Emerging Concepts in Medical Education III: Systems, Handover & Global Health

In February, Elaine van Melle  profiled “professional identify” and “emotion” as two emerging themes in the medical education literature.  As part of the CanMEDS 2015 renewal, Elaine’s review of the (grey) literature contributes to the discussion of defining the competencies of physician practice.  Today, in part three of the series, she addresses three additional themes. On Friday, Elaine discusses “social media” and “financial incentives.”  Share your comments with the ICENet blog regarding these themes from the literature.  How do they compliment / contradict your understanding of physician competence? See below for her previous posts.

–  Jonathan (@sherbino)

By Elaine Van Melle (@elainevanmelle)


In the last post, I highlighted the need to consider two emerging concepts as we work to update the CanMEDS framework: professional self identity and emotions. This post focuses on three additional concepts; “systems thinking,” “handover or transfer of care,” and “global health.” After providing a definition of the concept, the CanMEDS Role most likely impacted by the theme is presented.

 Systems Thinking

Systems thinking is defined as “the ability to analyze systems as a whole, including the
recognition of essential interrelationships within the system, between subsystems and any changes and patterns that arise out of the networks of relationships and interactions
1(p.180) Thinking on a systems level falls within the Manager Role. Currently, this Role includes the requirement for a physician to be able to “participate in systemic quality process evaluation and improvement such as a patient safety initiative2(p.18) Systems thinking is a critical element of this enabling competency. But is it explicit enough? This is the challenge for the CanMEDS 2015 framework.


A handover is the transfer of responsibility and accountability for some or allHandover aspects of care for a patient or group of patients, on a temporary or permanent basis.3 The increasing complexities of patient care make these periods of transition particularly susceptible to medical error.4 The development of communication skills is a key competency in ensuring quality in patient handovers3,4. The question then becomes how to best incorporate this new competency as part of the Communicator Role.

 Global Health

Global Health is defined by some as “an area for study, research, and practice that places priority on improving health and achieving equity in health for all people worldwide.”5(p.1995) The phrase “think globally, act locally” demonstrates one focus of global health.6 Global health perhaps best falls within the Health Advocate Role. Current global healthHealth Advocate competencies include “identifying determinants of health”.7 It is suggested, however, that competency in global health includes “understanding one’s personal background, culture, value and biases in order to demonstrate sensitivity to the patient’s culture, beliefs, values, gender and age .”7 The challenge is how to incorporate an enhanced focus on this theme in the CanMEDS 2015 framework, while the global health construct is rapidly debated and evolving.



 1. Colbert CY, Ogden PE, Ownby AR, Bowe C. 2011. Systems-Based Practice in Graduate Medical Education: Systems Thinking as a Missing Foundational Construct. Teaching and  Learning In Medicine 23(2): 179-185.

2. Frank,JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada

  1. Canadian Medical Protective Agency. Good Practices Guide. http://www.cmpaacpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/communication/Handovers/what_is_a_handover-e.html Accessed April 30, 2013.

4. Garment AR, Lee WW, Harris C, Phillips-Caesar E. 2012. Development of a Structured Year-End Sign-Out Program in an Outpatient Continuity Practice. Journal of General Internal Medicine  28(1): 114-120.

5. Koplan JP, Band TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN. Towards a common definition of global health. 2009. Lancet 373(9679): 1993-1995.

6. McKimm J, McLean M. 2011. Developing a global health practitioner: Time to act? Medical Teacher 33(8): 626-631.

7. Kumagai AK, Lypson ML. 2009. Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic medicine 84(6): 782-787.