Detailed Curriculum Map

Transition to Discipline

Required 1. Clinical training experiences:
	1.1. Any rheumatology clinical service
		1.1.1. Clinic
		1.1.2. Consultation service to inpatient units and/or emergency department
	1.2. Afterhours coverage for a rheumatology service
Required 2. Other training experiences:
	2.1. Orientation to
		2.1.1. The training program, its functioning and relevant policies and procedures
		2.1.2. The Rheumatology Portfolio and local electronic platform
		2.1.3. The local institution(s) and clinical environment(s)
		2.1.4. Patient care protocols and care pathways
	2.2. Dedicated academic sessions, which may include
		2.2.1. Rounds
		2.2.2. Academic half day
		2.2.3. Journal club
	2.3. Formal instruction (e.g., boot camp) in rheumatologic emergencies
Recommended 3. Other training experiences:
	3.1. Formal instruction (e.g., boot camp) in
		3.1.1. Musculoskeletal (MSK) physical examination
		3.1.2. Approach to teaching and learning
		3.1.3. Medico-legal issues
Optional 4. Clinical training experiences:
	4.1. Longitudinal clinic
Optional 5. Other training experiences:
	5.1. Simulation training in rheumatologic emergencies

Foundation of Discipline

Required 1. Clinical training experiences:
	1.1. Any rheumatology clinical service
		1.1.1. Clinic
		1.1.2. Consultation service to inpatient units and/or emergency department
	1.2. Afterhours coverage for a rheumatology service
Required 2. Other training experiences:
	2.1. Formal instruction in
		2.1.1. Clinical functional anatomy and related physical exam
		2.1.2. Approach to joint and soft tissue injections
	2.2. Dedicated academic sessions, which may include
		2.2.1. Rounds
		2.2.2. Academic half day
		2.2.3. Journal club
Recommended 3. Other training experiences:
	3.1. Simulation experience with
		3.1.1. Arthrocentesis and/or joint injections
		3.1.2. Soft tissue injections
	3.2. Formal and/or informal instruction in
		3.2.1. MSK anatomy
		3.2.2. MSK imaging
		3.2.3. Immunology
		3.2.4. Epidemiology and pathophysiology of rheumatologic diseases
	3.3. Identification of a potential scholarly project
Optional 4. Clinical training experiences:
	4.1. Longitudinal clinic
Optional 5. Other training experiences:
	5.1. Establishment of a relationship with a mentor

Core of Discipline

Required 1. Clinical training experiences:
	1.1. Breadth of rheumatology practice in different settings to include
		1.1.1. Consultation service to inpatient units and/or emergency department
		1.1.2. Clinics
			1.1.2.1. Academic centre
			1.1.2.2. Community-based practice (for adult stream)
		1.1.3. Longitudinal clinic
		1.1.4. Pediatric Rheumatology (for adult stream)
		1.1.5. Adult Rheumatology (for pediatric stream)
		1.1.6. Afterhours coverage for a rheumatology service
Required 2. Other training experiences:
	2.1. Formal instruction in
		2.1.1. Immunology
		2.1.2. Epidemiology and pathophysiology of rheumatologic diseases
		2.1.3. Diagnostic testing in rheumatology, including serologic and genetic testing, medical imaging, and tissue diagnostics
		2.1.4. MSK radiology interpretation
		2.1.5. Quality improvement
		2.1.6. Patient safety
		2.1.7. Ethics
	2.2. Dedicated academic sessions, which may include
		2.2.1. Rounds
		2.2.2. Academic half day
		2.2.3. Journal club
	2.3. Participation in quality improvement activities (e.g., morbidity and mortality rounds)
	2.4. Provision of informal and/or clinical teaching for junior learners
	2.5. Career planning
Recommended 3. Clinical training experiences:
	3.1. Clinics for adolescents and/or young adults transitioning to adult rheumatology care
	3.2. Infusion clinics
	3.3. Disease-specific clinics in Rheumatology (e.g., lupus, vasculitis)
	3.4. Clinics in Orthopedic Surgery
	3.5. Clinics in Physical Medicine and Rehabilitation
Recommended 4. Other training experiences:
	4.1. Formal and/or informal instruction in MSK anatomy
	4.2. Participation in scholarly activity (e.g., research)
Optional 5. Clinical training experiences:
	5.1. MSK ultrasound
	5.2. Rheumatology in the community setting (for pediatric stream)
Optional 6. Other training experiences:
	6.1. Formal and/or informal instruction in
		6.1.1. Practice management
		6.1.2. Maintenance of certification, continuing professional development, and lifelong learning
	6.2. Experience in a basic science laboratory relevant to Rheumatology

Transition to Practice

Required 1. Clinical training experiences:
	1.1. Breadth of rheumatology practice in different settings with responsibility at level of a junior attending
		1.1.1. Consultation service to inpatient units and/or emergency department
		1.1.2. Clinic
		1.1.3. Calls from outside physicians and/or patients
		1.1.4. Longitudinal clinic
		1.1.5. Afterhours coverage for a rheumatology service
Required 2. Other training experiences:
	2.1. Formal instruction in
		2.1.1. Conflict of interest and ethics of interactions with pharmaceutical industry
		2.1.2. Medico-legal issues of practice management (e.g., privacy requirements, documentation, chart storage)
		2.1.3. Practice management (e.g., negotiating contracts/leases, hiring and firing staff, billing practices)
		2.1.4. Maintenance of certification, continuing professional development, and lifelong learning
		2.1.5. Conflict management
	2.2. Dedicated academic sessions, which may include
		2.2.1. Rounds
		2.2.2. Academic half day
		2.2.3. Journal club
	2.3. Presentation of formal teaching activities (e.g., rounds, academic half-day)
Recommended 3. Clinical training experiences:
	3.1. Infusion clinics
Recommended 4. Other training experiences:
	4.1. Provision of informal and/or clinical teaching for junior learners
	4.2. Participation in scholarly activity
	4.3. Advocacy activities with the community or population (e.g., committee service, involvement in Canadian Rheumatology Association activities, public patient forum)
	4.4. Mentor/advisor meetings to prepare for practice
Optional 5. Other training experiences:
	5.1. Formal and/or informal instruction in
		5.1.1. Organization/structure of the provincial health care system and/or department relevant to Rheumatology
		5.1.2. Academic versus community practice

Transition to Discipline

TTD1a. Performing histories and physical examinations in uncomplicated patients with rheumatologic disease, including documenting and presenting findings - Part A: History and Physical
TTD1b. Performing histories and physical examinations in uncomplicated patients with rheumatologic disease, including documenting and presenting findings - Part B: Assessment and Documentation
TTD2. Recognizing emergency rheumatologic situations and following up appropriately

Foundation of Discipline

F1. Assessing and providing initial diagnosis and treatment plans for patients with uncomplicated rheumatology presentations
F2. Triaging and proposing initial management of patients with emergency rheumatologic conditions
F3. Detecting MSK abnormalities through physical examination
F4. Performing knee arthrocentesis
F5. Counselling patients and/or families regarding diagnosis and treatment plans for uncomplicated rheumatologic diseases
F6a. Completing written documentation for uncomplicated patient encounters - Part A: Clinical Documentation
F6b. Completing written documentation for uncomplicated patient encounters - Part B: Prescriptions

Core of Discipline

C1. Providing initial assessment, diagnosis, and management for patients with a range of acute and chronic rheumatologic presentations
C2. Detecting rheumatologic disease abnormalities through physical examination
C3a. Performing and interpreting the results of joint, bursa and tendon aspirations and/or injections - Part A: Aspiration/Injection
C3b. Performing and interpreting the results of joint, bursa and tendon aspirations and/or injections - Part B: Interpretation of Results
C3c. Performing and interpreting the results of joint, bursa and tendon aspirations and/or injections - Part C: Logbook (Optional)
C4. Providing ongoing management for patients with stable, chronic and/or complex conditions
C5. Managing patients with exacerbations, disease progression, and/or complications of chronic rheumatologic diseases and/or treatment
C6. Assessing and managing patients in whom there is uncertainty in rheumatologic diagnosis and/or treatment
C7a. Counselling patients/families regarding diagnosis and treatment plans for a broad range of rheumatologic diseases - Part A: Counselling on the Disease State
C7b. Counselling patients/families regarding diagnosis and treatment plans for a broad range of rheumatologic diseases - Part B: Counselling on the Treatment Plan
C8. Completing written documentation for complex patient care
C9. Leading the provision of care for patients on a rheumatology service
C10. Managing a longitudinal clinic
C11a. Delivering scholarly teaching to a variety of audiences, including peers, junior trainees and/or other health professionals - Part A: Formal Teaching
C11b. Delivering scholarly teaching to a variety of audiences, including peers, junior trainees and/or other health professionals - Part B: Clinical Teaching
C12. Recognizing and triaging presentations of common pediatric rheumatologic diseases and identifying when to refer

Transition to Practice

TTP1. Facilitating access to treatments and/or services for individual patients
TTP2. Planning and implementing transfers of care through the health care system
TTP3. Advancing the discipline through scholarly activities
TTP4. Developing a personal learning plan for future practice and ongoing professional development

Medical Expert

1. Practise medicine within their defined scope of practice and expertise
	1.1. Demonstrate a commitment to high-quality care of their patients
	1.2. Integrate the CanMEDS Intrinsic Roles into their practice of Rheumatology
	1.3. Apply knowledge of the clinical and biomedical sciences relevant to Rheumatology							TTD: 1a F: 1 · 3 · 5 · 6b C: 1 · 2 · 2 · 4 · 5 · 5 · 5 · 12
	1.4. Perform appropriately timed clinical assessments with recommendations that are presented in an organized manner							TTD: 2 F: 1 · 2 · 3 C: 1 · 4 · 5 · 9 · 10 · 12
	1.5. Carry out professional duties in the face of multiple competing demands							C: 10
	1.6. Recognize and respond to the complexity, uncertainty, and ambiguity inherent in Rheumatology practice							C: 5 · 5 · 6
2. Perform a patient-centred clinical assessment and establish a management plan
	2.1. Prioritize issues to be addressed in a patient encounter							F: 2 C: 4 · 5
	2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion							TTD: 1a · 1a · 1a · 1b · 1b · 2 · 2 · 2 F: 1 · 1 · 1 · 1 · 2 · 2 · 3 · 3 · 4 · 6a · 6a · 6b C: 1 · 1 · 1 · 1 · 1 · 2 · 2 · 2 · 2 · 2 · 2 · 3a · 4 · 4 · 5 · 5 · 5 · 5 · 6 · 6 · 8 · 10 · 12 · 12 · 12 · 12
	2.3. Establish goals of care in collaboration with patients and their families, which may include slowing disease progression, treating symptoms, achieving cure, improving function, and palliation							C: 4 · 5
	2.4. Establish a patient-centred management and/or rehabilitation plan for patients with rheumatologic disease							TTD: 2 F: 1 · 2 · 6a · 6b C: 1 · 4 · 5 · 6 · 6 · 8 · 10 · 12
3. Plan and perform procedures and therapies for the purpose of assessment and/or management
	3.1. Determine the most appropriate procedures or therapies							F: 4 · 5 · 5 C: 5 · 9
	3.2. Obtain and document informed consent/assent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy							F: 4 C: 3a · 3a · 7b
	3.3. Prioritize procedures or therapies, taking into account clinical urgency and available resources							C: 5
	3.4. Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances							F: 4 · 4 · 4 · 4 · 4 · 4 · 4 · 4 · 4 C: 3a · 3a · 3a · 3a · 3a · 3a · 3a · 3a · 3b
4. Establish plans for ongoing care and, when appropriate, timely consultation
	4.1. Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation							F: 2 · 2 · 4 · 6b C: 1 · 3a · 4 · 5 · 7a · 7b · 7b · 9 · 12 TTP: 2
5. Actively contribute, as an individual and as a member of a team providing care, to the continuous improvement of health care quality and patient safety
	5.1. Recognize and respond to harm from health care delivery, including patient safety incidents
	5.2. Adopt strategies that promote patient safety and address human and system factors							F: 6b · 6b

Communicator

1. Establish professional therapeutic relationships with patients and their families
	1.1. Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion							F: 5 C: 7a · 7b
	1.2. Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety							F: 3 C: 2
	1.3. Recognize when the perspectives, values, or biases of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly							F: 5
	1.4. Respond to a patient’s non-verbal behaviours to enhance communication
	1.5. Manage disagreements and emotionally charged conversations							C: 7a · 7b
	1.6. Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances							F: 5 C: 4 · 7a · 7b
2. Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families
	2.1. Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information							TTD: 1a · 1b F: 1
	2.2. Provide a clear structure for and manage the flow of an entire patient encounter							TTD: 1a
	2.3. Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent							F: 1 · 2 C: 1 · 12
3. Share health care information and plans with patients and their families
	3.1. Share information and explanations that are clear, accurate, and timely, while assessing for patient and family understanding							F: 5 · 5 C: 4 · 5 · 6 · 7a · 7a · 7b · 12
	3.2. Disclose harmful patient safety incidents to patients and their families accurately and appropriately
4. Engage patients and their families in developing plans that reflect the patient’s health care needs and goals
	4.1. Facilitate discussions with patients and their families in a way that is respectful, non-judgmental, and culturally safe							C: 6 · 7b
	4.2. Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health							F: 5
	4.3. Use communication skills and strategies that help patients and their families make informed decisions regarding their health
5. Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy
	5.1. Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements							TTD: 1b F: 1 · 2 · 3 · 4 · 6a · 6a · 6a · 6a · 6a · 6b C: 1 · 2 · 3a · 3b · 6 · 8 · 8 · 8 · 8 · 8 · 9 · 10 TTP: 1
	5.2. Communicate effectively using a written health record, electronic medical record, or other digital technology
	5.3. Share information with patients and others in a manner that enhances understanding and respects patient privacy and confidentiality

Collaborator

1. Work effectively with physicians and other colleagues in the health care professions
	1.1. Establish and maintain positive relationships with physicians and other colleagues in the health care professions to support collaborative care
	1.2. Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care							C: 1 TTP: 1
	1.3. Engage in respectful shared decision-making with physicians and other colleagues in the health care professions							TTD: 2 F: 1 · 2 · 6a C: 8 · 8 · 9 · 9 · 10 · 10
2. Work with physicians and other colleagues in the health care professions to promote understanding, manage differences, and resolve conflicts
	2.1. Show respect toward collaborators							C: 9 · 10
	2.2. Implement strategies to promote understanding, manage differences, and resolve conflict in a manner that supports a collaborative culture
3. Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care
	3.1. Determine when care should be transferred to another physician or health care professional							TTD: 2 TTP: 2
	3.2. Demonstrate safe handover of care, using both oral and written communication, during a patient transition to a different health care professional, setting, or stage of care							C: 9 TTP: 2

Leader

1. Contribute to the improvement of health care delivery in teams, organizations, and systems
	1.1. Apply the science of quality improvement to contribute to improving systems of patient care
	1.2. Contribute to a culture that promotes patient safety							C: 7a · 7b
	1.3. Analyze patient safety incidents to enhance systems of care
	1.4. Use health informatics to improve the quality of patient care and optimize patient safety
2. Engage in the stewardship of health care resources
	2.1. Allocate health care resources for optimal patient care							TTD: 2 C: 9 TTP: 1 · 2
	2.2. Apply evidence and management processes to achieve cost-appropriate care							C: 1 TTP: 1
3. Demonstrate leadership in health care systems
	3.1. Demonstrate leadership skills to enhance health care
	3.2. Facilitate change in health care to enhance services and outcomes
4. Manage career planning, finances, and health human resources in personal practice(s)
	4.1. Set priorities and manage time to integrate practice and personal life							C: 9 · 10 · 10 · 11b TTP: 3
	4.2. Manage personal professional practice(s) and career							C: 10 TTP: 4
	4.3. Implement processes to ensure personal practice improvement

Health Advocate

1. Respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment
	1.1. Work with patients to address determinants of health that affect them and their access to needed health services or resources							C: 1 · 5 · 7a · 7b · 9 TTP: 1 · 1 · 2
	1.2. Work with patients and their families to increase opportunities to adopt healthy behaviours							C: 4 · 4 · 4 · 6
	1.3. Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients							C: 7a · 7b
2. Respond to the needs of the communities or populations they serve by advocating with them for system-level change in a socially accountable manner
	2.1. Work with a community or population to identify the determinants of health that affect them
	2.2. Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities
	2.3. Contribute to a process to improve health in the community or population they serve

Scholar

1. Engage in the continuous enhancement of their professional activities through ongoing learning
	1.1. Develop, implement, monitor, and revise a personal learning plan to enhance professional practice							TTP: 4 · 4
	1.2. Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources							TTP: 4
	1.3. Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice
2. Teach students, residents, the public, and other health care professionals
	2.1. Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners							C: 9 · 11b
	2.2. Promote a safe and respectful learning environment							C: 11b
	2.3. Ensure patient safety is maintained when learners are involved							C: 9 · 11b
	2.4. Plan and deliver learning activities							C: 11a · 11a · 11a · 11a
	2.5. Provide feedback to enhance learning and performance							C: 11b
	2.6. Assess and evaluate learners, teachers, and programs in an educationally appropriate manner
3. Integrate best available evidence into practice
	3.1. Recognize practice uncertainty and knowledge gaps in clinical and other professional encounters and generate focused questions that can address them
	3.2. Identify, select, and navigate pre-appraised resources
	3.3. Critically evaluate the integrity, reliability, and applicability of health-related research and literature							C: 6 · 11a TTP: 3
	3.4. Integrate evidence into decision-making in their practice							C: 1 · 6 · 9 · 11b
4. Contribute to the creation and dissemination of knowledge and practices applicable to health
	4.1. Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health care
	4.2. Identify ethical principles for research and incorporate them into obtaining informed consent/assent, considering potential harms and benefits, and vulnerable populations							TTP: 3
	4.3. Contribute to the work of research program
	4.4. Pose questions amenable to scholarly investigation and select appropriate methods to address them							TTP: 3 · 3 · 3 · 3 · 3
	4.5. Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry							TTP: 3 · 3

Professional

1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards
	1.1. Exhibit appropriate professional behaviours and relationships in all aspects of practice, demonstrating honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality							TTD: 2 C: 5 · 5 · 6 · 10 · 10 TTP: 1
	1.2. Demonstrate a commitment to excellence in all aspects of practice							C: 10
	1.3. Recognize and respond to ethical issues encountered in practice
	1.4. Recognize and manage conflicts of interest
	1.5. Exhibit professional behaviours in the use of technology-enabled communication
2. Demonstrate a commitment to society by recognizing and responding to societal expectations in health care
	2.1. Demonstrate accountability to patients, society, and the profession by responding to societal expectations of physicians							TTP: 1 · 4 · 4
	2.2. Demonstrate a commitment to patient safety and quality improvement
3. Demonstrate a commitment to the profession by adhering to standards and participating in physician-led regulation
	3.1. Fulfil and adhere to professional and ethical codes, standards of practice, and laws governing practice							F: 6b C: 8
	3.2. Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions
	3.3. Participate in peer assessment and standard setting
4. Demonstrate a commitment to physician health and well-being to foster optimal patient care
	4.1. Exhibit self-awareness and manage influences on personal well-being and professional performance
	4.2. Manage personal and professional demands for a sustainable practice throughout the physician life cycle
	4.3. Promote a culture that recognizes, supports, and responds effectively to colleagues in need