CanMEDS

Question 1

CanMEDS roles

Answer 1

Communicator.
Professional.
Scholar.
Health advocate.
Leader.
Collaborator.
Medical expert.

Question 2

Aspects of medicine (C2LEO)

Answer 2

Cultural communication.
Legal.
Ethical.
Organizational.

Question 3

Health advocate. Acces to health care

Answer 3

Individuals are morally equal and equally worthy of respect.
Consider need and potential benefit.
Equality rights are recognized in section 15 of the Canadian Charter of Rights and Freedoms.

Question 4

Canadian health system

Answer 4

Constitution (1867). Provinces have primary responsabililties for health care.
The national Canada Health Act framework leverages the use of conditional federal-provintial transfer payments to achieve specific aims among provinces.

Question 5

Canada Health Act

Answer 5

Passed in 1984. Provinces must establish a publicly administered health care insurance program that provides universal, comprehensive, portable and accesible coverage.

Question 6

Collaborator - health system

Answer 6

provinces and territories administer hospital and medical services through a universal single payer system, remunarate physicians through billing schedules negotiated with the provincial medical association.
Consultations.
health care team.

Question 7

Collaborator- Conflicts - factors

Answer 7

Physician: attitudes (insecurity, burnout, time pressures, uncertainty); conditions (contextual stressors, health issues, lack of sleep, exhaustion, mental health concerns); knowledge (lack of medical knowledge, limited knowledge of patient condition)
Skills: lack of communication skills, easily frustrated
Patient: behavioral issues; conditions (substance abuse, chronic pain syndromes, low literacy, multiple medical issues per visit, functional somatic disorders, previous abuse); psychiatric diagnosis (personality disorders, anxiety disorders, mood disorders).

Question 8

Collaborator- conflicts- the calmer approach

Answer 8

Catalyst for change
Alter thoughts to change feelings.
Listen and then make diagnosis
Make an agreement
Education and folllow up
Reach out and discuss feelings

Question 9

Communicator. SPIKES protocol

Answer 9

S- setting up the interview
P- assesing patients perception
I- obtaining patients invitation
K- giving knowledge and information to patient
E- addressing patients emotions
S- strategy and summary

Question 10

Communicator. Eliciting information.

Answer 10

Questioning techniques (open ended, directed, multiple choice, yes/no)
Questions to avoid (leading questions, rapid fire questions, jargon questions)
Facilitating responses. (encouragement, silence. repetition, paraphrasing).

Question 11

Communicator. Written communicacion.

Answer 11

patients have a right of access to health information, including the contents of the medical record.

Question 12

Communicator. Communication with third parties.

Answer 12

infectious disease reporting to public health officials often constitutes mandatory disclosures of health information. It is usually desirable to notify the patient about the required disclosure. In the abscense of legislation requiring otherwise, medical staff members need not report gunshot wounds, stabbings, admitted use of illegal drugs, or injuries suffered during the commission of a crime. Such information may be obtained by a police officer with a valid court order.

Question 13

Leader. prudent use of clinical resources and obligation to seek patient best interests.

Answer 13

Cost constraints should not interfere with clinical care. Cost constraints are no defense against negigence.

Question 14

Professional. Accountability to self

Answer 14

Preofessionalism requires achieving balance and equanimity in both clinical and personal matters. Impairment occurs when personal factors interfere with the professional practice of medicine.

Question 15

Professionalism. Accountability to patient.

Answer 15

patient physician relationship: fiduciary relationship. Physician bound to serve the patients interest with due care and diligence, refrain from conflicts of interrests and resolve conflicts of interest in patients favor.
Physicians must provide continous and accesible care, and never abandon their patient.

Question 16

Professionalism. Accountability to society.

Answer 16

Canada charter of rights and freedoms: patient with human and other legal rights, including the right to security of person and inviolability, and right to freedom from discrimination.
Rights may be legimately limited for certain social interests.

Question 17

Prefessionalism. Accountability to profession.

Answer 17

professionalism refers to the practice of medicine according to a common set of norms and standards, characterized by ethical conduct, clinical independencem, and self regulation.

Question 18

Professionalism. Certification and licensing.

Answer 18

certification regime. certain agencies are granted power to certify individuals as having met particular performance or educational standards. The national character of these organizations means that the medical degreee and certification are portable from province to province.
(CFPC- family practice, RCPSC specialty practice, MCC- independent medical practice).
Licensing regime. unlincesed individuals are legally prohibited from providing certain services. Provincial physician run colleges or boards govern licensing, Provincial colleges typicallu require certification from the MCC, CFPC or RCPSC.

Question 19

Professionalism. Self regulation.

Answer 19

the interests of the profession may clash with the interest of thepublic. To prevent conflicts of interest, distinct medical associations carry out professional advocacy separately.
The CMPA, a legal defense fund, looks after the legal interests of individual practitioners.

Question 20

Professionalism. Output regulation.

Answer 20

Disciplinaty proceedings, whereby provincial colleges leverage their powers to grant, revoke or suspend medical licensure to penalize breaches of professional standards, are an important form of output regulation.

Question 21

LEO. Confidentiality.

Answer 21

privacy. Patients control over kkowledge of his personal affairs.
confidentiality. Physicians duty to safeguard information disclosed by patients. Confidentiality prostects patients privacy.
Health information must be disclosed to a third party when: the law requieres reporting, prevent serious harm from befalling a third party (duty to warn), prevent esrious harm from befalling the patient, where a valid court order requires disclosure, where the patient requests or authorizes thet health information be transferred.

Question 22

LEO. Consent.

Answer 22

required, by respect for patient autonomy and legally, by the patients common law right to self determination and by statue.
Requires: disclosure iof information, voluntarism, capacity.
The patient has the right to refused consent, even when this may lead to death.

Question 23

LEO. Consent. Disclosure of information

Answer 23

Disclosure includes whatever a reasonable person in the patients circumstances would want to know. (nature of intervention, gravity of the situation and of intervention, material risks and benefits, alternatives and consequences of nonconsent, information regarding delegation of care)

Question 24

LEO. Consent. Voluntarism

Answer 24

freedom from coercion so that a patients authentic sense of what is best cvan guide medical desicions.

Question 25

LEO. Consent. Capacity.

Answer 25

ability to consent or refuse consent to medical treatment. The patient is able to understand tne information that is relevent to making a desicion and able to appreciate the reasonably foreseeable consequences of a desicion or lack of desicion.

Question 26

LEO.Consent. The incapable patient.

Answer 26

at least two justifications for proxy or substitute decisions should be recognized: waht the patient would have wanted and the best interests standards.
Physicians must report a parents failure to seek necessary medical therapy to child protection authorities.
Statutiry lawe may supersede common law.

Question 27

LEO. Legal system.

Answer 27

two sources of law: the law created by statute and the common law developed by judgements rendered in legal actions the have proceeded through the courts. Across Canada, except in Quebec, common law is applicable.
Patient self determination or autonomy is a fundamental right. In common law, the physicians find themselves liable for battery if they treat a patient without consent or negligence if they treat a patient under inadequately formes consent and patient harm occurs as a result.