Family Medicine Care of Underserved Populations (CUP) Competencies*

Medical Expert

1. Conduct preventive health screening and other clinical care of underserved and marginalized populations in an evidence- and epidemiology-informed manner.

2. Access, adapt, and apply information on best medical practices (e.g., clinical guidelines, journal articles, and other relevant literature) in a variety of remote and under-resourced settings.

3. Synthesize medical expertise with cultural and social safety. 

4. Articulate the global burden of communicable and non-communicable diseases including knowledge of global indicators of health and geographic distribution of disease.

5. Apply community and public health principles on an individual patient and systemic level, including assessment of the social and structural determinants of health in a community. 

Communicator 

1. Display awareness of one’s own worldview and contextual biases (academic, sociocultural, political, advantage and power) and the ability to “viewpoint” (understand, while not necessarily taking, another point of view) empathically with another individual or community. (Also known as reflexivity.)

2. Develops therapeutic relationships with patients, while adapting to overcome linguistic, cultural, physical, and other barriers to effective communication.

3. Use setting-appropriate methods and tools for sharing and gathering information with/from patients, transdisciplinary colleagues, and other stakeholders in clinical and community contexts.

4. Display skills in intercultural verbal, non-verbal, and written communication.

Collaborator 

1. Navigates power dynamics diplomatically and effectively with an attitude of cultural humility, while reflecting critically on the different models of partnership experienced.

2. Demonstrate the skills required to initiate, build, and sustain reciprocal partnerships with transdisciplinary, inter-sectoral, and community partners.

3. Articulate the purpose, structure and function of key organizations in health equity (including international governmental and non-governmental agencies), as well as the programs and policies that affect the communities served by these.

4. Describe the types of health professionals, and their scopes of practice and roles, present in various health care systems.  

Advocate 

1. Actively seek out collaborations with local individuals and entities in the communities one is serving before initiating advocacy activity oneself.

2. Advocate for sustainable change that addresses inequity in the social and structural determinants of health, projecting the potential positive and negative downstream consequences of advocacy.

3. Advocate for sustainable change that builds capacity for health care in a health system and community.

4. Choose advocacy techniques (e.g., grant writing, public speaking, fundraising, campaigning, letter writing, teaching, etc.) appropriate to the context of the need(s), resources, and stakeholders relevant to an advocacy activity or product.

5. Pursue skill development in advocating at various levels of civic life:  individual, family, community, sector, government, and global stage.   

Leader 

1. Takes initiative to identify the health and social needs of a health system and the community it serves.

2. Innovate and construct from available resources effective solutions to problems, even in austere environments.

3. Identify a community’s resources and needs beyond the material (e.g., social capital, spirituality, natural resources, traditional knowledge) in order to more fully understand the term “under-resourced.”

4. Steward resources equitably, appropriately and thoughtfully. 

5. Navigates the politics and policies of health care with appropriate sensitivity to power dynamics, balancing pragmatism with a commitment to solidarity for health equity. 

Scholar 

1. Contributes to meaningful and ethical research among the underserved, in a manner that reflects the principles of reciprocity, sustainability, solidarity (as an alternative to charity).

2. Values a community-based approach to research (e.g., strengths-based/appreciative and participatory action techniques).

3. Compare and evaluate health care delivery systems in various geographical settings.

4. Evaluate programs, practices and policies and implement appropriate methods for quality improvement. 

5. Educate junior learners in health care about global indicators, guidelines, and policies produced by international health agencies, such as the World Health Organization and the United Nations.

6. Contribute to the development of the nascent discipline of care of underserved populations and global health in research and medical education. 

Professional 

1. Identify and manage ethical dilemmas and challenges that arise when working in a setting of limited-resources and differences from one’s own.

2. Apply ethical principles as they relate to principles of development (including reciprocity, sustainability, and solidarity (as an alternative to charity)) in various underserviced settings, cognizant of both intended and unintended consequences of intervention (including one’s presence) or research. 

3. Practices critical self-appraisal and reflexivity regularly in order to learn from successes and failures and therefore be able to change. 

4. Provides mentorship, education, and role modeling for junior learners in the health equity / care of underserved populations field.

5. Demonstrates an attitude of cultural humility (including respect, flexibility, and a posture of learning) in cross-cultural, transdisciplinary, and community-engagement relationships.

*Adapted from University of Calgary Family Medicine Global Health CanMEDS Competencies.