Family Medicine
Description
The goal of family medicine block rotations is to provide learning opportunities that will enable
residents to develop skills required for comprehensive, family-centred patient care.
Objectives
By the completion of the residency, residents will be able to:
Family Medicine Expert
FAM1. Practice within the full scope of Family Medicine.
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1.1 Quality care: Demonstrate a commitment to high quality care and to the four principles of
family medicine:
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The family physician is a skilled clinician
Family medicine is a community-based discipline
The family physician is a resource to a defined practice population
The patient-physician relationship is central to the role of the family physician
1.2 Range of competencies: Utilize the competencies of a family physician across the life cycle
and in different practice settings.
1.3 Knowledge & skills: Demonstrate knowledge of sufficient breadth and depth to practice family
medicine.
1.5 Balancing competing demands: Carry out professional duties in the face of multiple,
competing demands.
FAM2. Perform patient-centered clinical assessments across all domains with the goal of
establishing a management plan. (see domain specific content)
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2.1 Prioritizing: Effectively and selectively identify, assess and prioritize main presenting
symptom(s)in a patient encounter.
2.2 Establishing urgency: Recognize a patient with a serious acute, urgent, emergent, potentially
life threatening condition and act promptly.
2.3 Assessment: Elicit a history, perform a physical exam, select appropriate investigations and
interpret results for the purpose of diagnosis.
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History: Take a appropriately focused history regarding the presenting problem
Red flag: Elicit pertinent associated symptoms, red flags and risk factors
Physical: Perform an appropriately thorough physical examination in a timely manner
Differential diagnosis: Construct an appropriately thorough differential diagnosis that is congruent
with the data generated by the history and physical and that considers prevalence of the condition in
the population but also serious or life threatening conditions
Selecting investigations: Select investigations based on consideration of prevalence, evidence of
benefit and risk, patient’s wishes, and cost
Interpreting results: Interpret the test results promptly and correctly
Communicating results: Communicate results in a timely fashion
2.4 Patient perspective: Solicit the patient's perspective and establish goals of care in
collaboration with patients and their families.
2.5 Management plan: Establish a patient-centered management plan.
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Prescribing: Plan and arrange pharmacologic treatments, which address key principles of good
prescribing practice
Non-pharmacologic intervention: Integrate non-pharmacologic interventions in management plans
Follow-up: Establish an appropriate schedule for reassessment of the condition
FAM3. Provide comprehensive preventative care throughout the life cycle incorporating
strategies that modify risk factors and detect disease in early treatable stages (see domain
specific content)
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3.1 Screening & prevention: Apply current evidence-based guidelines for screening, and disease
prevention for different groups of patients by age and sex.
3.2 Health promotion: Work with patients and their families to increase their opportunities to adopt
healthy behaviors (ie exercise, healthy eating).
3.3 Risk reduction: Recognize modifiable risk behaviors and provide advice on risk reduction.
3.4 PHE: Perform all components of a complete periodic health assessment.
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Adapting PHE: In a proactive or opportunistic manner, selectively adapt the periodic health
examination to the patient's specific circumstances
FAM4. Demonstrate an effective approach to the ongoing care of patients with chronic conditions
and/or to patients requiring regular follow- up (see domain specific content)
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4.1 Screening: Screen for and identify patients with chronic disease.
4.2 Monitoring: Monitor for complications of common chronic diseases.
4.3 Patient perspective: Solicit the patient's perspective and establish goals of care in
collaboration with patients and their families.
4.4 Patient education: Educate the patient about their chronic disease and empower patient to
take some ownership of the disease.
4.5 Management plan: Establish a patient-centered management plan, which integrates an interprofessional approach.
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Targets: Report the correct treatment targets for common chronic diseases as recommended by the
most relevant clinical practice guidelines
Prevention: Integrate health promotion and prevention into management plan
Pharmacotherapy: Recommend pharmacotherapy when appropriate for alleviating symptoms,
achieving treatment targets or preventing complications
Lifestyle interventions: Propose that the patient set small achievable lifestyle goals in order to
maximize their ability to control of their disease
Inter-professional care: Work with other health professionals to integrate care for individual patients
or groups of patient
FAM5. Perform family medicine specialty-appropriate procedures to meet the needs of individual
patients and is knowledgeable about procedures performed by other specialists to guide their
patients’ care (see procedures list)
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5.1 Selection: Determine the most appropriate procedures or therapies.
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Contraindications: Identifies contraindications to procedure.
Own skill level: Recognizes own skill level in performing procedure and refers is procedure exceeds
skill set
5.2 Consent: Obtain and document informed consent, explaining the risks and benefits of, and the
rationale for, a proposed procedure or therapy.
5.3 Prioritize: Prioritize a procedure or therapy, taking into account clinical urgency and available
resources.
5.4 Performance: Prepare and perform procedures in a skillful and safe manner, adapting to
unanticipated findings of changing clinical circumstances, all the while ensuring patient comfort and
safety.
5.5 After care: Develop a plan with the patient for after care and follow-up after completion of a
procedure.
5.6 Complications: List normal post-operative healing course and recognize and manage common
postoperative complications.
FAM6. Establish patient-centered care plans that include the patient, their family, other health
professionals and consultant physicians
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6.1 Patient-centred care plans: Implement patient-centred care plans that supports ongoing care,
follow-up on investigations, response to treatment, and further consultation.
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Referrals: When indicated make timely, complete and clear referrals to colleagues.
Team-based care: Establish the roles and contributions of physicians, other healthcare professionals, the
patient and his/her family in the provision of patient-centered care plan that supports ongoing care, including
follow-up on investigations, response to treatment, and further consultation.
FAM7. Actively participate, as an individual or as a member of a team providing care, in the
continuous improvement of health care quality and patient safety
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7.1 Patient safety: Recognize and respond to harm from health care delivery, including patient
safety incidents.
7.2 Human and system factors: Adopt strategies that promote patient safety and address human
and system factors.
Communicator
FAM8. Establish effective professional relationships with patients and their families
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8.1 Patient-centered approach: Communicate using a patient-centered approach that encourages
patient trust and autonomy and is characterized by empathy, respect, and compassion.
8.2 Environment: Optimize the physical environment for patient comfort, dignity, privacy,
engagement, and safety.
8.3 Patient perspective: Recognize when the values, biases, or perspectives of patients,
physicians, or other health care professionals may have an impact on the quality of care, and
modify the approach to the patient accordingly.
8.4 Non-verbal communication: Respond to a patient’s non-verbal behaviors to enhance
communication.
8.5 Disagreements: Manage disagreements and emotionally charged conversations.
8.6 Adapting communications: Adapt to the unique needs and preferences of each patient and to
his or her clinical condition and circumstances.
FAM9. Elicit and synthesize accurate and relevant information, incorporating the perspectives of
patients and their families
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9.1 Patient-centered interviewing: Use patient-centered interviewing skills to effectively gather
relevant biomedical and psychosocial information.
9.2 Interview structure: Provide a clear structure for and manage the flow of an entire patient
encounter.
9.3 Corroborating information: Seek and synthesize relevant information from other sources,
including the patient’s family or caregivers, with the patient’s consent.
FAM10. Share health care information and plans with patients and their families
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10.1 Sharing information: Share information and explanations that are clear, accurate, and timely,
while checking for patient and family understanding.
10.2 Disclosure: Disclose harmful patient safety incidents to patients and their families accurately
and appropriately.
FAM11. Engage patients and their families in developing plans that reflect the patient’s health
care needs and goals
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11.1 Cultural safety: Facilitate discussions with patients and their families in a way that is
respectful, non-judgmental, and culturally safe
11.2 Supporting decision-making: Assist patients and their families to identify, access, and make
use of information and communication technologies to support their care and manage their health
11.3 Common ground: Use communication skills and strategies that help patients and their
families make informed decisions leading to a shared plan of care
FAM12. Document and share written and electronic information about the medical encounter to
optimize clinical decision-making, patient safety, confidentiality, and privacy
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12.1 Documentation requirements: Document clinical encounters in an accurate, complete,
timely, and accessible manner, in compliance with regulatory and legal requirements
12.2 Record formats: Communicate effectively using a written health record, electronic medical
record, or other digital technology
12.3 Information sharing: Share information with patients and others in a manner that respects
patient privacy and confidentiality and enhances understanding
Collaborator
FAM13. Work effectively with physicians and other colleagues in the health care professions
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13.1 Relationship: Establish and maintain positive relationships with physicians and other
colleagues in the health care professions to support relationship-centered collaborative care
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Own role: Clearly describe their roles and responsibilities to other professionals
Others’ roles: Clearly describe their roles and responsibilities of other professionals within a
healthcare team
Team leader: Participate in a collegial process to designate appropriate team leadership roles.
Where appropriate demonstrate leadership in the healthcare team
13.2 Team communication: Demonstrate clear and effective communication (both written and
verbal) with physicians and other colleagues in the health care professions
13.3 Shared decision making: Negotiate overlapping and shared responsibilities with physicians
and other colleagues in the health care professions
13.4 Positive working environment: Implement strategies to promote understanding, manage
differences, and resolve conflicts in a manner that supports a collaborative culture
FAM14. Hand over the care of a patient to another health care professional to facilitate continuity
of safe patient care
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14.1 Timing of transfers: Determine when care should be transferred to another physician or
health care professional
14.2 Safe transfers: Demonstrate safe handover of care, using both verbal and written
communication, during a patient transition to a different health care professional, setting, or stage
of care
Leader/Manager
FAM15. Contribute to the improvement of health care delivery in teams, organizations, and
systems
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15.1 Application of QI: Apply the science of quality improvement to contribute to improving
systems of patient care
15.2 Culture of safety: Contribute to a culture that promotes patient safety
15.3 Adverse events: Analyze adverse events and near misses to enhance systems of care
15.4 QI & informatics: Use health informatics to improve the quality of patient care and optimize
patient safety
FAM16. Organize and manage patient information in an EMR in order to better manage and
individual patient and practice population care
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16.1 EMR in the office visit: Effectively integrate the EMR into the office visit.
16.2 EMR and individual patient care: Use appropriately organized information in the EMR to
plan individual patient care.
16.3 EMR for care of populations: Demonstrate how data can be extracted and used in order to
improve the management of a practice population
FAM17. Engage in the stewardship of health care resources
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17.1 Resource allocation: Allocate health care resources for optimal patient care, including
referral to other health care professionals and community resources
17.2 Cost-appropriate care: Apply evidence and management processes to achieve costappropriate care
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Cost appropriate investigations
Cost appropriate referrals
Cost appropriate prescribing
FAM18. Demonstrate leadership in professional practice
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18.1 Leadership: Demonstrate leadership skills to enhance health care and/or education
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Meetings: Chair or participate effectively in committees and meetings.
Administrative roles: Participate in relevant administrative roles related to clinical care
18.2 Facilitating change: Facilitate change in health care to enhance services and outcomes
FAM19. Manage practice and career effectively
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19.1 Setting priorities: Set priorities and manage time to integrate practice and personal life
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19.2 Practice management: Manage career planning, finances and human resources in a practice
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Insurance needs
Finance and debt management
Accounting support
Legal issues
Practice options
Income streams & billing
Overhead requirements
Medical record options
Office set up
Human resource plan
FAM20. Implement processes to ensure personal practice improvement
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20.1 Practice improvement: Participate in implementing personal practice improvement
processes to achieve goals of the CFPC Patient Medical Home
Health Advocate
FAM21. Respond to an individual patient’s health needs by advocating with the patient within
and beyond the clinical environment
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21.1 Determinants of health of individuals: Work with patients to address determinants of health
that affect them and their access to needed health services or resources
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Community resources: Demonstrate awareness of community resources to help support patients.
Recognize the indications for these services and advocate effectively
Barriers to care: Identify barriers that prevent patients from accessing healthcare, including financial,
cultural or geographic.
FAM22. Respond to the needs of the communities they serve by advocating with them for
system-level change in a socially accountable manner
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22.1 Determinants of health of communities: Work with their community to identify, identify
vulnerable or marginalized populations, the determinants of health that affect them, including
barriers to accessing care and resources
22.2 Improving health of communities: Contribute to a process to improve health in the
community or population they serve
Scholar
FAM24. Integrate best available evidence, contextualized to specific situations, into real-time
decision-making
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24.1 Identifying learning gaps: Recognize practice uncertainty and knowledge gaps in clinical
(and other professional) encounters and generate focused questions that can address them.
24.2 Pre-appraised information: Demonstrate proficiency in identifying, selecting, and navigating
pre-appraised resources.
24.3 Selecting sources of information: Select and critically evaluate the integrity, reliability, and
applicability of health-related research and literature.
24.4 Integrating evidence: Integrate evidence into decision-making in their practice.
FAM26. Facilitate the learning of students, residents, the public and other health care
professionals
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26.1 Role modeling: Recognize the power of role modeling.
26.2 Learning environment: Promote a safe learning environment.
26.3 Identifying learning needs: Collaboratively identify learning needs and desired learning
outcomes.
26.4 Ethics in teaching: Describe the principles of ethics with respect to teaching. Ensure that
patient safety is maintained when learners are involved.
26.5 Teaching activities: Demonstrate effective learner-centered teaching and reflect on the
teaching encounter.
26.6 Feedback: Provide effective feedback to enhance learning and performance.
Professional
FAM27. Demonstrate a commitment to patients by applying best practices and adhering to high
ethical standards
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27.1 Professional behaviors: Exhibit appropriate professional behaviors and relationship in all
aspects of professional practice, reflecting honesty, integrity, commitment, compassion, respect,
altruism, respect for diversity, and for maintenance of confidentiality.
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Caring & compassion: Demonstrates a caring and compassionate manner.
Respect for patients & boundaries: Demonstrate respect for the patient and ensure an appropriate
respect for boundaries at all times.
Respect of colleagues: Engage in respectful shared decision-making with physicians and other
colleagues in the health care profession
Comfort & dignity: Take steps to ensure patient comfort and dignity at all times during exams or
procedures.
Reliability: Day-to-day behavior reassures one that the physician is responsible, reliable, and
trustworthy.
Flexibility: Demonstrates a flexible, open-minded approach that is resourceful and deals with
uncertainty.
Evokes confidence: Evokes confidence without arrogance, and does so when needing to obtain
further information or assistance.
Knows limits: Recognizes, his/her limits of clinical competencies and seeks help appropriately.
Confidentiality: Demonstrates adherence to confidentiality constraints and Manitoba's Personal
Health Information Act (PHIA).
27.2 Excellence: Demonstrate a commitment to excellence and is guided by evidence in all
aspects of practice.
27.3 Ethical issues: Recognize and respond to ethical issues encountered in practice.
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27.4 Conflicts of interest: Recognize and manage conflicts of interest.
27.5 E-communication: Exhibit professional behaviors in the use of technology- enabled
communication.
FAM28. Demonstrate a commitment to society by recognizing and responding to societal
expectations in health care
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28.1 Accountability: Demonstrate accountability to patients, communities, society, and the
profession by responding to societal expectations of physicians.
FAM29. Demonstrate a commitment to the profession by adhering to standards and participating
in physician-led regulation
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29.1 Adherence to codes: Fulfill and adhere to the professional and ethical codes, standards of
practice, and laws governing practice.
29.2 Unprofessional behavior: Recognize and respond to unprofessional and unethical behavior
in physicians or other colleagues.
29.3 Peer assessment: Participate in peer assessment and standard setting.
FAM30. Demonstrate a commitment to physician health and well-being to foster optimal patient
care
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30.1 Well-being: Exhibit self-awareness and manage influences on personal well-being and
professional performance.
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Knowing limits: Recognizes one’s own limits and seeks help appropriately.
Mindful approach: Understands how one’s attitudes impact interactions.
Reflecting on practice events: Reflects on practice events to deepen self-knowledge.
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30.2 Work-life balance: Manage personal and professional demands for a sustainable practice
throughout the physician life cycle.
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30.3 Supporting colleagues: Promote a culture that recognizes, supports, and responds
effectively to colleagues in need.
Entrustable Professional Activities
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Provide periodic health exams and preventative health care to adults.
Assess, manage, and follow-up patients presenting undifferentiated symptoms.
Assess, manage and follow-up patient presenting with common (key) conditions.
Recognize and appropriately respond to emergent conditions.
Diagnose and manage common chronic conditions and multiple co-morbidities.
Identify, diagnose, evaluate and manage common mental conditions
Perform common office procedures.
Manage the elderly patient with multiple co-morbidities.
Determine when an adult patient requires admission and inpatient hospital care.
Assess and appropriately manage the adult patient in hospital.
Recognize and provide initial management of the unstable adult patient in the
hospital setting.
Plan and coordinate discharge of adult patients from hospital.
Provide palliative and end-of-life care.
Provide pre-conception and pre-natal care.
Provide intra-partum care and perform low-risk deliveries.
Recognize and manage common intra-partum emergencies.
Provide postpartum care.
Provide family medicine centered care to newborns in their first weeks of life.
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Provide periodic health exams and preventative care to infants, children and
adolescents.
Assess, manage and follow-up infants, children, and adolescents presenting with
common (key) conditions.
Provide expert advice and obtain consultation for patients whose condition is
improved by care in addition to that provided by the family physician.
Facilitate family and interdisciplinary meetings.
Optimize the quality and safety of health care through utilization of best practices
and application of QI.
Provide care to vulnerable and underserved populations.
Provide care to First Nation, Inuit and Métis people.
Evaluation
In-training Assessment Report (ITAR)
Field Notes