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CANMEDS 2000 and 2005: Defining Roles for Canadian Physicians

1. Core Knowledge:

The CANMEDS initiative was established by the Royal College in the 1990s in reaction to the rapidly changing face of medical practice. The changes include the explosion of medical knowledge, growing patient consumerism and access to medical information via the Web, financial restrictions and increased government regulation, increasing litigation against doctors, and rapidly changing technology.

In the face of these challenges, the CANMEDS program defines "core competencies" that physicians need, and roles they should master, to respond to these pressures while providing the best quality of care. In the late 1990s, the Royal College worked to incorporate the CANMEDS goals into residency programs, and undergraduate education has responded to these guidelines. Hence the emphasis on professionalism, and on topics such as critical appraisal of the literature, in our curriculum.  A revised version of the original document was produced in 2005, and is summarized below.

The CANMEDS framework describes seven roles for physicians, of which the first, Medical Expert, is central. Here are the key competencies; for more detail see the complete document:

Physicians are able to...

  1. Function effectively as consultants, (...) to provide optimal, ethical and patient-centered medical care;
  2. Establish and maintain clinical knowledge, skills, and attitudes appropriate to their practice;
  3. Perform a complete and appropriate assessment of a patient;
  4. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic;
  5. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise.

Physicians are able to...

  1. Develop rapport, trust and ethical therapeutic relationships with patients and families;
  2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals;
  3. Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;
  4. Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care;
  5. Convey effective oral and written information about a medical encounter.

Physicians are able to...

  1. Participate effectively and appropriately in an inter-professional healthcare team;
  2. Effectively work with other health professionals to prevent, negotiate, and resolve inter-professional conflict.

Physicians are able to...

  1. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems;
  2. Manage their practice and career effectively;
  3. Allocate finite healthcare resources appropriately;
  4. Serve in administration and leadership roles, as appropriate.

Health Advocate
Physicians are able to...

  1. Respond to individual patient health needs and issues as part of patient care;
  2. Respond to the health needs of the communities that they serve;
  3. Identify the determinants of health of the populations that they serve;
  4. Promote the health of individual patients, communities and populations.

Link: Dr. Robert Cushman: advocate for bicycle helmets

Picture of a road grading machine

I like the image of a health advocate smoothing the road!

Physicians are able to...

  1. Maintain and enhance professional activities through ongoing learning;
  2. Critically evaluate information and its sources, and apply this appropriately to practice decisions;
  3. Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate;
  4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

Physicians are able to...

  1. Demonstrate a commitment to their patients, profession, and society through ethical practice;
  2. Demonstrate a commitment to their patients, profession, and society through participation in profession-led regulation;
  3. Demonstrate a commitment to physician health and sustainable practice.

Link to CANMEDS Web Site
The College of Family Physicians has published its own version of the roles; this document gives a good overview of the ideas involved.

“My role does not stop at treating the illness of the person visiting my office, but extends to my roles as advocate and educator. If I stop my practice at the front door of my building then the lives of my patients will never really improve. It is only by extending myself beyond those doors that I can begin to make a difference in the health of my patients.” 
(Fourth year medical student, Mercer University School of Medicine).