MCC Objectives and CanMEDS | AFMC Primer on Population Health

Appendix 1 Mapped Content to Medical Council of Canada (MCC) Population Health Objectives and CanMEDS.
Drawn from the MCC Objectives for the Qualifying Examination © The Medical Council of Canada.
CanMEDS roles have been applied to match the associations made on the MCC website. © the Royal College of Physicians and Surgeons of Canada, CanMEDs.

Chapter	CanMEDS Role(s)	78-1-E CONCEPTS OF HEALTH AND ITS DETERMINANTS
		Rationale Concepts of health, illness, disease and the socially defined sick role are fundamental to understanding the health of a community and to applying that knowledge to the patients that a physician serves. With advances in care, the aspirations of patients for good health have expanded and this has placed new demands on physicians to address issues that are not strictly biomedical in nature. These concepts are also important if the physician is to understand health and illness behaviour.
1	Med Expert	Key Objectives Define and discuss the concepts of health, wellness, illness, disease and sickness.
2	Advocate	Describe the determinants of health and how they affect the health of a population and the individuals it comprises.
		Enabling Objectives As defined by Health Canada and the World Health Organization:
1	Scholar	Discuss alternative definitions of health;
2	Advocate	Describe the determinants of health. These include: Income and Social Status Social Support Networks Education and Literacy Employment and Working Conditions Social Environment Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health Services Gender
3		Culture
2	Med Expert	Explain how the differential distribution of health determinants influences health status, and
2	Scholar	Explain the possible mechanisms by which determinants influence health status.
2, 4	Med Expert	Discuss the concept of life course, natural history of disease, particularly with respect to possible public health and clinical interventions.
2	Scholar	Describe the concept of illness behaviour and the way this affects access to health care and adherence to therapeutic recommendations.
1, 2	Med Expert, Advocate	Discuss how culture and spirituality influence health and health practices, and how they are related to other determinants of health.

Chapter	CanMEDS Role(s)	78-2-E ASSESSING AND MEASURING HEALTH STATUS AT THE POPULATION LEVEL
		Rationale Knowing the health status of the population allows for better planning and evaluation of health programs and tailoring interventions to meet patient/community needs. Physicians are also active participants in disease surveillance programs, encouraging them to address health needs in the population and not merely health demands.
6	Scholar, Med Expert	Key Objectives Describe the health status of a defined population.
2, 5	Scholar	Measure and record the factors that affect the health status of a population with respect to the principles of causation.
6		Enabling Objectives Know how to access and collect health information to describe the health of a population:
5, 7	Med Expert, Scholar	Describe the types of data and common components (both qualitative and quantitative) used in creating a community health needs assessment.
6	Scholar	Be aware of important sources of clinical / population-level health data and recognise the advantages and disadvantages of each of them.
6, 7	Scholar	Critically evaluate possible sources of data to describe the health of a population including the importance of accurate coding and recording of health information.
6	Scholar	Describe the uncertainty associated with capturing data on the number of events and populations at risk.
6, 7	Med Expert	Understand surveillance systems and the role of physicians and public health in reporting and responding to disease.
	Scholar	Analyze population health data using appropriate measures:
5	Med Expert	Apply the principles of epidemiology in analyzing common office and community health situations.
6, 11	Scholar, Med Expert	Describe the concepts of, and be able to calculate, incidence, prevalence, attack rates, case fatality rates and to understand the principles of standardization.
5	Scholar, Med Expert	Discuss different measures of association including relative risk, odds ratios, attributable risk and correlations.
	Med Expert	Interpret and present the analysis of health status indicators:
7, 12	Med Expert	Demonstrate an ability to use practice-based health information systems to monitor the health of patients and to identify unmet health needs.
6	Scholar	Understand the appropriate use of different graphical presentations of data [see table of contents in Chapter 6].
5	Scholar, Med Expert	Describe criteria for assessing causation.
5	Scholar	Demonstrate an ability to critically appraise and incorporate research findings with particular reference to the following elements:
5	Scholar	characteristics of study designs (RCT, cohort, case-control, cross sectional);
5, 6	Scholar	predictive value, negative predictive value; bias, confounding; error, reliability);
5, 6	Scholar	measures of health and disease (incidence and prevalence rates, distributions; measures of central tendency) and sampling.
6	Scholar, Communicator	Apply the principles of epidemiology by accurately discussing the implications of the measures.

Chapter	CanMEDS Role(s)	78-3-E INTERVENTIONS AT THE POPULATION LEVEL
		Rationale Many interventions at the individual level must be supported by actions at the community level. Physicians will be expected to advocate for community wide interventions and to address issues that occur to many patients across their practice.
4	Med Expert	Key Objectives Understand the three levels of prevention (primary, secondary and tertiary).
4, 7, 8	Med Expert	Describe strategies for community needs assessments, health education, community engagement and health promotion.
8	Med Expert	Appreciate the role that physicians can play in promoting health and preventing diseases at the individual and community level (e.g. prevention of low birth weight, immunization, obesity prevention, smoking cessation, cancer screening, etc.).
8, 14	Advocate	Understand how public policy can influence population-wide patterns of behaviour and affect the health of a population.
4, 8	Med Expert	Enabling Objectives Be able to both define the concept of levels of prevention at the individual (clinical) and population levels, as well as formulate preventive measures into their clinical management strategies.
2, 10, 12	Med Expert	Name and describe the common methods of health protection (such as agent-host-environment approach for communicable diseases, and source-path-receiver approach for occupational / environmental health).
3, 10	Communicator	Describe the importance and impact of good, culturally-appropriate communication with the patient, the patient’s family and, if necessary, the community as a whole with regard to risk factors and their modification.
9	Med Expert, Scholar	Apply the principles of screening and be able to evaluate the utility of a proposed screening intervention, including being able to discuss the potential for lead-time bias and length-prevalence bias.
7, 11	Med Expert	Understand the importance of disease surveillance in maintaining population health and be aware of approaches to surveillance.
14	Professional, Advocate	Identify ethical issues with the restricting of individual freedoms and rights for the benefit of the population as a whole (e.g., issues in designating non-smoking areas or restricting movements of person with active tuberculosis).
8	Scholar	Describe the advantages and disadvantages of identifying and treating individuals versus implementing population-level approaches to prevention.
4	Med Expert	Describe the five strategies of health promotion as defined in the Ottawa Charter and apply them to relevant situations.
2, 8	Med Expert, Advocate	Describe one or more models of behaviour change, including predisposing, enabling and re-enforcing factors.
8	Advocate	Identify the potential community social, physical and environmental factors that might promote healthy behaviours, as well as ways to assist communities in addressing these factors.
12	Collaborator	Be aware of the role of, and work collaboratively with, community and social service agencies (e.g. schools, municipalities and non-governmental organizations).
12	Collaborator, Communicator	Demonstrate awareness of the contribution of allied professionals such as social workers in addressing population health issues [see the Chapter 12 box “Regulated health professions”].
8	Advocate, Communicator	Be able to describe the health impact of community-level interventions to promote health and prevent disease.
14	Med Expert, Advocate	Describe examples of public policies which have had an effect on population health.

Chapter	CanMEDS Role(s)	78-4-E ADMINISTRATION OF EFFECTIVE HEALTH PROGRAMS AT THE POPULATION LEVEL
12		Rationale Knowing the organization of the health care and public health systems in Canada as well as how to determine the most cost-effective interventions are becoming key elements of clinical practice. Physicians also must work well in multidisciplinary teams within the current system in order to achieve the maximum health benefit for all patients and residents.
12	Med Expert	Key Objectives Know and understand the pertinent history, structure and operations of the Canadian health care system [see “Milestones” box in Chapter 12].
7, 14	Scholar, Med Expert	Be familiar with economic evaluations such as cost-benefit / cost effectiveness analyses as well as issues involved with resource allocation.
13	Manager, Scholar	Describe the approaches to assessing quality of care and methods of quality improvement.
		Enabling Objectives Describe at a basic level:
12		methods of regulation of the health professions and health care institutions;
12		supply, distribution and projections of health human resources;
12		health resource allocation;
12		organization of the Public Health system; and
		the role of complementary delivery systems such as voluntary organizations and community health centres.
12	Med Expert, Collaborator	Describe the role of regulated and non-regulated health care providers and demonstrate* how to work effectively with them.
7, 12	Med Expert	Outline the principles of and approaches to cost containment and economic evaluation.
4, 7, 8, 12	Med Expert	Describe the main functions of public health related to population health assessment, health surveillance, disease and injury prevention, health promotion and health protection.
14	Professional	Demonstrate an understanding of ethical issues involved in resource allocation.
5	Med Expert, Manager	Define the concepts of efficacy, effectiveness, efficiency, coverage and compliance and discuss their relationship to the overall effectiveness of a population health program.
12	Advocacy	Be able to recognize the need to adjust programs in order to meet the needs of special populations such as new immigrants or persons at increased risk.
14	Collaborator	Participate effectively in and with health organizations, ranging from individual clinical practices to provincial organizations, exerting a positive influence on clinical practice and policy-making.
13	Med Expert, Manager	Define quality improvement and related terms: quality assurance, quality control, continuous quality improvement, quality management, total quality management; audit.
13	Manager, Advocate	Describe and understand the multiple dimensions of quality in health care, i.e. what can and should be improved.

Chapter	CanMEDS Role(s)	78-5-E OUTBREAK MANAGEMENT
		Rationale Physicians are crucial participants in the control of outbreaks of disease. They must be able to diagnose cases, recognize outbreaks, report these to public health authorities and work with authorities to limit the spread of the outbreak. A common example includes physicians working in nursing homes and being asked to assist in the control of an outbreak of influenza or diarrhea.
7, 11	Med Expert	Key Objectives Know the defining characteristics of an outbreak and how to recognize one when it occurs.
11	Med Expert, Collaborator	Demonstrate essential skills involved in controlling an outbreak and its impact on the public, in collaboration with public health authorities as appropriate.
11	Med Expert	Enabling Objectives Define an outbreak in terms of an excessive number of cases beyond that usually expected.
11	Med Expert	Describe and understand the main steps in outbreak management and prevention.
11	Med Expert, Collaborator	Demonstrate skills in effective outbreak management including infection control when the outbreak is due to an infectious agent.
11	Med Expert	Describe the different types of infection control practices and justify which type is most appropriately implemented for different outbreak conditions.
10	Communicator	Demonstrate effective communication skills with patients and the community as a whole.
11	Med Expert	Describe appropriate approaches to prevent or reduce the risk of the outbreak recurring.

Chapter	CanMEDS Role(s)	78-6-E ENVIRONMENT
		Population Health
		Rationale Environmental issues are important in medical practice because exposures may be causally linked to a patient’s clinical presentation and the health of the exposed population. A physician is expected to work with regulatory agencies to help implement the necessary interventions to prevent future illness. Physician involvement is important in the promotion of global environmental health.
10	Med Expert	Key Objectives Recognize the implications of environmental hazards at both the individual and population level.
10	Scholar, Communicator	Respond to the patient’s concerns through appropriate information gathering and treatment.
10	Advocate, Collaborator	Work collaboratively with local, provincial and national agencies/ governments as appropriate to address the concerns at a population level.
10	Med Expert	Make appropriate recommendations for patients and exposed populations so as to minimize their health risks and maximize their overall function.
10	Med Expert	Enabling Objectives Identify common environmental hazards and be able to classify them into the appropriate category of chemical, biological, physical and radiation.
10	Med Expert	Identify the common hazards that are found in air, water, soil and foods.
10	Scholar, Med Expert	Describe the steps in an environmental risk assessment and be able to critically review a simple risk assessment for a community.
10	Med Expert	Conduct a focused clinical assessment of exposed persons in order to determine the causal linkage between exposure and the clinical condition.
12	Med Expert	Be aware of local, regional, provincial and national regulatory agencies that can assist in the investigation of environmental concerns.
10	Med Expert	Describe simple interventions that will be effective in reducing environmental exposures and risk of disease (e.g. sunscreen for sunburns, bug spray for prevention of West Nile Virus infection).
10	Communicator	Communicate simple environmental risk assessment information to both patients and the community.

Chapter	CanMEDS Role(s)	78-7-E HEALTH OF SPECIAL POPULATIONS
		Rationale Health equity is defined as each person in society having an equal opportunity for health. Each community is composed of diverse groups of individuals and sub-populations. Due to variations in factors such as physical location, culture, behaviours, age and gender structure, populations have different health risks and needs that must be addressed in order to achieve health equity. Hence physicians need to be aware of the differing needs of population groups and must be able to adjust service provision to ensure culturally safe communications and care.
2	Med Expert	Key Objectives Understand how variation in the determinants of health in different populations promotes or harms their health status.
	Manager	Discuss how populations may have challenges with respect to access to health services, and how members of the population may rely on traditional or alternative sources of health services that are not commonly used by society as a whole.
3	Manager	Discuss the implications of the different cultural perspective and how this affects the planning, delivery and evaluation of services (both preventive and curative).
3	Manager	Discuss how to provide culturally safe care with different populations.
3, 12	Collaborator, Manager	Discuss the unique roles provided by government, social agencies, or special groups (e.g. Aboriginal health centres, traditional healers) in providing services to the population
		Enabling Objectives
2, 3		First Nations, Inuit, Métis Peoples First Nations, Inuit and Métis peoples are the original inhabitants of Canada. Collectively, they have a special relationship with the federal government due to their treaty status, and many historical events have had a strong impact on their health expectancy.
3	Med Expert	Describe the diversity amongst First Nations, Inuit, and/or Métis communities in your local area in terms of their various perspectives, attitudes, beliefs and behaviours. Describe at least three examples of this cultural diversity.
3	Med Expert, Advocate	Describe the connection between historical and current government practices towards First Nations, Inuit, Métis peoples (including, but not limited to colonization, residential schools, treaties and land claims), and the intergenerational health outcomes that have resulted.
1	Advocate, Manager	Describe how the medical, social and spiritual determinants of health and well-being for First Nations, Inuit, Métis peoples impact their health
12	Manager	Describe the various health care services that are delivered to First Nations, Inuit, Métis peoples, and the historical basis for the systems as they pertain to these communities.
		Global health and immigration Increasing transportation of people, food and consumer goods is breaking down previous geographic boundaries. Diseases such as SARS can travel quickly around the world and events in other parts of the world affect medical practice in Canada. Canada is also dependent on new immigrants for growth with many locations having a very high proportion of new immigrants and refugees.
	Scholar, Med Expert	Identify the travel histories and exposures in different parts of the world as risk factors for illness and disease.
12	Manager, Med Expert	Appreciate the challenges faced by new immigrants in accessing health and social services in Canada.
3	Collaborator, Med Expert	Appreciate the unique cultural perspective of immigrants with respect to health and their frequent reliance on alternative health practices.
	Manager, Med Expert	Discuss the impact of globalization on health and how changes in one part of the world (e.g. increased rates of drug-resistant Tuberculosis in one country) can affect the provision of health services in Canada
		Persons with disabilities Persons with physical, mental, or sensory disabilities have unique needs and may require health and social services to be provided in alternative ways
	Med Expert	Identify the challenges of persons with disabilities in accessing health and social services in Canada.
	Advocate	Discuss the issues of stigma and social challenges of persons with disabilities in functioning as members of society (link to mental health).
	Collaborator, Manager	Discuss the unique health and social services available to some persons with disabilities (e.g. persons with Down’s syndrome) and how these supports can work collaboratively with practicing physicians.
		Homeless persons Homeless persons have unique needs due to their physical lack of basic shelter and ability to bath and prepare food safely. In addition, being homeless is associated with many other conditions such as mental health and may require health and social services to be provided in alternative ways.
	Manager, Advocate	Identify the challenges of providing preventive and curative services to homeless persons.
	Med Expert	Discuss the major health risks associated with homelessness as well as the associated conditions such as mental illness.
12		Challenges at the extremes of the age continuum The elderly and very young children both share the challenges of being at high risk for certain medical conditions (e.g. Hemolytic Uremic Syndrome) as well as being very vulnerable to changes in the determinants of health. For example, children living in poverty or poor seniors living in isolation are both at high risk for adverse health outcomes.
	Manager, Collaborator	Identify the challenges of providing preventive and curative services to isolated seniors and children living in poverty.
	Med Expert, Advocate	Discuss the major health risks associated with isolated seniors and children living in poverty.
	Med Expert	Discuss potential solutions to these concerns.