CanMEDS is an initiative to improve patient care by enhancing physician training and practice. From its beginning in the 1990s, its main purpose has been to articulate a comprehensive definition of the competencies that physicians need to deliver high-quality patient care. These competencies are now well established in the Royal College's training standards. In 2012, the Royal College began a multi-year review and update of the CanMEDS 2005 Physician Competency Framework. As part of the CanMEDS 2015 project, the Royal College engaged a wide variety of contributors (experts, partners and stakeholders) to ensure that the third edition of the framework provides a valid and practical foundation for excellence in patient care now and in the future. The revision process started with a thorough review of the 2005 framework to determine whether it needed updating for contemporary practice. The contributors, led by a set of expert working groups (EWGs), identified many ways to update and improve the framework. This document describes the Royal College's rationale for one of these changes: the decision to emphasize leadership competencies in CanMEDS 2015. "In CanMEDS's 20-year history, Manager is the only role to undergo a name change: this change to leader represents a timely evolution for contemporary health care." Key Messages The positive, collaborative frame of the CanMEDS 2015 Leader Role will encourage physicians to develop and use leadership skills to advance the care of their patients and to contribute to improving the health care system. CanMEDS has always included leadership competencies, but in the past the framework emphasized managerial competencies. All physicians lead in their everyday practice; some hold titled leadership positions. Physicians need to lead the health care system in collaboration with other professionals. A physician does not have to be the boss to be a leader. Stakeholders in the CanMEDS 2015 review process included patients, medical students and residents, Royal College fellows, leaders in medical education, other health care professionals, specialty bodies, governing institutions and partner organizations, and international collaborators. Stakeholders want a greater emphasis on the physician as leader without sacrificing managerial competencies. The Future of Medical Education in Canada undergraduate and postgraduate projects both endorse leadership competencies for physicians.

BackgroundOver 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients’ perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies.MethodsQualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta.ResultsFour illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities.ConclusionsPatients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to “eat less, move more”. Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.

The aim of this study was to describe family physicians' perspectives of their role in the primary care team and factors that facilitate and hinder teamwork. A qualitative study was conducted employing individual interviews with 19 academic/community-based family physicians who were part of interprofessional primary care teams in Edmonton, Alberta, Canada. Professional responsibilities and roles of physicians within the team and the facilitators and barriers to teamwork were investigated. Interviews were audiotaped, transcribed and analysed for emerging themes. The study findings revealed that family physicians consistently perceived themselves as having the leadership role on in the primary care team. Facilitators of teamwork included: communication; trust and respect; defined roles/responsibilities of team members; co-location; task shifting to other health professionals; and appropriate payment mechanisms. Barriers to teamwork included: undefined roles/responsibilities; lack of space; frequent staff turnover; network boundaries; and a culture of power and control. The findings suggest that moving family physicians toward more integrative and interdependent functioning within the primary care team will require overcoming the culture of traditional professional roles, addressing facilitators and barriers to teamwork, and providing training in teamwork.

Expectations appear to be embedded in both hopes and fears, suggesting that clinicians should address both when negotiating realistic goals and educating patients. This approach is particularly relevant for cases of nonspecific musculoskeletal pain, where diagnoses are unclear and treatment may not completely alleviate pain.

ObjectivesTo identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice.MethodsThis was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. ResultsParticipants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths.  At the same time, IMG residents appeared to experience challenges in the areas of:  (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada’s health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning,  unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles.   ConclusionsResidency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum.  IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.