Establish patient-centred care plans that include the patient, their family, other health professionals and consultant physicians
6.1
5.1
Determine the most
appropriate
procedures or therapy
Implement patientcentred care plans that
support
ongoing care, follow
up on investigations,
response to
treatment, and
further consultation
Identify procedures that family
physicians perform
Describe to patients
common procedures in family
medicine for the purpose of
assessment and/or management of a given problem
Begin the process of
identifying additional
procedural skills he or she may
need or desire to have for future
practice
Integrate planned procedures into
global assessment and management plans
Describe the indications,
contraindications, risks,
and alternatives for a given
procedure
5.2
Obtain and document
informed consent,
explaining the risks and
benefits of, and the rationale for, the proposed
procedure or therapy
Describe the ethical principles and
legal process of obtaining and
documenting informed consent
Integrate all sources of information
to develop a procedural plan
that is safe, patient-centred, and
considers the risks and benefits of
all approaches
Obtain informed consent
for commonly performed
procedures and therapies, under
supervision,
explaining the
indications, risks, benefits, and
alternatives
Use shared decision making in the
consent process, taking risk and
uncertainty into consideration
Determine the most appropriate procedure(s) for
the purpose of assessment
and/or management
Seek additional
opportunities to perform
or assist with procedures
identified as areas of need
within the
community
Prioritize procedure,
taking into account
clinical urgency and
available resources
Demonstrate sterile technique
Recognize and discuss the importance of the triaging and
timing of clinical procedures
Consider urgency, and potential
for deterioration, in advocating
for the timely execution of
procedures for their patients
Key and enabling
competencies
Triage procedures, taking into
account clinical urgency, potential
for deterioration, and available
resources
Advocate for patients’
procedures on the basis of
urgency and available resources
5.4
Perform procedure in a
skillful and safe manner,
adapting to unanticipated findings or changing
clinical circumstances
Perform simple procedures under
direct supervision
Demonstrate effective procedure preparation, including
the use of a
pre-procedure timeout or
safety checklist as
appropriate
Appropriately set up and position patients for procedures
5.5
Develop a plan with the
patient for aftercare and
follow up after completing a procuedure
Describe the need for follow-up
postprocedure
Establish and implement a
plan for postprocedure care
5.6
Describe the normal
postoperative healing
course and recognize
and manage common
postoperative
complications
Describe common
postoperative complications
Counsel patients on common
postoperative complications
Recognize common
postoperative
complications
Perform common
procedures in a skillful, fluid,
and safe manner with minimal
assistance
Seek more supervision as
needed when
unanticipated findings or
changing clinical
circumstances are
encountered
Competently and efficiently
execute discipline-specific
procedures
Recognize uncertainty and the
need for assistance in
situations that are complex or new
to the physician
Prioritize procedures, taking
into account
clinical urgency,
potential for
deterioration, and
available resources
Independently perform
procedures in a skillful and
safe manner,
adapting to
unanticipated findings
or changing clinical
circumstances
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
T0
T6
Establish plans for ongoing
care for the patient, taking into
consideration his or her clinical
state, circumstances, preferences,
and actions, as well as available
resources, best practices, and
research evidence
Determine the necessity and appropriate timing of consultation
Establish the roles of
physicians, other health
care
professionals, and the
patient in the provision
of a patient-centred
care plan that supports
ongoing care, including
follow-up on
investigations, response to
treatment, and further
consultation
T12
T18
T24
Medical Expert Milestones
FAM7
Actively participate, as an individual or as a member of a team providing care, in ensuring and improving patient safety
7.1
Recognize and respond
to harm from health
care delivery, including
patient safety incidents
Describe the scope and burden of health Recognize the
care-related harm
occurrence of an adverse
event or near miss
Prioritize the initial medical
response to adverse events to
mitigate further injury
Disclose adverse events or near
misses to patients and families
and to appropriate institutional
representatives
Include adverse events in
differential diagnoses, as
appropriate
7.2
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
Establish and implement a plan for
postprocedure care that considers
individual
patient factors that may affect
recovery
Provide anticipatory
guidance to paitents
regarding normal
postoperative healing and when
and how to access care
Accept responsibility for the
coordination of care
Obtain and document
informed consent explaining the risk and benefits of,
and the
rationale for, the proposed
options
Document procedures accurately
5.3
Describe the importance of
consultation and follow up in patient
care
T24
Describe common types of
cognitive 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
mitigate the negative
effects of human and system
factors on clinical practice
Recognize near misses in
real time and
respond to correct them,
preventing them from
reaching the patient
Identify potential
improvement
opportunities arising from
adverse events and near
misses
Apply the principles of
situational awareness to
clinical practice
Adopt strategies that promote patient safety and
mitigate negative human
and system factors
Engage patients and their families
in the continuous improvement of
patient safety
Review postoperative
complications in order to
adjust future apporach to
procedures
Manage postoperative
complications
100
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Key and enabling
competencies
T0
T6
T12
T18
Communication Milestones
Establish effective professional relationships with patients and their families
8.1
Communicate using
a patient-centred approach that encourages
patient trust and autonomy and is characterized
by empathy, respect,
and compassion
Describe the key components of a
patient-centred approach to medical
care
Optimize the
physician
environment for
patient comfort, dignity,
privacy, engagement,
and safety
Describe elements of the physical environment that affect patient comfort,
privacy, engagement, and safety (e.g.,
curtains, background noise, time standing or sitting, lighting, heating)
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
Describe how patient and physician
values, biases, and perspectives affect
clinical encounters
Respond to patients’
non-verbal
behaviours to
enhance
communication
Identify non-verbal
communication on the part of patients
and their families and its impact on
physician-patient communication
8.3
8.4
Outline the evidence that
effective physician-patient
communication enhances
patient and physician
outcomes
Demonstrate the key
components of a patientcentred approach in complex
clinical encounters
Mitigate physical
barriers to
communication to
optimize patient
comfort, privacy,
engagement, and safety
Optimize the physical environment for patient comfort,
privacy,
engagement, and safety
Manage
disagreements and
emotionally charged
conversations
Describe physician, patient, and
contextual factors that lead to strong
emotions
Describe how strong emotions may
affect the physician-patient interaction
8.6
Adapt to the unique
needs and
preferences of each
patient and to his or her
clinical condition and
circumstances
Describe models of decision making
along the spectrum from “paternalistic”
to “shared” to “autonomous”
Assess a patient’s health literacy
Demonstrate flexibility in applying
a patient-centred approach in the
breadth of clinical encounters in
practice
Communicate using a
patient-centred
approach that facilitates
patient trust and autonomy and is characterized
by empathy, respect, and
compassion
T6
T12
T18
Identify, verify, and validate
non-verbal cues on the
part of patients and their
families
Critically reflect on
emotional encounters and
identify how different approaches may have affected
the interaction
Use appropriate
non-verbal
communication to demonstrate attentiveness, interest,
and
responsiveness to patients and
their families
Recognize when personal
feelings in an encounter are
valuable clues to the patient’s
emotional state
FAM9
Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families
9.1
Use patient-centred
interviewing skills to effectively gather relevant
biomedical and psychosocial information
Describe the basic elements of the
patient-centred interview
Provide a clear
structure for and manage the flow of an entire
encounter
Use a model to guide a patient
encounter
Seek and synthesize
relevant
information from other
sources,
including the patient’s
family, with the
patient’s consent
Describe potential sources of information that may assist in a given patient’s
care
9.2
Recognize when patient and
physician values, biases, or
perspectives threaten the quality
of care, and modify the approach
to patient care according to the
context of the discipline
Describe how to use
non-verbal
communication to
build rapport
8.5
T0
T24
Communication Milestones
FAM8
8.2
Key and enabling
competencies
T24
9.3
Conduct a patient interview without
using a checklist
Conduct a patient-centred interview, gathering all relevant
biomedical and psychosocial
information for any clinical
presentation
Actively listen and respond to
patient cues
Conduct a focused and efficient
patient interview, managing
the flow of the encounter
while being attentive to the
patient’s cues and responses
Manage the flow of
challenging patient
encounters, including those with
angry, distressed, or
excessively talkative
individuals
Integrate, summarize, and present
the bio-psychosocial information
obtained from a patient-centred
interview
Use patient-centred
interviewing skills to
effectively gather relevant
biomedical and psychosocial information
Provide a clear
structure for and manage
the flow of an entire
patient encounter
Seek and synthesize relevant
information from other
sources, including the patient’s
family, with the patient’s
consent
Respond to patients’ non-verbal
communication and use appropriate non-verbal behaviours to
enhance
communication with patients
Recognize when strong emotions
are affecting an interaction and
respond
appropriately
Manage
disagreements and
emotionally charged
conversations
Key and enabling
competencies
Assess patients’ decision making capacity
Discuss the advantages and risks of
actively involving patients in decisions
about their care
T0
T6
T12
T18
T24
Communicate the plan of care
clearly and
accurately to patients and their
families
Communicate clearly with patients
and others in the
setting of ethical dilemmas
Skillfully share information and explanations
that are clear, accurate,
timely, and adapted to
the patient’s and his or
her family’s level of
understanding and
need
Communication Milestones
FAM10
Share health care information and plans with patients and their families
10.1
Share information and
explanations that are
clear, accurate, and
timely while checking
for patient and family
understanding
Describe ethical principles of
truth-telling in the physician-patient
relationship
Disclose harmful
patient safety incidents
to patients and their
families accurately and
appropriately
Define the terms “close call,” “no-harm
event,” “potential harm event,” and
“adverse event”
Establish boundaries as needed in
emotional situations
Assess patients’ preferred
involvement in decisions
about their care
Conduct a patientcentred interview under
supervision, gathering
relevant biomedical and
psychosocial information in the context of an
uncomplicated
presentation of a
common medical problem
Tailor approaches to decision making to
patient capacity,
values, and preferences
10.2
Recognize when to seek
help in providing clear
explanations to patients
and their families
Provide information on
diagnosis and prognosis in a clear,
compassionate,
respectful, and objective manner
Describe the ethical, professional, legal
obligations, and policies for, disclosure
of reporting adverse events
Describe the steps in
providing disclosure after
an adverse event
Disclose the reasons for unanticipated outcomes and adverse
events
Express regret for an adverse event
and apologize
appropriately
Disclose adverse events
to patients and their
families accurately and
appropriately
Plan and document
follow-up to an adverse
event
Differentiate complications or expected
outcomes of disease from adverse
events
102
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Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
T18
T24
Communication Milestones
Communication Milestones
FAM11
Engage patients and their families in developing plans that reflect the patient’s health care needs and goals
FAM12
11.1
Facilitate discussions
with patients and their
families in a way that is
respectful, non-judgmental, and culturally
safe
Document and share written and electronic information about the medical encounter to optimize clinical decision making, patient safety, confidentiality, and
privacy
12.1
Document clinical encounters in an accurate,
complete, timely, and
accessible manner, in
compliance with legal
and regulatory requirements
Describe principles of cross-cultural
interviewing
List relevant questions to ask patients,
families, and partners in care to elicit
an understanding of health care goals
and needs
Demonstrate
interviewing techniques for
encouraging
discussion, questions, and
interaction
Conduct an interview, demonstrating cultural awareness
Describe steps for
conducting an interview with
a translator
Explore the perspectives of
patients and others when
developing care plans
Communicate with cultural
awareness and sensitivity
Facilitate discussions with
patients and their families
in a way that is respectful,
nonjudgmental, and
culturally safe
Engage patients and others in
shared decision making
11.2
11.3
Assist patients and their
families to
identify, access, and
make use of
information and
communication technologies to
support their care and
manage their health
Use appropriate
communication skills
and strategies to help
patients and their
families make informed
decisions leading to a
shared plan for care
Describe the various technologies
available to enhance patients’ understanding and management of their
health care
Identify reliable sources of
consumer health
information
Describe the various sources of
consumer health information that
can enhance their understanding and
management of their health care
Describe elements of informed consent
Demonstrate steps to
obtaining informed consent
Answer questions from
patients and their families
about next steps
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Describe the regulatory and legal
requirements, including privacy
legislation, for record keeping
Organize information in
appropriate sections within
an electronic or written
medical record
Demonstrate proficiency in
using the vocabulary and
appropriate abbreviations
specific to their discipline and
workplace
Document information about
patients and their medical
conditions in a manner that
enhances
intra- and
interprofessional care
Document clinical
encounters to adequately convey
clinical reasoning and the
rationale for decisions
Adapt record keeping to the specific guidelines of their discipline
and clinical context
Participate in an analysis of patient safety incidents involving
suboptimal written, verbal, or
electronic communication
Identify and correct vague
or ambiguous documentation
Document clinical
encounters in an
accurate, complete, timely,
and accessible manner,
and in
compliance with legal and
privacy
requirements
Document the essential elements of a
clinical encounter using a structured
approach
Maintain accurate and up-to-date
problem lists and medication lists
12.2
Use appropriate
communication skills to
help patients and their
families make informed
decisions regarding their
health
12.3
104
Describe the record keeping guidelines for their
discipline
Identify potential difficulties and
errors in medical record keeping that
have a negative impact on patient
care or patient safety
Assist patients and their
families to identify, access,
and make use of information and
communication technologies to support their care
and manage their health
Assist patients and their
families to identify,
access, and make use of
evidence-based consumer
health information to support their care and manage
their health
Describe the functions and principle
components of a
medical record
Communicate effectively
using a written health
record, electronic
medical
record, or other digital
technology
Share information with
patients and others in
a manner that respects
patient privacy and
confidentiality and
enhances
understanding
Demonstrate effective
documentation of a simulated
encounter in a written or
electronic record
Build reminders and clinical
practice
guidelines into the health
record to enhance care
Share information in his or her
health record with the patient
to enhance collaboration and
joint decision making
Demonstrate reflective listening,
open-ended inquiry, empathy, and
effective eye contact while using a
written or electronic medical record
Describe the legal requirements
for protection of personal health
information
Adapt use of the health record to
the patient’s health literacy and
the clinical context
Communicate effectively
using a written health
record, electronic medical
record, or other digital
technology
Use electronic tools appropriately to
communicate with
patients, protecting their
confidentiality
Apply processes for patient
authorization of sharing of
personal health
information
Share information effectively with patients and
others in a manner that
respects patient privacy
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Key and enabling
competencies
T0
T6
T12
T18
Collaborator Milestones
T0
T6
T12
T18
T24
Collaborator Milestones
FAM13
Work effectively with physicians and other colleagues in the health care professions
13.1
Establish and
maintain positive
relationships with
physicians and other
colleagues in health care
professions to support
relationship-centred
collaborative care
Describe relationship-centred care
Compare and contrast enablers
of and barriers to collaboration
in health care
Identify the stages of group development in health care settings
Anticipate, identify, and respond
to patient safety issues related to
the function of a team
Respect established rules of
their team
Introduce themselves and their role
to physicians and other colleagues in
health care professions
Establish and maintain
healthy relationships
with physicians and other
colleagues in health care
professions to support
relationship-centred
collaborative care
FAM14
Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care
14.1
Determine when care
should be transferred
to another physician or
health care
professional
Describe how scope of practice can
trigger transfer of care
Identify the
appropriateness of
transferring patients to other
physicians or services
Describe common transitions in health
care and the process of safe transfer
of care
Negotiate
overlapping and shared
responsibilities with
physicians and other
colleagues in health care
professions
Describe the importance of professional role diversity and integration in
high quality and safe patient care
Discuss the role and
responsibilities of a
specialist in their discipline
Describe the roles and scope
of practice of other health care
professionals related to the
discipline
13.3
Demonstrate clear and
effective
communication (both
written and verbal) with
physicians and other
colleagues in health
professions
Describe the importance of good
communication with physicians and
other colleagues in health professions
Identify barriers to communication with collaborators
Actively listen and engage in
interactions with collaborators
13.4
Engage in respectful
shared decision
making with
physicians and other
colleagues in health care
professions
Describe strategies to promote
engagement of physicians and other
colleagues in health care professions
in shared
decision making
Discuss with patients and
their families* any plan for
involving other health care
professionals, including
other physicians, in their
care
Identify referral and
consultation as
opportunities to improve quality of care and patient safety
by sharing expertise
Integrate the patient’s perspective and context into the
collaborative care plan
Decide when care should
be transferred to another
physician or health care
professional
Analyze gaps in
communication between health
care professionals
during transitions in care
Demonstrate safe transfer
of care, both verbal and
written, during a patient’s
transition to a different
health care professional,
setting, or stage of care
Recognize and act on patient
safety issues in the transfer
of care
Differentiate between task
and relationship issues among
health care professionals
13.2
Organize the transfer of care to
the most appropriate health care
professional
Summarize a patient’s issues in
the transfer
summary, including plans to
deal with ongoing issues
Receive and appropriately
respond to input from other
health care professionals
Identify opportunities for collaboration among health care professionals
along the continuum of care
106
Key and enabling
competencies
T24
Consult, as needed, with other
health care professionals, including other physicians or surgeons
Negotiate
overlapping and shared
care
responsibilities
with physicians and other
colleagues in health care
professions
Use effective
communication (both
written and verbal) to
build relationships with
collaborators and to
develop shared plans
of care
Communicate effectively with
physicians and other colleagues in
health care
professions
Provide timely and necessary
written information to colleagues
to enable effective relationshipcentred care
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
14.2
Demonstrate safe hand
over, using both verbal
and written communication, during a patient
transition to a different
health care professional,
setting, or stage of care
Describe a structured
communication framework for transfer
of care
Describe specific information required for safe hand
over during transition
in care
Communicate with health care
professionals during transitions in care,
clarifying issues after transfer
as needed
Communicate with a patient’s
primary health care professional about his or her contribution to the patient’s care
Engage in
respectful shared decision
making with patients
and their families and
with physicians and other
colleagues in health care
professions
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Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
T18
T24
Leader/Manager Milestones
Leader/Manager Milestones
FAM15
Contribute to the improvement of health care delivery in teams, organizations, and systems
FAM16
Organize and manage patient information in an EMR to better manage an individual patient’s care
15.1
Apply the science of
quality
improvement to contribute to
improving systems of
patient care
16.1
Effectively integrate the
EMR into the office visit
Describe the potential positive and
negative impacts on the doctorpatient relationship
Organize the
physical space to maintain
maximal visual contact with
patients
Integrate strategies to share
information from the EMR with
patients during the office visit
16.2
Use appropriately
organized
information in the EMR
to plan
individual patient care
Identify how information is
organized within an EMR
Enter patient data in
appropriate fields to plan
preventative patient care and
chronic disease management
Use care communication and
recall functionalities to plan
patient care
Use recall and reporting functionalities to identify patients
requiring care
Integrate multiple EMR functionalities to plan individual
patient care
16.3
Demonstrate how
data can be extracted
and used to improve
the management of a
practice population
Identify how information is
organized within an EMR
Describe how EMR can be
used to assess patient access
and continuity of care
Define the nature of one’s
clinical population through the
use of various electronic data
sources
Use an organized method,
such as a registry, to assess and
manage population health
Use informatics tools to reflect
on and evaluate one’s practice
population and practice activities in comparison to evidence
and practice norms
T6
T12
T18
T24
Identify costs of common
diagnostic and
therapeutic
interventions as well as factors affecting these costs
Model practice patterns after
senior colleagues who deliver a
high standard of service
Recognize inefficiencies, inequities, variation, and quality gaps
in health care delivery
Describe the relevance of
system theories in health care
at the practice, organization,
and health system levels
Describe the domains of health
care quality (safe, effective,
patient-centred, timely,
efficient, equitable)
Describe quality
improvement methodologies
Compare and contrast the
traditional methods of research
design with those of improvement sciences
Use a systematic
improvement (e.g., Plan-DoStudy-Act [PDSA] cycle) to
address and identify areas of
improvement
Compare and contrast systems
thinking with
traditional approaches to quality
improvement
Analyze processes seen in
one’s own practice, team,
organization, and system
Provide feedback on
processes seen in one’s own
practice, team, organization,
and system
Engage health
professionals and others to
collaborate in improving
systems of patient care
Seek data to inform practice and
engage in an iterative process of
improvement
15.2
Contribute to a culture
that promotes patient
safety
Describe the features of a fair
and non-punitive approach to
patient safety
Respond to feedback on their
own practice and patient
outcomes
Describe EMR scheduling and billing functionalities
Use the EMR as an effective
adjunct to physician-patient
communication in the office
setting
Contribute to a
culture that
promotes patient safety
Actively encourage all involved
in health care, regardless of their
role, to report and respond to
unsafe situations
15.3
Analyze adverse events
and near misses to
enhance systems of care
Describe the elements of the
health care system that facilitate
or protect against adverse
events or near misses
Describe the process for
reporting adverse events and
near misses
Report patient safety hazards
and adverse events
Describe the available supports
for patients and health care
professionals when adverse
events and near misses occur
Analyze a given adverse
event or near miss to
generate
recommendations for safer
care
Model a blame-free
culture to promote openness
and
increased reporting
Key and enabling
competencies
T0
Leader/Manager Milestones
FAM17
Engage in the stewardship of health care resources
17.1
Allocate health care
resources for optimal
patient care, including
referral to other health
care professionals and
community resources
Explain health care spending and
how it has changed over time
Discuss the differences between
cost, efficacy, and value with
respect to health care delivery
Describe the ethical debate related
to resource stewardship in health
care
17.2
Apply evidence and
management processes
to achieve cost-appropriate care
Recognize that health care
resources and costs impact patients
and the health care system
Describe potential changes in practice that could address rising costs
108
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Use clinical judgment and
assessment of probability to
minimize wasteful practices
Describe models for resource
stewardship in health care
used at the institutional level
Optimize practice patterns for
cost-effectiveness and cost
control
Develop practice- and systembased rules for resource
allocation
Account for costs when choosing care options
Know and consider cost and
risks/benefits of
different treatment options
in common situations
Describe how
evidence-informed
medicine can be applied
to optimize health care
resource allocation
Discuss strategies to
overcome the personal,
patient, and organizational
factors that lead to waste of
health care resources
Determine cost discrepancies
between best practices and their
current practice
Partner with patients to
consistently use resources
efficiently and cost
effectively in complex and
challenging cases
Apply evidence and
guidelines with respect to use
relevant to common clinical
scenarios
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109
Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
T18
T24
Use their institution’s and/
or discipline’s
practice management tools
Analyze potential
facilitators of and
barriers to
implementation of
practice
management tools and
process improvement
Describe how practice
standardization can improve quality
of health care through specific case
examples and
reflection on personal
experience
Complete a plan for personal
practice
improvement, including evaluating a problem, setting priorities,
executing the plan, and analyzing the results
T12
T18
T24
Leader/Manager Milestones
Leader/Manager Milestones
FAM18
Demonstrate leadership in professional practice
FAM20
Implement processes to ensure personal practice improvement
18.1
Demonstrate
leadership in
professional practice
to enhance health
care and/or health
education
20.1
Participate in
implementing personal
practice
improvement processes
to achieve goals of the
CFPC Patient Medical
Home
Describe leadership styles as they Describe how
relate to health care
self-awareness,
self-reflection, and
self-management are
important to developing
leadership skills
Actively engage in change
initiatives led by others
Discuss aspects of one’s
own leadership style
(including strengths,
weaknesses, and biases)
Facilitate change
in health care to
enhance services and
outcomes
18.2
Describe the key issues regarding
the need to improve health care
delivery and the role of physician
leadership in this improvement
Participate in activities and
educational programs that
develop self-awareness,
self-reflection, and selfmanagement as a leader
and a follower in health care
organizations
Use self-awareness,
self-reflection, and
self-management to
improve practice
Develop systemic habits for
practice management (e.g.,
checklists, prompts, to-do lists, and
standard operating procedures)
Use tools and technologies to manage their own schedules
Describe the elements of
the CFPC Patient Medical
Home model
Demonstrate techniques to
motivate themselves and
others for quality care
Analyze patient feedback Present a recommendation
to help improve patient for a change in health care
experiences and clinical delivery at a team meeting
outcomes
Develop a strategy for
implementing change with
patients, colleagues, and staff
Critique an ongoing
change occurring in
health care delivery
Key and enabling
competencies
T0
T6
Health Advocate Milestones
Key and enabling
competencies
T0
T6
T12
T18
T24
Leader/Manager Milestones
FAM19
Manage to integrate practice and career effectively
19.1
Set priorities and
manage time to
integrate practice
and personal life
Reflect on and set personal,
educational, and professional
goals
Align priorities with
expectations for
education and clinical
work
Align short-, medium-, and longterm goals
Identify and approach
potential mentors
Demonstrate time management
skills
19.2
Manage career
planning, finances,
and human resources
in a practice
Describe societal needs and
current and projected workforce
requirements, aligning these
with personal factors important
to choosing a career
Organize work using
strategies that address
strengths and areas to
improve in personal
effectiveness and efficiency
Balance personal life
with responsibilities
in education, research,
administration, and
patient care
Examine personal interests Reconcile
and seek career mentorship expectations for practice
with job opportunities
and counselling
and workforce needs
Select educational
experiences to gain
Reconcile projected
competencies necessary
residency expenses
for future independent
against expected income practice
Review opportunities for
practice preparation,
including choices
available for further
training
FAM21
Respond to the individual patient’s health needs by advocating with the patient within and beyond the clinical environment
21.1
Work with patients to
address determinants
of health that affect
them and their access to
needed health services
or resources
Align goals with
opportunities for
participation in work and
other activities
Develop time management
skills in specific contexts,
such as for delegation, in
meetings, and for teamwork
Align early practice with
career goals and current
opportunities
Plan practice finances,
considering short- and longterm goals
Key and enabling
competencies
Describe the role of health care
professionals in patient advocacy
Define determinants of
Identify the obstacles
patients and families face
in obtaining health care
resources
Demonstrate an approach to
working with patients
to advocate for
beneficial
services or resources
T6
T12
health and explain their implications
T0
Facilitate timely patient access to
services and resources
T18
Work with patients to address
the determinants of health that
affect them and their access
to needed health services or
resources
T24
Health Advocate Milestones
FAM22
Respond to the needs of the communities or patient populations they serve by advocating with them for system-level change in a socially accountable manner
22.1
Work with their
community to identify
vulnerable or
marginalized populations
and the determinants of
health that affect them,
including barriers to accessing care and resources
22.2
Contribute to a process
to improve health in the
community or population
they serve
22.3
Participate in a process to
improve health in the community or
populations they serve
Outline remuneration models
as they pertain to discipline
Describe communities or populations facing health inequities
Participate in health promotion and disease
prevention programs
relevant to their practice
Identify communities or
populations they serve
that 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
Identify patients or
populations that are not
being served
optimally in their clinical
practice
Report epidemics or clusters of
unusual cases seen in practice,
balancing patient confidentiality with the duty to protect public
health
Improve clinical practice by applying a process of continuous
quality improvement to disease
prevention, health promotion,
and health surveillance
activities
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
Participate in a process to
improve health in the
communities or
populations they serve
Distinguish between the potentially
competing health interests of the
individuals, communities, and
populations they serve
110
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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111
Key and enabling
competencies
T0
T6
T12
T18
Scholar Milestones
Engage in the continuous enhancement of their professional activities through ongoing learning and reflection
23.1
Develop, implement,
monitor, and revise a
personal learning plan
to enhance
professional practice
Identify
opportunities for learning and improvement
by regularly assessing
their performance using
various internal and
external data sources
Describe principles of effective learning
relevant to medical education
Describe learning opportunities, resources, and assessment and feedback
opportunities relevant to learning in
the clinical setting
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 selfassessment and improve learning
23.3
Engage in
collaborative
learning to
continuously improve
personal practice and
contribute to
collective
improvements in
practice
T0
T6
T12
T18
Participate effectively in
collaborative group learning
Describe physicians’ obligations for lifelong learning
and ongoing enhancement
of competence
Demonstrate a structured approach to monitoring progress
of learning in the clinical
setting
Describe the CFPC Mainpro+ framework
Create a learning plan in
collaboration with a main preceptor and others, as needed,
identifying learning needs
related to their own discipline
and career goals
Identify, record, and answer
questions arising in daily
work
Seek help or pursue
learning opportunities, as
appropriate, when limits
of current
expertise are reached
Regularly engage in
personal learning by drawing
on various sources (daily
work, literature, scanning of
literature,
formal or informal education
sessions) to identify and
prioritize learning needs
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
goals
Compare, with guidance,
self-assessment with external
assessments
Create a learning plan,
incorporating all CanMEDS
domains for transition to
practice
Discuss a learning plan
and strategy for ongoing
selfmonitoring with the main
preceptor
FAM24
Integrate best available evidence, contextualized to specific situations, into real time decision making
24.1
Recognize practice
uncertainty and knowledge gaps in clinical and
other
professional
encounters and generate focused questions
that can address them
Describe the different kinds of evidence
and their roles in clinical decision
making
24.2
Demonstrate
proficiency in
identifying, selecting,
and navigating
pre-appraised resources
Describe the advantages and
limitations of pre-appraised resources
Demonstrate initiative
and maintenance
of improvements to
performance
Select appropriate sources of knowledge as they relate to
addressing focused questions
Recognize uncertainty and
knowledge gaps in clinical and
other professional encounters
relevant to their discipline
Describe the need for and
benefits of evidence-alerting services appropriate to
one’s scope of
professional practice
Generate focused
questions that can address
practice
uncertainty and
knowledge gaps
Develop a system to store and
retrieve relevant educational
material
Demonstrate proficiency in
identifying, selecting, and
navigating clinical
information sources that
provide or are based on preappraised evidence
Use quality appraised evidencealerting services that highlight
new evidence appropriate to
their scope of professional
practice
Seek and interpret multiple
sources of performance data
and feedback, with guidance,
to continuously improve
performance
24.3
Identify the learning needs of a
health care team
Engage in collaborative
learning to
continuously improve
personal practice and
contribute to collective
improvements in practice
Select and
critically evaluate the
integrity, reliability, and
applicability of healthrelated
research and
literature
Formulate structured clinical or scholarly questions using a specific question
architecture that can inform a critical
appraisal exercise
Contrast the various study designs used
in medicine and the quality of various
pre-appraised resources
Identify the design best suited to address a given clinical question
Identify scholarly sources
that inform the clinical
question at the centre of a
structured critical appraisal
activity
Demonstrate an understanding of the principles of
knowledge translation and
the Knowledge to Action
Framework
Interpret study findings,
including a discussion and
critique of their relevance to
professional practice
Formulate clinical or
scholarly questions in the
categories of diagnosis and
therapy
Determine the validity and
risk of bias in a wide range of
scholarly sources
24.4
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Integrate evidence into
decision making in their
practice
For a given clinical case,
demonstrate the application of
evidence during decision making
Formulate detailed scholarly
questions in the categories of
diagnosis, prognosis, prevention therapy, harm reduction,
and clinical prediction, incorporating outcomes important to
the patient
Demonstrate how various
scholarly sources such as studies, expert opinion, and audits
inform practice
Describe how various sources of clinical
information (studies, expert opinion,
practice audits) contribute to the
evidence base of medical practice
112
T24
Scholar Milestones
FAM23
23.2
Key and enabling
competencies
T24
Evaluate the applicability
(external validity or
generalizability) of evidence
from a wide range of research
Discuss the barriers to and
facilitators of
applying study findings to
professional practice
Demonstrate the use of an
integrated model of
decision making that combines
best evidence, resources, and
clinical expertise in the context
of patient values and
preferences
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113
Key and enabling
competencies
T0
T6
T12
T18
Key and enabling
competencies
T24
T0
T6
T12
Scholar Milestones
Scholar Milestones
FAM25
Contribute to the creation, dissemination, application, and translation of new knowledge and practices
FAM26
Facilitate the learning of students, residents, the public, and other health care professionals
25.1
Demonstrate an
understanding of the
scientific principles of
research and scholarly
inquiry and the role of
research evidence in
contemporary
family medicine
Describe the basic scientific principles of
research and scholarly inquiry
26.1
Recognize the power of
role modellling
Describe ethical
principles for research in
family medicine
Describe the ethical principles applicable to research and scholarly inquiry
25.2
25.3
Discuss the role of research and
scholarly inquiry in
addressing questions in family
medicine
Describe the role of research and
scholarly inquiry in contemporary
health care
Describe the
approach to research
methods and outline
statistical concepts
and epidemiological
concepts used in
family medicine
research
Describe the characteristics of a wellconstructed research question
25.4
Apply research
concepts in the
process of engaging in
quality
improvement
Describe common
methodologies used for scholarly
inquiry in medicine
25.5
Summarize and
communicate the findings of relevant research
and scholarly inquiry
Describe the concepts of formal,
informal, and hidden curricula
Identify behaviours
associated with positive and
negative role
modelling
T18
T24
Use strategies for deliberate, positive role modelling
Apply strategies to
mitigate the tensions
between formal, informal,
and hidden curricula
Describe the link between
role modelling and hidden
curricula
Discuss and provide
examples of the ethical principles applicable to research
and scholarly inquiry relevant
to family medicine
Describe and compare the
common methodologies used
for scholarly inquiry in their
discipline
Discuss and critique the possible
methods of addressing a given
scholarly question
26.2
Describe factors that can positively
or negatively affect the learning environment
Explain how power
differentials between learners
and teachers can affect the
learning environment
Ensure a safe learning
environment for all
members of the team
Describe strategies for reporting and
managing witnessed or experienced
mistreatment
26.3
Collaboratively
identify learning needs
and desired learning
outcomes
26.4
Describe the
principles of ethics with
respect to teaching,
and ensure that patient
safety is maintained
when learners are
involved
Work within their limitations, seeking
guidance and supervision when
needed
26.5
Demonstrate
effective learnercentred teaching and
reflect on the
teaching encounter
Describe the characteristics of effective teachers in medicine
26.6
Provide effective
feedback to enhance
learning and
performance
Describe the features of effective
feedback and its importance for
teaching and learning
Pose relevant and
appropriately constructed
questions amenable to
scholarly inquiry
Summarize and
communicate to
professional audiences the
findings of relevant research or
scholarly inquiry
Promote a safe
learning environment
Inquire about the
knowledge and skill level
of learners
Demonstrate basic skills in
teaching others, including
peers
Describe how to formally plan
a medical education session
Define specific learning
objectives for a teaching activity
Describe sources of
information used to assess
learning needs
Speak up in situations in the
clinical training environment
where patient safety may be
at risk
Recognize unsafe clinical
situations involving learners and
manage them appropriately
Balance clinical
supervision and
graduated
responsibility, ensuring
the safety of patients and
learners
Describe a model of clinical
teaching relevant to their
discipline
Choose appropriate
content, teaching format,
and strategies tailored
to a specific educational
context
Participate in the provision
of feedback to other learners,
faculty, and other members of
the team
Role model regular selfassessment and feedbackseeking behaviour
Provide effective feedback
to enhance learning and
performance of others
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Key and enabling
competencies
T0
T6
T12
T18
FAM27
Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards
27.1
Exhibit
appropriate
professional
behaviours and relationships in all aspects of
practice, reflecting
honesty, integrity,
commitment, compassion, respect, altruism,
respect for diversity,
and maintenance of
confidentiality
Exhibit honesty and integrity with
patients, other physicians, and other
health care professionals
Consistently prioritize
the needs of patients and
others to ensure a patient’s
legitimate needs are met
Demonstrate caring and
compassion
Independently manage
specialty-specific issues on
confidentiality, intervening when confidentiality is
breached
Manage complex issues while
preserving confidentiality
Intervene when behaviours toward
colleagues and
learners undermine a
respectful environment
Recognize and respect boundaries
Demonstrate sensitivity to issues
concerning diversity with respect to
peers, colleagues, and patients
Exhibit appropriate
professional behaviours
and relationships in all
aspects of practice, reflecting honesty, integrity,
dedication, compassion,
respect, altruism, respect
for diversity, and
maintenance of confidentiality
Consistently maintain
confidentiality in the clinical
setting, while recognizing the special
limitations on
confidentiality
Demonstrate a
commitment to
excellence in all aspects
of practice
FAM28
Practice within the full scope of Family Medicine
28.1
Demonstrate
accountability to patients, society, and the
profession by responding to societal expectations of physicians
Key and enabling
competencies
T12
Attend to
responsibilities and complete
duties as required
Manage tensions between
societal and physicians’
expectations
T18
T24
Engage in a self-initiated
pursuit of excellence
Demonstrate a
commitment to
excellence in all aspects
of practice
Recognize and respond
to ethical issues encountered in practice
Describe principles and theories of
core ethical concepts
Identify ethical issues
encountered during clinical
and academic activities
Describe a strategy to approach
ethical issues encountered in
the clinical setting
Manage ethical issues encountered Recognize and respond to
in the clinical and academic
ethical issues encountered
setting
in
independent practice
27.4
Recognize and manage
conflicts of interest
Describe the implications of potential
personal, financial, and institutional
conflicts of interest, including conflicts
of interest with industry
Recognize one’s own
conflicting personal and
professional values
Recognize personal conflicts of
interest and demonstrate an
approach to managing them
Proactively resolve real,
potential, or perceived
conflicts of interest
transparently and in
accordance with ethical, legal, and
moral obligations
Recognize and manage
conflicts of interest in
independent practice
Explain the potential abuses of
technology enabled
communication and their relation to
professionalism
Use technology enabled
communication,
including their online
profile, in a professional,
ethical, and respectful
manner
Intervene when aware of breaches
of professionalism involving technology enabled communication
Exhibit professional
behaviours in the use
of technology enabled
communication
Describe policies related to
technology enabled
communication
Describe the social contract between
the profession of medicine and society
Explain physician roles and duties in
the promotion of the public good
T0
Demonstrate a commitment
to the promotion of the public
good in health care, including
stewardship of resources
Demonstrate accountability
to patients, society, and the
profession by recognizing and
responding to societal expectations of the profession
Demonstrate a commitment
to maintaining and enhancing
competence
T6
T12
T18
T24
Professional Milestones
Reflect on experiences in the
clinical setting to identify personal
deficiencies and modify behaviour
accordingly
27.3
Exhibit professional
behaviours in the use of
technology enabled
communication
T6
Describe the tension between the
physician’s role as advocate for
individual patients and the need to
manage scarce resources
FAM29
Demonstrate a commitment to the profession by adhering to standards and participating in physician-led regulation
29.1
Fulfill and adhere to the
professional and ethical
codes, standards of practice, and laws governing
practice
Analyze how the
system of care supports or
jeopardizes
excellence
27.5
T0
Professional Milestones
Professional Milestones
27.2
Key and enabling
competencies
T24
Follow relevant policies
regarding the
appropriate use of
electronic medical records
Describe the regulatory
structures governing
physicians and the profession
29.2
Engage in
respectful and
collegial relationships
with collaborators
Respect the diversity of
perspectives and expertise among
health care
professionals
29.3
Recognize and respond to
unprofessional and
unethical behaviours in
physicians and other colleagues in health care
professions
Describe and recognize key behaviours that are
unprofessional or unethical
Participate in peer assessment and standard
setting
Describe the principles of peer
assessment
29.4
Personally respond to peer group
lapses in professional conduct
Convey information considerately
Describe the relevant
codes, policies, standards,
and laws governing
physicians and the
profession, including
standard setting,
disciplinary, and
credentialing procedures
Describe how to respond to a
complaint or legal action
Actively listen to and
engage in interactions
with collaborators
Maintain positive relationships
in all professional contexts
Engage physicians and other
colleagues in health care
professions in genuine and
respectful relationships
Describe and
identify regulatory codes and
procedures relevant to involving
a regulatory body in a case of
serious unprofessional behaviour
or practice
Recognize and respond to
unprofessional and unethical
behaviours in physicians
and other
colleagues in health care
professions
Participate in the review of
practice, standard setting, and
quality improvement activities
Participate in peer
assessment and standard
setting
Monitor institutional and clinical
environments and respond to
issues that can harm patients or
the delivery of health care
Fulfill and adhere to the professional and ethical codes,
standards of
practice, and laws
governing practice
Demonstrate
accountability to patients,
the profession, and society
with regard to the impact of
decisions that are made
Participate in the assessment of
junior learners
Prepare a morbidity and
mortality report or chart review
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Key and enabling
competencies
T0
T6
T12
T18
T24
Integrate skills that support adaptation and recovery in challenging
situations
Exhibit self-awareness and
effectively manage influences
on personal well-being and
professional performance
Professional Milestones
FAM30
Demonstrate a commitment to physician health and well-being to foster optimal patient care
30.1
Exhibit selfawareness and
effectively
manage influences on
personal well-being
and professional
performance
Describe how physicians are
vulnerable to physical,
emotional, and spiritual illness
Manage personal and
professional demands
for a sustainable
practice throughout the
physician life cycle
Identify strategies to support
personal well-being, a healthy
lifestyle, and appropriate self-care,
with the help of a primary health
professional, therapist, and/or
spiritual advisor
30.2
Use strategies to
improve self-awareness to
enhance performance
Describe the connection between
self-care and patient safety
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
Recognize evolving professional identity transitions
and manage inherent
stresses
Incorporate self-care into
personal routines
Describe the influence of personal
and
environmental factors on the
development of a career plan
Manage personal and professional demands for a sustainable practice throughout the
physician life cycle
Practice positive behaviours
and deal with negative
behaviours to
promote a collegial work
environment
Recognize, support, and
respond
effectively to
colleagues in need
Support others in their
professional transitions
Promote a culture that recognizes, supports, and responds
effectively to colleagues
in need
Seek appropriate health care for
their own needs
Use strategies to mitigate stressors
during transitions and enhance
professional development
30.3
Promote a culture that
recognizes,
supports, and
responds effectively to
colleagues in need
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 professional and ethical obligations
and options for intervention
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Entrustable Professional Activities
1. Provide periodic health exams and preventative
health care to adults
2. Assess, manage, and follow up patients presenting
with undifferentiated symptoms
3. Assess, manage, and follow up adults presenting
with common (key) conditions
EPA 1: Provide periodic health exams and preventative health care to adults
17. Provide postpartum care
18. Provide family medicine-centred care to newborns
in their first weeks of life.
19. Provide periodic health exams and preventative
care to infants, children, and adolescents
4. Diagnose and manage patients with common
chronic conditions and multiple comorbidities
20. Assess, manage and follow-up infants, children
and adolescents presenting with common (key)
conditions
5. Identify, diagnose, evaluate, and manage patients
with common mental health issues
21. Recognize and provide initial management of
common pediatric emergencies
6. Perform common family medicine procedures
22. Determine when a child or adolescent requires
admission and in-patient hospital care
7. Manage the elderly patient with multiple
comorbidities
8. Recognize and provide initial management of
common adult emergencies
9. Determine when an adult patient requires
admission and in-patient hospital care
10. Assess and appropriately manage the adult patient
in hospital
11. Recognize and provide initial management of the
medically unstable adult patient in the hospital
setting
12. Plan and coordinate discharge of adult patients
from hospital
13. Provide palliative end-of-life care
14. Provide pre-conception and prenatal care
15. Provide intrapartum care and perform low-risk
deliveries
23. Assess and appropriately manage the child or
adolescent patient in hospital
24. Recognize and provide initial management of the
medically unstable pediatric patient in the hospital
setting
25. Plan and coordinate discharge of the child or
adolescent from hospital
1. Description of the activity
In the outpatient setting, residents will perform an evidence-based well-adult periodic health assessment. They will
adapt and individualize the review, exploring new symptoms and signs as indicated. They will apply evidence-based
prevention guidelines in a patient-centred way, and provide lifestyle counselling as needed.
2. Most relevant CanMEDS-FM roles
√ Expert
Collaborator
√ Health Advocate
√ Professional
3. Competencies within each domain critical to entrustment
decisions
ADU1 FAM1 FAM3 FAM6
FAM27
4.
Priority topics
11, 12, 16, 23, 24, 25, 30, 42, 46, 47, 49, 54, 58, 63, 65, 68, 69, 72, 76, 77, 82, 83, 84, 85, 88, 89, 91, 92, 93, 94, 97
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
gathering, manifested as errors of omission or commission in gathering
exam pertinent
to the patient visit; actively searches for and addresses risk behaviours; and recognizes and responds
information. This resident does not recognize risk factors or determinants
to cues about underlying health determinants (e.g., poverty, literacy).
of health; is inconsistent in doing reviews of systems, being overly or
inadequately comprehensive; may also incorrectly perform physical exam
27. Facilitate family and interdisciplinary meetings
connections between information gathered from primary and secondary
28. Optimize the quality and safety of health care
through use of best practices and application of QI
sources. Additionally, this resident has a limited ability to identify
16. Recognize and manage common intrapartum
emergencies
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history
manoeuvres; and may miss key physical exam findings.
30. Provide care to First Nations, Inuit, and Métis
peoples
FAM8 FAM9 FAM10 FAM11
FAM12 FAM16 FAM17 FAM21
26. Provide expert advice and obtain consultation for
patients
29. Provide care to vulnerable and underserved populations
√ Communicator
√ Leader/Manager
Scholar
The resident at this level has a limited ability to filter, prioritize, and make
The resident at this level consistently engages the patient, inquiring about the patient’s concerns and building a
therapeutic relationship.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning; effectively documents care provided in the medical record; and uses EMR
functionalities that support preventative care management.
and reflect on pertinent information as it emerges, to continuously
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
update the differential diagnosis and avoid errors of clinical reasoning.
from the patient in a professional manner even when uncertain about the answer.
Documentation is incomplete and the learner does not use EMR
The entrustable learner actively plans for continuity of care for the patient, and makes evidence-based follow-up plans
functionalities to support care management.
that integrate appropriate use of community resources or other health providers.
When this resident offers a management plan, it may not be sufficiently
inclusive of all items in the differential, thereby
missing confirmation or
disconfirmation of important diagnoses.
This resident often fails to incorporate preventative care or education
and has limited understanding of community resources or other health
providers. He/she often inadequately plans for follow-up.
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EPA 2: Assess, manage, and follow up adults presenting with undifferentiated
symptoms
1. Description of the activity
In the outpatient setting, residents will demonstrate an ability to assess and manage patients presenting with
2. Most relevant CanMEDS-FM roles
common conditions, working efficiently through an appropriately broad initial differential diagnosis, and ruling out
potential dangerous diagnoses. They will develop appropriate follow-up management plans.
FAM1 FAM2
√ Communicator
√ Leader/Manager
Scholar
2. Most relevant CanMEDS-FM roles
FAM6 FAM8
1, 3, 5, 16, 17, 26, 31, 32, 33, 36, 39, 41, 42, 51, 55, 56, 61, 77, 79, 84, 93, 94, 95, 96
5. Assessment methods
Field notes, ITER
Entrustable
4. “unsupervised” practice
3. Competencies within each domain critical to entrustment
decisions
or inadequately comprehensive; may also incorrectly perform physical
exam manoeuvres; and may miss key physical exam findings.
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary and
secondary sources. Additionally, this resident has a limited ability to
Scholar
FAM1 FAM2 FAM6 FAM8
FAM9 FAM10 FAM11 FAM12
FAM27 ADU4 ADU5
4.
Priority topics
1, 3, 5, 16, 17, 26, 31, 32, 33, 36, 39, 41, 42, 51, 55, 56, 61, 77, 79, 84, 93, 94, 95, 96
5. Assessment methods
Field notes, ITER
Pre-Entrustable
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
2. practice with full supervision
gathering (manifested as errors of omission or commission in gathering exam pertinent
to the patient visit.
information); is inconsistent in doing reviews of systems, being overly
√ Leader/Manager
√ Professional
FAM9 FAM10 FAM11 FAM12
3. practice with supervision on demand
√ Communicator
√ Health Advocate
Priority topics
The resident at this level demonstrates underdeveloped skill in history
√ Expert
Collaborator
4.
2. practice with full supervision
In the outpatient setting, residents will demonstrate an ability to assess and manage patients presenting with
out potential dangerous diagnoses. They will develop appropriate follow-up management plans.
FAM17 FAM27 ADU2 ADU5
Pre-Entrustable
1. Description of the activity
undifferentiated symptoms, working efficiently though an appropriately broad initial differential diagnosis, and ruling
√ Expert
Collaborator
Health Advocate
√ Professional
3. Competencies within each domain critical to entrustment
decisions
EPA 3: Assess, manage, and follow up adult presenting with common
(key) conditions
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
The resident at this level consistently engages the patient, inquiring about the patient’s concerns and building a
gathering, manifested as errors of omission or commission in gathering
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
therapeutic relationship.
information. This resident does not recognize risk factors or determinants
beyond the patient his/herself.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning; effectively documents care provided in the medical record; and uses EMR
functionalities that support preventative care management.
of health; is inconsistent
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
in doing reviews of systems, being overly or inadequately
relationship.
comprehensive; may
also incorrectly perform physical exam manoeuvres; and may miss key
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
identify and reflect on pertinent information as it emerges, in order
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
physical
avoid most errors of clinical reasoning. This resident identifies urgent conditions and responds appropriately. He/she
to continuously update the differential diagnosis and avoid errors of
from the patient in a professional manner even when uncertain about the answer.
exam findings.
effectively documents care provided in the medical record, and uses EMR functionalities that support patient care (e.g.,
The entrustable learner actively plans for continuity of care for the patient, and makes evidence-based follow-up plans
The resident at this level has a limited ability to filter, prioritize, and
that integrate appropriate use of community resources or other health providers.
clinical reasoning. Documentation is incomplete and the learner does
not use EMR functionalities to support care management.
diagnosis list, medication lists).
make connections between information gathered from primary and
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
When this resident offers a management plan, it may not be
secondary sources. Additionally, this resident has a limited ability to
from the patient in a professional manner even when uncertain about
sufficiently inclusive of all items in the differential, thereby
missing
identify and reflect on pertinent information as it emerges, in order to
the answer.
confirmation or disconfirmation of important diagnoses.
continuously update the differential diagnosis and avoid errors of clinical
He/she has difficulty reassuring patient when a diagnosis cannot be
confirmed. He/she often inadequately plans for follow-up.
reasoning. Documentation is incomplete, and the learner does not use
EMR functionalities to support care management.
This learner develops and implements cost-effective plans collaboratively with the patient. The entrustable learner
actively plans for continuity of care for the patient, and makes evidence-based follow-up plans that integrate
appropriate use of community resources or other health providers.
When this resident offers a management plan, it may not be sufficiently
inclusive of all items in the differential, thereby
missing confirmation or
disconfirmation of important diagnoses.
This resident learner often fails to incorporate the patient perspective
or consider cost/resource use when developing management plan. He/
she often inadequately plans for follow-up, leading to lack to continuity
of care.
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EPA 4: Diagnose and manage patients with common chronic conditions and multiple comorbidities
1. Description of the activity
Across multiple settings, residents will adeptly provide guideline-guided care for chronic conditions, adapting targets
2. Most relevant CanMEDS-FM roles
EPA 5: Identify, diagnose, evaluate, and manage patients with common
mental health issues
1. Description of the activity
Across multiple settings, the resident will effectively assess and manage the full range of mental health issues, including
and plans of care based on a patient’s individual factors. The resident will manage multiple medical problems,
emergency presentations and involuntary treatment when appropriate. He/she will use specific counselling techniques
prioritizing as indicated.
as indicated and use the capacity of the multi-disciplinary team.
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
√ Health Advocate
2. Most relevant CanMEDS-FM roles
√ Expert
√ Collaborator
Health Advocate
Scholar
4. Priority topics
Leader/Manager
Scholar
√ Professional
√ Professional
3. Competencies within each domain critical to entrustment
decisions
√ Communicator
FAM1 FAM2
FAM6 FAM8
FAM9 FAM10
FAM11 FAM12
FAM13 FAM17 FAM21 FAM27
FAM13 FAM27
BEH2 BEH3
ADU4 ADU5
BEH4 BEH5
BEH6 BEH7
3. Competencies within each domain critical to entrustment
decisions
FAM1 FAM4 FAM6 FAM8
FAM9 FAM10 FAM11 FAM12
1, 3, 4, 7, 12, 14, 15, 17, 21, 23, 25, 26, 27, 28, 29, 37, 38, 42, 44, 45, 46, 47, 52, 53, 54, 55, 57, 61, 63, 65, 66, 68, 69,
4. Priority topics
6, 18, 19, 24, 27, 28, 30, 34, 37, 38, 43, 44, 48, 53, 60, 65, 73, 75, 78, 80, 86, 87, 89, 90, 92, 98
5. Assessment methods
Field notes, ITER
71, 77, 81, 82, 84, 87, 88, 89, 91, 93, 97
Field notes, ITER
5. Assessment methods
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
The resident at this level demonstrates underdeveloped skill in history
The resident at this level consistently gathers an appropriately focused history and can perform an accurate physical and
history gathering, manifested as errors of omission or commission in
exam pertinent
to the patient visit; actively searches for and addresses risk behaviours; and recognizes and responds
gathering, manifested as errors of omission or commission in gathering
mental status exam pertinent to the patient visit; actively searches for and addresses risk behaviors; uses standardized
gathering information. This resident does not recognize risk factors
to cues about underlying health determinants (e.g., poverty, literacy), recognizing impact on management of
information. This resident may also incorrectly perform physical or
assessment tools for mental health disorders; and correctly assesses suicidal/homicidal risk.
condition(s).
mental status exam manoeuvres and may miss key findings. The
The resident at this level demonstrates underdeveloped skill in
or determinants of health; may incorrectly perform physical exam
manoeuvres; and may miss key physical exam findings.
This resident has a limited ability to identify and reflect on pertinent
information as it emerges in order to prioritize issues during the visit.
Documentation is incomplete and the learner does not use EMR
functionalities to support care management.
When this resident offers a management plan, it does not integrate
relevant guidelines or is not individualized to the patient’s
circumstances. He/she does not consistently integrate selfmanagement approaches.
This resident does not consistently integrate patient perspectives or
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
relationship. The resident prioritizes concerns based on their importance and available time.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning. This resident effectively documents care provided in the medical record, and
learner has a limited understanding of or fails to use assessment tools
for mental health disorders. He/she has difficulty assessing suicidal/
homicidal risk.
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
relationship.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
The resident at this level has a limited ability to filter, prioritize, and
avoid most errors of clinical reasoning. This resident effectively documents care provided in the medical record.
make connections between information gathered from primary and
The entrustable learner uses a variety of techniques to counsel patients, integrating self-management and making
secondary sources. Additionally, this resident has a limited ability to
effective use of other resources on the mental health team. He/she integrates pharmacotherapy as required. This
This learner develops cost-effective management plans based on the latest relevant chronic disease guidelines,
identify and reflect on pertinent information as it emerges, in order
resident correctly identifies indications and applies involuntary treatment when required.
adapting to the patient’s individual circumstances. Management plans include self-management approaches.
to continuously update the differential diagnosis and avoid errors of
uses EMR functionalities that support chronic disease management.
clinical reasoning. Documentation may be incomplete.
that integrate appropriate use of community resources or other health care providers.
This learner has rudimentary counselling skills, does not integrate
self-management, and does not consistently leverage other
resources on the mental health team. He/she may be over-reliant
This resident has limited understanding of available community
on pharmacotherapy. This resident has a limited understanding of
resources or does not use other health care providers to support patient
indications and processes for involuntary treatment when required.
care. He/she often inadequately plans for follow-up and thus has
difficulty building a therapeutic relationship with the patient.
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
The entrustable learner actively plans for continuity of care for the patient, following up with patients who fail to attend
visits. He/she is knowledgeable and counsels patient on crisis resources.
The entrustable learner actively plans for continuity of care for the patient, and makes evidence-based follow-up plans
seek common ground on management plans.
124
Pre-Entrustable
2. practice with full supervision
He/she often inadequately plans for follow-up, and does not
consistently discuss crisis resources with patients.
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EPA 7: Manage the elderly patient with multiple comorbidities
EPA 6: Perform common family medicine procedures
1. Description of the activity
1. Description of the activity
Across multiple settings, considering capacity for consent, need for a substitute decision maker, and advanced
directives, residents will provide guideline-directed care for elderly patients. Residents will adapt targets and plans of
In the outpatient setting, residents will demonstrate competency in performing core office-based procedures.
care based on the patient’s individual factors, and manage multiple medical problems, prioritizing as indicated.
2. Most relevant CanMEDS-FM roles
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
Collaborator
√ Leader/Manager
Health Advocate
FAM1
FAM 5
FAM7
FAM10
FAM11
FAM12
FAM17
FAM27
4. Priority topics
CFPC core procedures (office)
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
√ Communicator
√ Collaborator
√ Leader/Manager
√ Health Advocate
Scholar
Scholar
√ Professional
√ Professional
3. Competencies within each domain critical to entrustment
decisions
√ Expert
3. Competencies within each domain critical to entrustment
decisions
FAM1 FAM2 FAM4 FAM6
FAM8 FAM9 FAM10 FAM11
FAM12 FAM13 FAM17 FAM21
COE1 C0E2
Entrustable
4. “unsupervised” practice
COE3 COE4
4. Priority topics
1, 3, 4, 7, 12, 14, 15, 17, 21, 23, 25, 26, 27, 28, 29, 37, 38, 42, 44, 45, 46, 47, 52, 53, 54, 55, 57,
61, 63, 65, 66, 68, 69, 71, 77, 81, 82, 84, 87, 88, 89, 91, 93, 97
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
The resident at this level approaches a procedure as a mechanical task
The resident at this level understands both the skill required and the context of a procedure, such as patient-specific
history gathering, manifested as errors of omission or commission
exam adapted to the geriatric patient. This learner integrates functional assessment.
to perform, often at the behest of others, without understanding the
factors, indications, contraindications, risks, benefits, and alternatives. The entrustable learner avoids medical jargon
in gathering information. This learner does not consistently assess
context (such as patient-specific factors, indications, contraindications,
in communicating the indications, risks, benefits, and complications of a procedure to the patient. This enables the
functional status. This resident may also incorrectly perform physical
risks, benefits, alternatives). He/she uses medical jargon that limits the
patient to verbalize a clear understanding of why the procedure is being done, and to participate in shared decision
exam manoeuvers and may miss key physical exam findings. This
patient’s ability to verbalize a clear understanding of why the procedure
making about the procedure.
learner has difficulty assessing a patient’s capacity or does not
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
recognize the need for involvement of substitute decision makers.
avoid most errors of clinical reasoning. The resident effectively documents care provided in the medical record, and
is being done; this can impede shared decision making.
Additionally, the entrustable learner knows and recognizes complications of the procedure and how to mitigate them.
The resident consistently engages both the patient and substitute decision maker(s) (when indicated), inquiring about
their concerns and building a therapeutic relationship.
shares information with other health care providers involved in the patient’s care.
Additionally, the pre-entrustable learner may not be aware of potential
The learner at this level has confidence commensurate with his/her knowledge and skills, thus putting patients at ease
This resident has a limited ability to identify and reflect on pertinent
complications of the procedure, or may minimize or miss them.
during the procedure.
information as it emerges in order to prioritize issues during the
This learner develops cost-effective management plans, adapting to the patient’s individual circumstances, including
visit. Documentation is incomplete and does not effectively share
life expectancy, functional abilities, and patient preferences. He/she recognizes and addresses polypharmacy, and
information with other health care providers involved in the care of
effectively monitors for drug-drug or drug-disease interactions.
The resident’s mechanical skills in the procedure are often inconsistent,
This resident’s mechanical skills in the procedure are consistent and reliable in most situations, and he/she knows
resulting in an inability to reliably complete the procedure. This
when to get help for procedures or situations beyond his/her abilities. He/she consistently uses universal precautions
may include inconsistent use of universal precautions and aseptic
and aseptic technique. This resident’s skill level allows him/her to simultaneously pay attention to the procedure
technique.
This resident’s skill level may also require such intense focus
and the patient’s emotional response (e.g., pain, fear, frustration, anger). Finally, this learner’s documentation of
When this resident offers a management plan, it is not individualized
appropriate use of community resources or other health care providers, including specialized geriatric assessment
on the task that the resident is unable to attend to the emotional
procedures is complete and timely.
to the patient’s circumstances, and does not consider the impact of
teams.
response of the patient (e.g., pain, fear, frustration, anger). Finally, this
resident’s documentation of procedures may be incomplete
or absent.
the patient.
The entrustable learner actively plans for continuity of care for the patient, and makes follow-up plans that integrate
polypharmacy.
This resident does not consistently integrate patient perspectives or
does not consider the individual circumstances (functional status, life
expectancy) when developing management plans.
This resident learner has limited understanding of available
community resources or does not use other health care providers to
support patient care. He/she often inadequately plans for follow-up
and thus has difficulty building a therapeutic relationship with the
patient.
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EPA 8: Recognize and provide initial management of common adult
emergencies
1. Description of the activity
EPA 9: Determine when an adult patient requires admission and in-patient
hospital care
In an emergency room setting, residents will demonstrate the ability to arrive at a timely and correct diagnosis
considering an appropriately broad differential (including dangerous causes), prioritize and assess/reassess
appropriately, and initiate management and treatment in a timely way. They will effectively engage the health care
1. Description of the activity
Residents will demonstrate the ability to determine if a patient’s condition requires admission to hospital for further
assessment and management. Residents will demonstrate safe handover techniques.
team to optimize patient care.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
Health Advocate
2. Most relevant CanMEDS-FM roles
Collaborator
Health Advocate
Scholar
3. Competencies within each domain critical to entrustment
decisions
FAM1 FAM2 FAM6 FAM8
FAM9 FAM10 FAM11 FAM12
4. Priority topics
1, 2, 3, 4, 5, 7, 8, 11, 12, 13, 14, 15, 17, 21, 22, 25, 26, 29, 30, 34, 36, 37, 39, 40, 41, 42, 43, 44,
45, 47, 51, 54, 55, 57, 59, 60, 62, 63, 66, 74, 75, 78, 79, 81, 83, 84, 88, 89, 90, 92, 93, 94, 96, 98
5. Assessment methods
Field notes, ITER
3. practice with supervision on demand
Scholar
FAM1 FAM2 FAM4 FAM6
FAM8 FAM9 FAM10 FAM11
ADU4 ADU5
ADU5
Pre-Entrustable
√ Leader/Manager
FAM13 FAM14 FAM27 ADU 3
FAM13 FAM17 FAM21 ADU 3
2. practice with full supervision
√ Communicator
√ Professional
√ Professional
3. Competencies within each domain critical to entrustment
decisions
√ Expert
Entrustable
4. “unsupervised” practice
4. Priority topics
1, 2, 3, 4, 5, 7, 8, 11, 12, 13, 14, 15, 17, 21, 22, 25, 26, 29, 30, 34, 36, 37, 39, 40, 41, 42, 43, 44,
45, 47, 51, 54, 55, 57, 59, 60, 62, 63, 66, 74, 75, 78, 79, 81, 83, 84, 88, 89, 90, 92, 93, 94, 96, 98
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
gathering, manifested as errors of omission or commission in gathering
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
The resident at this level demonstrates underdeveloped skill in history
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
information. This resident may also incorrectly perform physical exam
beyond the patient him/herself (e.g., from emergency responders or others).
gathering, manifested as errors of omission or commission in gathering
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
information. This resident may also incorrectly perform physical exam
beyond the patient him/herself.
manoeuvres and may miss key physical exam findings. This resident
does not appreciate the seriousness of the condition.
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary and
secondary sources. Additionally, this resident has a limited ability to
identify and reflect on pertinent information as it emerges in order
re-assess the patient condition and adjust the management plan.
Documentation is not timely, is incomplete, or lacks pertinent details.
When this resident offers a management plan, it may not be
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
manoeuvres, and may miss key physical exam findings.
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
to avoid most errors of clinical reasoning. This resident quickly identifies the degree of urgency of the condition and
responds appropriately. He/she re-evaluates the patient as the conditions change, and adjusts care plans as required.
The resident at this level has a limited ability to filter, prioritize, and
relationship. The entrustable resident ensures the patient understands the need for admission to hospital, and
He/she effectively documents care provided in the medical record.
make connections between information gathered from primary and
establishes goals collaborative with the patient and, when appropriate, with his or her family.
secondary sources. Additionally, this resident has a limited ability to
This learner mobilizes resources (investigations, consultations) efficiently and in a timely fashion. This learner
identify and reflect on pertinent information as it emerges, and fails
demonstrates broad knowledge of emergency drug dosages and mechanisms.
to recognize the need for admission to hospital. Documentation is not
This resident communicates with the patient (if responsive) and family members to provide information on the
seriousness of the condition, confirms patient treatment wishes (such as ACP status), and seeks input.
sufficiently inclusive of all items in the differential, thereby
missing
The entrustable learner re-evaluates the patient at appropriate intervals and makes plans for safe transfer to providers/
confirmation or disconfirmation of important diagnoses. This resident
services for definite care.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning. This resident determines the need and the goals for admission to hospital.
timely, is incomplete, or lacks pertinent details.
This resident does not adequately communicate to the patient the need
for admission to hospital, or is unable to establish goals collaborative
with the patient (or a substitute decision maker).
may not have adequate knowledge of resuscitation algorithms,
He/she has difficulty determining the timing or appropriate setting for
approaches, or medications.
admission. This resident is unable to demonstrate safe handover of care,
This resident learner often fails to communicate the severity of the
and may have gaps in either verbal or written communication.
condition on management plans, to the patient, or to families. He/
she often inadequately plans for reassessment, consultation, or need
for transfer.
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129
EPA 10: Assess and appropriately manage the adult patient in hospital
1. Description of the activity
In the in-patient setting, residents will demonstrate ability to assess and manage patients presenting with a variety of
2. Most relevant CanMEDS-FM roles
EPA 11: Recognize and provide initial management of the medically unstable
adult patient in the hospital setting
1. Description of the activity
In hospital setting, residents will demonstrate the ability to assess the unstable hospitalized patient, considering
medical conditions. They will collaborate effectively within interprofessional teams.
an appropriately broad differential, including dangerous causes, prioritize and assess/reassess appropriately, and
√ Expert
initiate management and treatment in a timely way. They will effectively engage the health care team to optimize
√ Communicator
Collaborator
Leader/Manager
Health Advocate
Scholar
patient care.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Collaborator
√ Professional
3. Competencies within each domain critical to entrustment
decisions
3. Competencies within each domain critical to entrustment
decisions
ADU5 ADU6
4. Priority topics
1, 3, 5, 16, 17, 26, 31, 32, 33, 36, 39, 41, 42, 51, 55, 56, 61, 77, 79, 84, 93, 94, 95, 96
5. Assessment methods
Field notes, ITER
exam. When necessary, the learner identifies and uses alternative sources of information beyond the patient him/
gathering information. This resident does not recognize risk factors
herself.
make connections between information gathered from primary and
secondary sources. Additionally, this resident has a limited ability to
identify and reflect on pertinent information as it emerges in order
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
relationship. On admission to hospital, the entrustable learner confirms ACP goals.
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate
gathering, manifested as errors of omission or commission in gathering
physical exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of
information. This resident may also incorrectly perform physical exam
information beyond the patient him/herself (e.g., from emergency responders or others).
manoeuvres and may miss key physical exam findings. This resident does
not appreciate the seriousness of the condition.
The resident at this level has a limited ability to filter, prioritize, and make
and responds appropriately. He/she re-evaluates the patient as the condition changes and adjusts the care plan as
connections between information gathered from primary and secondary
required. He/she effectively documents care provided in the medical record.
effectively documents care provided in the medical record.
patient condition and adjust the management plan. Documentation is
within an interprofessional team to deliver patient care.
The entrustable learner re-evaluates the patient at appropriate intervals and provides the patient with feedback in
regard to his/her progress.
inclusive. This resident learner often fails to incorporate the patient
not timely, is incomplete, or lacks pertinent details.
When this resident offers a management plan, it may not be sufficiently
seriousness of condition, confirms patient treatment wishes (such as ACP status), and seek input.
The entrustable learner re-evaluates the patient at appropriate intervals and makes plans for safe transfer to
or disconfirmation of important diagnoses. This resident may not
providers/services for definite care.
have adequate knowledge of resuscitation algorithms, approaches, or
medications.
This resident learner often fails to communicate the severity of the
condition on management plans, to the patient, or to families. He/she
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
demonstrates broad knowledge of emergency drug dosages and mechanisms.
inclusive of all items in the differential, thereby
missing confirmation
to the goals of care.
interprofessional team members.
This learner mobilizes resources (investigations, consultations) efficiently and in a timely fashion. This learner
This resident communicates with the patient (if responsive) and family members to provide information on the
perspective. As a consequence, the patient is often not clear in regard
He/she does not communicate clearly or adequately with
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning. This resident quickly identifies the degree of urgency of the condition
reflect on pertinent information as it emerges in order re-assess the
clinical reasoning. This resident may not always recognize deterioration
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history
avoid most errors of clinical reasoning. This resident identifies urgent conditions and responds appropriately. He/she
When this resident offers a management plan, it may not be sufficiently
130
3. practice with supervision on demand
sources. Additionally, this resident has a limited ability to identify and
This learner develops and implements cost-effective plans with the input of the patient. The learner works effectively
patient progress.
Pre-Entrustable
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
to continuously update the differential diagnosis and avoid errors of
of the patient. Documentation is incomplete and does not clearly reflect
Field notes, ITER
2. practice with full supervision
4. “unsupervised” practice
history gathering, manifested as errors of omission or commission in
The resident at this level has a limited ability to filter, prioritize, and
FAM9 FAM10 FAM11 FAM13
59, 60, 62, 63, 66, 74, 75, 78, 79, 81, 83, 84, 88, 89, 90, 92, 93, 94, 96, 98
Entrustable
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
physical exam manoeuvres and may miss key physical exam findings.
FAM6 FAM8
1, 2, 3, 4, 5, 7, 8, 11, 12, 13, 14, 15, 17, 21, 22, 25, 26, 29, 30, 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 47, 51, 54, 55, 57,
5. Assessment methods
The resident at this level demonstrates underdeveloped skill in
or determinants of health. This resident may also incorrectly perform
FAM1 FAM2
FAM 17 FAM27 ADU 3
4. Priority topics
3. practice with supervision on demand
Scholar
√ Professional
FAM6 FAM8 FAM9
FAM14 FAM27 ADU 4
2. practice with full supervision
Leader/Manager
Health Advocate
FAM1 FAM2 FAM4
FAM10 FAM11 FAM13
Pre-Entrustable
√ Communicator
often inadequately plans for reassessment, consultation, or need for
transfer.
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EPA 12: Plan and coordinate discharge of adult patients from hospital
1. Description of the activity
In the hospital setting, the resident plans and coordinates the discharge of the adult patient from the hospital and
EPA 13: Provide palliative end-of-life care
1. Description of the activity
Across multiple settings, residents will be able to care for patients with advanced, complex,
or terminal conditions, while considering capacity for consent, and advanced directives. They
will understand goals of care and judiciously balance burden versus benefit when considering
management. They will manage the range of symptoms as effectively as possible, working
within the multi-disciplinary team.
2. Most relevant CanMEDS-FM roles
√ Expert
ensures appropriate follow-up with the patient’s family physician.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
√ Health Advocate
Scholar
√ Collaborator
Professional
3. Competencies within each domain critical to entrustment
decisions
3. Competencies within each domain critical to entrustment
decisions
FAM14 FAM17 FAM21 ADU3
ADU4 ADU6 COE3
1, 2, 3, 4, 5, 7, 8, 11, 12, 13, 14, 15, 17, 21, 22, 25, 26, 29, 30, 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 47, 51, 54, 55, 57,
Pre-Entrustable
The resident at this level has difficulty determining the readiness for
discharge of the patient, or demonstrates reluctance to discharge.
This resident does not consistently seek input from members of the care
team to inform the discharge plan, and does not solicit the patient’s
(or the family’s) perspective. The pre-entrustrable learner has a limited
understanding of external resources as required, and does not fully use
community supports.
PAL3 PAL4
PAL5 PAL6
PAL7 PAL8
FAM13
Field notes, ITER
3. practice with supervision on demand
PAL1 PAL2
PAL9 PAL10 PAL11 FAM1
59, 60, 62, 63, 66, 74, 75, 78, 79, 81, 83, 84, 88, 89, 90, 92, 93, 94, 96, 98
2. practice with full supervision
Scholar
√ Professional
FAM10 FAM11 FAM12
5. Assessment methods
Leader/Manager
Health Advocate
FAM1 FAM2 FAM6
4. Priority topics
√ Communicator
Entrustable
4. “unsupervised” practice
The resident at this level determines the readiness for discharge of the patient.
This resident seeks input from colleagues to inform the discharge plan and integrates the perspective of the patient
and his/her family. The entrustrable learner identifies and coordinates external resources as required.
This learner demonstrates safe hand-over of care using both verbal and written communication. The resident
completes clear, accurate, and timely discharge summaries, ensuring they are sent to appropriate providers in the
community.
This learner does not effectively communicate (either verbal or written)
regarding discharge. The resident does not have a clear format for
discharge summaries, leading to incomplete, unclear, or inaccurate
discharge summaries. This learner does not share discharge information
with the patient’s health care providers in the community.
4.
Priority topics
5, 12, 22, 26, 27, 28, 31, 38, 39, 40, 43, 44, 45, 49, 51, 53, 59, 61, 70, 77, 84, 87, 88, 94
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level demonstrates underdeveloped skill
in history gathering, manifested as errors of omission or
commission in gathering information. The resident avoids or
is uncomfortable discussing end-of-life issues. When he/she
develops advance care plans, they are general and lack detail.
The resident at this level has a limited ability to filter, prioritize,
and make connections between information gathered from
primary and secondary sources, including the patient’s history,
physical exam, and diagnostic evaluations such as laboratory
and radiographic studies. Additionally, this resident has a
limited ability to identify and reflect on pertinent information
as it emerges, in order to continuously update the differential
diagnosis and avoid errors of clinical reasoning. He/she may fail
to identify urgency.
The learner at this level does not have a clear approach to the
assessment and management of pain or other end-of-life
symptoms.
Entrustable
4. “unsupervised” practice
The resident at this level identifies patients who might benefit from a palliative approach and skillfully
assesses patient’s goals of care. The entrustable learner is able to develop highly specific and detailed
advance care plans. He/she understands that family members may have differing opinions regarding
plans of care, and is able to resolve conflicts that may occur.
The resident at this level consistently engages patients and families, and builds effective therapeutic
relationships.
The resident at this level consistently gathers
an appropriately focused history and can perform an
accurate physical exam. He/she collects information from family members and caregivers, and integrates
the use of tools to assess function and symptoms.
The resident at this level uses multiple modalities to manage pain and other end-of-life symptoms. He/
she identifies and addresses palliative care emergencies.
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or
challenges from the patient or family in a professional manner, even when uncertain about the answer.
The entrustable learner recognizes the personal impact of death and engages in self-reflection and
self-care.
The pre-entrustable learner is uncomfortable with ambiguity,
and is unable to mediate family conflicts.
The pre-entrustable learner has difficulty managing the
personal impact of death.
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133
EPA 14: Provide pre-conception and prenatal care
1. Description of the activity
2. Most relevant CanMEDS-FM roles
EPA 15: Provide intrapartum care and perform low-risk deliveries
In the outpatient setting, residents will effectively provide patient-centred pre-conception and prenatal care, guided
and documented on standardized prenatal forms. Through continuity of prenatal care, they will explore and respond to
medical and/or psychosocial issues with consideration for both maternal and fetal well-being.
1. Description of the activity
√ Expert
2. Most relevant CanMEDS-FM roles
√ Communicator
Collaborator
√ Health Advocate
In the hospital setting, residents will demonstrate the ability to safely manage normal labours and deliveries, being
attentive to maternal and fetal well-being. They will recognize abnormal labour and delivery patterns, and consult
appropriately.
√ Expert
Leader/Manager
√ Collaborator
Scholar
Health Advocate
√ Professional
3. Competencies within each domain critical to entrustment
decisions
FAM1
3. Competencies within each domain critical to entrustment
decisions
FAM12 FAM21 FAM27 MAT 1 MAT 2
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history, including collection of prenatal risk
factors, can perform an accurate physical exam pertinent
to the patient visit, and incorporates known information,
including information gathered from previous visits or from others.
The resident at this level consistently uses patient-centred interview skills and physical exam techniques that, even
under conditions of stress or fatigue, demonstrate respect for patients, insight about patients’ emotional responses,
sensitivity toward each patient’s unique background and needs, and the ability to communicate bi-directionally.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning, such as premature closure. The resident effectively documents using the
prenatal form.
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
from the patient or family in a professional manner, even when uncertain about the answer.
The entrustable learner actively plans for continuity of care for the patient, using encounters to build therapeutic
relationships with patients and their families.
This resident often fails to incorporate preventative care or education,
and has limited understanding of community resources. He/she often
inadequately plans for follow-up.
134
FAM 9 FAM 10
FAM 17 FAM27 MAT 8
3. practice with supervision on demand
When this resident offers a management plan, it may not be
sufficiently inclusive of all items in the differential, thereby
missing
confirmation or disconfirmation of important diagnoses.
FAM8
MAT 14
Field notes, ITER
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary and
secondary sources, including the patient’s history, physical exam, and
diagnostic evaluations such as laboratory and radiographic studies.
Additionally, this resident has a limited ability to identify and reflect on
pertinent information as it emerges, in order to continuously update
the differential diagnosis and avoid errors of clinical reasoning, such as
premature closure.
FAM 5 FAM 6
FAM11 FAM12 FAM13
5. Assessment methods
The resident at this level demonstrates underdeveloped skill in history
gathering, manifested as errors of omission or commission in gathering
information. This resident may also incorrectly perform physical
exam manoeuvres; may miss key physical exam findings; or may be
over-dependent on the prenatal form, using it as a script rather than
a guide.
FAM1
MAT 3 MAT 4 MAT 5 MAT 6 MAT 7
1, 3, 4, 5, 11, 22, 25, 30, 32, 34, 39, 42, 47, 49, 51, 61, 76, 82, 83, 85, 89, 91, 94, 95, 96, 97
2. practice with full supervision
Leader/Manager
Scholar
√ Professional
FAM 8 FAM9 FAM 10 FAM11
4. Priority topics
Pre-Entrustable
√ Communicator
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
MAT 9
4. Priority topics
3, 4, 16, 22, 31, 39, 51, 76, 81, 88, 89
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level does not consistently gather histories,
omitting relevant prenatal history. He/she may perform incomplete
physical exams. He/she does not incorporate known information
about the patient and her family for labour and delivery.
This resident has an inconsistent approach to monitoring progress in
labour, and there is potential for delay in identifying problems during
labour. The resident is unable to discern whether a labour pattern is a
variant of normal. The resident may not reliably or consistently assess
patient comfort and fetal well-being throughout labour.
The pre-entrustable learner does not use labour and delivery to build
a therapeutic relationship. This resident communicates sporadically
throughout labour and delivery, and may use medical jargon when
communicating with patients.
The resident does not or is ineffective in attempts to coach during
labour. He/she does not effectively work with the labour and delivery
team.
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history, including prenatal history, and can
perform an accurate physical exam to confirm labour and assess progress. He/she incorporates known information
about the patient and her family, including the patient’s wishes for labour and delivery.
This resident uses current and emerging information to continuously monitor progress in labour, and is able to identify
problems during labour. The resident reliably assesses patient comfort and fetal well-being throughout labour.
The entrustable learner uses labour and delivery to build a therapeutic relationship. This resident communicates
throughout labour and delivery, including forewarning the patient about maternal and fetal findings.
This resident works collaboratively with the labour and delivery team, and communicates effectively to manage labour
room dynamics.
This resident uses effective patient-centred labour and delivery coaching skills. Manual skills are consistent and reliable
in most situations, and this learner knows when to get help for procedures or situations beyond his/her abilities. He/
she consistently uses universal precautions. This resident’s skill level allows him/her to simultaneously pay attention to
the patient’s emotional response during delivery.
The resident’s manual skills are often inconsistent, resulting in
an inability to reliably complete a procedure. This may include
inconsistent use of universal precautions and aseptic technique.
This
resident’s skill level may also require such intense focus on the task
that the resident is unable to attend to the emotional response of the
patient (e.g., pain, fear, frustration, anger).
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135
EPA 16: Recognize and manage common intrapartum emergencies
1. Description of the activity
In the hospital setting, residents will recognize abnormal labour and intrapartum emergencies. Residents will initiate
2. Most relevant CanMEDS-FM roles
√ Expert
EPA 17: Provide postpartum care
1. Description of the activity
In hospital and outpatient settings, residents will effectively provide patient-centred postpartum care. They will adapt
the encounter to explore and respond to medical and/or psychosocial issues more thoroughly as indicated, and will
explore family functioning.
2. Most relevant CanMEDS-FM roles
√ Expert
management and call for assistance.
√ Communicator
√ Collaborator
Leader/Manager
Health Advocate
√ Collaborator
Scholar
Health Advocate
Professional
3. Competencies within each domain critical to entrustment
decisions
FAM1
FAM 2 FAM 5
FAM6
FAM8
3. Competencies within each domain critical to entrustment
decisions
FAM9
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The entrustable learner is able to anticipate and identify obstetrical emergencies. When responding to an urgent or
personal limitations. This may result in an overestimation of personal
emergent patient condition, he/she has insight into his/her personal limitations and will seek help from colleagues or
ability, dismissal of concerns that other health care team members
members of the health care team.
The entrustable learner has the ability to gather, filter, and prioritize information such as vital signs (including
fetal heart rate [FHR]), focused physical exam, and patient’s labour history to form a focused differential diagnosis
The pre-entrustable learner has difficulty gathering, filtering, and
and initiate interventions in the urgent or emergent setting. He /she can anticipate next steps in care, efficiently
prioritizing the
critical data for a patient. This learner has gaps in his/
communicate the patient scenario to the health care team, and interact with other team members based on an
her medical knowledge, and inconsistently applies the knowledge he/
understanding of their roles and skills.
her
to anticipate next steps for patients requiring urgent
or emergent
care.
Additionally, this learner does not understand the health care system
and, therefore,
may have difficulty mobilizing the skills and abilities of
This resident identifies indications for assisted vaginal delivery and Caesarean section. He/she is able to provide
assistance at Caesarean section.
After the encounter, the entrustable learner seeks guidance and feedback from the health care team to improve future
patient care.
team members.
Following urgent or emergent interventions, the pre-entrustable
learner may demonstrate a defensive and/or argumentative attitude in
debriefing sessions.
136
Scholar
4. Priority topics
3, 11, 32, 34, 37, 39, 41, 42, 51, 61, 76, 82, 83, 91, 95, 99
5. Assessment methods
Field notes, ITER
Pre-Entrustable
The pre-entrustable learner has an incomplete understanding of
she does have. Gaps in medical knowledge make it challenging for him/
FAM10 FAM11
MAT13
Field notes, ITER
asking for help for a patient in need of urgent
or emergent care.
FAM8
FAM13 FAM14 MAT 10
5. Assessment methods
express about a deteriorating patient, and delay in responding to or
FAM 2 FAM6
FAM12 FAM13 FAM14
3, 4, 16, 22, 31, 39, 51, 76, 81, 88, 89
Pre-Entrustable
FAM1
FAM10 FAM11 FAM12
4. Priority topics
Leader/Manager
Professional
MAT11 MAT12
2. practice with full supervision
√ Communicator
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
2. practice with full supervision
3. practice with supervision on demand
The resident at this level demonstrates underdeveloped skill in
history gathering, manifested as errors of omission or commission
in gathering information. This resident may also incorrectly perform
physical exam manoeuvres, and may miss key physical exam findings.
The resident fails to gather key information regarding the patient and
her prenatal and intrapartum course. This resident fails to ask about
the baby’s well-being and how the family is managing.
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary and
secondary sources, including the patient’s history, physical exam, and
diagnostic evaluations such as laboratory and radiographic studies.
Additionally, this resident has a limited ability to identify and reflect
on pertinent information as it emerges, in order to continuously
update the differential diagnosis, and avoid errors of clinical reasoning,
such as premature closure.
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history, including collection of relevant prenatal
and intrapartum information, and can perform an accurate physical exam pertinent
to the patient visit. He/she
incorporates known information, including information gathered from previous visits or from others. This resident asks
about the baby’s well-being and how the family is managing.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning, such as premature closure.
The resident at this level consistently uses patient-centred techniques to develop management plans that integrate
community resources.
The entrustable learner actively plans for continuity of care for the patient, including facilitating inclusion of the
newborn into the practice. The resident seeks to use encounters to build therapeutic relationships with patients and
their families.
When this resident offers a management plan, it may not be
sufficiently inclusive of all items in the differential, thereby
missing
confirmation or disconfirmation of important diagnoses.
This resident often fails to incorporate preventative care or education,
and has limited understanding of community resources. He/she often
inadequately plans for follow-up.
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EPA 18: Provide family-centred care to newborns in their first weeks of life
1. Description of the activity
In hospital and outpatient settings, residents will provide evidence-based care of the newborn. Residents will
demonstrate knowledge and competent assessment and management of problems presenting in the newborn
period. They will establish professional relationships with parents and effectively counsel parents about newborn
care.
2. Most relevant CanMEDS-FM roles
√ Expert
EPA 19: Provide periodic health exams and preventative health care to infants,
children, and adolescents
1. Description of the activity
In the outpatient setting, residents will perform evidence-based periodic health exams for infants, children, and
adolescents. They will demonstrate adaptability, individualizing the review in a patient-appropriate manner, as well as
exploring new symptoms and signs as indicated. They will be aware of changing cognitive and developmental stages
in children, and modify their approach accordingly as they assess and build their therapeutic relationship with the
patient.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
Collaborator
Leader/Manager
Health Advocate
Scholar
Collaborator
√ Health Advocate
√ Professional
3. Competencies within each domain critical to entrustment
decisions
3. Competencies within each domain critical to entrustment decisions
FAM8 FAM9 FAM10 FAM11
5. Assessment methods
Field notes, ITER, NRP course
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
FAM3 FAM6 FAM8
FAM9 FAM10 FAM11
FAM12 FAM21 FAM27
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history
gathering, manifested as errors of omission or commission in gathering
information. This learner does not incorporate information from the
pregnancy, labour, or delivery. This resident may also incorrectly
perform physical exam manoeuvres, demonstrate awkward handling of
the infant, or miss key physical exam findings.
The resident at this level consistently gathers
an appropriately focused history, including collection of prenatal and
labour information, and can perform an accurate physical exam pertinent
to the patient visit. The resident gently and
confidently handles the infant.
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary and
secondary sources, including the patient’s history, physical exam, and
diagnostic evaluations such as laboratory and radiographic studies.
Additionally, this resident has a limited ability to identify and reflect on
pertinent information as it emerges, in order to continuously update the
differential diagnosis and avoid errors of clinical reasoning. He/she may
fail to identify urgency.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning. He/she effectively documents using the standard forms.
The resident at this level consistently engages parents, inquiring about their concerns and building a therapeutic
relationship with them.
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
from a parent in a professional manner, even when uncertain about the answer.
The entrustable learner actively plans for continuity of care for the patient, and makes evidence-based follow-up
plans that integrate the parents’ perspectives or preferences.
When this resident offers a management plan, it may not be sufficiently
inclusive of all items in the differential, thereby
missing confirmation or
disconfirmation of important diagnoses.
This resident often fails to incorporate preventative care or education,
and has limited understanding of community resources. He/she often
inadequately plans for follow-up.
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Scholar
COC3 COC4 FAM1
FAM12 FAM27
22, 39, 45, 49, 51, 58, 62, 67, 74, 79, 81, 84, 89, 95
Leader/Manager
√ Professional
COC1 COC2 FAM1 FAM2
4. Priority topics
√ Communicator
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
4. Priority topics
4, 10, 12, 16, 24, 30, 34, 42, 43, 44, 45, 47, 49, 50, 53, 54, 57, 58, 60, 64, 66, 68, 29, 72, 75, 79,
82, 85, 89, 92, 96, 99
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history gathering,
manifested as errors of omission or commission in gathering information. This resident
does not recognize risk factors or determinants of health, may incorrectly perform
physical exam manoeuvres, and may miss key physical exam findings.
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
exam pertinent
to the patient visit. He/she actively searches for and addresses risk behaviours, integrates information
on the family context, and recognizes and responds to cues about underlying health determinants (e.g., poverty,
literacy).
The resident at this level has a limited ability to filter, prioritize, and make connections
between information gathered from primary and secondary sources. Additionally,
this resident has a limited ability to identify and reflect on pertinent information as it
emerges, in order to continuously update the differential diagnosis and avoid errors of
clinical reasoning. He/she may fail to discern a well child from an unwell child.
When seeing infants and children, the resident at this level consistently engages parents, inquiring about their
concerns and building a therapeutic relationship with them. Proactive in discussing confidentiality with adolescents
and their parents, this resident recognizes the adolescent’s requirement for progressive autonomy.
When this resident offers a management plan, it may not be sufficiently inclusive of all
items in the differential, thereby
missing confirmation or disconfirmation of important
diagnoses.
This resident often fails to incorporate preventative care or education, and has limited
understanding of community resources. He/she often inadequately plans for follow-up.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning. He/she effectively documents using Rourke or adolescent-specific preventative
care flow sheets.
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
from a parent in a professional manner, even when uncertain about the answer.
The entrustable learner actively plans for continuity of care for the patient, and makes evidence-based follow-up plans
that integrate patient/parental perspectives.
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EPA 20: Assess, manage, and follow up infants, children, and adolescents
presenting with common (key) conditions
In the outpatient setting, residents will demonstrate an ability to assess and manage infants, children, and
1. Description of the activity
EPA 21: Recognize and provide initial management of common pediatric
emergencies
1. Description of the activity
In the emergency room setting, residents will demonstrate the ability to arrive at a timely, correct diagnosis. They will
consider an appropriately broad differential (including dangerous causes), prioritize and assess/reassess appropriately,
and initiate management and treatment in a timely way. They will effectively engage the health care team to optimize
patient care.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
adolescents presenting with common conditions, working efficiently though an appropriately broad initial differential
diagnosis, and ruling out potential dangerous diagnoses. They will develop appropriate follow-up management plans.
2. Most relevant CanMEDS-FM roles
√ Expert
Collaborator
√ Health Advocate
√ Communicator
√ Leader/Manager
Scholar
Health Advocate
√ Professional
3. Competencies within each domain critical to entrustment
decisions
√ Professional
FAM1 FAM2
3. Competencies within each domain critical to entrustment decisions
FAM6 FAM8
FAM1 FAM2
FAM6 FAM8
FAM9 FAM10
FAM9 FAM10
FAM11 FAM12
FAM11 FAM12
FAM27 COC5
4. Priority topics
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level demonstrates underdeveloped skill in history
gathering, manifested as errors of omission or commission in gathering
information. This resident does not recognize risk factors or determinants
of health and is inconsistent in doing reviews of systems, being either
overly or inadequately comprehensive. This resident may also incorrectly
perform physical exam manoeuvres, and may miss key physical exam
findings.
The resident at this level has a limited ability to filter, prioritize, and make
connections between information gathered from primary and secondary
sources. Additionally, this resident has a limited ability to identify and
reflect on pertinent information as it emerges, in order to continuously
update the differential diagnosis and avoid errors of clinical reasoning.
His/her documentation is incomplete, and he/she does not use EMR
functionalities to support care management.
When this resident offers a management plan, it may not be sufficiently
inclusive of all items in the differential, thereby
missing confirmation or
disconfirmation of important diagnoses.
Entrustable
FAM13 FAM14
FAM27 COC7
4. Priority topics
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
5. Assessment methods
Field notes, ITER
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
beyond the patient him/herself.
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
relationship.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning. This resident identifies urgent conditions and responds appropriately. He/
she effectively documents care provided in the medical record, and uses EMR functionalities that support patient care
(e.g., diagnosis list, medication lists).
The entrustable learner is comfortable with ambiguity, manifested as an ability to respond to questions or challenges
from the patient in a professional manner, even when uncertain about the answer.
This learner develops and implements cost-effective plans collaboratively with the patient. He/she actively plans
for continuity of care for the patient, and makes evidence-based follow-up plans that integrate appropriate use of
community resources or other health care providers.
This resident often fails to incorporate the patient perspective or consider
cost/resource use when developing a management plan. He/she often
inadequately plans for follow-up, leading to a lack of continuity of care.
140
Scholar
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level demonstrates underdeveloped skill in history gathering,
manifested as errors of omission or commission in gathering information. This resident
may also incorrectly perform physical exam manoeuvres and may miss key physical
exam findings. This resident does not appreciate the seriousness of the condition.
The resident has a limited ability to filter, prioritize, and make connections between
information gathered from primary and secondary sources. Additionally, this resident
has a limited ability to identify and reflect on pertinent information as it emerges,
in order re-assess the patient’s condition and adjust the management plan. His/her
documentation is not timely, is incomplete, or lacks pertinent details.
When this resident offers a management plan, it may not be sufficiently inclusive
of all items in the differential, thereby
missing confirmation or disconfirmation of
important diagnoses. This resident may not have adequate knowledge of resuscitation
algorithms, approaches, or medications.
This resident often fails to communicate the severity of the condition on management
plans, to the patient, or to families. He/she often inadequately plans for reassessment,
consultation, or need for transfer.
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
beyond the patients themselves (e.g., emergency responders, others).
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning. This resident quickly identifies the degree of urgency of the condition and
responds appropriately. He/she re-evaluates the patient as the condition changes, and adjusts care plans as required.
He/she effectively documents care provided in the medical record.
This learner mobilizes resources (investigations, consultations) efficiently and in a timely fashion. He/she demonstrates
broad knowledge of emergency drug dosages and mechanisms.
This resident communicates with the patient (if responsive) and family members to provide information on the
seriousness of the condition, confirm patient treatment wishes (such as ACP status), and seek input.
The entrustable learner re-evaluates the patient at appropriate intervals, and makes plans for safe transfer to providers/
services for definite care.
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EPA 22: Determine when a child or adolescent patient requires admission and
in-patient hospital care
1. Description of the activity
Residents will demonstrate the ability to determine if a patient’s condition requires admission to hospital for further
assessment and management. Residents will demonstrate safe hand over techniques.
2. Most relevant CanMEDS-FM roles
√ Expert
Collaborator
Health Advocate
Scholar
Scholar
√ Professional
3. Competencies within each domain critical to entrustment decisions
FAM1 FAM2
FAM1 FAM2
FAM6 FAM8
FAM6 FAM8
FAM9 FAM10
FAM9 FAM10
FAM11 FAM13
FAM11 FAM13
FAM14 FAM27
FAM17 FAM27
COC5 COC6
Field notes, ITER
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
exam pertinent
to the patient visit. When necessary, the learner identifies and uses alternative sources of information
beyond the patients themselves.
The resident at this level consistently engages the patient, inquiring about concerns and building a therapeutic
relationship. The entrustable resident ensures the patient understands the need for admission to hospital, and
establishes goals collaborative with the patient and, when appropriate, with his/her family.
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
avoid most errors of clinical reasoning. This resident determines the need for and goals of admission to hospital.
This resident does not adequately communicate to the patient
the need for admission to hospital, or is unable to establish goals
collaborative with the patient (or a substitute decision maker).
He/she has difficulty determining timing or appropriate setting for
admission. This resident is unable to demonstrate safe hand over of
care, and may have gaps in either verbal or written communication.
142
√ Communicator
Health Advocate
5. Assessment methods
The resident at this level has a limited ability to filter, prioritize, and
make connections between information gathered from primary
and secondary sources. Additionally, this resident has a limited
ability to identify and reflect on pertinent information as it emerges,
and fails to recognize the need for admission to hospital. His/her
documentation is not timely, is incomplete, or lacks pertinent details.
√ Expert
√ Leader/Manager
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
The resident at this level demonstrates underdeveloped skill in
history gathering, manifested as errors of omission or commission
in gathering information. This resident may also incorrectly perform
physical exam manoeuvres and may miss key physical exam findings.
2. Most relevant CanMEDS-FM roles
Leader/Manager
4. Priority topics
2. practice with full supervision
In the in-patient setting, residents will demonstrate an ability to assess and manage patients presenting with a variety
of medical conditions. They will collaborate effectively within interprofessional teams.
Collaborator
COC5 COC6
Pre-Entrustable
1. Description of the activity
√ Communicator
√ Professional
3. Competencies within each domain critical to entrustment
decisions
EPA 23: Assess and appropriately manage the child or adolescent patient in hospital
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
4. Priority topics(s):
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
5. Assessment method(s):
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level demonstrates underdeveloped skill in history gathering,
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate physical
manifested as errors of omission or commission in gathering information. This resident exam. When necessary, the learner identifies and uses alternative sources of information beyond the patients
may also incorrectly perform physical exam manoeuvres and may miss key physical
themselves (e.g., parents).
exam findings.
The resident at this level consistently engages the patient and parents, inquiring about their concerns and building a
The resident at this level has a limited ability to filter, prioritize, and make connections therapeutic relationship. On admission to hospital, the entrustable learner confirms ACP goals.
between information gathered from primary and secondary sources. Additionally,
This resident uses current and emerging information to continuously update the differential diagnosis, and is able to
this resident has a limited ability to identify and reflect on pertinent information as it
avoid most errors of clinical reasoning. This resident identifies urgent conditions and responds appropriately. He/she
emerges, in order to continuously update the differential diagnosis and avoid errors of
effectively documents care provided in the medical record.
clinical reasoning. This resident may not always recognize deterioration of the patient.
His/her documentation is incomplete and does not clearly reflect patient progress.
This learner develops and implements cost-effective plans with the input of the patient. The learner works effectively
When this resident offers a management plan, it may not be sufficiently inclusive.
This resident often fails to incorporate the patient or parental perspective. As a
consequence, the patient is often not clear in regard to the goals of care.
within an interprofessional team to deliver patient care.
The entrustable learner re-evaluates the patient at appropriate intervals, and provides the patient feedback in regards
to his/her progress.
He/she does not communicate clearly or adequately with interprofessional team
members.
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EPA 24: Recognize and provide initial management of the medically unstable
pediatric patient in the hospital setting
1. Description of the activity
In the hospital setting, residents will demonstrate the ability to assess the unstable pediatric patient, arriving at a
timely and correct diagnosis that considers an appropriately broad differential, including dangerous causes. They
will prioritize and assess/reassess appropriately, and initiate management and treatment in a timely way. They will
effectively engage the health care team to optimize patient care.
√ Expert
2. Most relevant CanMEDS-FM roles
In the hospital setting, residents will plan and coordinate the discharge of the child or adolescent from the hospital,
and ensure appropriate follow-up with the patient’s family physician.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
Leader/Manager
Health Advocate
√ Health Advocate
Scholar
Scholar
Professional
√ Professional
FAM1 FAM2
1. Description of the activity
√ Communicator
√ Collaborator
3. Competencies within each domain critical to entrustment
decisions
EPA 25: Plan and coordinate discharge of the child or adolescent from hospital
3. Competencies within each domain critical to entrustment
decisions
FAM6 FAM8
FAM1 FAM2 FAM6
FAM10 FAM11 FAM12
FAM9 FAM10 FAM11 FAM13
FAM14 FAM17 FAM21
FAM14 FAM27 COC7
COC2 COC5
4. Priority topics
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
4. Priority topics
1, 2, 3, 4, 5, 7, 12, 17, 20, 22, 24, 25, 26, 30, 34, 36, 37, 38, 39, 40, 41, 43, 44, 50, 51, 54, 55, 56,
59, 60, 61, 62, 66, 74, 75, 78, 79, 80, 81, 83, 84, 89, 90, 92, 93, 94, 96
5. Assessment methods
Field notes, ITER
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level demonstrates underdeveloped skill in history
gathering, manifested as errors of omission or commission in gathering
information. This resident may also incorrectly perform physical exam
manoeuvres and may miss key physical exam findings. This resident may
not appreciate the seriousness of the condition.
The resident has a limited ability to filter, prioritize, and make
connections between information gathered from primary and secondary
sources. Additionally, this resident has a limited ability to identify
and reflect on pertinent information as it emerges, in order re-assess
the patient condition and adjust the management plan. His/her
documentation is not timely, is incomplete, or lacks pertinent details.
When this resident offers a management plan, it may not be sufficiently
inclusive of all items in the differential, thereby
missing confirmation
or disconfirmation of important diagnoses. This resident may not
have adequate knowledge of resuscitation algorithms, approaches, or
medications.
Entrustable
4. “unsupervised” practice
The resident at this level consistently gathers
an appropriately focused history and can perform an accurate and
focused physical exam. When necessary, the learner identifies and uses alternative sources of information beyond the
patients themselves (e.g., nursing staff, others).
This resident uses current and emerging information to continuously update the differential diagnosis, and is able
to avoid most errors of clinical reasoning. This resident quickly identifies the degree of urgency of the condition and
responds appropriately. He/she
re-evaluates the patient as the condition changes, and adjusts the care plan as required. He/she effectively documents
care provided in the medical record.
This learner mobilizes resources (investigations, consultations) efficiently and in a timely fashion. This learner
demonstrates broad knowledge of emergency drug dosages and mechanisms.
This resident communicates with the patient (if responsive) and family members to provide information on the
seriousness of the condition, confirm patient treatment wishes (such as ACP status), and seek input.
The entrustable learner re-evaluates the patient at appropriate intervals, and makes plans for safe transfer to
providers/services for definite care.
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level has difficulty determining the patient’s
readiness for discharge, or demonstrates reluctance to discharge.
This resident does not consistently seek input from members of the
health care team to inform the discharge plan, and does not solicit
the perspective of the patient or his/her family. The pre-entrustrable
learner has a limited understanding of external resources as required
and does not fully use community supports.
Entrustable
4. “unsupervised” practice
The resident at this level determines the patient’s readiness for discharge.
This resident seeks input from colleagues to inform the discharge plan, and integrates the perspective of the patient
and his/her family. The entrustrable learner identifies and coordinates external resources as required.
This learner demonstrates safe hand over of care, using both verbal and written communication. The resident
completes clear, accurate, and timely discharge summaries, ensuring they are sent to appropriate providers in the
community.
This learner does not effectively communicate (either verbally or
in writing) regarding discharge. The resident does not have a clear
format for discharge summaries, leading to incomplete, unclear, or
inaccurate discharge summaries. This learner does not share discharge
information with the patient’s providers in the community.
This resident often fails to communicate the severity of the condition
on management plans, to the patient, or to families. He/she often
inadequately plans for reassessment, consultation, or need for transfer.
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FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
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145
EPA 26: Provide expert advice and obtain consultation for patients
1. Description of the activity
Across multiple settings, the resident identifies patients whose condition would be improved by care provided by a
consultant. The resident also provides advice at the request of colleagues.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
Health Advocate
1. Description of the activity
Across multiple settings, the resident will be able to recognize the need for and facilitate interdisciplinary meetings.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
Health Advocate
Scholar
3. Competencies within each domain critical to entrustment
decisions
FAM6 FAM11
FAM12 FAM13
FAM6
FAM10
FAM11 FAM12
FAM13 FAM18
FAM14 FAM17
FAM27
FAM27
4. Priority topics
4. Priority topics
1, 3, 10, 11, 12, 13, 25, 34, 36, 41, 44, 55, 62, 78, 80, 89, 93, 96
9, 18, 27, 43, 70, 98
5. Assessment methods
5. Assessment methods
Field notes, ITER
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
The resident at this level does not consistently recognize if a patient’s
needs exceed the limits of his/her clinical competence. The resident may
delay referring patients or unnecessarily refer.
Scholar
√ Professional
√ Professional
3. Competencies within each domain critical to entrustment
decisions
EPA 27: Facilitate family and interdisciplinary meetings
Entrustable
4. “unsupervised” practice
The resident at this level recognizes if a patient’s needs exceed the limits of his/her clinical competence.
When indicated, the resident makes timely, complete, and clear referrals to colleagues. This resident ensures that the
patient understand the reasons for the referral and the referral process.
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
The resident at this level does not recognize situations that would
The resident at this level recognizes situations that would benefit from family or interdisciplinary meetings. This
benefit from family or interdisciplinary meetings. This resident is
resident uses meetings to establish or advance patient-centred care plans. He/she identifies necessary participants
unprepared for meetings, and does not identify necessary participants
and defines the focus of the meeting.
or the focus of the meetings.
When meeting with the patient and his/her family, this resident uses the opportunity to further strengthen the
During meetings, this resident shares explanations that are unclear,
patient-physician relationship. During meetings, this resident shares explanations that are clear and accurate, and
inaccurate, or too technical. He/she does not check for patient/family
checks for patient/family understanding. He/she uses meetings to support decision making that leads to a shared
understanding.
plan of care.
When meeting with interprofessional teams, this resident does not
When meeting with interprofessional teams, this resident ensures that each participant’s role is clear and that
clarify each participant’s role, or there is no clear focus for the meeting,
interactions are respectful. He/she effectively facilitates the discussion and ensures that a clear action plan is
assessments or fail to answer the question posed.
leading to an unclear action plan.
established.
This resident’s documentation may be inaccurate, incomplete, or delayed.
The resident at this level does not document the content and results of
The resident at this level documents the content and results of meetings accurately within the patient chart.
This resident’s referrals may be incomplete or unclear. The patient may
not understand the reasons for the referral or the referral process, which
may result in non-attendance.
When requested to provide advice, the pre-enstrustable learner may
not respond in a timely fashion. He/she may perform incomplete
This resident applies evidence and management processes to ensure cost-appropriate referrals.
At the request of colleagues, the enstrustable learner provides expert advice. This resident performs a comprehensive
assessment and responds to the question posed.
This resident documents consult requests and replies in an accurate, complete, and timely fashion.
meetings accurately within the patient chart.
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EPA 28: Optimize the quality and safety of health care through use of best
practices and application of QI
1. Description of the activity
Residents will demonstrate skill in practice management through implementation of best practices, principles of
continuity of care, quality improvement strategies, and optimizing of information management.
2. Most relevant CanMEDS-FM roles
√ Expert
EPA 29: Provide care to vulnerable and underserved populations
1. Description of the activity
Across multiple settings, residents will demonstrate competent provision of patient-centred care for vulnerable and
underserved populations. Residents will demonstrate a culturally sensitive holistic approach, and an understanding of
the unique determinants of health, beliefs, and traditions. As needed, residents will effectively use translators.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
Communicator
Collaborator
√ Leader/Manager
Health Advocate
√ Scholar
√ Professional
3. Competencies within each domain critical to entrustment
decisions
FAM1 FAM7
√ Health Advocate
FAM15 FAM16
√ Professional
FAM17 FAM20
3. Competencies within each domain critical to entrustment
decisions
FAM24 FAM27
FAM28
4. Priority topics
18, 19, 30, 72, 98
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Scholar
UND1 UND2 UND3 FAM1
FAM2
FAM6 FAM8 FAM9
FAM10 FAM11 FAM12 FAM13
FAM17 FAM21 FAM27
Entrustable
4. “unsupervised” practice
The resident at this level has a vague understanding of continuous
The resident at this level demonstrates a commitment to high quality care and actively participates in the continuous
quality improvement. He/she recognizes that commitment to excellence
improvement of health care quality and patient safety. He/she recognizes that his/her commitment to excellence and
is desirable, but does not necessarily recognize it as a personal
to continuous quality improvement is a professional responsibility.
4. Priority topics
24, 25, 26, 30, 42, 43, 44, 45, 48, 49, 51, 57, 58, 62, 74, 78, 87, 93, 94, 99
5. Assessment methods
Field notes, ITER
Pre-Entrustable
2. practice with full supervision
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
This resident does not fully appreciate the variety of perspectives,
This resident demonstrates an understanding of the cultural diversities that result in a variety of perspectives, attitudes,
attitudes, beliefs, and behaviours of patients in underserved or
beliefs, and behaviours. The resident is able to describe differences in the morbidity, mortality, and disease patterns of
This resident understands the principles of quality improvement and is able to apply these principles in the practice
vulnerable populations. The resident does not appreciate differences in
immigrant or homeless populations compared to the general population.
This resident has a limited understanding of the principles of quality
setting. He/she effectively organizes information in the electronic medical record in a way that allows it to be
morbidity and mortality patterns in immigrant, homeless, or disabled
improvement. He/she does not recognize the value of appropriately
extracted for audit purposes. The resident is able to complete practice audits and use information to guide practice
populations, and often fails to provide appropriate screening.
organizing information in specific fields in the electronic medical record
improvement.
professional responsibility.
in a way that allows it to be extracted for audit purposes. The resident
does not have requisite knowledge on how to complete a practice audit.
This resident cannot describe the Patient Medical Home model and is
unaware of initiatives (local or national) that attempt to achieve these
goals.
The entrustable resident demonstrates effective and culturally safe patient-centred care for patients and their families.
The resident consistently engages the patient, inquiring about his/her concerns and building a therapeutic relationship.
The pre-entrustable resident’s limited understanding of immigrant,
This resident can describe the Patient Medical Home model and can identify initiatives (local or national) that attempt
homeless, or disabled patients limits his/her ability to build therapeutic
to achieve these goals.
relationships with patients and their families.
The entrustable learner can select and critically evaluate health care research, and integrate evidence into decision
This resident does not enquire about whether the patient uses
making in his/her practice. He/she can review and appropriately apply guidelines from organizations.
traditional medicine and/or fails to integrate that knowledge into
This resident inquires about whether the patient uses traditional medicine and integrates that knowledge into patient
care plans.
The entrustable learner recognizes the various jurisdictional areas and how they impact health service delivery (e.g.,
patient care plans, which, in turn, affects compliance.
refugees). He/she uses this understanding to effectively coordinate the delivery of patient care.
This resident integrates understanding of health determinants and advocates for individual patients and, if applicable,
The pre-entrustable learner may have difficulty selecting and critically
their families.
evaluating health care research, and/or integrating evidence into
The entrustable learner has limited understanding of various
decision making in his/her practice. He/she applies guidelines rigidly,
jurisdictional responsibilities for provision of the health service model
not recognizing their limitations.
(e.g., refugees), and thus has difficulty effectively coordinating the
delivery of patient care.
This resident has a limited understanding of health determinants and
has difficulty advocating for individual patients.
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EPA 30: Provide care to First Nations, Inuit, and Métis peoples
1. Description of the activity
Across multiple settings, residents will demonstrate competent provision of patient-centred care for First Nations,
Inuit, and Métis peoples. Residents will demonstrate a culturally sensitive holistic approach, and an understanding of
the unique determinants of health, beliefs, and traditions. As needed, residents will effectively use translators.
2. Most relevant CanMEDS-FM roles
√ Expert
√ Communicator
√ Collaborator
√ Leader/Manager
√ Health Advocate
6. Perform common family medicine procedures
FNIM5 FNIM6
7. Manage the elderly patient with multiple comorbidities
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T24
8. Recognize and provide initial management of common adult emergencies
Field notes, ITER
This resident does not enquire about whether the patient uses traditional
medicine and/or fails to integrate that knowledge into patient care plans,
which, in turn, affects compliance.
T18
5. Identify, diagnose, evaluate, and manage patients with common mental issues
FNIM3 FNIM4
5. Assessment methods
The pre-entrustable resident’s limited understanding of First Nations,
Inuit, and Métis cultures limits his/her ability to build therapeutic
relationships with patients and their families.
T12
4. Diagnose and manage patients with common chronic conditions and multiple comorbidities
24, 25, 26, 30, 42, 43, 44, 45, 48, 49, 51, 57, 58, 62, 74, 78, 87, 93, 94, 99
The resident at this level has a limited understanding of the connection
between the historical and current situation of First Nations, Inuit,
and Métis peoples. This resident does not fully appreciate the cultural
diversities of Indigenous peoples that result in a variety of perspectives,
attitudes, beliefs, and behaviours. The resident does not appreciate
differences in the morbidity and mortality patterns of Aboriginal
peoples compared to the general population, and often fails to provide
appropriate screening.
T6
3. Assess, manage, and follow up adults presenting with common (key) conditions
FNIM1 FNIM2
3. practice with supervision on demand
Entrustable
4. “unsupervised” practice
2. Assess, manage, and follow up patients presenting with undifferentiated symptoms
4. Priority topics
2. practice with full supervision
3. practice with supervision on demand
1. Provide periodic health exams and preventative health care to adults
Scholar
FNIM8 FAM8
Pre-Entrustable
Pre-Entrustable
2. practice with full supervision
EPA
√ Professional
3. Competencies within each domain critical to entrustment
decisions
Projected development of EPAs
9. Determine when an adult patient requires admission and in-patient hospital care
10. Assess and appropriately manage the adult patient in hospital
11. Recognize and provide initial management of the medically unstable adult patient in the hospital setting
Entrustable
4. “unsupervised” practice
12. Plan and coordinate discharge of adult patients from hospital
13. Provide palliative end-of-life care
The resident at this level approaches interactions with patients with a good understanding of the connection
between the historical and current situation of First Nations, Inuit, and Métis peoples. This resident demonstrates
an understanding of the cultural diversities of Indigenous peoples that result in a variety of perspectives, attitudes,
beliefs, and behaviours. The resident is able to describe differences in the morbidity and mortality patterns of
Aboriginal peoples compared to the general population.
14. Provide pre-conception and prenatal care
The entrustable resident demonstrates effective and culturally safe patient-centred communication with First Nations,
Inuit, and Métis patients and their families. The resident at this level consistently engages the patient, inquiring about
his/her concerns and building a therapeutic relationship.
19. Provide periodic health exams and preventative care to infants, children, adolescents
This resident inquires about whether the patient uses traditional medicine and integrates that knowledge into patient
care plans.
15. Provide intrapartum care and perform low-risk deliveries
16. Recognize and manage common intrapartum emergencies
17. Provide postpartum care
18. Provide family medicine-centred care to newborns in their first weeks of life
20. Assess, manage, and follow up infants, children, and adolescents presenting with common (key) conditions
21. Recognize and provide initial management of common pediatric emergencies
22. Determine when a child or adolescent requires admission and in-patient hospital care
23. Assess and appropriately manage the child or adolescent patient in hospital
The entrustable learner recognizes the various jurisdictional areas and the local health service model. He/she uses this
understanding to effectively coordinate the delivery of patient care.
24. Recognize and provide initial management of the medically unstable pediatric patient in the hospital setting
This resident integrates understanding of health determinants and advocates for individual patients.
26. Provide expert advice and obtain consultation for patients
25. Plan and coordinate discharge of the child or adolescent from hospital
The pre-entrustable learner has limited understanding of various
jurisdictional areas and the local health service model, making it difficult
to effectively coordinate the delivery of patient care.
27. Facilitate family and interdisciplinary meetings
This resident has a limited understanding of health determinants and
has difficulty advocating for individual patients.
30. Provide care to First Nation, Inuit, and Métis peoples
FACULTY OF HEALTH SCIENCES, COLLEGE OF MEDICINE, DEPARTMENT OF FAMILY MEDICINE
28. Optimize the quality and safety of health care through use of best practices and
application of Quality Improvement
29. Provide care to vulnerable and underserved populations
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Appendix A: CFPC Core topics
1. Abdominal Pain
26. Diarrhea
51. Infections
76. Pregnancy
2. Advanced Cardiac Life
Support
27. Difficult Patient
52. Infertility
77. Prostate
28. Disability
53. Insomnia
78. Rape/Sexual Assault
29. Dizziness
54. Ischemic Heart Disease
79. Red Eye
30. Domestic Violence
(Sexual, Physical,
Psychological
55. Joint Disorder
80. Schizophrenia
56. Lacerations
81. Seizures
31. Dyspepsia
57. Learning
82. Sex
32. Dysuria
58. Lifestyle
33. Earache
59. Loss of Consciousness
83. Sexually Transmitted
Infections
34. Eating Disorders
60. Loss of Weight
35. Elderly
61. Low-back Pain
36. Epistaxis
62. Meningitis
37. Family Issues
63. Menopause
38. Fatigue
64. Mental Competency
39. Fever
65. Multiple Medical
Problems
3. Allergy
4. Anemia
5. Antibiotics
6. Anxiety
7. Asthma
8. Atrial Fibrillation
9. Bad News
APPENDICES
10. Behavioural Problems
11. Breast Lump
12. Cancer
13. Chest Pain
14. Chronic Disease
15. Chronic Obstructive
Pulmonary Disease
16. Contraception
41. Gastro-intestinal Bleed
17. Cough
42. Gender Specific Issues
18. Counselling
43. Grief
19. Crisis
44. Headache
20. Croup
45. Hepatitis
21. Deep Venous
Thrombosis
46. Hyperlipidemia
22. Dehydration
23. Dementia
24. Depression
25. Diabetes
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40. Fractures
84. Skin Disorder
85. Smoking Cessation
86. Somatization
87. Stress
88. Stroke
89. Substance Abuse
90. Suicide
66. Neck Pain
91. Thyroid
67. Newborn
92. Trauma
68. Obesity
93. Travel Medicine
69. Osteoporosis
94. Upper Respiratory Tract
Infection
70. Palliative Care
71. Parkinsonism
47. Hypertension
72. Periodic Health
Assessment/Screening
48. Immigrants
73. Personality Disorder
49. Immunization
74. Pneumonia
50. In Children
75. Poisoning
95. Urinary Tract Infection
96. Vaginal Bleeding
97. Vaginitis
98. Violent/Aggressive
Patient
99. Well-baby Care
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Appendix B: CFPC Core Procedures
Appendix B: CFPC Core Procedures (cont’d)
Integumentary Procedures
Ear Procedures
Musculoskeletal Procedures
Injections and Cannulations
Abscess incision and drainage
Removal of cerumen
Splinting of injured extremities
Intramuscular injection
Wound debridement
Removal of foreign body
Application of sling, upper extremity
Subcutaneous injection
Reduction of dislocated finger
Intradermal injection
Reduce dislocated radial head (pulled elbow)
Venipuncture
Reduce dislocated shoulder
Peripheral intravenous line; adult and child
Application of forearm cast
Peripheral venous access—infant
Application of ulnar gutter splint
Adult lumbar puncture
Insertion of sutures: simple, mattress, and subcuticular
Laceration repair: suture and gluing
Skin biopsy: shave, punch, and excisional
Excision of dermal lesions, e.g., papilloma, nevus, or cyst
Nose Procedures
Removal of foreign body
Cautery for anterior epistaxis
Anterior nasal packing
Cryotherapy of skin lesions
Electrocautery of skin lesions
Skin scraping for fungus determination
Use of Wood’s lamp
Release subungual hematoma
Drainage acute paronychia
Partial toenail removal
Wedge excision for ingrown toenail
Removal of foreign body, e.g., fish hook, splinter, or glass
Pare skin callus
Local Anesthetic Procedures
Infiltration of local anesthetic
Digital block in finger or toe
Eye Procedures
Instillation of fluorescein
Slit lamp examination
Removal of corneal or conjunctival foreign body
Application of eye patch
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Gastrointestinal Procedures
Nasogastric tube insertion
Fecal occult blood testing
Anoscopy/proctoscopy
Incise and drain thrombosed external hemorrhoid
Genitourinary and Women’s Health
Procedures
Placement of transurethral catheter
Cryotherapy or chemical therapy genital warts
Aspirate breast cyst
Pap smear
Diaphragm fitting and insertion
Application of scaphoid cast
Application of below-knee cast
Aspiration and injection, knee joint
Aspiration and injection, shoulder joint
Injection of lateral epicondyle (tennis elbow)
Aspiration and injection of bursae, e.g., patellar,
subacromial
Resuscitation Procedures
Oral airway insertion
Bag-and-mask ventilation
Endotracheal intubation
Cardiac defibrillation
Insertion of intrauterine device
Endometrial aspiration biopsy
Obstetrical Procedures
Normal vaginal delivery
Episiotomy and repair
Artificial rupture of membranes
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