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A framework for effective physician leaders

Susan Lieff

“The updated CanMEDS framework informs physicians about the capabilities they need to be effective healthcare professionals. It also helps faculty design teaching and learning programs for emergent and practising physicians in multiple roles including leadership to advance the care of patients and to contribute to improving the healthcare system.”
Dr. Susan Lieff
Professor and Vice Chair of Education, Department Psychiatry and
Director of Academic Leadership Development
University of Toronto’s Faculty of Medicine

What is CanMEDS?

The CanMEDS Physician Competency Framework facilitates improved patient care by enhancing physician training. Developed by the Royal College in the 1990s, the framework identifies and describes the abilities physicians need to effectively meet the healthcare needs of the people they serve.

Since its formal adoption by the Royal College in 1996, the CanMEDS framework has become the most widely accepted and applied physician competency framework in the world. The framework has been integrated into the Royal College’s accreditation standards, specialty training documents, final in-training evaluations, exam blueprints and the Maintenance of Certification Program.

Constantly evolving

Renewal is crucial to the framework’s ongoing success, which is why it has been updated twice since it was developed. The most recent update began in 2012 and the results were unveiled in 2015. During the multi-year update, changes were made to the seven CanMEDS roles, which were modified to become: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional.

“The way we think about healthcare has evolved over time, which means that the CanMEDS roles need to evolve, too,” says Dr. Susan Lieff. “When the framework was revisited in 2015, we looked at whether the current roles were still relevant and how we could best serve the needs of post-graduate training across the country.”

From ‘Manager’ to ‘Leader’

During the update, the Royal College looked at how the existing roles could be made more accessible and understandable for faculties of medicine and physicians. The existing ‘Manager’ role was one of the roles that took on a new look.

“Physician as leader implies taking initiative, systems-oriented work, engaging in relationships with other health professional colleagues, and taking responsibility for improvement and high-quality care,” says Lieff, who was a member of the working group that focused on the existing ‘Manager’ role. “A manager is more operational and not necessarily visionary, strategic or focussed on innovation, or the big picture of the healthcare system.”

Beyond the notion of physicians as leaders, the role changed in other ways. A significant emphasis on quality improvement and safety, which were not as dominant previously, was introduced and the terminology used to describe the role was made more collaborative.

“The ‘Leader’ role is more practical and realistic in terms of what physicians actually do and how they function,” says Lieff. “The role is now more directly linked to enhancing patient care, engaging in stewardship of healthcare resources, and contributing to the effectiveness of healthcare outcomes and services.”

A framework for practice

The updated CanMEDS framework reflects where practice is going. It guides physicians’ ongoing leadership development, enables curriculum development and informs assessment.

“Most Canadian physicians are quite competent and effective in practice,” finishes Lieff. “The CanMEDS framework is an extremely valuable tool for teaching, reflecting and learning. It tells physicians the capabilities they need to have in the future, and helps inform the teaching and learning strategies that will support physicians to be effective and engaged in improving the quality of our healthcare system.”

For more information about the CanMEDS Physician Competency Framework, please visit

For information on the CMA’s PLI courses and to register today, please visit