MD Program competencies

A new competency framework for the U of T MD Program, approved by Faculty of Medicine Faculty Council on February 8, 2016, represents a collaborative effort to align the existing U of T MD Program objectives with a competency-based approach to medical education, effective August 1, 2016.

The competency framework consists of the key and enabling competencies that are classified according to the seven CanMEDS roles of Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar, and Professional. Learning within each of these CanMEDS roles is facilitated by pursuing the relevant key competencies, and each of the key competencies is in turn supported by achievement of several enabling competencies.  The language used to describe the competencies is of necessity fairly general, and for the most part does not specify precisely the desired level of achievement within any given domain.

The table below provides guidance about the desired level of achievement through the use of milestones.  The MD Program competency framework, including milestones, is also available as a PDF

Further elaboration of several of the competencies (those marked with asterisks) is provided in *Appendix 1.  **Appendix 2 provides additional details about clinical presentations and ***Appendix 3 about common and life-threatening acute and chronic illnesses (Medical Expert role, enabling competency 1.2). ****Appendix 4 provides additional detail about technical procedures (Medical Expert role, enabling competency 3.5).

Goals

Recognizing the continuum of medical education, and the compelling logic of linking medical student education to subsequent post-graduate training and continuing education, and the scientific and humanistic foundations of medicine, the Faculty of Medicine at the University of Toronto has adopted the following goals for the undergraduate curriculum:

  • Graduates of the MD Program will demonstrate the foundation of knowledge, skills and attitudes necessary to achieve the CanMEDS  and CanMEDS-FM competencies. 
  • In keeping with the Faculty of Medicine’s vision of international leadership in improving health through innovation in research and education, the Undergraduate Medical Curriculum will encourage, support and promote the development of future academic health leaders, who will contribute to our communities, and improve the health of individuals and populations through the discovery, application and communication of knowledge.

Key & enabling competencies

 

    MEDICAL EXPERT

    Key Competency 1. Apply medical knowledge, clinical skills and professional attitude to the provision of patient centered care


    Enabling competencies Milestones

    1.1 Demonstrate integration of the CanMEDS roles into the practice of medicine in order to address the health care needs of individual patients and populations throughout the life cycle

    Achieved prior to Clerkship: 
    1. Identify and describe the CanMEDS roles
    2. In simulated cases, identify which CanMEDS role(s) is/are relevant to the patient care and/or population health scenario
    Achieved prior to graduation: 
    1. Describe the foundational discipline concepts relevant to, and the pathophysiology of, common medical problems
    2. Integrate and apply knowledge of foundational disciplines and clinical topics to diagnose common medical problems in simulated clinical cases, and to propose management plans for them
    3. Describe the psychological and social factors that influence the presentation and impact of illness

    1.2 Apply and integrate knowledge in the following domains, relevant to the study and practice of medicine:

    FOUNDATIONAL DISCIPLINES

    • Biomedical sciences *
    • Population and public health sciences
    • Social sciences *
    • Medical humanities*

    CLINICAL TOPICS

    • Approach to clinical presentations**
    • Features of common and/or life-threatening acute and chronic illnesses***
    • Use of diagnostic tests*
    • Application of therapeutic interventions*
    Achieved prior to Clerkship: 
    1. Describe the foundational discipline concepts relevant to, and the pathophysiology of, common medical problems
    2. Integrate and apply knowledge of foundational disciplines and clinical topics to diagnose common medical problems in simulated clinical cases, and to propose management plans for them
    3. Describe the psychological and social factors that influence the presentation and impact of illness
    Achieved prior to graduation: 
    • Describe the foundational discipline concepts relevant to, and the pathophysiology of, uncommon or more complex medical problems
    • Integrate and apply knowledge of foundational disciplines and clinical topics together with clinical skills to diagnose and address common medical problems in patients
    • Address psychological and social factors when assessing patients and developing care plans
    • Describe community and population level interventions when assessing patents and developing care plans

    1.3 Demonstrate an awareness of limits of their expertise and their potential biases

    Achieved prior to Clerkship: 
    1. Describe the nature of clinical expertise and of its limits
    2. Describe the potential for cognitive bias when making a clinical diagnosis related to one’s perspective and experience.  (Other biases are addressed in Communicator enabling competency 1.3.) 
    Achieved prior to graduation: 
    1. Demonstrate the capacity to reflect on their own competencies and identify situations where one requires help
    2. Demonstrate the capacity to identify situations where cognitive biases may have affected their patient management
    3. Describe the scope of practice of physicians and their role within the health care system

    1.4  Recognize the complexity, uncertainty and ambiguity inherent in medicine

    Achieved prior to Clerkship: 
    1. Recognize that there is a degree of uncertainty in all clinical decision making
    Achieved prior to graduation: 
    1. Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making

    1.5 Carry out professional duties in the face of multiple, competing demands

    Achieved prior to Clerkship: 
    1. Demonstrate an approach to balancing clinical duties as a clinical clerk with the need to continue learning as a medical student
    Achieved prior to graduation: 
    1. Recognize competing demands in professional duties and seek assistance in determining priorities

    Key Competency 2.  Perform a patient-centered clinical assessment


    Enabling competencies Milestones

    2.1 Prioritize issues to be addressed in a patient encounter

    Achieved prior to Clerkship: 
    1. In the interaction with a stable patient presenting with a straightforward problem, identify the concerns and goals of patients and their families for that specific encounter
    Achieved prior to graduation: 
    1. In the interaction with a patient presenting with an acute illness and/or a complex problem, identify the concerns and goals of patients and their families for that specific encounter

    2.2 Obtain a history of the clinical presentation of the patient * 

    Achieved prior to Clerkship: 
    1. Perform a detailed, comprehensive history
    2. Be able to document and review the  clinical encounter in an oral presentation, as a written document, and entered into an electronic medical record
    Achieved prior to graduation: 
    1. Perform a focused history based on all relevant information
    2. Be able to document and review the  clinical encounter concisely in an oral presentation, as a written document, and entered into an electronic medical record

    2.3 Perform a physical and mental status examination relevant to the patient’s presentation *

    Achieved prior to Clerkship: 
    1. Perform an assessment of vital signs
    2. Perform a detailed physical examination of all body systems
    3. Detect obvious major abnormalities on physical examination
    4. Apply appropriate patient draping and exposure
    Achieved prior to graduation: 
    1. Perform a focused physical examination based on the patient’s chief complaint and review of systems
    2. Detect all significant abnormal findings on physical examination

    2.4 Order and interpret appropriate diagnostic investigations based on the clinical assessment

    Achieved prior to Clerkship: 
    1. Select common investigations relevant to the findings on history and physical examination
    2. Describe the purpose of common diagnostic tests, including blood tests, tests of other body fluids, ECG and basic imaging tests
    3. In a simulated case, interpret the results of commonly ordered tests
    Achieved prior to graduation: 
    1. Select investigations focused on a possible diagnosis based on the history and physical examination, and interpret the results in the context of a patient presenting with the full spectrum of clinical problems
    2. Describe more specialized investigations, the limitations of these diagnostic tests and implications of the results

    2.5 Generate a problem list and for each problem a differential diagnosis and working diagnosis, when applicable

    Achieved prior to Clerkship: 

    In a stable patient presenting with a straightforward problem:

    1. Generate a problem list
    2. Formulate a broad differential diagnosis for each problem, based on the clinical encounter and investigations done to date
    3. Propose a most likely or working diagnosis for each problem
    Achieved prior to graduation: 

    In a stable patient presenting with a straightforward problem:

    In a patient presenting with one or more acute illnesses and/or complex problems:

    1. Generate a problem list
    2. Formulate a broad differential diagnosis for each problem, based on the clinical encounter and investigations done to date
    3. For each problem, formulate a working diagnosis and provide an interpretation of the clinical situation 

    2.6 Recognize a patient who requires urgent or emergent care

    Achieved prior to Clerkship: 
    1. Describe the characteristics of an acutely ill patient in terms of findings on history, physical examination and basic laboratory investigations
    Achieved prior to graduation: 
    1. Recognize when a patient has abnormal vital signs that requires immediate attention and investigation
    2. Recognize when a patient has a complaint or physical finding that suggests the possibility of a severe illness (including life- or limb-threatening) and therefore requires immediate attention and investigation

    2.7 Obtain, as needed, additional information about the patient’s history from other sources including health records, family members, friends, and other health care providers

    Achieved prior to Clerkship: 
    1. Describe the various sources that one may access for additional information
    2. For straightforward problems, and with the consent of the patient, in order to complete the database:
    • interview family members
    • contact other health professionals
    • review basic documents from the health record
    Achieved prior to graduation: 
    1. For both straightforward and complex problems, efficiently gather data from family members, other health professionals, and old health records to complete the database

    Key Competency 3. Propose and participate (under appropriate supervision) in implementing management plans 


    Enabling competencies Milestones

    3.1 Involve the patient and family in developing the care plan and determining goals of care *

    Achieved prior to Clerkship: 
    1. In a stable patient presenting with a straightforward problem and who is able to participate in the relevant conversation, develop the outline of a treatment plan that respects the patient’s desires and goals
    Achieved prior to graduation: 
    1. In a patient presenting with one or more acute illnesses and/or complex problems , establish a treatment plan considering the patient’s and family’s wishes

    3.2 Formulate a plan of management that includes a description and explanation of further investigations and/or therapeutic interventions, including considerations of priority and timing

    Achieved prior to Clerkship: 
    1. In a simulated case discussion, or in a stable patient presenting with a straightforward problem, propose a preliminary management plan
    Achieved prior to graduation: 
    1. In a patient presenting with one or more acute illnesses and/or complex problems, establish a therapeutic and management plan with appropriate timelines and follow up

    3.3 Under appropriate supervision, implement plans for assessment and/or treatment

    Achieved prior to graduation: 
    1. In a stable patient presenting with a straightforward problem, implement a plan for assessment and/or treatment under supervision

    3.4 Obtain informed consent

    Achieved prior to Clerkship: 
    1. Describe the underlying ethical principles and legal process of informed consent
    2. Describe the process of how to obtain informed consent for a test or treatment procedure
    Achieved prior to graduation: 
    1. Demonstrate the approach to obtaining and documenting informed consent under direct supervision by a resident or attending physician

    3.5 Perform, under appropriate supervision, essential medical procedures* skillfully and safely with attention to patient comfort, including providing appropriate care prior to and following the procedure

    Achieved prior to Clerkship: 
    1. Describe the indications for essential medical procedures, how they are performed, common risks, and follow-up care
    Achieved prior to graduation: 
    1. Implement plans for care prior to a procedure
    2. Perform essential medical procedures in a supervised or simulated setting
    3. Implement plans following the procedure, including monitoring for post-procedure complications and intervening effectively for major complications that occur

    3.6 Propose a follow-up plan regarding results of investigation and response to interventions

    Achieved prior to Clerkship: 
    1. In a simulated case discussion, or in a stable patient presenting with a straightforward problem, propose a basic follow-up plan regarding results of investigations and response to interventions
    Achieved prior to graduation: 
    1. In a patient presenting with one or more acute illnesses and/or complex problems propose a comprehensive follow-up plan regarding results of investigations and response to interventions

    3.7  Initiate evaluation and treatment of a patient who requires urgent or emergent care, and seek help

    Achieved prior to Clerkship: 
    1. Describe the steps taken in the emergency care of acutely ill patients
    Achieved prior to graduation: 
    1. Identify potential underlying causes of a patient’s deterioration
    2. Apply BCLS as needed
    3. Initiate a “code blue” when required
    4. Communicate effectively with the responding code blue team as needed
    5. Start the initial emergency care plan for a patient with common life- threatening conditions
    6. Demonstrate familiarity with ACLS and ATLS protocols
    7. Effectively call for help as needed
    8. Update family members as needed about the patient’s condition
    9. Clarify goals of care when deterioration is first appreciated

    3.8   Set priorities and manage time effectively when involved in the care of multiple patients

    Achieved prior to graduation: 

    When involved in the care of more than one patient:

    1. Make a plan to attend to the care of each patient within the available time
    2. Identify patients with the most urgent issues and attend to them first
    3. Identify if the clinical demands exceed one’s capacity to manage, and seek help to ensure safe care

    Key Competency 4. Understand and participate in continuous improvement in health care quality and patient safety


    Enabling competencies Milestones

    4.1 Describe the concept of continuous improvement in health care quality and be engaged in this process

    Achieved prior to Clerkship: 
    1. Describe the need for continuous improvement in health care quality
    2. List and describe the 6 aims of health care quality (safe, timely, effective, efficient, equitable, and patient- centered)
    3. Discuss examples of common health care quality problems (e.g.. lack of access, low screening rates) and identify underlying reasons for this and propose potential solutions
    4. Describe internal and external methods of tracking ongoing personal clinical performance (e.g. logging cases, reviewing complications, benchmarking, etc.)
    Achieved prior to graduation: 
    1. Identify instances in clinical practice where continuous improvement in health care quality can be applied
    2. Reflect on performance data and identify opportunities for improvement
    3. Plan a small personal learning/ improvement project using the model for improvement

    4.2. Identify an approach to patient safety based on individual and system factors

    Achieved prior to Clerkship: 
    1. Describe how cognitive and technical performance as it relates to patient care is heavily influenced by both human (e.g., fatigue, stress, cognitive biases) and environmental factors (e.g., work interruptions, equipment, technology)
    2. Define and explain commonly used patient safety incident terms such as adverse event, error, preventable adverse event, and near miss
    3. Describe how adverse events as harms related to the provision of health care are different from harm due to the underlying medical illness
    Achieved prior to graduation: 
    1. Describe the features of a fair and non-punitive approach to patient safety
    2. Recognize in the clinical care environment factors (e.g., environments with frequent interruptions, after-hours and weekend care) that threaten cognitive and technical performance, and apply strategies to mitigate their negative effects
    3. Identify and describe an approach to patient safety based on individual factors that can affect human performance (including sleep deprivation and stress) and system factors (including resource availability and physical and environmental factors)
    4. Recognize examples of patient safety incidents (adverse events, error, near misses, preventable adverse event) in the clinical setting
    5. Differentiate between cases where an adverse event has occurred from those that are due to the underlying medical illness
    6. Demonstrate disclosure of a simple medical error to a patient or family (e.g. inadvertent cancellation of a test), following established guidelines such as those recommended by the Institute for Healthcare Improvement
    7. Propose an approach to reducing the frequency of medical error in response to a patient safety incident

    Key Competency 5. Contribute to improving the health of individuals and the population


    Enabling competencies Milestones

    5.1 Assess the health status of individuals and of populations, in terms of the impact of determinants of health

    Achieved prior to Clerkship: 
    1. Describe the social determinants of health
    2. Describe how the social determinants of health impact the health status of an individual and of populations
    3. Explain how the differential distribution of health determinants influences health status
    Achieved prior to graduation: 
    1. Describe how the social determinants of health have specifically influenced the health of one’s patient and population
    2. Apply an understanding of the social determinants of health to the diagnosis and management of common problems in patients

    5.2 Apply principles of health promotion, health protection, health equity and disease prevention in the management of the health of individuals and populations

    Achieved prior to Clerkship: 
    1. Define and describe the key principles relevant to:
      • health promotion
      • disease prevention
      • health protection
      • health equity
    2. Describe the levels of prevention including primary, secondary and tertiary prevention and apply to individual and population scenarios
    3. Describe the principles of screening tests to detect disease
    Achieved prior to graduation: 
    1. Apply the concepts of health promotion, disease prevention, health protection and health equity in the care of patients with straightforward health problems
    2. Propose measures to be taken related to occupational and environmental health
    3. Identify and apply screening tests appropriate at different life stages
    4. Describe the evidence which supports the use of different disease prevention strategies

    5.3 Work together with public health to manage the health of individuals in situations that require public health intervention, including those subject to legal requirements

    Achieved prior to Clerkship: 
    1. Describe the rationale behind and legal requirements for reporting communicable disease
    Achieved prior to graduation: 
    1. Report communicable diseases to public health agencies
    2. Describe the impact on the patient and patient contacts on reporting of communicable diseases
    3. Document in the patient record the need for communication about communicable disease
    4. Interact effectively with public health agencies, including communicating relevant information

    5.5 Work together with community-based agencies to support patient care and community health

    Achieved prior to Clerkship: 
    1. Describe the spectrum of community agencies and how they may support the care of patients and populations
    Achieved prior to graduation: 
    1. Identify when and how to access community agency support for a patient based on their needs
    2. Complete referral forms for community-based agencies
    3. Interact in a professional manner with staff at community-based agencies

    5.6 Use epidemiological methods and data and other appropriate information sources to describe and assess the health of individuals and populations, and to assist in the diagnosis of disease

    Achieved prior to Clerkship: 
    1. Describe, measure and record the factors that affect the health status of a population
    2. Be aware of important sources of data to describe the health of a population
    3. Describe the concepts of and be able to calculate incidence, prevalence, attack rates and case fatality rates
    4. Apply the methods of epidemiology in analyzing a clinical and community health case scenario
    Achieved prior to graduation: 
    1. Identify how epidemiological methods assist in the diagnosis of disease

    COMMUNICATOR

    Key Competency 1. Establish professional therapeutic relationships with patients and their families


    Enabling competencies Milestones

    1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

    Achieved prior to Clerkship: 

    In interviewing and counseling a real patient who is medically stable and presenting with a simple illness, the student:

    1. Adheres to the principles outlined in the Calgary-Cambridge Guide to achieve patient-centeredness
    2. Encourages the patient to reveal their complete agenda by actively listening
    3. Uses verbal and non-verbal techniques to respond with empathy to the patient
    Achieved prior to graduation: 

    In interviewing and counseling a real patient who is acutely ill and/or presenting with a complex illness, the student:

    1. Adheres to the principles outlined in the Calgary-Cambridge Guide to achieve patient-centeredness
    2. Encourages the patient to reveal their complete agenda by actively listening
    3. Uses verbal and non-verbal techniques to respond with empathy to the patient

    1.2  Engage the patient by optimizing the physical environment for patient comfort, dignity, privacy, and safety

    Achieved prior to Clerkship: 

    In interviewing, counseling, and examining a real patient who is medically stable in an outpatient clinical setting, the student:

    1. Adjusts the environment for patient comfort, dignity, privacy, engagement, and safety
    Achieved prior to graduation: 

    In interviewing, counseling, and examining a real patient who is acutely ill, in a hospital emergency or ward room, the student:

    1. Adjusts the environment for patient comfort, dignity, privacy, and safety

    1.3 Recognize when professional or personal values, biases or perspectives may have an impact on the quality of care and modify the approach to the patient accordingly

    Achieved prior to Clerkship: 

    In interviewing and counseling a simulated patient or observing another health professional interview and counsel a real patient, the student:

    1. Identifies and describes the impact of professional values, biases or perspectives on the interaction
    2. Demonstrates respectful communication that reflects sensitivity to gender, culture, ethnic, socioeconomic and other diversities in the patient’s background
    3. Recognizes professional boundaries such as limits of knowledge and expertise, and knows how to modify the approach to the patient’s care to account for these
    Achieved prior to graduation: 

    In interviewing and counseling a real patient, the student:

    1. Identifies and describes impact of professional values, biases or perspectives on the interaction
    2. Demonstrates respectful communication that reflects sensitivity to gender, culture, ethnic, socioeconomic and other diversities in patient’s background
    3. Recognizes professional boundaries such as limits of knowledge and expertise, and knows how to modify the approach to the patient’s care to account for these

    1.4 Respond to patients’ cues and use appropriate behaviour to enhance communication

    Achieved prior to Clerkship: 

    In interviewing and counseling a real patient who is medically stable and presenting with a simple illness, the student:

    1. Recognizes verbal and non-verbal cues
    2. Responds to patient cues by effectively adjusting direction, tone, pace, eye contact and body posture to the patient’s needs
    3. Manages the flow of the interview so that it is experienced as logical and organized by the patient

    In examining a real patient who is medically stable, the student:

    1. Recognizes verbal and non-verbal cues
    2. Responds to patient cues by effectively adjusting physical examination technique to the patient’s needs without compromising completeness
    Achieved prior to graduation: 

    In interviewing and counseling a real patient who is acutely ill and/or presenting with a complex illness, the student:

    1. Recognizes verbal and non-verbal cues
    2. Responds to patient cues by effectively adjusting direction, tone, pace, eye contact and body posture to the patient’s needs
    3. Manages the flow of the interview so that it is experienced as logical and organized by the patient

    In examining a real patient who is acutely ill, the student:

    1. Recognizes verbal and non-verbal cues
    2. Responds to patient cues by effectively adjusting physical examination technique to the patient’s needs without compromising completeness

    1.5 Appropriately respond to disagreements and emotionally charged conversations

    Achieved prior to Clerkship: 

    In interviewing and counseling a simulated patient who presents communication challenges such anger, distress, a talkative nature, etc., the student:

    1. Acknowledges the communication challenge affecting the “doctor-patient” relationship in a manner that is respectful
    2. Demonstrates a range of appropriate communication techniques to respond to the challenge and manage the flow of the clinical encounter
    3. Recognizes and adheres to appropriate boundaries in emotional situations
    Achieved prior to graduation: 

    In interviewing and counseling a real patient who presents a communication challenge such as anger, distress, a talkative nature, etc., the student:

    1. Acknowledges the communication challenge affecting the “doctor-patient” relationship in a manner that is respectful
    2. Demonstrates a range of appropriate communication techniques to respond to  the challenge and manage the flow of the clinical encounter
    3. Recognizes and adhere to appropriate boundaries in emotional situations

    1.6 Demonstrate adaptability towards patients’ unique needs and preferences and their clinical circumstances

    Achieved prior to Clerkship: 

    In interviewing, counseling, and examining a real patient who is medically stable, presenting with a simple illness who can clearly articulate his/her needs and preferences, the student:

    1. Elicits the needs and preferences of the patient
    2. Demonstrates sensitivity to the patient’s medical concerns and the capacity to engage in a clinical encounter
    Achieved prior to graduation: 

    In interviewing, counseling, and examining a real patient who cannot clearly articulate his needs/preferences, the student:

    1. Elicits and clarifies the unique needs and preferences of the patient
    2. Demonstrates sensitivity to the patient’s level of understanding and complexity of illness, as well as the capacity to engage in a clinical encounter

    Key Competency 2. Use patient-centred skills to seek, gather, select and interpret accurate and relevant information of the clinical situation, incorporating the perspectives of patients and their families to inform management


    Enabling competencies Milestones

    2.1 Effectively seek and gather relevant biomedical and psychosocial information from a variety of sources including the patient, family, caregivers and/or other relevant individuals, while adhering to principles of confidentiality and consent

    Achieved prior to Clerkship: 

    In interviewing and counseling a real patient who is medically stable and presenting with a simple illness, the student:

    1. Elicits the patient’s beliefs, concerns and expectations about their medical problem
    2. Performs, under supervision, a comprehensive history that includes all the information needed to understand the key medical problems and the patient’s experience of illness
    3. Recognizes when a patient is unable to provide a clear history and can identify some potential alternate sources of information (e.g., interpreter, family member)
    4. Can be guided by their supervisor to integrate and synthesize relevant information from all sources
    Achieved prior to graduation: 

    In interviewing and counseling a real patient who is acutely ill and/or who presents with a complex illness, the student:

    1. Elicits the patient’s beliefs, concerns and expectations about their illness and treatment
    2. Performs, with minimal supervision, a comprehensive history to thoroughly understand the patient’s medical condition and experience of illness
    3. Recognizes when the patient is unable to provide a clear history and addresses the problem by using alternate sources to gather information (e.g., interpreter, family member)
    4. Integrates and synthesizes, with minimal reliance on the supervisor, the relevant information gathered from all sources

    2.2 Accurately select and interpret biomedical and psychosocial information

    Achieved prior to Clerkship: 

    In interviewing a real patient who is medically stable and presents with a simple illness, the student:

    1. Chooses which aspects of the history are worth spending additional time exploring and clarifying
    2. Asks questions designed to explore and clarify the aspects of the history that are most relevant
    3. Elicits pertinent positives and negatives to generate a broad differential diagnosis
    Achieved prior to graduation: 

    In interviewing a real patient who is acutely ill and/or presents with complex illness, the student:

    1. Chooses which aspects of the history are worth spending time exploring and clarifying
    2. Asks questions that work to explore and clarify the aspects of the history that are most relevant
    3. Elicits pertinent positives and negatives to generate a working diagnosis and targeted differential diagnosis

    2.3 Provide a clear structure for and manage the flow of the entire clinical encounter

    Achieved prior to Clerkship: 

    In interviewing and counseling a patient who is medically stable and presenting with a simple illness, the student:

    1. Clearly explains and negotiates the agenda for the patient’s visit
    2. Uses appropriate questioning techniques (e.g. open versus closed questioning) to guide the flow of the interview
    3. Adapts the structure and direction of the interview according to the unique needs of the patient, with some guidance from the supervisor
    4. Displays effective time management
    Achieved prior to graduation: 

    In interviewing and counseling a patient who is acutely ill and/or presenting with a complex illness, the student:

    1. Clearly explains and negotiates the agenda for the patient’s visit
    2. Uses appropriate questioning techniques (e.g. open versus closed questioning) to guide the flow of the interview
    3. Adapts the structure and direction of the interview according to the unique needs of the patient, with minimal guidance from the supervisor
    4. Displays effective time management

    2.4 Deliver messages (which are the sum total of everything that has been gathered, selected, interpreted, and managed) to patients and their caregivers in a clear and concise manner

    Achieved prior to Clerkship: 

    In counseling a patient and family member/caregiver about a simple illness, the student:

    1. Uses language that is understood by the patient and family/caregiver when summarizing information, clarifying information, or requesting patient feedback
    2. Checks to ensure that the patient and family/caregiver understand the information
    Achieved prior to graduation: 

    In counseling a patient and family member/caregiver about a complex illness, the student:

    1. Uses language uses language that is understood by the patient and family member/caregiver when summarizing information, clarifying information, or requesting patient feedback
    2. Checks to ensure that the patient and family member/caregiver understand the information

    Key Competency 3. Engage patients and their families in developing plans that reflect the patient's health care needs and goals


    Enabling competencies Milestones

    3.1 Approach discussions with patients and families in a manner that is respectful, non-judgmental, and culturally safe

    Achieved prior to Clerkship: 
    1. The student can discuss the impact of socio-cultural factors and principles of health equity on the medical interview

     

    In interviewing a real patient who can clearly articulate  their expectations of care as influenced by socio-cultural factors, the student:

    1. Explores the perspective of the patient, their family and/or caregivers and can identify the impact of these perspectives on the therapeutic options
    2. Adjusts their communication techniques to adapt to the socio-cultural expectations of the patient
    Achieved prior to graduation: 

    In interviewing and counseling a patient who is not forthcoming with their expectations of care as influenced by socio-cultural factors, the student:

    1. Is able to elicit the perspective of the patient, their family/caregivers and can incorporate these perspectives into the therapeutic plan
    2. Adjusts their communication techniques to adapt to the socio-cultural expectations of the patient

    3.2 Assist patients and their families to identify, access and make use of information and communication technologies to support their care and manage their health

    Achieved prior to Clerkship: 

    In counseling a real patient who is medically stable and presents with a common and simple illness, the student:

    1. Evaluates the patient’s health literacy with guidance from the supervisor, and adapts their communication and information sharing techniques to ensure patient and family member/caregiver understand the information
    2. Directs patients and family members/caregivers to relevant multimedia sources for decision-making
    Achieved prior to graduation: 

    In counseling a real patient who is acutely ill and/or presents with a complex, rare, or life-threatening illness, the student:

    1. Evaluates the patient’s health literacy with minimal guidance from their supervisor and adapts information sharing to ensure patient and family member/caregiver understand the information
    2. Directs patients and family members/caregivers to relevant multimedia sources for decision-making

    3.3 Support patients and their families to make informed decisions regarding their health

    Achieved prior to Clerkship: 

    In counseling a simulated patient who is presenting with a simple illness, the student:

    1. Verifies the patient’s and family member’s/caregiver’s understanding of the illness and explains the diagnosis, prognosis, and treatment using aids such as diagrams and pictures where appropriate
    2. Explains the indications, risks, and benefits of common treatment options including procedures
    3. Provides opportunities for patients and caregivers to ask general questions, seek clarification and express doubts
    4. Achieves, with the patient, a shared understanding of their medical problem(s) and, with input from their supervisor, creates a treatment plan that respects the patient’s perspectives
    5. Acknowledges the patient’s right to decline the treatment when the patient is capable of doing so
    Achieved prior to graduation: 

    In counseling a real patient who is presenting with a complex illness, the student:

    1. Verifies the patient’s and family member’s/caregiver’s understanding of the illness and explains the diagnosis, prognosis, and treatment using aids such as diagrams and pictures
    2. Explains the indications, risks, and benefits of common treatment options including procedures.
    3. Provides opportunities for patient and family members/caregivers to ask questions, seek clarification and express doubts
    4. Achieves, with the patient, a shared understanding of their medical problem(s) and, with minimal input from their supervisor, creates a treatment plan that respects the patient’s perspectives
    5. Acknowledges the patient’s right to decline the treatment when the patient is capable of doing so

    Key Competency 4. Share health care information and plans with patients and their families while adhering to principles of confidentiality and consent


    Enabling competencies Milestones

    4.1 Ensure information is shared in a timely and accurate manner which is adapted to the patient’s and family’s needs

    Achieved prior to Clerkship: 
    1. In counseling a simulated patient, the student adheres to the principles of confidentiality and privacy, and accurately explains relevant information to them in a clear and coherent manner
    Achieved prior to graduation: 
    1. In counseling a patient who is acutely ill and/or presenting with a complex illness, the student conveys accurate and relevant information regarding the patient’s health to the patient and the family member/caregiver in a clear and coherent manner
    2. In managing real patients, the student includes or excludes relevant others in a manner that respects the principles of confidentiality and privacy
    3. Provide clear and accurate oral and written instructions to the patient and the family member/caregiver about investigations and management

    4.2 Appropriately respond to adverse events affecting patients and the health care team

    Achieved prior to Clerkship: 
    1. The student describes, using examples, an approach to dealing with common adverse events, on an individual and systems level
    Achieved prior to graduation: 
    1. The student describes an appropriate strategy to address, on an individual and systems level, an adverse event that has occurred
    2. The student discusses, with guidance from their supervisor, an adverse event with the patient and their family member/caregiver including:
      • providing a description of the event and its potential consequences;
      • expressing empathy, and if appropriate regret and apology, while avoiding placing blame;
      • promising to follow-up with further information as it becomes known
    3. The student documents the event and the discussion in the medical record

    Key Competency 5. Document and share written and electronic information about the medical encounter, and share this information orally, with other members of the health care team, to optimize clinical decision-making, patient safety, and privacy


    Enabling competencies Milestones

    5.1 Document clinical encounters in an accurate, complete, timely and accessible manner, in compliance with legal and regulatory requirements

    Achieved prior to Clerkship: 
    1. For patients who are stable with a medical illness, summaries of the clinical encounter are documented promptly, all relevant details are included, and comply with legal and regulatory requirements
    2. The student describes the policies governing medical records set out by regulatory bodies including those related to access, use, and storage
    3. The student can effectively access and use the written or electronic medical record of a patient with a simple medical history in compliance with the regulatory policies governing their use
    Achieved prior to graduation: 
    1. For patients with complex medical   illness, summaries of clinical encounters are documented promptly, all relevant details are included, and comply with legal and regulatory requirements
    2. The student can effectively access and use the written or electronic medical record of a patient with a complex medical history in compliance with the regulatory policies governing their use
    3. The student composes written and electronic medical records that are in compliance with the regulatory policies governing their use

    5.2 Effectively communicate using a written health record, electronic medical record, or other digital technology, such as phone, social media or email

    Achieved prior to Clerkship: 

    In communicating the case of a medically stable patient presenting with a simple illness, using the medical record, telephone, email or other social media, the student:

    1. Effectively organizes the information in a manner that is easy to follow for the reader, and adheres to traditional schemata (e.g. SOAP)
    2. Uses language that is clear, accurate and appropriate for the intended reader
    3. Conveys clearly their clinical reasoning and rationale for care decisions 
    4. Uses communication strategies that reflect patient-centeredness
    5. Adheres to the policies governing communication media such as email, etc., set out by regulatory bodies
    Achieved prior to graduation: 

    In communicating the care of an acutely ill patient and/or one presenting with a complex illness, using the medical record, telephone, email, or other social media, the student:

    1. Effectively organizes the information in a manner that is easy to follow for the reader, and adheres to traditional schemata (e.g. SOAP)  
    2. Uses language that is clear, accurate and appropriate for the intended reader  
    3. Conveys clearly their clinical reasoning and rationale for care decisions
    4. Uses communication strategies that reflect patient-centeredness
    5. Adheres to the policies governing communication media such as email, etc., set out by regulatory bodies

    5.3 Present orally, to other members of the health care team, information about the medical encounter that is concise, thorough and logically organized, and in a manner that respects patient privacy and confidentiality

    Achieved prior to Clerkship: 

    In communicating orally with other health care professionals about a real patient who is medically stable and presents with a simple illness, the student:

    1. Is organized and logical in their approach
    2. Synthesizes and presents relevant clinical information and a prioritized differential diagnosis and care plan
    3. Is respectful and professional in their language and tone
    4. Adheres to the principles of patient confidentiality and privacy
    Achieved prior to graduation: 

    In communicating orally with other health professionals about a real patient who is acutely ill and/or presents with a complex illness, the student:

    1. Is organized and logical in their approach
    2. Synthesizes and presents relevant clinical information and a prioritized differential diagnosis and plan appropriate to the specified purpose, setting and audience
    3. Is respectful and professional in their language and tone
    4. Adheres to the principles of patient confidentiality and privacy

    5.4 Effectively communicate (by writing or electronically) instructions or requests to other health professionals, including prescriptions, in-hospital orders, and requests for investigations or consultations

    Achieved prior to Clerkship: 
    1. Write a clear and accurate prescription for a single, straightforward medication, that includes the medication’s generic name, route, dose, frequency, and amount to be dispensed
    2. Describe the elements of admission orders
    Achieved prior to graduation: 
    1. Write a clear and accurate prescription for multiple medications (including those that are less commonly used), that includes for each the medication’s generic name, route, dose, frequency, and amount to be dispensed
    2. Write (and enter into an electronic health record) admitting and other in-hospital orders, in a manner that covers all the required elements of these orders (e.g., diet, activity, vital signs, investigations and treatments, reasons for notification, etc.)
    3. Write a request for a consultation directed to another health professional, including a physician from a consulting service and other health professionals, that includes the reason for the consultation, relevant background information, and an indication of the urgency of the request

    COLLABORATOR

    Key Competency 1. Work effectively with physicians, trainees and other colleagues in the health care professions


    Enabling competencies Milestones

    1.1 Cultivate healthy relationships with collaborating colleagues in the clinical environment

    Achieved prior to Clerkship: 
    1. Demonstrate healthy relationships with classmates and preceptors
    2. Demonstrate a general understanding of unhealthy relationships and a willingness to address them
    Achieved prior to graduation: 
    1. Demonstrate a capacity to build and maintain healthy professional relationships across all clinical environments

    1.2 Explain how the organization, policies, and financing of the health care system impact collaborative patient care

    Achieved prior to Clerkship: 
    1. Display a general understanding of how health care funding and policies across systems and organizations impact collaborative patient care
    Achieved prior to graduation: 
    1. Explain the current and future financial and political

    1.3 Demonstrate an understanding of the roles and responsibilities of collaborators in the clinical environment

    Achieved prior to Clerkship: 
    1. Identify the various different collaborators they will work with in the clinical environment to provide patient care
    2. Demonstrate a general understanding of the roles and responsibilities of collaborators in the clinical environment
    Achieved prior to graduation: 
    1. Demonstrate an in-depth understating of the roles, responsibilities and contributions of collaborators in the clinical environment
    2. Develop collaborative patient management strategies that reflect their understanding of the contributions of collaborating team members 

    1.4 Employ a distributed leadership approach when solving problems with the health care team and be able to facilitate the creation of an optimal environment for collaborative practice

    Achieved prior to Clerkship: 
    1. Describe the distributed leadership approach as it pertains to their roles in health care
    Achieved prior to graduation: 
    1. Utilize the distributed leadership approach in collaborative clinical scenarios
    2. Demonstrate situational awareness when working in teams

    Key Competency 2. Consult effectively with physicians, trainees and other colleagues in the health care professions to provide care for individuals, communities and populations


    Enabling competencies Milestones

    2.1 Recognize a clinical situation that requires expertise beyond one's own

    Achieved prior to Clerkship: 
    1. Recognize the scope of practice of a clinical clerk, resident and medical doctor
    2. Articulate one’s personal and professional limitations as they pertain to patient care
    Achieved prior to graduation: 
    1. Identify clinical situations that require expertise beyond one’s own, and demonstrate the ability to recruit the appropriate colleague to assist

    2.2 Prioritize, based on urgency, the need for consultation

    Achieved prior to Clerkship: 
    1. Describe the factors that contribute to urgency of consultation
    Achieved prior to graduation: 
    1. Demonstrate the ability to prioritize the need for consultation in a manner cognizant of the quality of patient care, resource allocation and safe delivery of care

    2.3 Demonstrate comprehensive oral and written communication to the consultant that defines the rationale for consultation, urgency of consultation, and proposed clinical follow-up

    Achieved prior to Clerkship: 
    1. Describe the factors that must be included in communication to a consultant to ensure optimal patient care
    Achieved prior to graduation: 
    1. Demonstrate comprehensive oral and written communication when seeking consultation that defines the reason for consultation, urgency of the request, and proposed clinical follow-up

    2.4 Carry out recommendations proposed by other colleagues in the health care professions as appropriate and/or ensure that transfer of care takes place

    Achieved prior to Clerkship: 
    1. Recognize one’s duty to follow up on recommendations provided by colleagues when seeking consultation
    Achieved prior to graduation: 
    1. Demonstrate the ability and willingness to integrate various recommendations proposed by other colleagues to ensure optimal patient care

    2.5 Act collegially and responsibly when other health care providers request assistance and when requesting assistance from others

    Achieved prior to Clerkship: 
    1. Recognize the importance of collegiality and civility when working collaboratively with others in a consultative scenario
    Achieved prior to graduation: 
    1. Clearly explain the rationale for omission of any recommendations into a patient care plan in a professional manner

    Key Competency 3. Work with physicians, trainees and other colleagues in the health care professions to prevent misunderstandings, manage differences, and resolve conflicts


    Enabling competencies Milestones

    3.1 Show respect toward collaborators

    Achieved prior to Clerkship: 
    1. Show respect towards collaborators in all clinical and educational environments

    3.2 Identify the common situations that are likely to lead to disagreements or conflicts, including role ambiguity, power gradients, and differences in goals

    Achieved prior to Clerkship: 
    1. Describe factors that tend to stimulate conflict in teams
    Achieved prior to graduation: 
    1. Identify clinical scenarios that are likely to lead to conflict
    2. Describe the root causes of conflict in interprofessional teams

    3.3 Recognize one’s own approach to conflict and be able to recognize the conflict handling type in team members

    Achieved prior to Clerkship: 
    1. Recognize one’s own approach to conflict
    2. Describe the different conflict handing types and traits unique to each one
    Achieved prior to graduation: 
    1. Recognize other team members’ approach to conflict

    3.4 Implement strategies to resolve conflict in a manner that supports a collaborative culture

    Achieved prior to Clerkship: 
    1. Describe approaches to conflict resolution
    Achieved prior to graduation: 
    1. Synthesize a strategy to manage conflict in teams based on the different conflict handling types of the individuals involved
    2. Demonstrate the capacity to resolve conflicts that occur with colleagues related to issues such as prioritization of duties

    3.5 Apply basic principles of negotiation when collaborating with team members to ensure optimal patient outcomes

    Achieved prior to Clerkship: 
    1. Define the basic principles of negotiation
    2. Describe clinical scenarios where successful negotiation can positively impact patient outcomes
    Achieved prior to graduation: 
    1. Demonstrate a capacity for negotiating with collaborating team members to ensure optimal patient outcomes

    3.6 Seek help and advice when necessary, recognizing personal and professional limitations in conflict resolution

    Achieved prior to Clerkship: 
    1. Recognize that certain conflict scenarios will require guidance and assistance from supervisors
    Achieved prior to graduation: 
    1. Demonstrate insight into one’s personal and professional limitations in clinical conflict scenarios
    2. Demonstrate different strategies to seeking help and advice in challenging situations of conflict in the clinical environment

    Key Competency 4. Effectively and safely transfer care to another health care professional


    Enabling competencies Milestones

    4.1 Determine when care should be transferred to another physician or health care professional

    Achieved prior to Clerkship: 
    1. Recognize the range of possible transitions a patient may encounter (e.g., hospital to home, hospital to long term care facility, emergency department to ward)
    Achieved prior to graduation: 
    1. Demonstrate an understanding of why and when care of a patient should be transferred to another physician or health care professional

    4.2 Demonstrate safe handover of care, using both structured verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care

    Achieved prior to Clerkship: 
    1. List the elements of a high quality written “handover of care” document
    2. List the elements of a high quality verbal handover of care
    3. Describe the importance of multi-disciplinary involvement in transitions of care
    4. Describe the importance, during transitions of care, of patient/family involvement, shared decision-making and provider-patient communication
    Achieved prior to graduation: 
    1. Perform structured verbal handover of care that includes all relevant information necessary for safe transition of care (severity of illness, patient summary, to-do-items and contingency planning)
    2. Utilize standardized documentation tools and communication strategies for clear and timely exchange of patient information at care transitions
    3. Demonstrate up-to-date record keeping of relevant transfer of care documents (e.g., sign-out lists, discharge summaries)

    4.3 Recognize the impact on patient safety of poor handover of care and identify the common sources of error and barriers to safe handover of care

    Achieved prior to Clerkship: 
    1. Describe the importance of the handover environment
    2. Describe how improving handover of care can help reduce medical errors and improve value (e.g. not repeating tests
    3. Describe vulnerable times for transitions (e.g. after hours, weekends)
    Achieved prior to graduation: 
    1. Describe the relationship between handover, communication failures and sentinel events in a variety of clinical settings and contexts
    2. Select the appropriate environment to complete handover duties
    3. Demonstrate the ability to manage interruptions during the handover process

    LEADER

    Key Competency 1. Contribute to the improvement of health care delivery in teams, organizations, and systems


    Enabling competencies Milestones

    1.1 Describe the governance, structure, financing, and operation of the health care system and its facilities and how this influences patient care, research and educational activities at a local, provincial/territorial, regional, and national level

    Achieved prior to Clerkship: 
    1. Describe the federal and provincial roles in health care governance and funding in Canada and how those are similar to or different from the roles of governments in other countries
    2. Describe models of physician funding and their perceived pros and cons
    3. Describe the scope of practice of non-physician professionals and their roles in the health care team
    4. Understand the Canadian approach to professional self-regulation  and the role
    5. Discuss the role of funding and governance of the health care system as it pertains to quality improvement and patient safety
    6. Describe professional regulations that pertain to hospitals and health care providers’ handling of patient safety incidents (e.g., Quality of Care Information Protection Act – QCIPA) and that the Canadian Medical Protective Association or Provincial licensing body may be involved
    7. Describe large scale efforts (organizational or provincial) that measure and track quality performance (e.g. NSQIP, QBPs **in Ontario)

    1.2 Apply the science of quality improvement to contribute to improving systems of patient care

    Achieved prior to Clerkship: 
    1. Recognize that quality improvement methodologies are grounded in science and represent legitimate forms of scholarship
    2. Differentiate between QI and traditional Research
    3. Describe the key elements of the Model for Improvement***
    4. Propose a Plan-Do-Study-Act cycle (for a personal learning/ improvement goal)
    Achieved prior to graduation: 
    1. Construct a “SMART” aim statement for a quality problem (personal, learning, or clinical)
    2. Define and provide an example of an outcome, process and balancing measure
    3. Provide examples of  how patient/family engagement can facilitate quality improvement
    4. Use basic QI diagnostic tools such as process maps and fishbone/ Ishikawa diagrams *
    5. Understand and respect the diverse expertise of inter-professional QI team members
    6. Recognize the importance of stakeholder engagement in QI initiatives
    7. Recognize the importance of an inter-professional team approach to quality improvement

    1.3 Contribute to a culture that promotes patient safety

    Achieved prior to Clerkship: 
    1. Demonstrate an understanding of the culture of safety in hospital and office practice settings including both the concept of legislated standards for safety (such as operating room check lists and the emergency kit all physicians must have in their office) and the need for continuous quality improvement strategies focused on safety.
    2. Describe the impact of highly hierarchical contexts on a culture of safety
    3. Demonstrate an understanding of the concept and principles (behavioural choices, duties and skills) of a just culture and specifically how it applies to quality and safety in health care organizations
    Achieved prior to graduation: 
    1. Demonstrate the role of a medical student in recognizing and reporting patient safety incidents (PSIs)
    2. Identify situations where a highly hierarchical structure may deter from a culture of safety
    3. Report a PSI that occurs in a clinical setting in a constructive manner, including avoiding the adoption of a name-blame-shame approach

    1.4 Analyze patient safety incidents to enhance systems of care

    Achieved prior to Clerkship: 
    1. Describe the overall burden of healthcare associated harm (i.e., patient safety incidents) in Canada
    2. Demonstrate knowledge of systems theory as it applies to the practice of medicine and, with specific reference to the quality and safety agendas, how management systems rely on modelling to ensure the ongoing monitoring and evaluation of patient safety and the quality of care
    3. Describe the five characteristics of high reliability organizations and how these characteristics contribute to an environment of quality and safety
    Achieved prior to graduation: 
    1. Describe the importance of a systems-approach for evaluating PSIs
    2. Outline elements of recognized frameworks designed to comprehensively and non-judgmentally analyze PSI (e.g., Canadian Incident Analysis Framework[1])
    3. Contribute, wherever appropriate, to the open and transparent analysis of a PSI

    1.5 Use health informatics to improve the quality of patient care and optimize patient safety

    Achieved prior to Clerkship: 
    1. Describe how the capture, organization, tabulation and display of health information can impact patient care and outcomes, facilitate or impede information exchange and influence the safety and efficiency of the health care delivery
    2. Describe how the care and safety of the patient can be affected by the way their health data is captured
    3. Use information and communication technologies to enhance knowledge, skills and judgment in providing evidence-informed, safe, effective and efficient patient care
    4. Articulate an information need and gather relevant data from a variety of sources, including literature, web-based resources, electronic health records and databases
    5. Critically assess the reliability, quality and comprehensiveness of all data used to inform health care decisions
    Achieved prior to graduation: 
    1. Enter data in EHRs and EMRs in a way that supports safe and effective care
    2. Appraise, consolidate, apply and evaluate electronic and print information acquired to care for and manage patients, bearing in mind their unique biological, personal and cultural circumstances
    3. Employ decision-support tools as an adjunct to clinical judgment in providing timely, evidence-based, safe interventions
    4. Recognize basic usability problems in EHRs/EMRs and develop strategies to avoid common user errors
    5. Recognize how the structure of EHRs and EMRs and the manner in which data is recorded can distort the data and negatively affect patient safety,  and effectively advocate for and implement harm-reduction strategies to address this

    Key Competency 2. Engage in the stewardship of health care resources


    Enabling competencies Milestones

    2.1 Allocate health care resources for optimal patient care

    Achieved prior to Clerkship: 
    1. Describe each of the elements of the ‘Triple Aim” of health care (achieving improved population health, enhanced patient experience, at the lowest per capita cost)
    2. Define value in healthcare in terms of quality divided by cost
    3. Describe the phenomena of resource stewardship, appropriate allocation of health care resources, high value care and effective care
    4. Describe how resource stewardship has implications on both a patient and societal level
    5. Describe harms that can occur with medical overuse
    Achieved prior to graduation: 
    1. Adopt an approach to patient care that respects the principles of resource stewardship and high value care
    2. Recognize situations when a patient has been harmed by medical overuse
    3. Identify barriers that trainees and other health care providers face when trying to apply principles of resource stewardship during their clinical work
    4. Utilize methods to overcome these barriers to resource stewardship
    5. Recognize the need to balance resource stewardship and individual patient advocacy

    2.2 Apply evidence and management processes to achieve cost-appropriate care

    Achieved prior to Clerkship: 
    1. Describe the different types of health care costs, including direct costs, opportunity costs, and downstream costs
    2. Describe the impact of excess health care spending on quality of care
    3. Describe processes, models, and international organizations (including Choosing Wisely [1]) that are dedicated to promoting and educating health care providers and patients about resource stewardship and high value care
    4. Describe the nature of variations in health care utilization and spending patterns across individuals, organizations and provincial/national jurisdictions
    Achieved prior to graduation: 
    1. Describe health care delivery processes that support high-value care
    2. Utilize processes and tools, such as decision aids, that serve to promote the appropriate use of healthcare resources
    3. Describe quality indicators developed to measure health care cost and value
    4. Describe factors that promote overuse of healthcare resources on an individual and organizational level
    5. Identify wastes in the health care environment and discuss strategies to help eliminate them
    6. Identify data sources that may provide information on an institution’s/department’s clinical performance relative to peer organizations

    Key Competency 3. Demonstrate leadership in professional practice


    Enabling competencies Milestones

    3.1 Develop their leadership skills to enhance health care

    Achieved prior to Clerkship: 
    1. Describe what emotional intelligence is, why it is a fundamental leadership skill, and how it relates to healthcare
    2. Describe recognized leadership styles.
    3. Identify aspects of their own leadership style(s) (including, strengths, weaknesses, and biases
    4. Identify and describe one or more frameworks for leadership development
    5. Participate in reflective processes to inform their personal leadership development, understanding the need to be able to use an array of leadership styles, when each can or should be used and  their preferred leadership styles 
    6. Appreciate that leadership is not demonstrated only by leaders but that all physicians will be required to demonstrate “leadership” in the course of their careers
    7. Reflect on motivations, capabilities, skills, boundaries, and purpose as a leader
    8. Describe the importance of teamwork and collaboration in the healthcare setting, and participate in team-building and collaboration exercises
    Achieved prior to graduation: 
    1. Identify examples of each of the components of emotional intelligence in members of one’s clinical teams and in one’s self
    2. Be able to identify the leadership styles of members of a clinical team
    3. Apply different leadership styles in specific situations and clinical contexts, according to the strengths and weaknesses of these styles 
    4. Reflect on personal leadership styles learned during pre-clerkship years and, in a context enriched by clinical experience, be able to translate that learning into a choice of leadership style appropriate to clinical circumstances.
    5. Describe the fundamentals of teamwork and collaboration in general, and specifically the roles of leadership and motivation in clinical teams that function well
    6. Describe common situations in which conflicts arise in professional settings, in particular in the clinical setting
    7. Demonstrate preparedness to respond to conflict in the clinical setting
    8. Identify and employ tactics that facilitate conflict resolution

    3.2 Facilitate change in health care to enhance services and outcomes

    Achieved prior to Clerkship: 
    1. Describe the core metrics of health system performance measurement and describe the performance of the Canadian health care system including comparing it to other countries
    2. Describe the role of physician leadership in healthcare systems improvement
    3. Describe how  healthcare leadership impacts patient experiences and clinical outcomes
    4. Describe a recent local and/or national health system change and the basis for acceptance or resistance to this change
    5. Articulate the key components, purpose and use of health informatics in health information systems
    6. Demonstrate a working knowledge of health informatics
    7. Describe how health and population information can be used for disease surveillance, adverse event tracking, population health monitoring, and risk management
    8. Describe the principles of managing and using health and population information
    Achieved prior to graduation: 
    1. Describe the roles that physicians play in various clinical settings and their accountability for system improvement and optimal patient outcomes
    2. Describe the roles of clinical clerks and residents as both learners and health care providers in clinical settings 
    3. Describe the performance metrics that can be used to assess and track performance in different clinical settings 
    4. In the course of one’s clinical placements, identify examples of:  positive patient experiences, negative patient experiences, successful patient outcomes, and unsuccessful patient outcomes
    5. Describe why positive/successful results were achieved, and how negative/unsuccessful results could be improved
    6. Describe how a change in local and/or national health policy has had an impact on clinical performance
    7. Describe the role and potential impact of information and communication technologies to deliver patient-centred care to diverse populations in a variety of settings
    8. Assess benefits and limitations of health information systems in clinical environments
    9. Contrast the benefits and limitations of various health information systems and apply this knowledge to patient management, patient safety and continuous quality improvement in all clinical environments where one works

    Key Competency 4. Manage one’s time and plan one’s career


    Enabling competencies Milestones

    4.1 Set priorities and manage time to integrate professional learning and personal life

    Achieved prior to Clerkship: 
    1. Develop a systematic approach to learning and a time management strategy for pre-clerkship
    2. Access supports available to students to deal with stress and the health issues that are common in medical school 
    3. Describe the importance of punctuality in clinical service settings
    Achieved prior to graduation: 
    1. Develop a systematic approach to learning and a time management strategy for clerkship
    2. Demonstrate punctuality in clinical service settings
    3. Make, and adhere to, a rational plan each work day to ensure clinical obligations are met
    4. Develop short-, medium- and long-term learning goals in clinical service settings and seek feedback and guidance on goal selection and attainment   

    4.2 Develop and implement a career plan

    Achieved prior to Clerkship: 
    1. Describe the forces that drive health human resource planning
    2. Develop a strategy for creating and maintaining a curriculum vitae
    3. Demonstrate skills of reflection on one’s abilities, aptitudes and interests and how these relate to career choices as one is exposed to them
    4. Access opportunities for career exploration in both scheduled and unscheduled timeframes 
    Achieved prior to graduation: 
    1. Demonstrate an understanding of residency and longer term career opportunities in specific disciplines and programs when choosing priorities for residency matching and incorporate those as well as personal factors in selecting choices for residency applications
    2. Create written materials and establish effective interviewing skills for residency applications 

    HEALTH ADVOCATE

    Key Competency 1. Respond to the individual patient’s health needs by advocating with the patient within and beyond the clinical environment


    Enabling competencies Milestones

    1.1 Work with patients and their families, in the context of their communities, to identify and take action on the determinants of health that impede their ability to maintain or achieve the best possible health outcomes

    1.2 Work with patients and their families, in the context of their communities, to recognize and overcome barriers to facilitating and supporting healthy behaviour

    1.3 Identify and reduce barriers to disease prevention and health promotion for individual patients

    1.4 Contribute to working with patients and their families to navigate health care and social support systems to secure the resources and supports required to maintain or achieve the best possible health outcomes

    Achieved prior to Clerkship: 

    1. Identify resources which can benefit patients, particularly those who are disadvantaged:

    Demonstrate awareness and proficiency in the use of key websites related to advocating for patients and populations:

    • The Government of Canada’s Canada Benefits
    • Community Legal Education Ontario (CLEO) Yourlegalrights.on.ca
    • Ontario’s community and social services

    2. Legislation and Public Policy:

    i. Demonstrate a familiarity with and a general understanding of the Canada Health Act and the Canadian Charter of Rights and Freedoms.

     

    Achieved prior to graduation: 

    1. Community Partnerships:

    Assess a health issue from a community perspective through a survey of community needs using individual interviews, attendance at community meetings or events, and a survey of community resources

    2. Individual Patient Advocacy:

    i. Obtain and then provide a narrative patient story, including a full overview of their biopsychosocial issues and context.

    ii. Demonstrate proficiency in the use of the Health Equity Impact Assessment tool.

    iii. Demonstrate the capacity to complete either a federal or provincial financial assistance form (e.g., Canada Pension Plan , Ontario Disability Support Program, Ontario Works Program, Ontario Mandatory Special Necessities Benefit Request, Ontario Application for Special Diet Allowance).

    3. Community/Patient Population Advocacy:

    i. Demonstrate familiarity with the variety of options for advocacy activities, including:

    • publicity (e.g., press conference/op-ed/letter to the editor),
    • writing a policy brief,
    • writing an MP/MPP,
    • speaking at municipal/legislative/parliamentary committees,
    • membership on expert panels/committees,
    • drafting policy briefs,
    • participation with lobby groups,
    • participation in public consultation and
    • direct action (protests).

    ii. Demonstrate the ability to actively participate in at least one of these activities. 


    Key Competency 2. Respond to the needs of the communities or patient populations they serve by advocating with them for system-level change


    Enabling competencies Milestones

    2.1 Work with a community and a population to identify the determinants of health that affect them

    2.2 Contribute to taking action with patients and their families, their communities, relevant organizations, the health care sector, and private sector and political institutions to foster the conditions that promote good health and health equity

    2.3 Informed by principles of health equity, address the unique health needs and barriers to access to appropriate health and social services of medically underserved populations *

     

    * Context/details provided in an appendix

    Achieved prior to Clerkship: 

    1. Identify resources which can benefit patients, particularly those who are disadvantaged:

    Demonstrate awareness and proficiency in the use of key websites related to advocating for patients and populations:

    • The Government of Canada’s Canada Benefits
    • Community Legal Education Ontario (CLEO) Yourlegalrights.on.ca
    • Ontario’s community and social services

     

    2. Legislation and Public Policy:

    i. Demonstrate a familiarity with and a general understanding of the Canada Health Act and the Canadian Charter of Rights and Freedoms.

     

    Achieved prior to graduation: 

    1. Community Partnerships:

    Assess a health issue from a community perspective through a survey of community needs using individual interviews, attendance at community meetings or events, and a survey of community resources

    2. Individual Patient Advocacy:

    i. Obtain and then provide a narrative patient story, including a full overview of their biopsychosocial issues and context.

    ii. Demonstrate proficiency in the use of the Health Equity Impact Assessment tool.

    iii. Demonstrate the capacity to complete either a federal or provincial financial assistance form (e.g., Canada Pension Plan , Ontario Disability Support Program, Ontario Works Program, Ontario Mandatory Special Necessities Benefit Request, Ontario Application for Special Diet Allowance).

    3. Community/Patient Population Advocacy:

    i. Demonstrate familiarity with the variety of options for advocacy activities, including:

    • publicity (e.g., press conference/op-ed/letter to the editor),
    • writing a policy brief,
    • writing an MP/MPP,
    • speaking at municipal/legislative/parliamentary committees,
    • membership on expert panels/committees,
    • drafting policy briefs,
    • participation with lobby groups,
    • participation in public consultation and
    • direct action (protests).

    ii. Demonstrate the ability to actively participate in at least one of these activities. 


    SCHOLAR

    Key Competency 1. Engage in the continuous enhancement of their professional activities through ongoing learning


    Enabling competencies Milestones

    1.1 Develop, monitor and revise a personal learning plan to enhance professional learning

    Achieved prior to Clerkship: 
    1. Describe principles of effective learning relevant to medical school.
    2. Discuss physicians’ obligation for lifelong learning and enhancement of competence.
    Achieved prior to graduation: 
    1. Create a learning plan in collaboration with a supervisor and others, as needed, to achieve medical school learning objectives, and clerkship and longer-term career goals.
    2. Describe learning opportunities, resources (people and information resources), and assessment and feedback opportunities relevant to learning in the clinical setting.
    3. Monitor progress of learning in the clinical setting using the structured approaches and evaluation reports provided by the program.

    1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources

    Achieved prior to Clerkship: 
    1. Define reflective learning as it relates to medicine.
    2. Identify and prioritize, with guidance, personal learning needs to achieve pre-clerkship curriculum learning objectives
    Achieved prior to graduation: 
    1. Use reflective tools (e.g  journals, logbook or e-portfolio) to identify learning opportunities.
    2. Use examination results and feedback from teachers and peers to enhance self-assessment and improve learning.
    3. Identify and prioritize, with guidance, personal learning needs based on formal curriculum learning objectives.
    4. Seek and respond to feedback from supervisors, peers and others.
    5. Compare, with guidance, self-assessment with external assessment.

    1.3 Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice

    Achieved prior to Clerkship: 
    1. List attributes of successful collaborative group learning
    Achieved prior to graduation: 
    1. Actively participate in collaborative group learning with fellow medical students/postgraduate medical trainees, and with students from other health professions

    Key Competency 2. Teach students, residents, and other colleagues in the health care professions


    Enabling competencies Milestones

    2.1 Recognize the influence of role-modeling and the impact of the formal, informal, and hidden curriculum on learning

    Achieved prior to Clerkship: 
    1. Describe the concepts of the formal, informal and hidden curriculum
    Achieved prior to graduation: 
    1. Identify behaviours associated with positive and negative role-modelling

    2.2 Promote a safe learning environment

    Achieved prior to Clerkship: 
    1. Describe factors that can positively or negatively affect the learning environment
    Achieved prior to graduation: 

    1. Contribute to a positive atmosphere in the classroom and in clinical learning settings by demonstrating the following behaviours:

    • participating enthusiastically as a learner
    • providing encouragement to colleagues
    • refraining from belittling colleagues’ efforts

    2. Describe strategies for reporting and managing witnessed or experienced mistreatment


    2.3 Maintain patient safety when learning in the clinical setting

    Achieved prior to graduation: 
    1. Work within their limitations, seeking guidance and supervision when needed
    2. Speak up in situations in the clinical environment where patient safety may be at risk because of learner involvement

    2.4 Plan and deliver a learning activity

    Achieved prior to Clerkship: 
    1. Describe effective teaching approaches used in medical education
    Achieved prior to graduation: 
    1. Plan and deliver an effective presentation

    2.5 Provide feedback to enhance learning and performance

    Achieved prior to graduation: 
    1. Describe the features of effective feedback and its importance for teaching and learning
    2. Provide constructive feedback to colleagues about aspects of their clinical competence when requested to do so

    2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner

    Achieved prior to Clerkship: 
    1. Evaluate teachers and programs in an honest, fair, and constructive manner

    Key Competency 3. Integrate best available evidence into practice


    Enabling competencies Milestones

    3.1 Recognize practice uncertainty and knowledge gaps in clinical and other professional encounters and generate focused questions that address them

    Achieved prior to Clerkship: 
    1. Describe the different kinds of evidence and their roles in clinical decision-making.
    Achieved prior to graduation: 
    1. For a given clinical scenario, formulate a well-structured question to guide the search for further information from the medical literature and other resources, using available frameworks such as PICO (population, intervention, comparison, outcome).

    3.2 Identify, select, and navigate evidence-based resources to address knowledge gaps.  These resources include online applications and publications that provide summaries and appraisals of clinical evidence and also primary research articles. The U of T medical graduate is able to use digital technology for efficient retrieval of these resources and for their application at the point-of-care.

    Achieved prior to Clerkship: 
    1. Describe the advantages and limitations of pre-appraised resources.
    2. Select appropriate sources of knowledge as they relate to addressing focused questions.
    Achieved prior to graduation: 
    1. Identify, select, and navigate pre-appraised resources for given clinical scenarios.

    3.3 Critically evaluate the integrity, reliability, and applicability of health-related research, literature and digital technologies

    Achieved prior to Clerkship: 
    1. Identify appropriate sources that answer a clinical question.
    2. Interpret study findings, including a critique of their relevance to clinical questions using a valid framework (such as the JAMA Users’ Guides to the Medical Literature) .
    3. Determine the validity and risk of bias in a source of evidence using a valid framework.
    4. Describe study results in both quantitative and qualitative terms using a valid framework.
    Achieved prior to graduation: 
    1. Evaluate the applicability (external validity or generalizability) of evidence from a resource using a valid framework (such as the JAMA Users’ Guides to the Medical Literature)
    2. Critically evaluate the integrity, reliability, and applicability of health-related research and literature using a valid framework.

    3.4 Integrate evidence into decision-making in their practice

    Achieved prior to graduation: 
    1. Use evidence, as appropriate, during clinical decision-making.
    2. Describe the principles of knowledge translation and the knowledge to-action framework.

    Key Competency 4. Contribute to the creation and dissemination of knowledge and practices applicable to health


    Enabling competencies Milestones

    4.1 Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in contemporary health care. 

    Achieved prior to Clerkship: 
    1. Describe the basic scientific principles of research and scholarly inquiry.
    Achieved prior to graduation: 
    1. Begin to integrate the application of research and scholarly inquiry into clinical practice.

    4.2 Identify ethical principles for research and incorporate them into obtaining informed consent, considering the potential harms and benefits, and protecting vulnerable populations. 

    Achieved prior to Clerkship: 
    1. Identify and critically analyze fundamental ethical principles as they apply to research and scholarly inquiry
    Achieved prior to graduation: 
    1. Adhere to responsible practices and ethical behaviors when contributing to or participating in research.
    2. Appropriately apply ethical principles when contributing to or participating in research.

    4.3 Contribute to the work of a research project.

    Achieved prior to Clerkship: 
    1. Describe the basic components of a research project.
    2. Describe the different roles and responsibilities of principal investigators and collaborators in a research project.
    3. Collaborate with a research team in the articulation of a research question, the performance of a literature review, and the development of a research strategy to address the research question.
    4. Act as a member of a research team by carrying out assigned duties within their scope of competence in a diligent and responsible manner.
    5. Contribute to the written and oral presentation of results of a research project.
    Achieved prior to graduation: 
    1. Describe strategies for balancing the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician.

    4.4 Pose questions amenable to scholarly inquiry and select appropriate methods to address them

    Achieved prior to graduation: 
    1. Describe the characteristics of a well-constructed research question.
    2. In response to a scholarly topic of interest to the graduate, propose a well-constructed research question that could be the basis of a research study
    3. Identify and provide a rationale for one or more research methods that might be used to investigate a research question that has been created, and identify the strengths and limitations of each method.

    4.5 Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry.

    Achieved prior to graduation: 
    1. Discuss with peers and faculty the findings of applicable studies and reports.
    2. Explain to patients and families in general terms the results of research studies and their application to clinical issues.

    PROFESSIONAL

    Key Competency 1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards


    Enabling competencies Milestones

    1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, demonstrating honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, respect for boundaries, and maintenance of confidentiality

    Achieved prior to Clerkship: 
    1. Describe the unique ethical obligations of medical students as developing physicians.
    2. Recognize the influence of one’s own values, assumptions, attitudes and emotions on their own decision-making and practice.
    3. Recognize the need to engage and manage when confronted with an ethical concern.
    Achieved prior to graduation: 
    1. Exhibit honesty and integrity with patients, physicians and other health professionals.
    2. Demonstrate caring and compassion during all interactions with patients.
    3. Recognize the importance of trusting relationships with patients and others.
    4. Recognize and maintain boundaries when interacting with patients.
    5. Demonstrate sensitivity with respect to peers, colleagues, and patients.
    6. Consistently maintain patient confidentiality in all clinical, social and electronic settings, while recognizing situations that require disclosure of confidential information.
    7. Be sensitive to different levels of power that are relevant in health care encounters and do not abuse the power that one has as a physician or future physician.

    1.2 Exhibit a willingness to receive and act upon both positive and constructive feedback from teachers, colleagues, other health care professionals, and patients

    Achieved prior to Clerkship: 
    1. Consistently seek out and welcome feedback from others
    2. Accept constructive feedback without becoming defensive  
    3. Demonstrate the capacity to reflect upon feedback and use this as a basis for enhanced learning of relevant competencies

    1.3 Demonstrate a commitment to excellence in all aspects of practice

    Achieved prior to Clerkship: 
    1. Reflect on experiences in the preclinical setting to identify areas requiring improvement and modify behaviour by use of ethical frameworks.
    Achieved prior to graduation: 
    1. Reflect on experiences in the clinical setting to identify areas requiring improvement and modify behaviour by use of ethical frameworks.

    1.4 Be reliable and responsible in fulfilling obligations

    Achieved prior to Clerkship: 
    1. Be consistently aware of one’s obligations in the scholastic setting
    2. Consistently ensure all scholastic obligations are met
    3. Keep promises
    Achieved prior to graduation: 
    1. Be consistently aware of one’s obligations in the scholastic and clinical setting
    2. Balance clinical and scholastic responsibilities
    3. Consistently ensure all obligations are met including keeping promises that have been made
    4. Prioritize obligations such that the most urgent responsibilities are attended to first
    5. If initially unable to meet an obligation as had been promised, manage the situation including  providing an apology, and describing a plan to fulfill the obligation in future

    1.5 Recognize and respond to ethical issues in practice

    Achieved prior to Clerkship: 
    1. Recognize ethical issues presented in case vignettes.
    2. Recognize ethical dilemmas presented in case vignettes.
    3. Describe the importance of evaluating ethical decisions.
    4. Describe ethics as relational, including involving others to assist with ethical decision-making.
    5. Begin the process of examining their personal values in relation to challenges in the clinical domain.
    6. Describe and discuss ethical issues in the context of differing values.
    7. Describe what counts as an ethical justification of a decision or action.
    Achieved prior to graduation: 
    1. Describe principles and theories of core ethical concepts.
    2. Describe the nature of ethical reasoning and ethical justification within the clinical and academic environment.
    3. Identify and discuss ethical values and principles and their integration/application in the health care setting.
    4. Identify ethical issues in inter-professional practice and apply ethical reasoning skills to case situations.
    5. Examine their own personal values and how these influence their interactions with both patients and colleagues.
    6. Recognize, understand, and act appropriately with respect to complex ethical issues.

    1.6 Recognize and manage conflicts of interest

    Achieved prior to Clerkship: 
    1. Describe the University policies and guidelines on conflicts of interest and relationships with industry.
    Achieved prior to graduation: 
    1. Describe the implications of potential personal, financial, and institutional conflicts of interest, including conflicts of interest with industry.
    2. Recognize the potential for personal conflicts of interest and demonstrate an approach to managing them.

    1.7 Exhibit professional behaviours in the use of technology-enabled communication and social media

    Achieved prior to Clerkship: 
    1. Describe the requirements to maintain confidentiality of personal information in the context of technology-enabled communication.
    2. Avoid disclosing confidential patient information in online communications.
    Achieved prior to graduation: 
    1. Explain the potential abuses of technology-enabled communication and their relationship to professionalism.
    2. Describe University and CPSO policies related to technology-enabled communication.
    3. Use technology-enabled communication, including their on-line profile, in a professional, ethical, and respectful manner. Ensure responsible use of social media consistent with legal, professional and ethical obligations.
    4. Follow relevant policies regarding the appropriate use of electronic medical records.

    1.8 Demonstrate appreciation for patient autonomy and respect for persons in patient-physician interactions

    Achieved prior to graduation: 
    1. Demonstrate the application of patient autonomy and respect for persons in specific case situations.

    Key Competency 2. Demonstrate a commitment to society by recognizing and responding to societal expectations in health care


    Enabling competencies Milestones

    2.1 Demonstrate accountability to patients, society, and the profession by responding to societal expectations of physicians

    Achieved prior to graduation: 
    1. Describe the social contract between the profession of medicine and society and explain its impact.
    2. Explain physician roles and duties in the promotion of the public good.
    3. Describe the tension between the physician’s role as advocate for individual patients and the need to manage scarce resources.

    2.2 Demonstrate a commitment to patient safety and quality improvement

    Achieved prior to Clerkship: 
    1. Describe the importance of the commitment to patient safety and quality improvement as core daily activities for all physicians.
    2. Define near misses, adverse events and patient safety incidents (PSIs), and recognize that the health care system is fallible and that such adverse events will occur.
    3. Reflect on the role that physicians play in addressing health care quality, patient safety, and resource overuse problems.
    4. Recognize that both professional accountability and ethical standards are to uphold patient safety in a transparent way, which involves speaking up, reporting PSIs and disclosing PSIs.
    5. Recognize the patient experience as having equal importance to clinical quality and patient safety.
    Achieved prior to graduation: 
    1. Demonstrate a commitment to patient safety and quality improvement in their day-to-day work in the clinical setting.
    2. Reflect on examples from their clinical rotations and acknowledge that near misses, adverse events and patient safety incidents (PSIs) will occur.
    3. Alert others, including supervising staff and senior residents, about unsafe situations.
    4. List the key elements that should be included in the disclosure of a PSI (i.e., description of the facts, display of empathy, apology, commitment to prevent future errors).
    5. Reinforce the importance of trusting relationships between patient and physician.

    Key Competency  3. Demonstrate a commitment to the profession by adhering to standards and participating in physician-led regulation


    Enabling competencies Milestones

    3.1 Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing practice

    Achieved prior to Clerkship: 
    1. Demonstrate their understanding that the obligations of physicians include decisions to act using legal powers and duties.
    Achieved prior to graduation: 
    1. Describe the regulatory structures governing physicians and the profession.
    2. Describe the sources of physicians’ legal obligations including key legislation, and the powers and procedures of the CPSO and other regulators, including procedures involved in addressing patient complaints,and billing investigations.
    3. Describe legal principles that courts use to judge whether medical care met the required standard.
    4. Describe significant statutory provisions relating to: Consent, Capacity, Confidentiality, Duty to Report.
    5. Demonstrate awareness of and the ability to locate key regulatory provisions contained in CPSO policies, and demonstrate general familiarity with their contents. .*
    6. Demonstrate awareness of and the ability to locate significant university policies and guidelines governing student conduct, and a general familiarity with their contents.**

    3.2 Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions

    Achieved prior to graduation: 
    1. Describe and recognize behaviours that are unprofessional or unethical.
    2. Describe the options available to respond to peer group lapses in professional conduct.

    3.3 Participate in peer assessment

    Achieved prior to graduation: 
    1. Describe the clinical and professional expectations for performance in the clinical setting.
    2. Demonstrate the ability to give feedback to colleagues in a respectful manner when they fall short of expectations.
    3. Describe the factors (including health challenges and other stressors) that may impact a colleague’s performance.

    Key Competency 4. Demonstrate a commitment to physician health and well-being to foster optimal patient care


    Enabling competencies Milestones

    4.1 Exhibit self-awareness and manage influences on personal well-being and professional performance

    Achieved prior to Clerkship: 
    1. Identify strategies to develop,  increase and support self-awareness of personal and professional needs
    2. Develop an understanding of the importance and array of resilience skills
    3. Identify available resources that support personal well-being and professional performance, including family, social networks, and within the Faculty of Medicine
    4. Identify and reflect on personal strategies to foster self-care and resilience
    Achieved prior to graduation: 
    1. Describe how students are vulnerable to physical, emotional, and spiritual illness.
    2. Use strategies to improve self-awareness to enhance performance.
    3. Demonstrate appropriate use and enhancement of resilience skills
    4. Describe the connection between self-care and patient safety.

    4.2 Manage personal and professional demands for a sustainable practice throughout the physician life cycle

    Achieved prior to Clerkship: 
    1. Reflect on the transition from pre-clerkship to clerkship
    2. Develop approaches to evaluate career options throughout clerkship
    3. Access a primary health care provider
    Achieved prior to graduation: 
    1. 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.
    2. Describe the transitions through a physician’s life cycle, including periods of vulnerability.
    3. Manage personal and professional demands for a sustainable learning environment and ongoing professional development.
    4. Seek appropriate health care for their own needs.
    5. Use strategies to mitigate stressors and enhance professional development during transitions.
    6. Consider career options that will promote personal strengths and enhance well-being, while addressing the needs of society.
    7. Incorporate self-care into personal and professional routines.
    8. Seek mentorship to address professional development needs.

    4.3 Promote a culture that recognizes, supports, and responds effectively to colleagues in need

    Achieved prior to graduation: 
    1. Describe the multiple ways in which poor student health can present, including disruptive behaviour, and offer support to peers when needed.
    2. Describe the importance of early intervention for colleagues in need of assistance, identify available resources through student support services, and describe professional and ethical obligations and options for intervention.
    3. Practice positive behaviours and deal with negative behaviours in others to promote a collegial environment.
    4. Contribute to a culture of open communication and student support for assistance.

    4.4 Protect personal health and safety in clinical settings

    Achieved prior to Clerkship: 
    1. Demonstrate the procedures involved in universal body substance precautions, including handwashing, and donning and doffing of gowns, gloves, masks and eye protection
    2. Describe and apply principles of infection control when dealing with a patient who may have a communicable disease
    Achieved prior to graduation: 
    1. Demonstrate safe disposal of sharps
    2. Demonstrate the ability to maintain personal and patient safety when dealing with a potentially violent patient
    3. Describe and access the occupational health and safety services available in a clinical setting
    4. Describe the steps to follow in the event of a personal injury in the clinical setting, such as a needlestick injury or other exposure to potentially hazardous material

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