Activities and Ideas on Promoting a Competency-based Training Curriculum

1. Incorporating CanMEDS
In Residency Training:
Actions & Future Plans
at the Department of
Medicine at KAMC,
Riyadh, KSA
Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MSc MBBS
Chairman, CanMEDS Syllabus Subcommittee
Department of Medicine, KAMC,KSA

2. Objectives
 Why do we need to include CanMEDS in
Residents Education Curricula
 Prerequisites for a successful program
 What have the Department of Medicine
done?
 Future Directions

3. Is there a clear need for change:
Characteristics of current Heath
care?T/F
1. High Efficiency & Productivity
2. Contained Healthcare Costs
3. Guaranteed Good Clinical Outcomes
4. High Patient Care Quality (No Medical Errors)
5. No Unnecessary & Duplicate Tests
6. High Patient Satisfaction
7. High Patient Engagement
8. Comprehensive Dual Preventive as well as Therapy Inputs

4. Process
Diagram
Process
Input
Output

5. Process
Input
Output

6. Process
Input
Output X

7. Health Care Model: Donabedian
Model
Process
Structure
Outcome
Prevent the
Six Ds:
Death
Disease
Disability
Discomfort
Dissatisfaction
Destitution
(cost)
Care
Process
Anatomy
•Pathways
•Protocols
•Physician
orders
•Nursing Care
•Housekeeping
•Transport
•Staff
•Departments
•Equipment
•Supplies
•Environment

8. The Patient Journey: Chances of Poor
Performance?
Advice and education
Hypotheses,
health issues
(problems and
diagnoses), risks
Treatment
Medication and prescriptions
Symptoms
and history
Body physical
examination findings
Self management and
home monitoring
Conventional medical summary
Procedures and operations
Care planning
Chronic
disease
management
Tests and investigations
Prevention and
screening,
population health
measures
Protocols, guidelines, care
pathways
Communication, team-based collaboration
Well-being and fitness,
rehabilitation after illness
Consent, permissions, disclosures, complaints
Social welfare, culture, religion,
attitudes, expectations, hopes,
fears
Care
Process

9. Care Process
 Needs a Sino-atrial Node to keep it ticking!

10. Care Process
Multiple
Competencies
 Needs a COMPETENT workforce to keep it ticking!

11. How is the world making better doctors?
‘Scottish Doctor’
‘Tomorrow’s Doctor’
‘Good Medical Practice’
CanMEDS 2000
World Federation for Medical Education
Accreditation Council for Graduate Medical Education
WHO/EMRO
Gulf Cooperation Council
Institute for International Medical Education
Association of American Medical Colleges

12. 12
Why Outcome-based,
Competency-focused Training?
OUTCOME-BASED
MEDICAL TRAINING:
HAVING THE END PRODUCT
IN MIND

13. Building your Curriculum………..

14. What is Competency?
 Is a standardized requirement for an
individual to properly perform a specific job.
 It encompasses a combination of knowledge,
skills and attitude (behavior) utilized to
improve performance.
 More generally, competency is the state or
quality of being adequately or well qualified,
having the ability to perform a specific role.

15. Holistic Quality
• Quality Clinical
Care
Clinical
Skills
• Holistic
Continuous
Quality Care
Non-
Clinical
Skills

16. Importance of a Holistic Professional development not
only Clinical Skills Training

17. What Does CanMEDS stand
for?
17
CanMEDS 2005 Framework
“Canadian Medical Education
Directions for Specialists”…
Better standards. Better physicians. Better care.

18. CanMEDS Project Goal
18
To identify the core competencies generic to
all specialists to meet the needs of society.

19. What are CanMeds competencies?

21. The SEVEN
Habits of a
Highly Effective
Doctor

22. 1
• Be proactive (take control of your destiny)
• Principles of Personal Vision.
2
• Begin with the End in mind
• Principles of Personal Leadership
3
• Put first things first
• Principles of Personal Management.
4
• Think win-win
• Principles of Interpersonal Leadership
5
• Seek first to understand. . . Then to be understood
• Principles of Empathic Communication with patients, colleagues
etc
6
• Synergize
• Principles of creative cooperation
7
• Sharpen the saw (Continuous Improvement)
• Principles of Balanced Self-Renewal
Manager
Medical Expert
Manager
Manager/
Professional
Communicator
Collaborator/
Advocate
Scholar

23. Medical Expert
Optimal clinical,
procedural, ethical
and patient-centered
medical care
Establish and
maintain clinical
knowledge
appropriate to their
practice
Communicator
Documentation
Consultation skills
Counseling skills/
Breaking bad news
(verbal and non-verbal
)
Collaborator
Clinical Care
Collaboration
Community
International

24. Scholar
Continuous
professional
Development
Evidence-Based
Practice
Teaching
Research
Advocate
Patient Healthcare
Needs
Community Health
Needs
Population
Determinants of
Health
Professional
Ethical Practice
Professional
Practice
Self-Care

25. Manager
Health Care
Effective Healthcare
Career Development
Administrative Development

26. The Department of Medicine
CanMEDS Syllabus
1 • Definition of each Competency
2 • Sub-competency
3 • Recommended Activity
4 • Recommended Method of Delivery
5 • Recommended Assessment Tools

27. Sub-competency Recommended Activity Recommended Method of
Delivery
Recommended Assessment
Tool
Optimal clinical, procedural,
ethical and patient-centered
medical care
1. CanMed Clinical Care
Rounds/ Educational Activity
2. CanMed Technical Skills
Round*
1. Bedside Ward Round
2. Sitting Ward Rounds
3. Short Case Discussions
4. Long Case Presentations
5. Actual Patient & Simulation –
Technical Skill Lab Training
6. Videos/Multimedia
 In-training evaluation reports
 Mini-clinical evaluation
exercise (mini-CEX)
 Objective structured clinical
examinations OSCE
 Multi-source feedback
 Critical appraised topic (CAT)
 Progression tests
 Portfolio
 Objective structured
assessment of technical skills
(OSATS)
 Logbooks
 Simulation
Establish and maintain clinical
knowledge appropriate to their
practice
Educational Activities  Academic half-day teaching
 Morning Meetings
 Ward Rounds
 Grand rounds
 Case presentations
 Seminars
 Review courses
 Conferences/Symposia
 Exit Rounds
 EBM Rotation
 Teaching Workshops &
Presentations
 Literature Searching/PICO
Exercises
 Critical Appraisal
 Journal Club
 In-training evaluation reports
 Written examinations
(multiple choice and open-ending)
 Standardized oral
examinations
 Standardized Patient
Examinations
 Chart-stimulated recall oral
examinations
 Logbooks & Rating of
attendance, presentations,
literature searching/ Journal
Club-CAT exercises
Medical Expert

28. Sub-competency Recommended Activity Recommended Method
of Delivery
Recommended
Assessment Tool
Continuous
professional
Development
Learning Activities
Individual or group
learning activities that
occur on a regular or day
to day basis
Self-Assessment
Programs
Out 0f Hospital :
 Conferences
 Workshops
 Courses
 Subscription to
Knowledge update
electronic resources
In Hospital :
 Grand rounds
(1hr/week )
 Journal clubs
 Morning report
 Ward rounds
 Half day activities
 Residents Knowledge
Database
 Exit Rounds
 MCQs/Multimedia
Sessions & Quizzes
Personal:
 Medical Knowledge
Assessment Program
(MKSAP)
 Cecil's MCQs
 's MCQs
 Multi-source
Feedback
 Short Answer
Questions
 MCQ
Scholar

29. Scholar
Sub-competency Recommended Activity Recommended Method of
Delivery
Recommended
Assessment Tool
Evidence-Based Medicine  Asking (Relevant)
Questions (PICO
Exercises)
 Acquiring Knowledge
(Literature Searching
Exercises)
 Appraisal (Critical
Appraisal Exercises)
 Applying Knowledge
(Knowledge Translation
exercises)
 Assessment of EBM
Process
 EBM Rotation
 Regular Educational
Prescriptions Activity
 PICO Exercises
 5As in Journal Club,
Morning Meetings and
Ward Rounds
 Computer Lab Training
Sessions
 Developing Evidence-based
Policies,
Pathways and
Guidelines
 Multi-source Feedback
 Short Answer Questions
 MCQ
 Objective structured
assessment of technical
skills (OSATS)
Teaching  Presentation Skills
 Time Management
Skills
 Personal Performance
Skills
 Teaching e.g.
supervision, mentoring
 Courses
 Workshops
 Multi-source Feedback
Research  Research & Biostatics
 Creating Research
Ideas/Banks
 Writing research
Proposals
 Funding your Research
 Writing Papers & Thesis
 Publishing Research
 Courses
 Workshops
 Research Rotation
 Mandatory Research
 Multi-source Feedback
 Short Answer Questions
 MCQ

30. Sub-competency Recommended Activity Recommended Method of
Delivery
Recommended
Assessment Tool
Documentation  The Complete H&P
 Writing Follow-up
Notes (SOAP)
 Writing Handing-
Over/Sign-out Notes
 Writing/Dictating a
Discharge Summary
 Writing/Dictating a
Medical Report
 Lectures
 Small groups (PBL)
 Role modeling
 Daily progress note
assessment.
 Review of dictation
summary.
Consultation skills  Writing a Consultation
Letter
 Verbal Consultation
Skills
 Lectures
 Small groups
 Role modeling
 Direct observation
 OSCE
 Simulation
Counseling skills/
Breaking bad news
(verbal and non-verbal )
 Effective Rapport
 Empathy
 Psychosocial Skills
 Lectures
 Small groups
 Videos
 Bedside teaching
 Role modeling
 Direct observation
 OSCE
 Simulation
 Standardized Patient
Examination
 Patient Survey
Communicator

31. Sub-competency Recommended
Activity
Recommended
Method of Delivery
Recommended
Assessment Tool
Clinical Care
Collaboration
 Leadership skills
 Multidisciplinary/
Interdepartmental
Care Dynamics
 Resolution of
Interpersonal
Conflicts
 Discharge
Planning
 Lectures
 Small groups
(PBL)
 Role modeling
 Daily progress
note assessment.
 Review of
dictation summary
 Written tests
(short-answer
questions, essays)
 In-training
evaluation reports
(ITERs)
 Objective
structured clinical
examinations
(OSCEs)
 Simulation
 Multi-source
feedback
Community  Patients’ Friends
Societies &
Support Groups
 Government
Bodies
Collaboration
 Lectures
 Small groups
International  Research
Collaboration
 Quality of Care
Collaboration
 Lectures
 Small groups
Collaborator

32. Sub-competency Recommended Activity Recommended Method
of Delivery
Recommended
Assessment Tool
Health Care  Organization,
structure and
financing of the
healthcare system
 Lectures  Multi-source
feedback and Peer
Evaluation
 Simulation
 Portfolio
 Direct Observation
Effective Healthcare  System/Quality
Improvement
 Committee
membership e.g.
M&M committee
 Audit & Quality
Workshops &
Presentations
 Economic Appraisal
Workshops
 Implementation of
Change Strategies
 Discharge Planning
Career Development  Job Searching
 Writing curriculum
vitae, personal
statements and
covering letters
 Interview Skills
 Lectures
 Workshops
 Small groups
Administrative
Development
 Physician Roles
 Time Management
Skills
 Leadership Skills
 Lectures
 Workshops
 Small groups
MANAGER

33. Sub-competency Recommended Activity Recommended Method
of Delivery
Recommended
Assessment Tool
Patient Healthcare
Needs:
 Patient Education
(disease, drugs, etc)
 Health Promotion
(lifestyle, social,
economic,
psychological,
environmental)
 Disease Prevention
e.g. Vaccination,
Chemoprophylaxis,
Screening)
 Timely Referrals e.g.
Medical
Consultations, Home
Health Care
 Clinical care Activities
e.g. Ward Rounds,
Morning Meetings etc
 Lectures
 Workshops
 Essays
 Short-answer
questions (SAQs)
 Direct observation
and In-Training
Evaluation Reports
(ITERs)
 Objective structured
clinical evaluations
(OSCEs) and
standardized patients
 Multi-source feedback
and peer evaluations
 Portfolios
Community Health
Needs
 Membership of
Patient’s Help Groups
 Community Care
Service/Participation
 Community Service
Rotation
 Workshops
 Conferences
Population
Determinants of Health
 Health Ministry
Service/Participation
 Population/Public
Campaigns
 Community Service
 Workshops
 Conferences
HEALTH ADVOCATE

34. Sub-competency Recommended
Activity
Recommended
Method of Delivery
Recommended
Assessment Tool
Ethical Practice  Ethical Care
 Ethical dilemmas
 Workshops
 Role modeling
 Clinical Activities
(ward Round,
Morning Meetings
etc)
 Direct observation
 In-training
evaluation reports
(ITERs)
 Multi-source
feedback
 Portfolios
Professional
Practice
 Codes of Conduct
 Professional
Behaviour
 Islamic Moral
Values
 Legislative
Regulation
 Workshops
 Role modeling
 Clinical Activities
(ward Round,
Morning Meetings
etc)
Self-Care  Physical &
Psychological
Health
 Stress
Management
PROFESSIONAL

35. Necessary Structures
• Committed Leadership
• CanMEDS Skilled Faculty
• CanMEDS-Based Curricula
• Simulation Lab
• Education Department
 Both Junior and Senior staff training
 Educationalists members

36. Current and Future Plans
 CanMEDS-skilled Faculty.
 Outcome:
 Awaits: CanMEDS Cttee restructuring PLUS a Train-the-
Trainers program:
 Vertical TTT Program: inclusive of Senior Faculty and
Residents
 Horizontal TTT Program: Compulsory longitudinal
program

37. Restructuring the System of
Training:
 The CanMEDS Subcommittee
 Outcome:
 Expansion of Cttee membership to 6 Seniors
(Consultants/Assistants) and 1 Educational Specialist
(from the College of Medicine) PLUS 12 Residents from
R1, R2 and R3.

38. Restructuring the System of
Training:
 The CanMEDS Training Proposal (Syllabus)
 Outcome:
 The CanMEDS Training Proposal is rich in its content
and will serve as a reference at least for the initial
drafting of the TTT educational curriculum (together with
other resources as outlined below).

39. The CanMEDS Champions: Faculty
&
Resident  Outcome:
 The new number of members will “set in motion” the
practical creation of skilled Champions (from Seniors
and Residents) by facilitating the establishment of “
Competency-focused Micro Teams” e.g. Micro-team for
the Communicator Role, Micro-team for the Professional
Role etc.

40. The CanMEDS Champions: Faculty
&
Resident  Outcome:
 Each micro-team will consist of 1 Senior and
2 Residents at different levels of training.
R1
Resident
Consultant
R2
Competency
Champions
Micro-Team

41. Train-the-Trainers Workshops
 Outcome:
 Each micro-team will be entrusted with the task of
building a full-curriculum for their allocated competency.
Material (handouts, power-point etc) prepared would
have to be presented to the committee and approved for
inclusion in the TTT workshop.
 Resources from KAMC CanMEDS Collaborating centre
CD as well as from the RCP of Canada website may
provide the micro-teams with useful material.
 RCP of Canada CanMEDS best practice:
http://www.royalcollege.ca/portal/page/portal/rc/canmeds/whatworks

42. 5%
Method of Learning

43. Experiential Learning:

44. Bloom's Taxonomy of
Learning Objectives

45. TRAINING OF COMPETENCIES: MILLER
Does
Shows how
Knows how
Knows
Behaviour
practice
skills labs
problem solving
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement)
1990; 65: S63-S7.
Professional authenticity
Cognition
facts and concepts

46. Knowledge
(Concepts)
Understanding
Practice
Reflection
Assessment

47. Train-the-Trainers 3Ts in Communicator Role: See-One-Session SOS
Session Knowledge Understanding Skill/Practice Extras for the
Skill
Reflection Assessment
Documentation:
Follow-up Notes
Sign-
Out/Handing
Over notes
Lecture: SOAP
Sign-out
Case Discussion/
Clinical Vignettes
Experiential
Learning:
Case Scenarios
Video on
SOAP/Sign-out
Ad-hoc
Discussion
Session
Documentation:
Consultation
(Verbal/Written)
Lecture Case Discussion/
Clinical Vignettes
Experiential
Learning:
Case Scenarios
 Video on
Consultatio
n Skills
Ad-hoc
Discussion
Session
Documentation:
-Discharge
Summary
-Medical Report
Lecture Case Discussion/
Clinical Vignettes
Experiential
Learning:
Case Scenarios
 (Old
Discharge
Summaries)
Ad-hoc
Discussion
Session
Counseling
skills/ Breaking
bad news
(verbal and non-verbal
)
Lecture/
SPIKES
Cognitive Aid
Case Discussion/
Clinical Vignettes
Experiential
Learning:
Role Playing
 Video on
breaking
Bad News/
Counseling
Ad-hoc
Discussion
Session
Presentation
Skills:
PowerPoint
Lecture Examples of
“good” and “bad”
presentations
Videos

48. Train-the-Trainers 3Ts in COLLABORATOR Role: See-One-Session SOS
Session Knowledge Understanding Skill/Practice Extras for
the Skill
Reflection Assessment
Leadership
Skills
Lecture:
What?
How?
Case
Discussion/
Clinical
Vignettes
Experiential
Learning:
Case
Scenarios
Video on
Leadership
Ad-hoc
Discussion
Session
Team
Building
Skills
Lecture Case
Discussion/
Clinical
Vignettes
Experiential
Learning:
Case
Scenarios
 Video on
Team
Building
Skills
Ad-hoc
Discussion
Session
Resolution of
Interpersonal
Conflicts
Skills
Lecture Case
Discussion/
Clinical
Vignettes
Experiential
Learning:
Case
Scenarios
 Video on
Conflict
Resolution
Ad-hoc
Discussion
Session
Discharge
Planning
Skills
Lecture Case
Discussion/
Clinical
Vignettes
Experiential
Learning:
Case
Scenarios
 Story
Telling
Ad-hoc
Discussion
Session

49. Train-the-Trainers 3Ts in Manager Role: See-One-Session SOS
Session Knowledge Understanding Skill/Practice Extras for the
Skill
Reflection Assessment
Career Management
Skills
Lecture:
Job
Searching
Writing
curriculum
vitae, personal
statements
and covering
letters
Interview
Skills
 Experiential Learning:
proposing and completing a
career move
 Role Playing: Interview skills
 Video on good Interview skills
Ad-hoc
Discussion
Session
Time Management
Skills
Lecture Case
Discussion/Clini
cal Vignettes
Experiential
Learning:
Case Scenarios
 Video on
Time
Manageme
nt Skills
Ad-hoc
Discussion
Session
Quality Management/
Improvement Skills
Lecture : What
is QM? Audit?
Management
of Change?
Case
Discussion/Clini
cal Vignettes
Experiential
Learning:
Case Scenarios
Audit Exercise
Ad-hoc
Discussion
Session
Discharge Planning
Skills
Lecture Case
Discussion/Clini
cal Vignettes
Experiential
Learning: Case
Scenarios
 Story
Telling
Ad-hoc
Discussion
Session
Health
Organizations/Finance
& Physician Roles
Lecture

50. Restructuring the Process
of Training

51. Restructuring the Process of
Training and Assessment:
1. CanMEDS Competencies “Teaching Moments”.
2. Competency Structured Topic Presentation.
3. Competency Structured Morning Meeting
discussion format.
4. Competency structured Ward Round.

52. CanMEDS Competencies “Teaching
Moments”
 Highlighting in an “Explicit” manner a CanMEDS
competency whilst dealing with a patient care issue
e.g.
 Medical Expert with H&P
 Collaborator role when referring a patient
 Scholar when discussing New evidence, NNT etc
 Advocacy when referring to Home Health Care etc
 Manager when dealing with system/process improvement
 Communicator when breaking bad news etc
 Professionalism when discussing ethical issues etc

53. Competenc
y
Structured
Topic
Presentatio
n
Bronchial Asthma
Medical Expert  History & Physical Exam
 Essential Technical Skills (Pulse
Oximetry, Peak Flow meter
Recording, Use of Inhaler Devices
etc)
 Essential Investigations/Imaging
 Emergency Medical Interventions
 Monitoring Response to Treatment
 Discharge Planning/Criteria for
Discharge
Communicator  Presentation Skills Feedback
 Counseling skills/ Breaking bad news
Collaborator  Essential Consultations & Referrals
e.g. Pulmonology, Pulmonary
Educator, Allergologist etc
This Novel Method of
Presentation may
assist in realizing a more
competency-directed
clinical training
and decision-making
process, and in drafting a
comprehensive,
high-quality management
plan for every patient.

54. Competenc
y
Structured
Topic
Presentatio
n
Bronchial Asthma
Advocate  Essential Educational input
regarding Asthma and its
treatment, Self-management
Plans etc
 Risk Factors Counseling e.g.
smoking, allergens
 Referral to Patients’ Friends
Societies & Support Groups
Manager  Interventions to reduce Cost of
care/Length of stay
 Quality Indicators/Audit of
Asthma care
 Economic Comparisons of
various interventions
Scholar  Evidence-based resources for
Asthma guidelines, protocols
 Asthma Societies Websites
 Update on new studies on
Asthma
Professional  Ethical challenges in Asthma
e.g. Intubation or not,
Unorthodox treatments,
Refusing steroid therapy etc

55. CanMed Ward Round: Explicit Resident
Training
80 Yr old, bed-bound with AF , hypertension and DM. Was admitted
with a new stroke ?embolic.
As a medical expert: were the H & P up to CanMeds standard-structured,
comprehensive, relevant etc.
As a Communicator: Presentation skill? How did he/she convey the
news to the family? Empathy & support?
As a Collaborator: Were the necessary referrals appropriate and
professionally arranged?
As a Manager: Quality of care, cost of Care: Time and resource
utilization are appropriate?
As Health Advocate: Any arrangements with social and other
healthcare facilities?
As a Scholar: Literature searching exercise on the options of care
and preventive strategies for this particular patient.
As a Professional: Attitude and behavior observation, discussion of
the ethical issues re-anticoagulation, code status, etc

56. Restructuring the Process of
Training and Assessment:
5. Competency-enhancing Cognitive Aids like the
5S Cognitive Aid.
6. End-of-Rotation Competency Appraisal Form
(ERCA).
7. Others: Using CanMEDS headings in Clinical
Pathways etc
8. Simulation Lab. (as an essential structure for
fulfilling many aspects of training and
assessment in the CanMEDS competencies).

57. End-of-Rotation Competency
Appraisal Form (ERCA).
 Resident is requested to:
1. Select specific patient care issues
2. Itemize them and
3. Illustrate the selected CanMEDS
competency intervention that was used to
deal with each of them.

58. End-of-Rotation Competency
Appraisal Form (ERCA).
 An example courtesy of
Dr Raed Al Enazi R1.

59. Patient
Diagnosis &
MRN or
Work-related
Difficulty
Competency
Reason(s) for
selecting this
specific
patient/problem
Suggested Specific
Competency
Input(s)/Action(s) to
incorporate for the
selected
patient/problem
Recommendations
for future use in
other similar
patients/problems if
applicable
Deteriorating
level of
consciousness
Medical Expert
Patient with
prolonged INR (>9),
LVF, CKD, DM. septic
foot ulcer: many
possible reasons!
Using the 3Rs to diagnose
the cause: Rules of Thumb,
Red Flags, Rule-out-worst
Scenario
Use a bed-side check-list
for patients whose level
of consciousness
deteriorates during their
in-patient stay.
Advanced
Cholangiocarc
inoma
Communicator
Breaking bad news
and discussing
putting the patient
no code with the
family
Using SPIKES mnemonic
for breaking bad news
Providing written material
on what no-code means
Involving Religious affairs
department
Policy and Procedure for
NO Code patients with
both Physician and
Family educational
inputs, written material
etc

60. Patient
Diagnosis &
MRN or Work-related
Difficulty
Competency
Reason(s) for
selecting this specific
patient/problem
Suggested Specific
Competency
Input(s)/Action(s) to
incorporate for the selected
patient/problem
Recommendations for
future use in other
similar
patients/problems if
applicable
Elderly patient
with dementia,
Parkinsonism,
and bed-bound.
Admitted with
aspiration
pneumonia.
Collaborator
Patient refusing
discharge (2 months in
the hospital)
Multidisciplinary meeting
inclusive of MRP, HHC,
neurology, social services and
family
Earlier involvement of care
givers in the discharge
process/discharge planning.
17 year old
female patient
with acute sickle
cell crisis and
acute chest
syndrome
Health
Advocate
Patient due to get
married
Educating patient on her
disease
Preventative interventions
including vaccination
Pre-marital counseling and
husband screening for genetic
disease
Hospital wide genetic
disease patient and family
education support team,
procedure and policy

61. Patient
Diagnosis &
MRN or Work-related
Difficulty
Competency
Reason(s) for selecting
this specific
patient/problem
Suggested Specific
Competency
Input(s)/Action(s) to
incorporate for the selected
patient/problem
Recommendations for
future use in other similar
patients/problems if
applicable
Ward-round Time Manager
Ward round taking too
long
Time management skills
Use Lean system to make work
more efficient (study areas of
time wastage)
Develop a policy/procedure
to Re-organize the ward
round
Diuretic Resistant
fluid overload
Scholar
How to manage such
patients?
Literature searching for best
available evidence for dealing
with this problem.
Patient is
unhappy with the
provided medical
care.
Professional
Physician-patient-family
conflict with its negative
impact on patient care
MRP-Family conference
Involving trustworthy
Colleagues
Involving patient relations
department
Policy-procedure for conflict
resolution

62. The CanMEDS Sub-committee
 Important and worthwhile achievements
 Novel models: opportunity for educational
research
 Ahead of other Departments
 Pending actions:
 (3Ts) need for administrative and faculty support.
 ? Educationalists

63. Acknowledgement
 Dr Ali Al Khatahmi
 Dr Esam Al Banyan
 Dr Mohammed Al-Qahtani *
 Dr Thari Al-Anazi *
 Dr Abdulla Al Gwizani *
 Dr Mahfouz Farouqi
 Dr Marwan Al-Kishi
 Dr Thamer Al-Anazi
 Dr Hadi Kuriry
 Residents