Using the CanMEDS competency-framework to deliver a comprehensive care package-like nothing before!

1. AL TABABA
TRAINING
SERIES

2. T H E M I N D O F A
M A S T E R
C L I N I C I A N

4. Introduction
 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.
What is a Competency?

5. What is the
CanMEDS
competency
Framework for
Training?
“Canadian Medical Education
Directions for Specialists”…
CanMEDS is a framework that identifies and
describes the abilities physicians require to
effectively meet the health care needs of the
people they serve.
Better standards. Better physicians. Better care.

6. What are the 7
CanMEDS
competencies?

7. 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

8. 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

9. Leader (Manager)
Leader in Health Care
Effective Healthcare
Career Development
Administrative Development

10. Case
Scenario
A 62 year OLD woman from Wad Medani was
admitted with acute right thalamic hemorrhage
due to uncontrolled hypertension. She was non-
compliant to her blood pressure medications
because she was not able to afford the cost.
She had a left-sided hemiplegia with swallowing
dysfunction and dysarthria. She is now bed-
ridden and is weepy.
For the last 2 days, she was having more cough
associated with fever and was feeling breathless.

11. Management
using
Competency-
structured Care
Inputs
Medical
Expert:
Items
relevant to
this
Competency
•History & Examination focusing on possible
causes of respiratory symptoms: ?Aspiration
Pneumonia, ?Pulmonary Embolism, ?
Pulmonary Edema
Hypothesis-Driven
History Taking and
Physical Examination.
•Hemorrhagic Stroke, Swallowing
Dysfunction, Poor Mobility, Depression,
Financial Difficulties etc.
Detailed Problem-List
for comprehensive care
inputs
•BMI Calculator, CURB-65, Well’s Score for
DVT/PE risk, Creatinine Clearance, NIH
Stroke Score, etc.
Use of Calculators and
Scoring Tools for
decision-making
•What are the patient and family concerns and
aspirations.
•Use of Decision-support tools to select the
cheapest and most-effective BP medications!
Patient-and Family-
centered Care

12. Management
using
Competency-
structured Care
Inputs
Medical
Expert:
Items
relevant to
this
Competency
•BESDiagnosis: Aspiration Pneumonia, ?Hospital-acquired
organism, CURB-Score
•Site of Care (ward), Symptomatic (antipyretic), Supportive (IV
Fluids, O2), Specific (NPO, NGT Feeding, IV Antibiotic),
Specialty Referral (Swallowing/Speech Therapy , Stroke Team,
Stroke Rehab)
Using the BESD and 5S
for comprehensive
immediate diagnostic
and therapeutic input.
.
•Differential Diagnosis: P. Embolism, Pulmonary
Edema etc.
•Ruling Out worst Scenario e.g. Pulmonary
Embolism
•Red Flags e.g. Hemoptysis
Avoiding Cognitive
Biases Skills: DD
Scheme, ROWS, Red
Flags etc.
•BP measurement, Fundoscopy etc.
Procedural skills e.g.
Lumbar Puncture,
Ascitic Tap etc.

13. Management
using
Competency-
structured Care
Inputs
Communicator:
Items
relevant to
this
Competency
•H&P, SOAP for follow-up documentation,
Using SBAR/I-PASS for Handover, Discharge
Summary etc.
Documentation
•Communication using SBAR/I-PASS
Consultation
Referrals
•Breaking Bad News: Using SPIKES
mnemonic
Counseling Skills
•Reassurance
•Giving Hope
•Re-establishing self-confidence/reliance
Motivational
and Therapeutic
Communication

14. Management
using
Competency-
structured Care
Inputs
Collaborator:
Items
relevant to
this
Competency
•Multidisciplinary & Interdisciplinary etc.:
with stroke Team, Speech Therapist,
Physiotherapist, Social Worker etc.
Effective Team
Work
•Patient Support Groups etc.
Community
Collaboration
•Resolution of Interpersonal Conflicts
Interdepartmental
Care Dynamics
•Committed to one Goal, Coherence,
Communication, Creative, Democratic etc.
Team Building
Skills

15. Management
using
Competency-
structured Care
Inputs
Advocate:
Items
relevant to
this
Competency
•Psychosocial and Biological needs-e.g.
Feeding, Excreta (Laxatives/Foley’s),
Patient Education (leaflets, audiovisuals etc.),
Screening, Preventive Interventions e.g.
DVT prophylaxis, Timely Referrals
(Physio, Home Healthcare) etc.
Patient Needs
•Community Education
•Social/Financial Support.
Community Health
needs/
Determinants of
Health

16. Management
using
Competency-
structured Care
Inputs
Leader/
Manager:
Items
relevant to
this
Competency
•Coaches, Shows How, Says “We”, Says
“Thanks”, “Asks”, Says ”Let’s go” etc.
Leadership skills
•Standardize/Protocolize Care,
Interventions to reduce Cost of
care/Length of stay e.g. Stroke
Pathway, Stroke Team
•Audit of Stroke Care
Quality
Management/
Improvement
•Time Efficiency/Ward Round DynamicsTime Management

17. Management
using
Competency-
structured Care
Inputs
Scholar:
Items
relevant to
this
Competency
•PICO, Literature Searching, Implementation of
Evidence: Accessing Stroke Guidelines e.g. in
Guideline Clearinghouse or Point-of-care
resources such as BMJ Best Practice etc.
Evidence Based
Practice
•Styles, Methods etc.Teaching
•E.g. Association between Stroke and
Poverty or Aspiration Pneumonia
Research
•Courses/Conferences on Stroke etc.
Continuous
Professional
Development

18. Management
using
Competency-
structured Care
Inputs
Professional:
Items
relevant to
this
Competency
•Dealing with Ethical Dilemmas e.g. refusing
medication or “No Code/Not for
Resuscitation”, Not informing patient of
diagnosis as per next of kin request etc.
•Code of Conduct)/Islamic Cultural
Values & Legislative Regulations
Personal
Professional
Conduct
Self-Care
Ethical Patient
Care
•Physician Physical and Psychological
Health/Stress Management.

20. What is NEXT?
•Try it out!

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