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It is only 8:40 am and already Dr. Jones' clinic is hopping. The waiting room is full and the staff are busy screening patients, answering phones and setting up the minor procedure room.
One of the first patients seen is in for consultation because of a significant distortion in their vision which had appeared in the last few days. After examination and some testing, Dr. Jones explains about the wet form of macular degeneration and what the treatment options are.1
Between patients, Dr. Jones returns a call from the local pharmacist who has a question about a potential interaction with a patient's glaucoma medication. He also takes a call from a local family physician who has questions about a patient with transient visual losses, recurrent headache and pain in their hips when they walk. The possibility of giant cell arteritis is discussed and an appropriate plan of investigation and treatment is reviewed.2
A patient who was in a week ago with a rare retinal disease returns this morning for a follow-up visit, accompanied by their spouse. Dr. Jones has asked them to come back after he had a chance to check into the latest literature around this rare condition and to investigate the options for the patient to participate in a clinical trial that the patient and their spouse had heard about in the media.3
A 3rd-year ophthalmology resident is spending a week with Dr. Jones in his clinic and in the operating room to get exposure to his community-based, comprehensive ophthalmology practice, and Dr. Jones spends time reviewing patients and their care with her, after she has done the initial assessment.4
The morning passes quickly with a variety of patients and Dr. Jones quickly eats his lunch before heading off to a lunchtime meeting at the hospital. Dr. Jones chairs the Quality Assurance Committee for his site and there is a tele-meeting of the quality assurance chairs from all facilities within his health region.5
The early part of the afternoon is devoted to doing some minor surgical procedures and finishing up some paperwork including sub-specialty referrals resulting from the morning clinic. He also completes some insurance forms for a patient who recently experienced significant visual loss and is applying for long-term disability. Their initial application was rejected and Dr. Jones is supplying supporting documentation for the severity of their problem. In addition, a referral to the local Low Vision Clinic and to the CNIB has been arranged to assist the patient in adjusting to their situation.6
A group of ophthalmologists from the health region get together once a month for a journal club and tonight it is Dr. Jones turn to present the papers being considered, so he takes a few minutes to review his notes again.7
After finishing up seeing the patients scheduled for late afternoon, Dr. Jones heads out to fit in a run in the local park to clear his head before journal club. He joins some fellow physicians, nurses and paramedics who meet up every Wednesday at this time for an informal running club. It's a great way to unwind, get some exercise and relieve some of the stress of the day.8
CanMEDS roles found in this story
- Communicator - "Dr. Jones explains about the wet form of macular degeneration and what the treatment options are." - As communicators, physicians form relationships with patients and their families that facilitate the gathering and sharing of essential information for effective health care.
Collaborator - "He also takes a call from a local family physician who has questions about a patient with transient visual losses, recurrent headache and pain in their hips when they walk. The possibility of giant cell arteritis is discussed and an appropriate plan of investigation and treatment is reviewed." - As collaborators, physicians work effectively with other medical specialists and health care professionals to provide safe, high-quality, patient-centred care. Medical Expert - "Dr. Jones has asked them to come back after he had a chance to check into the latest literature around this rare condition and to investigate the options for the patient to participate in a clinical trial that the patient and their spouse had heard about in the media." - As medical experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional values in their provision of high-quality and safe patient-centred care. The medical expert role is central to the function of physicians and draws on the competencies included in the intrinsic roles (communicator, collaborator, leader, health advocate, scholar, and professional). Scholar - "A 3rd year ophthalmology resident is spending a week with Dr. Jones in his clinic and in the operating room to get exposure to his community-based, comprehensive ophthalmology practice, and Dr. Jones spends time reviewing patients and their care with her, after she has done the initial assessment." - As scholars, physician demonstrate a lifelong commitment to excellence in practice through continuous learning and by teaching others, evaluating evidence, and contributing to scholarship. Physician's scholarly abilities allow them to contribute to the application, dissemination, translation, and creation of knowledge and practices applicable to health and health care. Leader - "Dr. Jones chairs the Quality Assurance committee for his site and there is a tele-meeting of the Quality Assurance chairs from all facilities within his health region." - As leaders, physicians engage with others to contribute to a vision of a high-quality health care system and take responsibility for the delivery of excellent patient care through their activities as clinicians, administrators, scholars, or teachers. The CanMEDS leader role describes the engagement of all physicians in shared decision-making for the operation and ongoing evolution of the health care system. Health Advocate - "Their initial application was rejected and Dr. Jones is supplying supporting documentation for the severity of their problem. In addition, a referral to the local Low Vision Clinic and to the CNIB has been arranged to assist the patient in adjusting to their situation." - As health advocates, physicians contribute their expertise and influence as they work with communities or patient populations to improve health. They work with those they serve to determine and understand needs, speak on behalf of others when required, and support the mobilization of resources to effect change. Scholar - "A group of ophthalmologists from the health region get together once a month for a journal club and tonight it is Dr. Jones' turn to present the papers being considered, so he takes a few minutes to review his notes again." Professional - "He joins some fellow physicians, nurses and paramedics who meet up every Wednesday at this time for an informal running club. It's a great way to unwind, get some exercise and relieve some of the stress of the day." - As professionals, physicians are committed to the health and well-being of individual patients and society through ethical practice, high personal standards of behaviour, accountability to the profession and society, physician-led regulation, and maintenance of personal health. Professionalism is the basis of the implicit contract between society and the medical profession, granting the privilege of physician-led regulation with the understanding that physicians are accountable to those served, to society, to their profession and to themselves.
Conclusion
This short vignette represents a few of the many "hats" that a typical ophthalmologist might find themselves wearing in the course of a day. The many skills and competencies needed to perform well as an eye physician and surgeon are embodied in the CanMEDS 2015 Physician Competency Framework as developed by the Royal College of Physicians and Surgeons of Canada (RCPSC).
As you can see, the framework merely reflects and formalizes the skills, attributes and characteristics that are needed to provide excellent care to our patients. This framework is currently being used to structure the training programs for ophthalmology residents across the country, and to assist in competency-based evaluation of their training. In addition, the COS is using this framework to help develop, evaluate and expand the Continuing Professional Development programs offered to our membership.
The RCPSC is taking initial steps toward a competency-based CPD program across the specialties and the COS is at the table assisting in shaping this development. The COS Council on CPD is actively evaluating whether sufficient continuing education opportunities, addressing the breadth of the CanMEDS roles, are available to Canadian ophthalmologists. The Council will be exploring the options for addressing any gaps that might be identified.
Further information about the CanMEDS 2015 Physician Competency Framework can be found at: http://canmeds.royalcollege.ca/
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