URGENT: a new CanMEDS model survey. They want to de-centre "medical expert" for "social activist"

[who_knows]

"A new model of CanMEDS would seek to centre values such as anti-oppression, anti-racism, and social justice, rather than medical expertise."

Hello colleagues. Please take a few minutes to read through the document, complete the survey (the deadline is December 31) and offer your input.

To me, this is a scary document. The changes will lead to the degrading of the medical expertise of Canadian-trained doctors.

As someone who had opportunities to compare medical education in different countries and a current medical student at a Canadian school, I can say that Canadian medical education is not that great. These changes will bring it down more. Ultimately, patients (or "people" as the new changes demand) will suffer because they will be treated by social justice activist, not medical experts. Canadian physicians (or "providers" according to the new proposed terminology) will lose their high-regard stand among other doctors in the world, because, truly, we will be a jock in the eyes of the international medical community.

Please do not disregard this if you at all care about the future of Canadian medicine.

https://survey.alchemer-ca.com/s3/50210723/CanMEDS-OpenCall

[Bobthebuilder]

I care about future of Canadian medicine and I agree with this change of framework. First, because medical expertise is not a value in itself. It is a goal. It is a role. It is something that is accomplished through multiple things including acquiring the mentionned values. I believe our values should guide us toward becoming medical experts. To me centering our attention on these values will lead to better medical experts. Medical expertise alone is not enough. It is clearly not enough for the most underpriviledged in our society and shouldn't be the center of everything we do. Hence, centering values around fighting oppression, racism and injustices should be a corner stone in our goal of achieving a healthier society. We can discuss where it should be on a ''framework'' but this current framework should be modified to include values as well as roles (which is the only aspect CanMEDS covers at the moment)  

My 0,02$

Peace

Bob

[who_knows]

"... centring values around fighting oppression, racism and injustices" - we are not social workers, politicians, judges, sociologists, philosophers etc. We are medical doctors, fighting oppression, racism and injustices should not be our job description. Social determinants of health exist. We should let professionals who deal with social fabric such as sociologists, teachers, social workers, and politicians do their job at improving it. But we should not sacrifice even an ounce of our professional expertise. If a black man with a complex syndrome is dying in front of you, he wants you to recognize his disease and treat it immediately, not explore his oppression. The patient will value your medical knowledge and skills more than your anti-oppressive attitude. That is why the premise of the view that "medical expertise is not a value" is false. It is absolutely a value.

 

[Bobthebuilder]

4 hours ago, who_knows said:

"... centring values around fighting oppression, racism and injustices" - we are not social workers, politicians, judges, sociologists, philosophers etc. We are medical doctors, fighting oppression, racism and injustices should not be our job description. Social determinants of health exist. We should let professionals who deal with social fabric such as sociologists, teachers, social workers, and politicians do their job at improving it."

 

 

I am sure you can understand why I totally disagree with this statement. I don't think we are gonna find common ground but just wanted to let you know that there are people in medicine who will fight racism, oppression and injustices and will support a change to the traditional view of what is a physician. Also, it is everybody's job to fight for the most vulnerable in our society and make sure health care is a little bit less toxic every day.

Farewell colleague,

Bob

[Jef_fries]

7 hours ago, who_knows said:

Canadian medical education is not that great

As an IMG from Europe, I have to agree with the OP on this one. I witnessed several times CMG residents lacking medical knowledge. One time, a resident did not know what Aicardi syndrome is, but she sure did have a "she/her" pin on her shirt. The Aicardi kid's parents must have been ecstatic about the resident's pronounces regardless of her medical cluelessness. Another resident could not explain the embryology of the transposition of great vessels. All this we learn in med school. These are just two examples that come to mind immediately. I can remember more.

[Synth1]

2 hours ago, Jef_fries said:

As an IMG from Europe, I have to agree with the OP on this one. I witnessed several times CMG residents lacking medical knowledge. One time, a resident did not know what Aicardi syndrome is, but she sure did have a "she/her" pin on her shirt. The Aicardi kid's parents must have been ecstatic about the resident's pronounces regardless of her medical cluelessness. Another resident could not explain the embryology of the transposition of great vessels. All this we learn in med school. These are just two examples that come to mind immediately. I can remember more.

Those examples are beyond obscure, rare genetic syndromes and embryology are not core clinically relevant knowledge. 

[Jef_fries]

1 hour ago, Synth1 said:

genetic syndromes and embryology are not core clinically relevant knowledge

Well, the kid's parents were looking for guidance and explanation. Good that there was an IMG from the Middle East who could talk medicine to parents.
If embryology and genetics are not core relevant knowledge, what is? All foundational medical knowledge is very relevant. This is what makes you an expert. With this attitude, why not get a PA diploma and follow algorithm printouts?

[hero147]

3 hours ago, Jef_fries said:

Well, the kid's parents were looking for guidance and explanation. Good that there was an IMG from the Middle East who could talk medicine to parents.
If embryology and genetics are not core relevant knowledge, what is? All foundational medical knowledge is very relevant. This is what makes you an expert. With this attitude, why not get a PA diploma and follow algorithm printouts?

That's not even foundational. That's some obscure knowledge that 99% of physicians won't ever see in their lifetime. It's likely only relevant to geneticists and possibly very remotely to pediatrics. It is impossible to know and remember everything unless you are a genius with a photographic memory. 

Foundational knowledge is important but I sure don't use embryology and genetics knowledge on a daily or sometimes yearly basis. 

[Pakoon]

I don't agree with ever referring to physicians as providers. It opens up the flood gates for mid-level encroachment and obscures the lines between level of training. 

[shikimate]

Meh, you know, in our part of the globe, people who have no knowledge of finance is finance minister, naive actor is head of the state, deserter with bone spur control nukes, and budget balance themselves. So what harm is there having a few doctors without medical expertise.

[1D7]

Reminds me of the initial seeds that has led to florid anti-intellectualism that in the U.S.

The core of what we do is based on medical expertise (amongst a few other qualities, which are already in the current CanMEDS). I'm fine with expanding the 'advocate' role, but it should not come at the cost of devaluing the very reason why the public comes to us for help.

[who_knows]

7 hours ago, shikimate said:

So what harm is there having a few doctors without medical expertise.

It would be funny if it weren't so tragic.

[who_knows]

32 minutes ago, 1D7 said:

I'm fine with expanding the 'advocate' role, but it should not come at the cost of devaluing the very reason why the public comes to us for help.

Exactly. Why de-centre medical expertise, the essence of our profession?

They also bluntly attack physicians by "not assuming physicians should inherently lead". I want to see how this turns out. No MD in their right mind will assume accountability for treatment without making final decisions and being a leader. Patients will receive inferior care.

[ytho]

On 12/10/2023 at 9:36 PM, Jef_fries said:

Aicardi syndrome

lol

[who_knows]

No verdict yet. They are still gathering public opinion. 

4 hours ago, Ralph_Manrique said:

it's a scary move that might water down the solid medical skills Canadian docs are known for

Not "might", it definitely will. The proposition is to de-center medical expertise. If it is not the priority anymore, then of course it will suffer.

Please consider filling out the survey and expressing your concerns. 

[GH0ST]

Disagree completely with this thread

Albeit I practice FM, but my skills didn't wane because I care about population health and the social determinants. I am much better at connecting with my patients and understand the workings of society and its challenges, particularly with priority populations. I have become much better when working with those that are homeless, victims of substance use, immigrants, among many others. 

I will always support the notion of improving physician social awareness, since it's sorely lacking even this day. 

- G 

[slaverymustend]

The central role of a physician is not to be ''an anti-racist''. This profession is derailing. We have to stop paying these people from running all the organizations that supposedly represent us and remove them from these supposed positions of authority.

[haenurplaza]

On 12/10/2023 at 9:36 PM, Jef_fries said:

As an IMG from Europe, I have to agree with the OP on this one. I witnessed several times CMG residents lacking medical knowledge. One time, a resident did not know what Aicardi syndrome is, but she sure did have a "she/her" pin on her shirt. The Aicardi kid's parents must have been ecstatic about the resident's pronounces regardless of her medical cluelessness. Another resident could not explain the embryology of the transposition of great vessels. All this we learn in med school. These are just two examples that come to mind immediately. I can remember more.

I'm just a mere MS4 speaking (and don't necessarily agree with medical expertise being "replaced"), but I feel like these are things that could be refreshed with a Google search (or 15 minutes of reading on UpToDate); however, stuff like social awareness and advocacy for underprivileged patients aren't.

[GH0ST]

@Jef_fries way to cherry pick very specialized examples when you aren't looking at the big picture... those are things that at most, require some review. Being a decent human being and aware of your surroundings have a lot more impact than you think when it comes to both patient care and population health. I've also seen plenty of residents state the treatment, act "manner-of-factly" with the patient not accepting due to not having their trust, regardless of efficacy of treatment. 

People here are really showing so many misconceptions ... 

1. That you can't have medical expertise and humanistic values... you absolutely can. 

2. That medical expertise trumps humanistic values... case-by-case basis. No one here is disputing that a doctor needs to have a solid knowledge base. But this pandemic has highlighted the importance of communication and trust building, health inequities, and barriers to even the most basic of medical care as well as medical understanding. Having the experience necessary to work with diverse populations and recognizing their unique needs is arguably just as critical as knowing every treatment for condition X under the sun. 

3. That these values are applied every single second... in the middle of surgery I don't expect my surgeon to care about social determinants of health... but does it hurt you to care a bit a little bit more to help a patient that will struggle more with post-op care? Or connecting with a patient that requires spiritual guidance? Or maybe a patient who has had very bad experiences with health providers in the past ... give them some time just to build a solid foundation of trust? Furthermore, we aren't saying that social awareness is critical for every speciality, but I would expect at minimum that my GPs have that level of understanding since they interact with such a diverse population. 

News flash people... you can be a good person as well as a good doctor. I know many of you think otherwise... sad really. I'm not surprised that there are so many of you with the same mindset as @who_knows since people seem to lose perspective when they gain the privilege of being a doctor. We serve the people at the end of the day, not just their condition. 

- G

[GH0ST]

On 1/12/2024 at 6:21 PM, slaverymustend said:

The central role of a physician is not to be ''an anti-racist''. This profession is derailing. We have to stop paying these people from running all the organizations that supposedly represent us and remove them from these supposed positions of authority.

The irony of a name like @slaverymustend but then saying that physicians don't have a central role to play to address prejudice. Wow

- G

[who_knows]

16 hours ago, GH0ST said:

but does it hurt you to care a bit a little bit more to help a patient that will struggle more with post-op care? Or connecting with a patient that requires spiritual guidance? Or maybe a patient who has had very bad experiences with health providers in the past ... give them some time just to build a solid foundation of trust? Furthermore, we aren't saying that social awareness is critical for every speciality, but I would expect at minimum that my GPs have that level of understanding since they interact with such a diverse population. 

You have not read the proposal, have you? It literally says "decentring medical expertise". What you described above is just being "an empathetic and kind person". Do you need a course for that? Do you need to completely dismantle the medical curriculum for that? Do you need your profession to become a joke in order to be empathetic? No, no and no.

Besides, people like you are most often narcissistic and ego-driven and display the white saviour complex. You think that because you are a physician, you should become a social justice activist and solve society's economic, social, and racial issues. No. Stick to doctoring, my friend. Let professionals in social issues deal with social issues. They know more than you do. It's hard to accept, I know, but make an effort, my friend. Be empathetic and be a social justice activist in your own time, but don't ruin the medical profession and don't rob your patients of professional medical care.

During COVID when so many MDs used Twitter to shame people and overtly align themselves with political parties (eg formed CMA's president), the trust in the medical profession became at all times low and it is not recovering. So, add oil to the fire, now partisans within the medical profession want to hurt our profession even more by making doctors far-left activists who preach incomprehensible and highly questionable leftist theories. Disgusting.

 

[Bobthebuilder]

58 minutes ago, who_knows said:

You have not read the proposal, have you? It literally says "decentring medical expertise". What you described above is just being "an empathetic and kind person". Do you need a course for that? Do you need to completely dismantle the medical curriculum for that? Do you need your profession to become a joke in order to be empathetic? No, no and no.

Besides, people like you are most often narcissistic and ego-driven and display the white saviour complex. You think that because you are a physician, you should become a social justice activist and solve society's economic, social, and racial issues. No. Stick to doctoring, my friend. Let professionals in social issues deal with social issues. They know more than you do. It's hard to accept, I know, but make an effort, my friend. Be empathetic and be a social justice activist in your own time, but don't ruin the medical profession and don't rob your patients of professional medical care.

During COVID when so many MDs used Twitter to shame people and overtly align themselves with political parties (eg formed CMA's president), the trust in the medical profession became at all times low and it is not recovering. So, add oil to the fire, now partisans within the medical profession want to hurt our profession even more by making doctors far-left activists who preach incomprehensible and highly questionable leftist theories. Disgusting.

 

Can you imagine thinking a physician is not a professionnal involved in dealing with social issues, systemic racism and discrimination ?

You are unbelievable. I have no idea where you practice or what you do but to be so blind to your surrounding is astonishing to read. Honestly, I cant even...

You even have the audacity to tell a PUBLIC HEALTH PHYSICIAN that it is not his/her role to care about these topics. At this point, I think you are trolling.

Bob

[who_knows]

1. I am not trolling. Looks like I have a diametrically opposite opinion from yours. It does not mean that I am trolling.

2. Stop misrepresenting me. I never denied that doctors are not involved with "social issues, systemic racism and discrimination". I said earlier that social determinants of health exist and physicians should recognize them. At the same time, physicians are not social justice professionals. We are medical professionals. We are first and foremost medical doctors whose expertise is medical science. Do not turn medical doctors into professional social activists. Such language as "decentring medical expertise" is a direct attack on the profession. It is sad that you do not recognize this.

3. Again, you are putting words in my mouth. I literally said, "be a social justice activist in your own time, but don't ruin the medical profession and don't rob your patients of professional medical care." Yes, PH doctors have more involvement with social issues and their curriculum reflects that. But this does not mean that medical expertise in PH's curriculum should be decentred to make room for "anti-oppression" theories.

[GH0ST]

4 hours ago, who_knows said:

You have not read the proposal, have you? It literally says "decentring medical expertise". What you described above is just being "an empathetic and kind person". Do you need a course for that? Do you need to completely dismantle the medical curriculum for that? Do you need your profession to become a joke in order to be empathetic? No, no and no.

Besides, people like you are most often narcissistic and ego-driven and display the white saviour complex. You think that because you are a physician, you should become a social justice activist and solve society's economic, social, and racial issues. No. Stick to doctoring, my friend. Let professionals in social issues deal with social issues. They know more than you do. It's hard to accept, I know, but make an effort, my friend. Be empathetic and be a social justice activist in your own time, but don't ruin the medical profession and don't rob your patients of professional medical care.

During COVID when so many MDs used Twitter to shame people and overtly align themselves with political parties (eg formed CMA's president), the trust in the medical profession became at all times low and it is not recovering. So, add oil to the fire, now partisans within the medical profession want to hurt our profession even more by making doctors far-left activists who preach incomprehensible and highly questionable leftist theories. Disgusting.

 

Haha I'm not even white... I am technically a minority. Talk about assumptions. 

I think we're just going to have to agree to disagree since I don't see you opening your mind. My text is for the readers who truly care about not only good medicine, but good social activism. I will emphasize once again that we as a profession can ABSOLUTELY DO BOTH. 

EDIT: I was thinking back since I remember we had engaged previously but I couldn't put my mind on where... you were the one that gave a 2nd year med student at UofT so much shit for a long 1 hr hx from a CMAJ blog lols. 

I think this summarizes our fundamental differences as people:

"OP: They also assumed a role of a friend instead of being professional. In my opinion, they failed the patient. The patient needed a doctor to help her with her medical problems, she did not need a fake friend. Me: Disagree... you can be friendlier with patients and still maintain objectivity. "

To address the arguments...

"decentring medical expertise" isn't saying medical expertise isn't important... it's acknowledging that there is a balance and not everything we do in medicine involves medical knowledge as the top priority. Just using the CanMEDS roles ... medical expert is only one of the categories, but advocate and communicator are also competencies we are expected to have. Now we can get into more nuanced arguments like what specialties and what proportions are involved (for example... a surgeon I suspect will not require as much of a knowledge base in social determinants of health... so spoiler alert they don't take nearly as many classes on that topic). That said, in my field, or those that are more forward facing like psychiatry, or FM, and EM (to some extent) really requires greater awareness, knowledge, and application of social principles like health promotion. I don't expect them to know health policy or do environmental health (I expect my PHPM physicians to do that), but it's discouraging to think of how many patients are simply lost to the system. If I had a nickel for example for every victim of substance use that gets tossed around the ED and then sent home, only to not have a stable situation to go back to.... only ending up back in the ED, well I'd earn more than my resident salary. 

Coincidentally there's many physicians who started their careers elsewhere who moved into the PHPM space due to their desire to address the upstream social factors surrounding health (not only health care). Using Ontario as an example, Dr. Kieran Moore was a CCFP-EM doc who practiced for over 20 years before going back to doing another residency in PHPM. He played a significant role in the medical surveillance system development where increasing respiratory diseases in the ED get flagged to neighbouring areas to be on the lookout for increased respiratory conditions and to adjust their practices accordingly (this system is still being used to this day, and I am oversimplifying this system for the purposes of this discussion). He then was the MOH for KFLAPH and now is the CMOH in Ontario. There are many CMOHs that had clinical experience prior to their roles. Many docs in IM (particularly ID) and EM incorporate PHPM into their careers over time as they recognize how important it is. 

The point about letting professionals in social activism handle social issues is myopic at best and ignorant at worst. If we do not do our own advocacy for our patients and share those experiences and stories, why should we lose our unique understanding of what the system is like or not speak to the stories we see from patients?. We also see how when we focus too much on the acute problem how that affects our ability to advocate in other areas. Should we let some CEO or a health policy professor take the reins without our input? 

In PHPM we talk about an acronym known as: A MANIC HUG (Associations, Media, Academia, Non-governmental organizations, Industry and private sector, Clients/community: persons with lived experience, caregivers, public, Healthcare (health care system, lab, EMS, first responders), Unions, Governments (leaders, cabinet, treasury, ministries, justice, finance)) and how we need to consider many stakeholders when developing an intervention or policy (we can discuss policy instruments, stakeholder evaluation and analysis, etc at a separate time). Imagine if we weren't involved in this process... the landscape of health interventions at a population level would be drastically different (and not for the better). 

Last point I will mention is the notion that they know more...THEY DO. That's not really the "gotcha" that you think. I'm incredibly proud that when I work with an epidemiologist, a public health nurse, a health policy analyst, a HR advisor, an infection prevention and control specialist, or public health inspector, that I know they know the specifics better than me. I am humbled every day when I learn from these people about their craft. I think you are confusing the need to be the absolute expert with having competency in the area. @who_knows point of view is very specialist centric... the concept that unless you are the expert, your opinion matters little, is a farce. Using PHPM physicians as an example, we use knowledge in all areas both in terms of medical practice (such as infectious disease) as well as subjects like health promotion, policy, environmental health, emergency management, etc and combine them to help guide and facilitate decision making. Our diversity of knowledge base is what makes us unique and by having the ability to see different perspectives in different practice areas, we can make more informed decisions and do our best to lead our respective organizations. Using something more clinically relevant... are you really going to think that just because the GP isn't a cardiologist, or psychiatrist, that they shouldn't have an input on how to manage cardiac or psychiatric issues? That's basically what the OP is saying.

Leave it only to the specialists only since if you aren't an expert ... your opinion matters less. That's quite a sad way of thinking and I surmise that something happened in your life that made you have that perspective. 

The only weakness I think we as physicians could work on is social media literacy/utilization. Definitely have seen many inflammatory posts over the years and I can definitely see how that affects public perception of the profession. The irony of that point is that it only supports the notion of improving/enhancing social activism education. We don't exactly get better in this area by reading medical textbooks. We get better by working on communication and advocacy skills, while contextualizing social issues. 

Ladies and gentleman of this premed101 forum. I've learned a lot from many of you over the years. You didn't need to be experts to teach or help shape the future of medicine. You were/are just amazing people first and foremost. Let's focus on bringing each other up and supporting one another in all aspects.... the clinical medicine as well as social awareness. We can do better in all areas and I look forward for us to do it as a team. 

I'll leave this on a more positive note as I won't be engaging in this thread further. Take care everyone. 

- G