| Undeveloped competencies | Emerging competencies | Attained competencies |
| Medical Expert | ||
|---|---|---|
| Medical knowledge | ||
| Lacks knowledge of key basic science concepts related to common and urgent clinical problems. | Inconsistently relates to common and urgent clinical problems. | Relates basic science principles to common and urgent clinical problems. |
| Medical history | ||
| Medical histories are disorganized, overly detailed, missing important details, or not patient-centred. Focus is on a questionnaire approach. | Able to gather a systemic and accurate patient-centred medical history that generally focuses on one or two hypotheses. | Adjusts the depth and focus of patient-centred medical histories to detect most key and some relevant minor findings that generate relevant hypotheses. |
| Physical examinations (PE) are overly detailed or perfunctory. Maneuvers are incorrectly performed. Does not explain actions to the patient. | PE are focused on only one hypothesis or on some irrelevant hypotheses. Maneuvers are correctly performed but misinterpreted. Explains actions to the patient. | PE depth and focus are generally appropriate. Detects most key findings and some relevant minor findings. Explains actions to the patient. |
| Diagnosis | ||
| May have some difficulty identifying chief complaint when multiple problems exist. Unable to identify some major clinical problems. | Independently identifies chief complaint and major clinical problems but has difficulty prioritizing them. | Independently identifies and prioritizes major clinical problems. |
| For identified chief complaint or clinical problems, unable to come up with differential diagnosis. | For identified chief complaint and clinical problems, identifies common and urgent diagnostic possibilities. | For identified chief complaint and clinical problems, identifies and takes into consideration the relative likelihood of the common and urgent diagnostic possibilities within different populations. |
| Investigations | ||
| Plans of investigations relate to the clinical problems but are incomplete, not prioritized, or not pertinent. | Plans of investigation relate to clinical problems but are not prioritized or pertinent. | Plans of investigation relate to clinical problems and their priority and pertinence. |
| Unable to interpret or is incorrect when interpreting results of common diagnostic and screening tests. | Correctly but inconsistently interprets results of common diagnostic and screening tests. | Correctly interprets results of common diagnostic and screening tests. |
| Management | ||
| Management plans do not relate to clinical problems or are not patient-centred (e.g. does not seek patient鈥檚 perspectives). | Management plans relate to clinical problems and are patient-centred but are not prioritized or fully pertinent. | Patient-centred management plans relate to clinical problems and their priority and pertinence. |
| Unable to order management reliably. | Orders need adjustments at times before being co-signed. | Orders rarely need adjustments before being co-signed. |
| Explains the proposed treatment plan to the patient and the healthcare team but does not consider possible complications. | Explains anticipated effects and some possible complications of the proposed treatment plan to the patient and the healthcare team. | Explains anticipated effects, possible complications and the expected course of the proposed treatment plan to the patient and the healthcare team. |
| Documenting the encounter | ||
| Written documents are disorganized, difficult to read, information is not always in the correct section, and relevant information is missing. Irrelevant information is also included. | Written documents are mostly organized, focused, and information is found in the correct section, but some relevant information is missing. | Written documents are organized, focused, relevant and legible. Minor relevant information may be missing. |
| Case presentations are long, unfocused and simply repeat patient's terms. | Case presentations are organized and complete but overly long. At times, able to translate patient's terms into medical terminology. | Case presentations are succinct, accurate, well organized and generally able to use medical terminology to represent patient's terms. |
| Procedures | ||
| Describes most indications but knows few contraindications as well as few risks and benefits of the procedure. | Describes most indications and contraindications and most risks and most benefits of the procedure. | Describes all indications and contraindications and most risks and most benefits of the procedure. |
| For procedures assigned a level of responsibility 2 or above, lacks the skills to perform the procedure. | For procedures assigned a level of responsibility 2 or above, inconsistently demonstrates the skills to perform the procedure. | For procedures assigned a level of responsibility 2 or above, demonstrates the skills to perform the procedure. |
| Doesn't recognize complications of the procedure or doesn't know to seek help when necessary. | Recognizes complications but is unsure how to address them. | Recognizes complications and seeks help when necessary. |
| Patient requiring urgent or emergent care | ||
| Does not consistently recognize when a patient is unstable or does not seek help. | Consistently recognizes when a patient is unstable and seeks help but may not recognize the need to do so in less urgent situations. | Consistently recognizes when a patient is unstable and when to seek help. |
| Communicator | ||
| Provides incomplete information to the patient or not adapted to the patient's perspectives or in an inappropriate manner. Does not provide information in an organized, logical manner. | Provides complete information to the patient but inconsistently respectful to the patient's perspectives. | Seeks to provide the patient with the right amount and type of information by exploring the patient's perspectives, checking for understanding, avoiding medical jargon, and with cultural awareness. |
| Condescending, offensive, or judgmental with patient, their loved ones or healthcare team. | Courteous and respectful with patient, their loved ones or healthcare team. | Courteous, warm and respectful with patient, their loved ones or healthcare team. |
| Moderately at ease, uses appropriate language as well as different types of questions. | Generally at ease, uses appropriate language. Most frequently uses open to closed-ended questions. | Consistently uses open to closed-ended questions, clarifies statements that are not clear and periodically summarizes to verify understanding. |
| Interrupts inappropriately, ignores patient's answers or misses on patient's answers and/or non-verbal cues. Does not verify for understanding or does not address concerns. | Attentive and responsive to patient's answers. Verifies occasionally for understanding. | Attentive and responsive to patient's answers and blatant non-verbal cues. Verifies for understanding and addresses concerns. |
| Does not introduce themselves and/or does not explain the purpose of the visit. Does not show sensitivity to patient preference (alone, with loved ones, etc.) as applicable. | Introduces themselves, their role in the patient's care and explains the purpose of the conversation. Positions themselves to communicate comfortably. | Introduces themselves, their role in the patient's care and explains the purpose of the conversation. Positions themselves to communicate comfortably. |
| Professional and Healer | ||
| Is insufficiently present to the patient or abandons the patient at critical times. Impairs attempts by patients, their loved ones or other members of the health care team to instill hope and/or an appropriate positive outlook. | Recognizes opportunities to promote healing but may need guidance to best use these opportunities. | Recognizes opportunities to promote healing and actively engages in them. |
| Aspects of the student's behaviors are called into question. Attendance or punctuality at academic sessions or for clinical activities is inconsistent. Does not always adhere to all 捆绑SM社区 and UGME policies and procedures. Appearance is not consistent with a student in a professional role. | 听 | Behaves honestly, responsibly, and with integrity. Is punctual at clinical and other mandatory learning activities. Adheres to all 捆绑SM社区 and UGME policies and procedures. Appearance is consistent with a student in a professional role. |
| Argumentative or defensive when provided with feedback regarding challenges. Does not respond to the feedback. Minimizes challenges or knowledge gaps despite direct feedback. | Initially defensive when provided with feedback but later demonstrates improvement and recognizes challenges or knowledge gaps. | Open to feedback on both strengths and challenges. Recognizes their own challenges and knowledge gaps. Demonstrates improvement in response to feedback received. |
| Provides information about a patient to others without obtaining consent. | Verifies who should be present and is aware of what information can and cannot be shared without consent. | Verifies who should be present and is aware of what information can and cannot be shared without consent. |
| Communicates in a public or crowded space with others around, which may impact confidentiality. | Does not discuss patients in public space (e.g. in the cafeteria). Communicates in crowded space with others around but uses methods to minimize the impact like closing the curtains. | Plans the encounter and communicates in a private setting and if not possible, uses methods to minimize impact. |
| Doesn't obtain informed consent for care or procedures. | Supplies partial information to the patient, therefore obtaining a partially informed consent for care or procedures. | Obtains informed consent for care or procedures. |
| Collaborator | ||
| Is unaware of the roles of other health care members. | Identifies other health care team members who could be involved. | Knows the scope of practices of healthcare team members and coordinates with them to ensure appropriate care and shared decision making. |
| Does not respond to concerns raised by other team members. Fails to incorporate information provided by interprofessional team members into clinical decision-making. | Shows an interest in better understanding the concerns of other team members by communicating with them, asking questions, and reading their notes. | Involves the interprofessional team in patient care. Is responsive to concerns raised by other team members and incorporates their input into clinical decision-making. |
| For safe handover, omits important details of the patient's clinical presentation and management plan, thereby affecting the continuity of care of the patient or fails to anticipate possible issues. | For safe handover, transmits most relevant information of the patient's clinical presentation and management plan. | For safe handover, transmits relevant information of the patient's clinical presentation and management plan and anticipates possible issues. |
| Leader | ||
| Disorganized. Struggles with time management. Does not always complete tasks on time or needs reminders to do so. | Completes tasks without reminders but somewhat inefficiently. | Demonstrates effective time management. Follows up on and completes expected patient-care tasks in order of priority. |
| Health Advocate | ||
| Ignores the patient鈥檚 social determinants of health. | Elicits some information about the patient's social determinants of health. Makes minor adjustments to adapt patient care to these needs. | Enquires about the patient's social determinants of health. Identifies opportunities to connect to resources or adapt patient management. |
| Lacks strategies to improve health care for patients of diverse culture backgrounds, lower socioeconomic status, or without robust support networks. | With prompting: Attempts to mitigate risk factors for vulnerability. Considers issues such as culture, socioeconomic status, and support networks when proposing management plans. |
Independently: Attempts to mitigate risk factors for vulnerability. Considers issues such as culture, socioeconomic status, and support networks when proposing management plans. |
| Does not consider evidence-based preventive measures in management plan in collaboration with the patient. Does not direct to appropriate health care resources or does not refer with the adequate time standards. | Incorporates evidence-based preventive measures into management plans in collaboration with the patient. With prompting and guidance: Identifies some health care resources for a patient and refers to these resources. | Incorporates evidence-based preventive measures into management plans in collaboration with the patient. Independently identifies some relevant health care resources for a patient with judicious use of these resources. |
| Scholar | ||
| Is unaware of salient performance gaps or limitations. Does not identify resources to help with these. | Recognizes own areas of relative weakness in knowledge and skills or limitations, but needs prompting and guidance to identify a strategy to address this, and takes action. | Demonstrates awareness of limitations. Recognizes own areas of relative weakness in knowledge and skills, identifies at least one strategy to address this, and takes action. |
| Unsure what topics to read. Unable to apply evidence to clinical cases. | Consults literature to address clinical questions. Struggles to apply specific evidence to the individual patient. | Consults the literature to address clinical questions, with judicious application of guidelines, judicious use of information technologies when seeking solutions, and efforts to confirm the applicability and reliability of information. Often identifies how specific evidence applies to the individual patient. |