If there was some obvious framework to guide your pre-application extra-curricular and academic life, would you use it? Fortunately, the Royal College of Physicians and Surgeons of Canada developed such a framework – known as the CanMEDS Framework – to “describe the knowledge, skills and abilities that specialist physicians need for better patient outcomes.” (A similar framework exists for the US provided by the AAMC) This was not developed to show you how to plan your life for medical school but it does help you see why and how medical schools demand certain competencies and skills from their learners.
Today, we will go through each of the domains of the framework and articulate how you might demonstrate your capacity in that area.
Professionalism is an attribute that can be illustrated in a number of different ways. Work experience in any field is an excellent start. If you are coming from another career, that’s an advantage and it demonstrates professionalism. The actual area of work matters less than being able to show you’ve worked in teams or in a service role. Employment in a lab, research institute or clinic is also nice to have. Your reference letters should reflect your punctuality, your respect for others and for rules, as well as your general behavior.
Medicine is a self-regulated profession so having work experience that demonstrates use of ethical principles and high standards is a home-run in this category. Additionally, experience that shows commitment to excellence and high performance standards is reassuring to any admissions committee if the rest of the application is sound. Extra-curricular activities that show you are a committed, tenacious person who can foster a sense of camaraderie with many different kinds of people is valuable.
This domain is dedicated to describing people who can handle tough situations with poise and clarity. Your personal statements go a long way in demonstrating communication skills, especially if you describe situations that involve conflict, errors and vulnerabilities. In describing these situations, make sure you dive into how your communication skills enriched and moved the situation forward. Ensure that you position yourself as an actor in those situations, not just a bystander.
Performance in writing courses at the university level is also a good indicator of communication skills. This shows a level of verbal reasoning and analysis that indicates a strong communicator.
Verbal communication skills will be highlighted in the admissions process and throughout your life as a physician. The ability to think quickly, adapt and be flexible during tense times with a patient is the basis of the ‘art of medicine.’ You can demonstrate these through participation in teams and being involved in group leadership roles. By volunteering in clinical settings and engaging in civil society, you can also show and improve your verbal communication skills.
Lastly, try to narrow down experiences that allow you to highlight, reflect on, and demonstrate empathy with other human beings. This is very different than pity and the distinction is key. If, in your personal statement, you talk about your two-week trip to Ghana and describe in terms that express pity, rather than empathy, then your statement will not be achieving the goal. You must go deeper when describing these experiences and reflect on the inner changes that occur in the face of difficult situations. Empathy is one of the most powerful motivators, day to day, for physicians and empathy should inspire you to do your best. If you struggle to identify with the struggles and experiences of others, medicine will be a very difficult and complicated road.
A collaborator is someone who supports a team-based approach to health care through their actions, thoughts and words. Extra-curricular activities that involve groups, teams and partnerships are best. Sometimes research experiences work well in this domain and sometimes they don’t. Labs that foster critical thinking and reciprocity are good fodder for discussing collaboration. Qualitative research also works well here because the subjects are, typically, human and your interaction with them is the basis of the research design.
Also, as with professionalism and communication, work experience in teams or in a service profession are very helpful.
The Manager domain is one of the most ‘big picture’ domains in the CanMEDS Framework. It requires that you be able to zoom out from the individual level to a broader meso- or macro- system level. Later career doctors involved in health system administration make use of the Manager competency in an obvious way but so do doctors working exclusively in clinical settings.
You can demonstrate managerial competencies without experience as a manager. Activities that show good time management, skilled triaging of commitments, an awareness of scarcity of resources and time, capacity for creative problem solving under stress and acknowledgement of limitations are ideal. Just getting a university degree while also being involved in your community can show managerial potential. Leadership roles, however, are best for demonstrating the Manager competency. If you can articulate a leadership role wherein you improved the effectiveness of a team in a measurable way, this is ideal.
This domain is about a physician’s higher order duties to the community of patients and people they serve. Engagement in social justice or civil society work is the place to begin. You may also add clinical or research experiences around access to care, health inequities or the social determinants of health. Taking a course or more in health studies or health policy, with an eye towards vulnerable populations shows legitimate interest in health advocacy. Taking on volunteer opportunities with older adults, differently-abled people or people experiencing poverty is a good way to show your budding capacity as an advocate, if that work has meaning for you.
Personal narratives of marginalization that are insightful can also be very valuable here, provided that they are true and focused. The goal of sharing your experience of marginalization is to show that you recognize the various ways in which society and sickness interact, through power imbalances and discrimination. Additionally, when sharing global health experiences, the focus of your description should be on the meaning of the experience for you. Going to a low-income nation and writing in your personal statement, “We went and built a school, and life was better for the people in the village” doesn’t communicate meaning nor that you understand the broader determinants of community wellness. An appropriate statement about a global health experience might discuss your own feelings, how it changed you, your attitudes, beliefs and skills.
Your GPA is one place to start to demonstrate scholarship excellence. But the scholarship domain is also about “reflective learning” which requires self-awareness in the application, sharing, and iteration of technical medical knowledge. Your GPA shows that you have technical knowledge but doesn’t make it obvious how you engage with that knowledge.
The best way to demonstrate self-awareness in scholarship is to take courses from a variety of disciplines and to do very well in these courses. A chemistry student should take an English class. This shows academic bravery and insight into the need to expand how you learn.
Another way to demonstrate scholarship is through curiosity about the world. Travel, if possible, or take language lessons. Don’t be afraid to try something outside of your natural aptitudes because this is the only way to develop new aptitudes. In your medical career, you will find new skills and talents popping up every week as a result of being pushed by the work. Start now so you’re confident later.
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