CanMEDS Frequently asked questions

What is CanMEDS?

The CanMEDS physician competency framework helps physicians deliver quality patient care by setting the highest standards for their training and continuing professional development. Developed by the Royal College in the 1990s, its main purpose is to define the necessary competencies for all areas of medical practice and provide a comprehensive foundation for medical education and practice in Canada.

This educational framework identifies and describes the seven Roles that lead to optimal physician performance, care delivery and health care outcomes. These roles include: Medical Expert (central Role), Communicator, Collaborator, Leader (formerly Manager), Health Advocate, Scholar and Professional.

In Canada, the framework is used by residents in all medical specialties as part of their postgraduate training, and it provides the foundation for the Royal College’s certification and accreditation processes. This competency model has also been adopted by other organizations in Canada and internationally, both in and outside the health professions, making it the most recognized and widely applied health profession competency framework in the world.

What is CanMEDS 2015?

CanMEDS 2015 is the foundational project for the Royal College’s Competence by Design (CBD) program. The CanMEDS 2015 Framework includes new competencies relating to patient safety and quality improvement, resource stewardship and handover, for example. It also introduces new competency milestones for each CanMEDS Role.

There are two earlier editions of the CanMEDS Framework, the original edition, which was released in 1996 and a second, which was released a decade later in 2005. This periodic review and revision process is demonstrative of the College’s commitment to continuous quality improvement on behalf of physicians and patients.

How does the 2015 Framework differ from the previous version (2005)?

  • The addition of complementary milestones is arguably the largest change between the 2005 and 2015 versions of the CanMEDS 2015 Framework. The milestones will be available in an online companion document, the CanMEDS Milestones Guide, and unlike the Framework they will undergo continual revision as educators modify the milestones for their specific specialty.
  • New themes have been introduced, such as patient safety, quality improvement, handovers, and eHealth.
  • A renewed emphasis on the overall coherence of the framework and on its practical application.
  • Role descriptions and definitions are expressed in simpler, more direct language.
  • Overlapping areas between Roles have been minimized.
  • Competencies and milestones describe the abilities to be demonstrated in practice, as distinct from the information or content related to aspects of a Role.

What is a milestone? What is an EPA? How are they different?

A milestone is an observable marker of an individual's ability along a developmental continuum, which is used for planning and teaching. An Entrustable Professional Activity (EPA) is a task in the clinical setting that may be delegated to a resident by their supervisor once sufficient competence has been demonstrated. Typically, each EPA integrates multiple milestones and it is generally used for overall assessment. The key difference between EPAs and milestones is that EPAs are the tasks or activities that must be accomplished, whereas milestones are the abilities of the individual.

How is the College coordinating the implementation of CBD and CanMEDS 2015?

The implementation of the CanMEDS 2015 Physician Competency Framework is occurring as part of the Royal College’s Competence by Design (CBD) initiative. CBD is being implemented through multiple cohorts and over an extended period of time. The final cohort of disciplines converting to CBD is expected to happen no earlier than 2022. One of the main reasons for this extended transition is because CBD involves major systems changes that require careful planning and ongoing consultation.

The changes introduced as part of the CanMEDS 2015 project will lead to better trained physicians and improved patient care. For this reason, Royal College Fellows feel it is important for CanMEDS 2015 to be incorporated into training and practice as rapidly as possible, but in a way that is efficient and mindful of the other systems changes underway. Too long a delay between the development and implementation of CanMEDS will minimize its potential value to the system.

Next steps for implementation
In July 2016, the Royal College will incorporate a CanMEDS 2015 special addendum to the Objectives of Training for all disciplines that transition to CBD after July 2018. Its role is to facilitate the timely implementation of CanMEDS 2015 by focusing on key NEW content areas found in the Framework. This approach will ensure the major highlights of CanMEDS 2015 are incorporated into training in a timely way, without over-burdening our stakeholders many of whom are also involved in the broader changes associated with CBD.

Implementing CanMEDS 2015
The Special Addendum focuses on KEY new content areas in the key and enabling competencies of the CanMEDS 2015 Framework and is organized by CanMEDS Role under three main headings: “Patient safety, Quality improvement and Resource management”, “eHealth and Technology” and “Leadership and Physician health”.

The addendum will apply to those who begin training in the identified disciplines on or after July 1st, 2016. Accountability for ensuring the curriculum is taught in accordance with the Generic OTR addendum and the Discipline-Specific OTR remains with the faculty and program. General accreditation standards will not change as a result of this addendum. Surveyors will, however, seek to determine how the CanMEDS 2015 OTR addendum has been integrated into training. Programs reviewed after July 1, 2017 will be expected to demonstrate that these requirements have been integrated in the program’s curriculum.

Once a discipline has transitioned to CBD and begins to accept trainees into its revised training programs this addendum will no longer apply.

What resources and tools are available to help implement CanMEDS 2015?

We are committed to providing more support than ever before. Below you will find a detailed list of the tools and resources available to you to help implement CanMEDS 2015.

  • CanMEDS Interactive – With this online, interactive platform you can explore and engage with the CanMEDS 2015 Physician Competency Framework, including with the milestones across each stage of the competency continuum. Discover CanMEDS in a way that you haven’t before by using filters to generate the milestones that you choose to use.
  • Teaching Quality Improvement in Residency Education Author Roger Y.M. Wong, MD, FRCPC, has developed an innovative curriculum to teach quality improvement to residents. This electronic publication covers topics such as setting learning objectives, assessing competencies, evaluating curriculum from fundamentals to advanced quality improvement.
  • CanMEDS Teaching and Assessment Tools Guide – This is a standalone, practical resource to support program directors as they implement CanMEDS 2015. The guide is designed as a practical teaching and assessment resource for competency-based medical education, and will help clarify important educational concepts.
  • CanMEDS Introduction for Clinical Teachers – Video Series – This series features short videos with our Clinician Educators, who explain the changes to each CanMEDS Role, provide information on teaching and assessing each Role, and share how the Roles can be incorporated into practice.
  • CBD Community Touchpoint – this new ePublication is released three times a year and is intended to provide you with regular information and progress updates on CBD. Sign up to receive the Touchpoint directly in your inbox, or check out the June 2015 and October 2015 issues.

Additional resources, including slide decks, info sheets and webinars are available in the CBD Resources section of the Royal College website.

How will the CanMEDS Framework be applied across the continuum of a physician’s career?

CanMEDS is a framework that is already used by various medical education organizations around the world for undergraduate medicine, residency, faculty development and continuing professional development. In Canada, many medical schools use a CanMEDS-like framework for their MD programs. By providing generic milestones for each domain of competence starting at entry to residency, the CanMEDS Milestones will allow educators to adapt CanMEDS to different stages of training – including a practicing physician’s future professional development activities.

As CanMEDS 2015 rolls out over the next few years, the Royal College will work with partners continuing professional development (CPD) leaders, regulatory authority representatives and assessment experts to build recommendations for a CPD model which incorporates CanMEDS content and competency-based practices.

We recognize that the smooth transition to a competency-based CPD model will require careful consideration, coordination and cooperation. All recommendations will be shared with stakeholders as a means to seek further guidance and collaboration on a competency-based CPD model that will meet the needs of the public and of the profession.

I’d like to reproduce part or all of CanMEDS in my work, who do I contact for permission?

Please email and we will be happy to discuss this further with you.