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

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.

Work is ongoing to ensure that the MD Program competency framework aligns with the development of AFMC Entrustable Professional Activities (EPAs) for the Transition from Medical School to Residency. The AFMC EPAs are pan-Canadian core clinical activities that all medical students should be able to perform with an indirect level of supervision (supervisor is not in the room but is available to provide assistance) on day one of residency. Each AFMC EPA maps to multiple CanMEDS roles. The MD Program has developed Foundations EPAs, which operationalize the attainment of the MD Program competencies at the point of entry to clerkship and anticipate the achievement of the AFMC EPAs by the end of clerkship. Both the competency framework and EPAs inform how the MD Program assesses that U of T medical students have demonstrated level- and context-appropriate achievement of the knowledge, skills, attitudes and activities required to progress through and graduate from the MD Program.

Further elaboration of several of the competencies (those marked with asterisks) is provided in *Appendix 1.

For Medical Expert 1.2, the approach to clinical presentations is informed by the Medical Council of Canada (MCC) list of clinical presentations and corresponding causal conditions. For Medical Expert 3.5, the approach to technical procedures is informed by encounters required for each clerkship rotation.

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. Editorial revisions to selected enabling competencies were approved by the MD Curriculum Committee on June 11, 2019.

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

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*


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

1.4  Recognize the complexity, uncertainty and ambiguity inherent to medicine

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

Key Competency 2. Perform a patient-centered clinical assessment

Enabling competencies

2.1 Prioritize issues to be addressed in a patient encounter

2.2 Obtain a focused and relevant 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

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

Enabling competencies

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

3.2 Formulate a management plan 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 and implement, under appropriate supervision, 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

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

Enabling competencies

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

Key Competency 5. Contribute to improving population health.

Enabling competencies

5.1 Assess the health status of populations, including the impact of social determinants of health

5.2 Apply principles of health promotion; health protection; injury and disease prevention; and emergency preparedness and response in the management of the health of individuals and populations

5.3 Describe the role of and work together with public health organizations 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


Key Competency 1. Establish professional therapeutic relationships with patients

Enabling competencies

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

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

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

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

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

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

Enabling competencies

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 , make informed decisions, and manage their health

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

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

Enabling competencies

4.1 Ensure information* is shared in a timely , clear, concise, 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

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

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 or electronic medical record, or other digital technology, such as phone or email

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

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


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

Enabling competencies

1.1 Cultivate healthy and respectful relationships with collaborating colleagues in the clinical environment

1.2 Practice collaborative care that recognizes the impact of 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 Participate in a distributed leadership approach* when solving problems with the health care team and contribute to the creation of an optimal environment for collaborative practice

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

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 requesting assistance from others and when other health care providers request assistance

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

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 approaches used by 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

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

Enabling competencies

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

Enabling competencies

1.1 Analyze the impact of the governance, structure, financing, and operation of the health care system and its facilities on 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

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

Enabling competencies

2.1 Allocate health care resources for optimal patient care

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

Key Competency 3. Demonstrate leadership in professional practice

Enabling competencies

3.1 Develop leadership skills to enhance health care

3.2 Contribute to change in health care to enhance services and outcomes

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

Enabling competencies

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

4.2 Develop and implement a career plan

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

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, community-based agencies, and social support systems to secure the resources and supports required to maintain or achieve the best possible health outcomes

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

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

2.2 Contribute to taking action with patients and their families, their communities, relevant organizations, the healthcare sector, private sector and/or political institutions, as relevant, to foster the conditions that improve health and decrease health inequities

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


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

Enabling competencies

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 performance using internal and external data sources

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

Key Competency 2. Teach learners and other colleagues in the health care professions

Enabling competencies

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 provide feedback to learners and teachers effectively

Key Competency 3. Integrate best available evidence into practice

Enabling competencies

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.

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 practice

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

Enabling competencies

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 need for protection for 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 the findings of relevant research and scholarly inquiry to professional and lay audiences, including patients and their families


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

Enabling competencies

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, civility, and maintenance of confidentiality

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

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

Enabling competencies

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

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

Enabling competencies

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

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

Enabling competencies

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