1. changing the focus of specialty training from the interests and abilities of providers (supply) to the needs of society (demand), and
2. orienting these programs to consider the needs of individual patients in context of the population at large. These are two relatively simple and widely accepted concepts, yet profound in their implications for change.
   

At the outset, the project was divided into two streams, each with their own task force. The Societal Needs Working Group (SNWG), headed by Dr. Peter Tugwell, was asked to identify societal health care needs and, based on these, to define a profile of competencies essential to practising specialist physicians in Canada. Within this mandate, the SNWG was given the task of outlining the objectives and the educational and evaluation strategies for the various competencies, and making recommendations for implementation including the implications for accreditation of postgraduate programs and certification of residents. The second task force, the Specialty Physician Resources Working Group (SPRWG), headed by Dr. Hugh E. Scully, was charged with developing strategies regarding the number and mix of specialists in light of identified societal needs and to recommend strategies for needsbased rationalization of the specialty physician workforce and for ongoing needs-based planning within the Royal College. This report will describe only the work of the SNWG.

The initial concept of identifying the various tasks or behaviours required of physicians, and then organizing these into distinct roles, came from the work of the EFPO (Educating Future Physicians for Ontario) project whose goal has been to make medical education in Ontario more responsive to the evolving health needs of that province. As EFPO's focus was on Ontarians and all physicians providing health care for that population, it was necessary to reexamine these issues to make them more germane to the tasks required of specialist physicians serving patients across the country. This process began with extensive reviews of the relevant published and unpublished literature, including consumer surveys and focus groups. From this information, general competencies of specialists were extracted and these were clustered into seven major roles. These physician roles include the following: medical expert/clinical decision-maker, communicator, collaborator, manager, health advocate, scholar, and professional.

Over the course of several months, participation was sought from key stakeholders and leaders in medical education who added further breadth, depth and reality to the existing framework. Working in task groups, each of the seven roles was explicitly defined and the key competencies for each were determined. With a view to implementation of the Framework, specific educational objectives, relevant learning and evaluation methods, and pertinent faculty development issues were also described for each role. The Roles Framework of the CanMEDS 2000 project is therefore the product of many months' work involving medical education experts across Canada and reflects overlapping clusters of the generic knowledge, attitudes, and skill set required of all specialists.

In order to validate this framework, the SNWG conducted major surveys involving two cohorts of RCPSC Fellows and all Canadian specialty program directors. Respondents were asked to rate each of the competencies from two perspectives: first, how important each is to their practice and second, how well they felt they were prepared for each during their training programs. Survey analysis demonstrates that not only do the roles make sense to program directors and new Fellows, but substantial gaps have also been The CanMEDS 2000 Project Societal Needs Working Group Report 2 identified within each of the roles. That is, while many of the competencies were rated as important, preparation for them was relatively poor, as perceived by the Fellows and observed by the program directors.

This document is organized as follows: first, the key competencies within each group are summarized in Table 1. This list is not all-inclusive but is intended to reflect the essence of each role. Following this, each role is described further in terms of a definition, key competencies, and specific objectives. Methods for teaching and learning and evaluation are discussed in later sections. Finally, relevant issues in the development of faculty necessary for this curricular reform are discussed.

Collaboration has begun with other organizations including the College of Family Physicians of Canada, provincial colleges and licensing authorities, the regional advisory committees of the Royal College, the Canadian Association of Internes and Residents, and the Fédération des médecins residents du Québec. Equally important will be collaboration with nursing and allied health organizations and representatives of the public at large. Recognizing that health care needs and opportunities will continue to evolve, mechanisms for ongoing surveillance of these change will also be necessary to maintain relevance and societal-responsiveness of specialty medical education. Excellence in specialty care is a covenant we must pursue.

Essential Roles >>

[ Table of Contents ]