Reclaiming physician identity: It’s time to integrate ‘Doctor as Person’ into the CanMEDS framework

In 1996, the Royal College of Physicians & Surgeons of Canada (RCPSC) adopted the CanMEDS framework with seven key roles: medical expert, communicator, collaborator, health advocate, manager, professional, and scholar. For many years, CanMEDS has been recognized around the world for defining what patients need from their physicians. From the start, the RCPSC acknowledged that these roles should evolve over time to continue to meet patient and societal needs (updates in 2005 & 2015). We propose that an 8th role is now needed in the framework: “Doctor as Person”. Interestingly, this role was present in the foundational work through the Educating Future Physicians for Ontario (EFPO) project that the RCPSC drew upon in creating CanMEDS more than 20 years ago. Given today’s challenges of providing care in an increasingly stressed Canadian healthcare system, physicians are struggling more than ever with health and wellness, burnout, and the deterioration of the clinical environment. From the patient perspective, there is growing concern that physician-patient interactions are becoming increasingly impersonal and decreasingly patient-centered. The crack emerging in the foundation of physician identity needs to be remedied. We need to pay close attention to how we define ourselves as physicians, by better identifying the competencies required to navigate the personal and professional challenges we face. Only in so doing can we ward off the threat that exists in losing authentic human to human care interactions. Formalizing Doctor as Person as an 8th role in the CanMEDS framework will help patients and physicians create the space to have essential conversations about the humanity of medical care.

White Coat Ceremony as a Professional Identity Formation Activity in a United States Family Medicine Residency Program

Introduction White coat ceremonies (WCCs) in medical school mark the transition of students to medicine, beginning their professional identity formation as a physician. However, a literature/web search revealed a paucity of residency-focused WCCs. Methods A 90-minute Family Medicine Residency (FM) WCC was designed to support residents’ professional identity formation as a specialty physician. Through faculty narratives and brief histories of the white coat and the specialty, the WCC concludes with new residents donning their specialty embroidered white coats. A brief e-survey was sent to attendees, and WCC leaders were debriefed to determine the value and key elements of WCC. Results Seventy-nine percent of survey respondents (34/43) agreed that the WCC is an important transition event for residents’ identity while reaffirming FM values for faculty/staff. WCC leaders identified critical steps for initiating a WCC. Conclusion A resident WCC formally marks the transition to specialty physician identity. Lessons Learned Ceremony structure will evolve over time.

Liaison in Reverse: The Role of a Psychosomatically-Oriented Internist in a Department of Psychiatry

The renewal of interest in the physician identity of the psychiatrist has exposed widespread deficits in skills such as physical examination. A program designed to provide medical consultation and teaching in a 107 bed psychiatric inpatient unit of a university medical center is described. The contributions of a psychosomatically-oriented internist to the development of this program of reverse liaison are considered. Bidirectional liaison units may prove to be a resource for psychiatry departments in the remedicalization process.