Competencies in Family Medicine


FAM1. Understand the role of generalist physician in the health care system

1A. Appreciate how the knowledge, skills and attitudes of the generalist physician differ from the specialist physician.

1B. Provide continuity of care.

1C. Utilize the competencies of a family physician across the life cycle and in different practice settings.

1D. Provide appropriate preventative care.

1E. Understand the role of the family physician in promoting the health of communities.

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FAM2. Take an appropriately thorough history in a timely manner.

2A. Demonstrates ability to effectively and selectively identify, assess and prioritize main presenting symptom(s).

2B. Move quickly into a focused history regarding the main symptom.

2C. Elicit pertinent associated symptoms, red flags and risk factors.

2D. Convey (to the observer) through the nature and sequence of questions that diagnostic hypotheses are being generated and tested.

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FAM3. Display effective, professional and non-judgmental communication skills.

3A. Employ rich mixture of techniques such as open-ended questions, direct questions, scaling, narrative.

3B. Employ flexible style to suit varying cultural, educational levels.

3C. Illustrate age-appropriate approach e.g. using play, humour with children.

3D. Communicate effectively and professionally to family members

3E. Establish therapeutic relationship with patients and families.

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FAM4. Adopt a patient centered approach

4A. Determine patient agenda and illness experience (i.e., FIFE)

4B. Identify and articulate patient goals and priorities and negotiate patient priorities.

4C. Develop and monitor contracts with patients.

4D. Balance patient needs with desired treatment outcome.

4E. Clarify the patient’s understanding and develop mutually agreeable treatment plan.

4F. Demonstrate sensitivity to cultural, gender and socioeconomic differences

4G. Generate a family systems hypotheses based on mastery of family developmental stages.

4H. Obtain basic family 2-generational genogram.

4I. Assess family stability around major life events (birth, disability, end of life care).

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FAM5. Perform an appropriately thorough physical examination in a timely manner.

5A. Exhibit an awareness of the role of the physical examination in making certain diagnoses more or less likely.

5B. Convey (to the observer) through the nature and sequence of the examination that the hypotheses from the history are being tested.

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FAM6. Construct an appropriately thorough differential diagnosis that is congruent with the data generated by the history and physical.

6A. Demonstrates the core knowledge of Family Medicine informed by evidence.

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FAM7. Recognize the typical and atypical presentation of common diagnoses as well as possible emergent life-threatening disease.

7A. Demonstrate appreciation of the unique considerations for recently hospitalized and/or post-operative patients.

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FAM8. Demonstrate an effective approach to the presentation of undifferentiated symptoms/ conditions.

8A. Exhibit a meaningful understanding of the clinical challenges that develop as a result the fact that the family physician sees a significant amount of transient and emotional illness and diseases presenting early in their course, prior to the full clinical picture developing.

8B. Consider subtle initial presentations of common diseases in the differential diagnosis.

8C. Explore actively the undifferentiated symptom as a possible complication of an established diagnosis.

8D. Consider medication side effects and interactions as a potential contributor to patients’ symptoms.

8E. Assess the possible contributions of both organic and psychosocial factors in the development of undifferentiated symptoms.

8F. Explore the patient’s cultural and social context to understand how these may influence the presentation of their symptom(s).

8G. Display cultural sensitivity and awareness of the social context of the patient when implementing a treatment plan.

8H. Employ a strategy of patient care over time to facilitate diagnosis and treatment of illnesses presenting in an undifferentiated stage.

8I. Commit only to diagnostic investigations that are justifiable in terms of pre-test likelihood of disease, best available evidence and cost.

8J. Build therapeutic rapport with patients presenting with undifferentiated disease.

8K.Check with patients to ensure common ground with respect to the disposition of their medically unexplained symptom(s).

8L. Plan appropriate follow-up of patients with undifferentiated symptoms.

8M. Commit to ongoing care of “illness” in patients with undifferentiated or medically unexplained symptoms

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FAM9. Demonstrate an effective approach to the presentation of acute self-limiting illness and potentially life threatening illness.

9A. Formulate a differential diagnosis that includes the most likely diagnosis (taking into account the prevalence of the condition in the population), a hierarchy of likely alternatives, and the most serious or life-threatening possibility.

9B. Demonstrate an understanding of the natural history and prognosis of the established diagnosis when treated and untreated.

9C. Locate the relevant evidence when needed for diagnosis and treatment

9D. Discuss the most relevant evidence for medical therapy for the diagnosis

9E. Recommend only pharmaceuticals that are clearly indicated for the diagnosis

9F. Outline for the patient the most common and the most serious risks associated with the pharmaceuticals

9G. Reinforce to the patient the importance of appropriate non-pharmacological therapy

9H. Explain to the patient when and/or why they need to follow up in the office.

9I. Manage the majority of common diagnoses without the need for referral

9J. List and demonstrate the use of the essential skills, equipment and medications required to deal with acute, life threatening conditions in the office.

9K. Access safely and expeditiously emergency services for the patient with a potentially life-threatening condition.

9L. Share key information with emergency services when referring patients with life-threatening conditions.

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FAM10. Demonstrate an effective approach to the presentation of common chronic diseases.

10A. Evaluate screening and case-finding recommendations for early detection of asymptomatic chronic disease.

10B. Screen asymptomatic patients where appropriate based on the most relevant evidence-based recommendations.

10C. Interpret correctly the results of tests used to diagnose chronic disease

10D. Check to ensure a patient meets the diagnostic criteria for a chronic disease before confirming the diagnosis.

10E. Report the correct treatment targets for common chronic diseases as recommended by the most relevant clinical practice guidelines.

10F. Demonstrate an awareness of the major complications of common chronic diseases and how to appropriately monitor for them

10G. Consider the possible role of an established chronic disease in contributing to a new patient symptom.

10H. Recommend pharmacotherapy when appropriate for alleviating symptoms, achieving treatment targets or preventing complications.

10I. Review as necessary the status of a patient’s chronic disease(s), even when the entrance complaint is seemingly unrelated.

10J. Propose that the patient set small achievable lifestyle goals in order to maximize their ability to control of their disease.

10K. Emphasize educating the patient about their chronic disease and uses available tools and resources to do so, empowering them to take some ownership of the disease.

10L. Recommend to the patient that they seek out appropriate community resources to further educate and empower themselves.

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FAM11. Demonstrate an effective approach to the presentation of illnesses with a strong psychological component.    

11A. Identify examples where an interaction between the physical and the psychological is complicating the presentation and management of symptoms.

11B. Explore actively the underlying psychological issues that can contribute to illness in primary care.

11C. List common medications that can have psychological side effects.

11D. Explore intentionally the patient’s cultural and social context to better understand the impact of these variables on their illness experience.

11E. Exhibit cultural sensitivity when implementing a treatment plan and seek common ground

11F. Limit the number of referrals, investigations and medical interventions to those that will likely be of benefit to the patient.

11G. Employ the power of the doctor-patient relationship in the patient’s illness experience and recovery

11H. Manage most patients using psychological as well as pharmacological interventions.

11I. Mobilize an appropriate interdisciplinary team when necessary

11J. Commit to the follow-up and care of patients with psychological and psychosomatic illness

11K. Demonstrate willingness to build therapeutic relationships with patients presenting with psychological and psychosomatic illness

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FAM12. Modify the differential diagnosis in light of unexpected or changing symptoms or when symptoms persist beyond what one would ordinarily expect.

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FAM13. Justify selection of laboratory and imaging tests and employs them only when they would have an impact on patient management.

13A. Select investigations based on consideration of prevalence, evidence of benefit and risk, past experience of physician, patient’s wishes, and cost.

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FAM14. Interpret the test results promptly and correctly.

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FAM15. Communicate results in a timely fashion.

15A. Demonstrate sensitivity in breaking bad news.

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FAM16. Develop an appropriate treatment plan.

16A. Inform patient about the diagnosis, possible alternative diagnoses and likely prognosis.

16B. Link patient’s symptom to a lifestyle behaviour and in doing so, employ the principles of disease prevention and health promotion.

16C. Counsel on the risks and benefits of treatment if diagnosis is amenable to treatment.

16D. Synthesize and help focus treatment goals.

16E. Integrate the patient’s viewpoint of above.

16F. Judge the patient’s understanding, ability to adhere to the plan and ability to pay and based on these factors adjust the treatment plan as necessary.

16G. Write a complete prescription when appropriate.

16H. Recommend to the patient when and/or why they should present for reassessment.

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FAM17. Document appropriately in the chart.

17A. Document clearly in chart to enhance patient follow-up.

17B. Utilize the cumulative patient profile (CPP)

17C. Outline in chart outstanding issues requiring follow-up.

17D. Collate all necessary documentation

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FAM18. Engage other resources appropriately in the health care system.

18A. Communicate in a timely fashion with other relevant health care providers.

18B. Refer when appropriate and construct a meaningful referral letter.

18C. Engage appropriate health providers and community resources.

18D. Mobilize services within the health care and community institutions on

behalf of the patient.

18E. Demonstrate awareness of the limitations of his/her knowledge and skill and has a sound approach to searching for an answer.

18F. Construct an interdisciplinary team approach where appropriate.

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FAM19. Demonstrate an awareness of the need to become a lifelong learner.

19A. Employ, whenever possible, the principles of evidence-based medicine.

19B. Engage in quality improvement activities.

19C. Demonstrate effective teaching skills.

19D. Develop basic skills in research and scholarly inquiry.

19E. Commit to following up on clinical cases in order to learn from both good and bad patient outcomes.

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FAM20. Develop skills related to practice management.

20A. Describe principles related to practice management including accurate billing, finances and juman resources.

20B. Employ information technology including the electronic medical record to plan appropriately for patient care.

20C. Understand the need to manage scarce healthcare resources to achieve cost-effective care.

20D. Describe the basic structure and function of the health care system including different models of primary care organization and funding.

20E. Demonstrate effective time management.

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FAM21. Demonstrate a commitment to patients, colleagues, profession and society through ethical and reflective practice.

21A. Demonstrate an awareness of self leading to a commitment to physician well-being and personal reflection.

21B. Demonstrate core values of honesty, compassion, reliability, awareness of limits of clinical competence and appropriate patient boundaries.

21C. Demonstrate an awareness of the balance of work and leisure.

21D. Develop personal strategies for maintaining health.

21E. Incorporate feedback into learning and practice.

21F. Debrief critical incidents with preceptor or supervisor.

21G. Recognize and respond to other professionals in need.

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How to Use this Document

The document currently provides the Key Essential Competencies required of all trainees in the program. All key competencies are further defined by a set of enabling competencies. The Integrating Family Medicine page lists the generic competencies of the graduating practice-ready Family Physician. The key competencies are further grouped according to practice domain which will allow program directors and residents to develop rotation-specific learning outcomes. The Care of Adults domain incorporates general competencies in the provision of care to adults. However, there are links available within the document which may be used by both program directors and residents in planning specific rotations in Women’s Health, Musculoskeletal Medicine and Mental Health. Prior to beginning a learning experience or rotation, it would be helpful to review the competencies applicable to the experience and to develop a strategy for achieving them. Throughout the learning experience or rotation the competencies should be reviewed to ensure that they are being achieved.