What is CanMEDS?

CanMEDS is a framework developed by the Royal College of Physicians and Surgeons Canada that describes seven roles and qualities of a competent physician who is able to effectively address the health care needs of patients in society.

The goal of developing these roles is to attain the seventh and most important role of CanMEDs; the ‘Medical Expert’. Attaining the Medical Expert role means that you have developed all six other roles and are able to integrate them in your medical practice simultaneously. This in essence is what defines the physician’s clinical scope of practice.

In Canada, residents in all medical specialties use this framework as part of their post-graduate training alongside medical schools who use a similar framework for their MD programs. Medical schools will be assessing whether you are a good fit for the profession. Knowing what CanMEDS is and working to meet those criteria will give you a key advantage during the application process into medical school.

This article breaks down each of the seven CanMED roles and highlights several competencies that are required to attain each role. You will notice that these traits are very general, benefiting students who can develop these traits while pursuing their interests.

1. Communicator

Clearly, professions that are people-focused require communication skills, but what does that exactly entail for a physician practicing medicine? In short, physicians have to interact with an extensive group of individuals making effective communication amongst all vital.

Physicians must partake in patient-centred therapeutic communication through which they will explore patient symptoms as well experience of illness to make decisions. Throughout this process, they need to understand the patients’ perspective, fears, and expectations. Then to take that and also understand their background, including socioeconomic status, medical history, family history, stage of life, living situation, work or school setting, and other relevant issues. A patient’s illness usually also engages their families through the entire process which requires physicians to be able to communicate effectively with every individual who is involved. Physicians are also responsible for interacting with a team of colleagues and health care professionals in many scenarios in which effective communication will determine the success of the entire scenario. Written communication is also important as physicians are required to document and share information about their medical encounters and work with written health records in writing or electronically.

So, how can you as a future physician develop this role and become the medical expert? CanMEDS highlights the following competencies if you are looking to step up your communication skills:

• Able to establish rapport.
• Able to incorporate active listening, offering autonomy, respect and compassion to those you speak with.
• Have accuracy and efficiency in communication
• nderstand how peoples’ values, biases, or perspectives of others impact their actions.
• Be non-judgemental and behave with a culturally safe manner
• Understand non-verbal behaviour and utilize that to enhance your own communication.
• Manage disagreements and emotionally charged conversations
• Understand and adapt to the uniqueness of every individual’s character and circumstances.
• Be able to lead the flow of a conversation during an encounter if necessary.

2. Collaborator

In today’s society, no major project that is able to make an impact can be accomplished from a single person. Medicine, similar to other fields, requires teamwork to be effective. Physicians must be able to work well with other healthcare professionals to provide safe, high quality, patient-centred care. In addition, medical professionals have to work collaboratively with those outside health care such as community partners, families and health system stakeholders.

The ability to work well in a team and/or collaborative environment translates into developing several qualities that should become the focus of your teamwork-based extracurricular activities, including:

• Learning to establish and maintain positive professional relationships
• Constructive negotiation when delegating tasks and sharing responsibilities with others.
• Engaging with shared decision making.
• Understanding others, being respectful, and managing conflicts.
• Using Intraprofessionalism (working with people in your specific field who have similar tasks but different competencies) and using Interprofessionalism (being able to collaborate with people that are outside your specific job, but bring in other expertise) towards your goals.
• Recognizing one’s own roles and limits and having the ability to handover tasks
• Sharing of knowledge and information with others
• Having Situational awareness

3. Leader

As a physician, you are expected to demonstrate collaborative leadership and management within the healthcare system. A physician’s leadership encompasses the management of many critical activities including but not limited to:

• Allocating health care resources to achieve optimal patient care while being efficient and cost-effective.
• Leading changes in health care to enhance service and outcomes when necessary. Physicians are active participant-architects in a health care team.
• Managing career planning, finances, and health human resources in a medical firm/ practice.

Based on the competencies highlighted by CanMEDs, a good leadership based extracurricular activity should allow you to develop these skills:

• Priority Setting
• Resources management
• Time management
• Financial Planning
• Personal Leadership Skills
• Supervising others
• Systems thinking and Quality Improvement
• Negotiation

4. Health Advocate

Physicians must utilize their powers to improve health at a systemic level. Improving health is not limited to eliminating illnesses, but it also includes the promotion of health, disease prevention, health protection as well promoting health equity so that people are not disadvantaged by race, ethnicity, religion, gender, sexual orientation, age, social class, economic status, or level of education. As the famous saying goes, with great power comes great responsibility. Physicians need to leverage their position to improve the health and well-being of their patients, their communities, and the broader populations they serve. They need to contribute their knowledge of factors that impact health to make positive influences while learning about issues, developing mechanisms to address needs and call for changes. This process usually requires physicians to develop partnerships with patients, their families support networks, or community agencies and organizations to influence health determinants. Advocacy also often requires engaging other health care professionals, community agencies, administrators, and policy-makers.

Consider working on the following attributes to become a better health advocate. Please note that this specific role is a lot more specifically directed to physicians with expertise, so make sure that your actions are within your field of competence if you are a student (don’t worry, you will get there one day!):

• Understand the significance of equity in health care.
• Learn responsible use of your position and influence in making positive changes in the community.
• Have the willingness to take action and call for change
• Look for continuous quality improvement
• Learn about current issues in healthcare
• Be able to promote your cause overall

5. Scholar

Physicians remain scholars all throughout their careers because they need to master their domain of expertise and stay updated. The role of the scholar may also include teaching other physicians and contributing to scholarship (research in medicine). Focus on the following competencies:

Lifelong Learning

• Learn how to learn effectively. Although high school and university are good opportunities for improving learning skills, other forms of learning such as experiential education must be learned through your extracurricular activities.
• Be able to evaluate yourself, understand learning gaps and improve your weaknesses, constantly.
• Be able to learn collaboratively.
• Seek feedback from others and incorporate them in order to strengthen yourself.

Teaching (If teaching interests you)

• Mentoring and being a role model.
• Supervision and providing feedback.

Research (If pursuing research interests you)

Learn scientific research from your experiences during your years of education. These include but are not limited to:

• Understanding the principles of research and the role of research evidence in health care
• Learn about research ethics and moral principles
• Have an inquisitive nature that can result in presenting questions that can be subject to scholarly research. This can result in new or improving knowledge in your field.

6. Professional

Professionalism in medicine means that you must be able to live up to your expectations as a physician. These include ethical practice, having high personal standards of behaviour, remaining accountable to the expectations of the profession and society, following regulations,  having a commitment to ongoing professional development, promotion of the public good, adherence to values such as integrity, honesty, altruism, humility, respect for diversity, and transparency with respect to potential conflicts of interest.

CanMEDS also highlights commitment to improving your own health and well being as an important aspect of professionalism. Unfortunately, this is often overlooked by many students who tend to become easily overwhelmed. Although it is important to work hard towards your goals, you need to realize that your well being will have an impact on those around you as well, especially if you decide to become a physician. Always be responsible for maintaining good health just as much as you are responsible for your other commitments!

Focus on these competencies:

• Instill a high moral standard in your character based off of positive traits such as honesty, integrity, humility, commitment, etc.
• Be committed to excellence in areas of life that are important to you
• Commit to all of your responsibilities.
• Recognize and respond to ethical issues and unprofessional and unethical behaviour
• Stay accountable to codes of ethics
• Committed to professional standards
• Resilience for sustainable practice
• Be aware and follow legal frameworks
• Be responsible for self, including personal care, in order to serve others