Competencies are the abilities and skills that are required to practice a profession effectively. Based on the recent changes that was applied by CanMEDS 2015 project, there are variable sets of competencies, key competencies and enabling competencies. These competencies are further classified under seven different groups, the physician roles. These 7 roles are:
1- The medical expert, who has an efficient knowledge and skills to provide high-quality care.?
2- The communicator, who has the ability to interact with the patient and involve them in decision-making.
3- Collaborator, which requires building relationships based on trust and cooperation with others with complementary skills.?
4- The leader, managing the healthcare resources, and is able to balance between professional and personal life.
5- The health advocate, who uses her knowledge to improve healthcare and teach the public.
6- The scholar, a life-long learner, a teacher, and works on testing current knowledge by research.
7- The professional, who meets the community expectations of a physician and adheres to ethical standards.
Competency number one is to actively contribute to the continuous improvement of health care quality and patient safety. This competency is classified under the medical expert role as well as the leader role. The doctors in the case misdiagnosed the patient because her earlier symptoms weren’t indications to carry out tuberculosis (TB) investigations yet this patient happened to have the infection and went unnoticed. The doctors’ duty in this situation is to report the incident and study the circumstances that led to this error in order to prevent the recurrence of the incident.
Secondly, sharing health care information and plans with patients and their families. This competency is a part of the communicator role. Since the diagnosis is TB, it is crucial to tell the patient the seriousness of their disease and explain to them the treatment plan and the consequences of it. In addition, as TB is a serious infectious disease, the family members should be informed about their daughter’s condition as a preventive measure.
The third competency, which is also enlisted under the leader role, is engaging in the stewardship of health care resources. It is the ability of the physician to use the healthcare resources effectively to provide an optimal patient care, and to apply management with reasonable cost. In the case study, although the doctors missed the diagnosis, they didn’t order further tests for the patient as her condition at the time didn’t indicate the need to go through all those investigations. So they tried to minimize the usage of resources when there is no obvious reason behind it.
Responding to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment, a competency of the health advocate role. This key competency includes: working with patients and their families to increase opportunities to adopt healthy behaviors, and incorporating disease prevention, health promotion, and health surveillance into interactions with individual patients. The relevance of it to the case is that the doctors should educate the individual patient and her family about TB treatment and prevention. Plus, they should teach the whole community about such an infectious disease and raise the awareness of its prevention.
The fifth competency is engaging in the continuous enhancement of the professional activities through ongoing learning, which comes under the scholar role of the physician. The doctors must identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources. Moreover, they need to engage in collaborative learning to add to the collective practice and knowledge and improving personally from others. This can be applied to our case as the occurrence of an incident is a good opportunity to notice the defects that caused it, overcome them, and learn from them. Additionally, having the role of scholar means that the physician must not only learn, but also teach. Therefore, the physician should utilize these situations to teach students/ residents.
The sixth and final competency is related to the ‘professional role’ that is demonstrating a commitment to patients by applying best practices and adhering to high ethical standards. The doctor has to exhibit appropriate professional behaviors in all aspects of practice, demonstrating
honesty, integrity, humility, commitment, compassion, respect, and maintenance of confidentiality. In the case study, the diagnosis of TB can be a huge stigma and can affect the life of the patient negatively but it can also spread to others since it is infectious. However, the confidentiality should be maintained except for the persons who are directly involved in the patient care.
Finally, we can conclude with some key messages regarding the importance of the competencies in patient safety. As in the case, patient safety and proper care can be assured and the incident will be prevented in the future if the doctors work in collaboration with one another. They will be able to exchange knowledge and benefits from each other’s experiences. Plus, they can work on identifying shortcomings in the health care system, analyze it, and work on improving it. Therefore, healthcare providers must undergo continuous self- and peer-assessment to maintain the competencies that are needed to perform optimally, and to enhance patient safety and the quality of care.