Education goals and competency framework

Education goals

The MD Program aspires to prepare graduates who are:

  • clinically competent and prepared for life-long learning through the phases of their career
  • ethical decision-makers dedicated to acting in accordance with the highest standards of professionalism
  • adaptive in response to the needs of patients and communities from diverse and varied populations
  • engaged in integrated, team-based care in which patient needs are addressed in an equitable, individualized and holistic manner
  • reflective and able to act in the face of novelty, ambiguity and complexity
  • resilient and mindful of their well-being and that of their colleagues
  • capable of and committed to evidence informed practices and scholarship, and a culture of continuous performance improvement

Approved by the MD Program Executive Committee, June 12, 2018

Competency framework

The MD Program's 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.

A separate document provides guidance about the desired level of achievement through the use of milestones.  See MD Program milestones (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 (under development) 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).

The current iteration of the MD Program’s competency framework was approved by Faculty of Medicine Faculty Council on February 8, 2016, effective August 1, 2016.

Key & enabling competencies



    Key competencies Enabling competencies  

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

    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


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


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


    • Approach to clinical presentations**
    • Features of common and/or life-threatening acute and chronic illnesses***
    • Use of diagnostic tests*
    • Application of therapeutic interventions*


    1.3. Demonstrate an awareness of limits of their expertise and their potential biases
    1.4 Recognize the complexity, uncertainty and ambiguity inherent in medicine
    1.5 Carry out professional duties in the face of multiple, competing demands

    2. Perform a patient-centered clinical assessment

    2.1 Prioritize issues to be addressed in a patient encounter
    2.2 Obtain a history of the clinical presentation of the patient*
    2.3 Perform a physical and mental status examination relevant to the patient’s presentation*
    2.4 Order and interpret appropriate diagnostic investigations based on the clinical assessment
    2.5 Generate a problem list and for each problem a differential diagnosis and working diagnosis, when applicable
    2.6 Recognize a patient who requires urgent or emergent care
    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

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

    3.1 Involve the patient and family in developing the care plan and determining goals of care*
    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
    3.3 Under appropriate supervision, implement plans for assessment and/or treatment

    3.4 Obtain informed consent

    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
    3.6 Propose a follow-up plan regarding results of investigation and response to interventions
    3.7 Initiate evaluation and treatment of a patient who requires urgent or emergent care, and seek help
    3.8 Set priorities and manage time effectively when involved in the care of multiple patients

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

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

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

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

    5.1 Assess the health status of individuals and of populations, in terms of the impact of determinants of health*
    5.2. Apply principles of health promotion*, health protection*, health equity* and disease prevention in the management of the health of individuals and populations
    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
    5.4. Describe the roles of physicians and public health in the identification of health problems in the community, and their role in diagnosis and management of these problems
    5.5 Work together with community-based agencies to support patient care and community health
    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




    1. Establish professional therapeutic relationships with patients and their families

    1.1 Communicate using a patient-centred approach* that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
    1.2 Engage the patient by optimizing the physical 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
    1.4 Respond to patients’ cues and use appropriate behaviour to enhance communication
    1.5 Appropriately respond to disagreements and emotionally charged conversations
    1.6 Demonstrate adaptability towards patients’ unique needs and preferences and their clinical circumstances

    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

    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
    2.2 Accurately select and interpret biomedical and psychosocial information
    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

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

    3.1 Approach discussions with patients and families in a manner that is respectful, non-judgmental, and culturally safe
    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
    3.3 Support patients and their families to make informed decisions regarding their health

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

    4.1 Ensure information* is shared in a timely and accurate manner which is adapted to the patient’s and family’s needs
    4.2 Appropriately respond* to adverse events* affecting patients and the health care team

    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

    5.1 Document clinical encounters in an accurate, complete, timely and accessible manner, in compliance with legal and regulatory requirements
    5.2 Effectively communicate using a written health record, electronic medical record, or other digital technology, such as phone, social media or e-mail
    5.3 Present orally, to other members of the health care team, information about the medical encounter that is concise, thorough and logically organized, Share patient information with other members of the health care team in a manner that respects patient privacy and confidentiality
    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





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

    1.1 Cultivate healthy relationships with collaborating colleagues in the clinical environment
    1.2 Explain how the organization, policies, and financing of the health care system impact collaborative patient care
    1.3 Demonstrate an understanding of the roles and responsibilities of collaborators in the clinical environment
    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

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

    2.1 Recognize a clinical situation that requires expertise beyond one's own
    2.2 Prioritize, based on urgency, the need for consultation
    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
    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
    2.5 Act collegially and responsibly when other health care providers request assistance and when requesting assistance from others

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

    3.1 Show respect toward collaborators
    3.2 Identify the common situations that are likely to lead to disagreements or conflicts, including role ambiguity, power gradients, and differences in goals
    3.3 Recognize one’s own approach to conflict and be able to recognize the conflict handling type in team members
    3.4 Implement strategies to resolve conflict in a manner that supports a collaborative culture
    3.5 Apply basic principles of negotiation when collaborating with team members to ensure optimal patient outcomes
    3.6 Seek help and advice when necessary, recognizing personal and professional limitations in conflict resolution

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

    4.1 Determine when care 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
    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



    Key competencies Enalbing competencies

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

    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
    1.2 Apply the science of quality improvement to contribute to improving systems of patient care
    1.3 Contribute to a culture that promotes patient safety

    1.4 Analyze patient safety incidents to enhance systems of care

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

    2. Engage in the stewardship of health care resources

    2.1 Allocate health care resources for optimal patient care
    2.2 Apply evidence and management processes to achieve cost-appropriate care

    3. Demonstrate leadership in professional practice

    3.1 Develop their leadership skills to enhance health care
    3.2 Facilitate change in health care to enhance services and outcomes

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

    4.1 Set priorities and manage time to integrate professional learning and personal life
    4.2 Develop and implement a career plan




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

    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

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

    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*




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

    1.1 Develop, monitor and revise a personal learning plan to enhance professional learning
    1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources
    1.3 Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice

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

    2.1 Recognize the influence of role-modeling and the impact of the formal, informal, and hidden curriculum on learning
    2.2 Promote a safe learning environment
    2.3 Maintain patient safety when learning in the clinical setting
    2.4 Plan and deliver a learning activity
    2.5 Provide feedback to enhance learning and performance
    2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner

    3. Integrate best available evidence into practice

    3.1 Recognize practice uncertainty and knowledge gaps in clinical and other professional encounters and generate focused questions that address them
    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.
    3.3 Critically evaluate the integrity, reliability, and applicability of health-related research, literature and digital technologies
    3.4 Integrate evidence into decision-making in their practice

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

    4.1 Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in contemporary health care.
    4.2 Identify ethical principles for research and incorporate them into obtaining informed consent, considering the potential harms and benefits, and protecting vulnerable populations.
    4.3 Contribute to the work of a research project.
    4.4 Pose questions amenable to scholarly inquiry and select appropriate methods to address them.
    4.5 Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry.




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

    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, as well as a willingness to receive and act upon both positive and negative feedback from teachers, colleagues, other health care workers, and patients
    1.2 Exhibit a willingness to receive and act upon both positive and constructive feedback from teachers, colleagues, other health care professionals, and patients
    1.3 Demonstrate a commitment to excellence in all aspects of practice
    1.4  Be reliable and responsible in fulfilling obligations
    1.5 Recognize and respond to ethical issues in practice
    1.6 Recognize and manage conflicts of interest
    1.7 Exhibit professional behaviours in the use of technology-enabled communication and social media
    1.8 Demonstrate appreciation for patient autonomy and respect for persons in patient-physician interactions

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

    2.1 Demonstrate accountability to patients, society, and the profession by responding to societal expectations of physicians
    2.2 Demonstrate a commitment to patient safety and quality improvement

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

    3.1 Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing practice
    3.2 Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions
    3.3 Participate in peer assessment

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

    4.1 Exhibit self-awareness and manage influences on personal well-being and professional performance
    4.2 Manage personal and professional demands for a sustainable practice throughout the physician life cycle
    4.3 Promote a culture that recognizes, supports, and responds effectively to colleagues in need
    4.4 Protect personal health and safety in clinical settings


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