Swiss Catalogue of Learning Objectives for Undergraduate Medical Training

Under a mandate of the Joint Commission of the Swiss Medical Schools

3. General Objectives

3.1 Introduction

In the 1990s the Royal College of Physicians and Surgeons of Canada (RCPSC), responsible for setting residency training, examination and accreditation standards across the country asked its “Societal Needs Working Group” to “identify the core competencies generic to all specialists to meet the needs of society.” The result was the CanMEDS framework. The physician “Roles” concept was provided by the “Educating Future Physicians for Ontario” Project. The framework was the result of a sophisticated process lasting several years and based on expert input e.g. on physician-patient communication, on consultation with other healthcare organizations, on systematic literature search and on input from public focus groups. The seven CanMEDS Roles or thematic groups of competencies, as defined by the framework have since obtained growing international acceptance in medical education as a well suited structure for catalogues of goals and objectives. So the Working Group decided to adopt these Roles to structure the General Objectives.

The CanMEDS Roles and their definition are as follows:

Medical Expert

Definition: As Medical Experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.

Communicator

Definition: As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.

Collaborator

Definition: As Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care.

Manager

Definition: As Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.

Health Advocate

Definition: As Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.

Scholar

Definition: As Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.

Professional

Definition: As Professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behavior.

CanMEDS Diagram

A diagram was created in 2001 to illustrate the elements and the interconnections of the CanMEDS Roles embodied by competent physicians: Medical Expert (the central role), Communicator, Collaborator, Health Advocate, Manager, Scholar and Professional. This diagram — also known as the CanMEDS “cloverleaf,” “daisy” or “flower” — was officially trademarked in 2005 and was revised to more accurately reflect the fluidity and overlap amongst the CanMEDS Roles.


The following General Objectives have been formulated by the Working Group. The first draft relied for a substantial part on the “CanMEDS 2005 Framework” and on the British “Curriculum for the foundation years in postgraduate education and training”.

3.2 Medical Expert (ME)

Description:

At the end of undergraduate education and the beginning of postgraduate training physicians possess a defined body of knowledge, clinical skills, procedural skills and professional attitudes, which are directed to patient care under supervision. They apply these competencies to collect and interpret information, make proposals for clinical decisions, and carry out some defined diagnostic and therapeutic procedures. The role of Medical Expert is central to the function of physicians, and draws on the competencies included in the Roles of Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional. (See „daisy-flower” preceding page)

Competencies: The physician is able to...

... elicit a relevant, concise and accurate history from the patient and other sources

Objective ID  
G ME 1   The physician demonstrates clear history taking and communication with patients, their families and other carers and seeks information from other sources, differentiating the concepts of ‘illness’ as the patient’s story and of ‘disease’ as the medical history of a health disorder
G ME 2   The physician clarifies the patient’s expectations and requests for the encounter and elicits information on both the somatic and psychological aspects of her/his symptoms and complaints as well as the patient’s situation, her/his understanding and concerns, social and cultural background and illness experience
G ME 3   The physician shows knowledge of common typical presenting symptoms and complaints, even when less explicit and in early stages of disease.

... conduct an effective physical examination

Objective ID  
G ME 4   The physician explains the examination procedure, gains appropriate consent for the examination and minimizes patient discomfort.
G ME 5   The physician masters clinical examination techniques to elicit relevant clinical signs and uses a coordinated approach to the examination respecting patient dignity.
G ME 6   The physician performs a targeted or a detailed examination corresponding to the patient’s symptoms and the actual diagnostic question.

... analyze and interpret data to establish a differential and a working diagnosis and construct a management plan

Objective ID  
G ME 7   The physician analyzes and interprets the collected information and establishes a problem list with a differential diagnosis in the order of likelihood and urgency, and establishes a principal working diagnosis taking into account the different epidemiology of disease presentations in primary and secondary care.
G ME 8   The physician takes into consideration relevant context and background of the patient, including family, social, cultural and spiritual factors.
G ME 9   The physician constructs a management plan based on the interpretation of the collected data, including further investigations and treatments and consecutive requests/instructions to other health care professionals, keeping open the option of a wait-and-see approach.
G ME 10   The physician appreciates positive or negative predictive value of symptoms and signs, and of findings from ancillary tests obtained in clinical data collection, and their dependency on the prevalence of the target disease.

... carry out under supervision relevant procedures and organize further investigations

Objective ID  
G ME 11   The physician carries out specific investigative or therapeutic procedures as outlined in the section “General Skills”.
G ME 12   The physician weighs risks and benefits for the patient before undertaking any investigation or procedure.
G ME 13   The physician explains to the patient the arguments for further investigations, their risks and benefits and the specific procedure

... demonstrate appropriate medical data and information management

Objective ID  
G ME 14   The physician synthesizes the relevant information and reports on her/his findings and her/his proposals concerning the management plan in a concise form to her/his supervising physician and other healthcare professionals
G ME 15   The physician records accurate, logical, comprehensive and pertinent accounts of history, physical examination, investigations, management plan and follow up that are structured, timed, dated and personally attributable with the understanding that they might be read by the patient
G ME 16   The physician takes into account the medico-legal importance of good record-keeping and data protection.
G ME 17   The physician structures reports clearly to communicate findings and outcome of illness episodes

... deliver good quality medical care and ensure patient safety

Objective ID  
G ME 18   The physician demonstrates knowledge of the relevant structures and functions of the human body from molecular level to the individual as a whole in its social context, in its different phases of development and the range from normal to pathological condition.
G ME 19   The physician demonstrates awareness of the scientific base and conceptual framework of modern medicine, its perception in society and its historical evolution over time
G ME 20   The physician demonstrates up-to-date knowledge of the evidence-based standard of medical care for common ailments and illnesses and of the basic urgent interventions
G ME 21   The physician applies her/his knowledge in daily work by diagnosing and treating the common conditions and mastering the basic urgent interventions.
G ME 22   The physician informs patient and family, colleagues and other professionals in a readily comprehensible way, encouraging discussion and participation in decision-making
G ME 23   The physician pays attention to the importance of continuity of care and of patient information transfer e.g. from inpatient to outpatient setting
G ME 24   The physician allows patients sufficient time to talk, express concerns and to ask questions, listens actively
G ME 25   The physician seeks advice promptly when unable to answer a patient’s query or concerns.
G ME 26   The physician supports self-management by patients.
G ME 27   The physician demonstrates an understanding of the social and cultural background of patients and takes it into account in her/his clinical work.
G ME 28   The physician shows awareness of possible consequences of disease for family members and further environment (including workplace) of the patient.
G ME 29   The physician identifies the main information elements that have to be transmitted to the patient in order to get her/his informed consent on a medical act and respects patient’s rights to refuse treatment.
G ME 30   The physician takes particular care in dealing with vulnerable patients such as children, severely ill and dying patients and patients with mental ill-health
G ME 31   The physician considers appropriateness of interventions according to patient’s wishes, severity of illness and chronic or co-morbid diseases.
G ME 32   The physician respects patient’s wishes for confidentiality.
G ME 33   The physician explains criteria for issuing ‘Do Not Attempt Resuscitation’-orders and the level of experience required to issue them.
G ME 34   The physician recognizes personal limits of expertise and decides appropriately if and when other professionals are needed to contribute to a patient’s care
G ME 35   The physician acts appropriately when a medical error has occurred.
G ME 36   The physician is sensitive to situations where patients are unhappy with aspects of care and seeks to remedy concerns.
G ME 37   The physician demonstrates basic knowledge of detection and appropriate management of medical errors

... demonstrate safe prescribing

Objective ID  
G ME 38   The physician prescribes drugs, oxygen, fluids and blood products appropriately, clearly and unambiguously with date and signature clearly visible.
G ME 39   The physician considers drug costs when prescribing.
G ME 40   The physician applies the principles of safe prescribing for children and elderly people and in the context of pregnancy and breastfeeding, hepatic or renal dysfunction or heart failure.
G ME 41   The physician explains and applies the principles of therapeutics in treatment of pain, palliative and end-of-life care.
G ME 42   The physician shows awareness of possible drug interactions and of adequate tools to reduce prescribing errors.
G ME 43   The physician monitors therapeutic effects and compliance, and appropriately adjusts treatments and dosages and encourages patient compliance.
G ME 44   The physician identifies patients who are not responding as expected to any investigative or treatment measure and takes appropriate and timely action.
G ME 45   The physician shows awareness of the importance to notify drug monitoring agencies in the case of a possible significant adverse drug reaction.
G ME 46   The physician shows understanding of common complications and side effects of treatments / procedures and gives the patient appropriate information, instructions and warnings.
G ME 47   The physician shows awareness of the importance of security issues in respect of prescription forms.

... foster infection control

Objective ID  
G ME 48   The physician describes the principles and sources of cross infection.
G ME 49   The physician minimizes the risk of transferring infection through personal behavior, including appropriate hand hygiene.
G ME 50   The physician avoids posing risk to patients by personal (infectious) health problems.

... promote health of patients and the community

Objective ID  
G ME 51   The physician recognizes and uses opportunities to counsel for disease prevention and to promote health.
G ME 52   The physician shows basic counseling skills explaining to patients, as appropriate, the possible effects of lifestyle, including the effects of diet, nutrition, smoking, alcohol and illicit drugs
G ME 53   The physician recommends screening tests and immunizations appropriately.

... access relevant information on diagnostic and therapeutic options and apply it under supervision to clinical practice

Objective ID  
G ME 54   The physician, starting from a patient problem, elaborates an appropriate clinical question and efficiently searches for an answer in the literature, using appropriate sources of information
G ME 55   The physician actively accesses relevant evidence and demonstrates basic ability to appraise the quality of evidence from different sources in the literature and proposes appropriate conclusions for patient care to the supervising physician

3.3 Communicator (CM)

Description:

At the end of undergraduate education and the beginning of postgraduate training physicians enable patient-centered therapeutic communication through partnership and effective dynamic interactions with patients, families, caregivers, other professionals, and important other individuals. Communication skills are essential for the functioning of a physician, effective communication is critical for optimal patient outcomes.

Competencies: The physician is able to...

... develop rapport, trust, and ethical therapeutic relationships with patients and families

Objective ID  
G CM 1   The physician shows recognition that good communication is a core clinical skill for physicians that can foster patient and physician satisfaction, compliance, and improve clinical outcomes.
G CM 2   The physician shows awareness of nonverbal cues in encounters with patients and acts appropriately.
G CM 3   The physician chooses a suitable setting with necessary support when giving complicated or bad news.
G CM 4   The physician deals with the help from senior colleagues appropriately with angry or dissatisfied patients or relatives.
G CM 5   The physician seeks assistance when dealing with patients with special communication needs, e.g. language or speech problem.
G CM 6   The physician demonstrates an ability to anticipate patients’ needs; explains clearly and checks understanding.
G CM 7   The physician balances appropriately distance and proximity with the patient and shows appropriate level of emotional involvement.

... accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals

Objective ID  
G CM 8   The physician demonstrates clear history taking and communication with patients, their families and other carers and seeks information from other sources, differentiating the concepts of ‘illness’ as the patient’s story and of ‘disease’ as the medical history of a health disorder
G CM 9   The physician clarifies the patient’s expectations and requests for the encounter and elicits information on both the somatic and psychological aspects of her/his symptoms and complaints as well as the patient’s situation, her/his understanding and concerns, social and cultural background and illness experience
G CM 10   The physician explores, respectfully and without judgment, the social and family context of the patient’s health needs and preferences.

... accurately convey relevant information and explanations to patients and families, colleagues and other professionals and foster the development of a common understanding on issues, problems and plans to develop a shared plan of care

Objective ID  
G CM 11   The physician informs patient and family, colleagues and other professionals in a readily comprehensible way, encouraging discussion and participation in decision-making
G CM 12   The physician ensures that relatives of acutely ill or unconscious patients are being supported and that relatives, if not present, are notified by someone competent.
G CM 13   The physician explains to the patient the arguments for further investigations, their risks and benefits and the specific procedure
G CM 14   The physician allows patients sufficient time to talk, express concerns and to ask questions, listens actively
G CM 15   The physician takes particular care in dealing with vulnerable patients such as children, severely ill and dying patients and patients with mental ill-health
G CM 16   The physician identifies effectively problems to be addressed in a patient encounter, including the patient’s context, concerns and preferences.
G CM 17   The physician shows basic counseling skills explaining to patients, as appropriate, the possible effects of lifestyle, including the effects of diet, nutrition, smoking, alcohol and illicit drugs
G CM 18   The physician communicates in an efficient way with all team members to ensure shared understanding of patients’ problems and to foster continuity of care

... convey effective oral and written information about a medical encounter

Objective ID  
G CM 19   The physician synthesizes the relevant information and reports on her/his findings and her/his proposals concerning the management plan in a concise form to her/his supervising physician and other healthcare professionals
G CM 20   The physician records accurate, logical, comprehensive and pertinent accounts of history, physical examination, investigations, management plan and follow up that are structured, timed, dated and personally attributable with the understanding that they might be read by the patient
G CM 21   The physician structures reports clearly to communicate findings and outcome of illness episodes

3.4 Collaborator (CL)

Description:

At the end of undergraduate education and the beginning of postgraduate training physicians work in partnership with others who have to be appropriately involved in the care of individuals or specific groups of patients. This is increasingly important in a modern multiprofessional environment, where patient-centered care is widely shared by several teams in multiple locations

Competencies: The physician is able to...

... effectively consult with her/his supervisor and other physicians and health care professionals, striving for good teamwork aiming at optimal patient care and at patient safety

Objective ID  
G CL 1   The physician synthesizes the relevant information and reports on her/his findings and her/his proposals concerning the management plan in a concise form to her/his supervising physician and other healthcare professionals
G CL 2   The physician discusses treatment options including relative risks and benefits with the supervising physician and colleagues.
G CL 3   The physician recognizes personal limits of expertise and decides appropriately if and when other professionals are needed to contribute to a patient’s care
G CL 4   The physician communicates in an efficient way with all team members to ensure shared understanding of patients’ problems and to foster continuity of care
G CL 5   The physician demonstrates good handover practice and ensures continuity of care when going off duty, accurately summarizing the main points of patients’ diagnoses, active problems, and management plans.
G CL 6   The physician cross-checks ambiguous instructions and actions with a senior physician.
G CL 7   The physician pays attention to the importance of continuity of care and of patient information transfer e.g. from inpatient to outpatient setting
G CL 8   The physician seeks and welcomes appraisal from patients and colleagues on the quality of her/his work and copes with feedback, even when negative

... contribute effectively to other interdisciplinary team activities

Objective ID  
G CL 9   The physician displays effective team working skills and describes her/his personal role and responsibilities in the team.
G CL 10   The physician supports nursing staff in designing and implementing monitoring or calling criteria concerning her/his patients.
G CL 11   The physician seeks out opportunities to discuss the evidence base of clinical decision making and clinical care with colleagues and other health professionals
G CL 12   The physician shows understanding of the need for collective responsibility for health care of individuals and for health promoting interventions both of which require a multidisciplinary approach and partnership with the patient and the population served.

3.5 Manager (MA)

Description:

At the end of undergraduate education and the beginning of postgraduate training physicians function as Managers when (under guidance by their supervisors) they take everyday practice decisions involving resources. They have to make systematic choices when allocating finite healthcare resources and personal time, using informa- tion technology.

Competencies: The physician is able to...

... utilize personal time and resources effectively in order to balance patient care, learning needs, and private activities outside the workplace, and to protect her/his own health

Objective ID  
G MA 1   The physician employs effective time management, plans and prioritizes her/his work.
G MA 2   The physician delegates or calls for help in time when she/he is falling behind.
G MA 3   The physician recognizes excessive stress or early symptoms of illness and seeks appropriate help to protect patients, being aware that own performance may be affected by personal stress and illness.
G MA 4   The physician takes care of her/his own health at work by using adequate protection measures and keeping her/his own immunizations up-to-date.

... use effectively under supervision finite healthcare resources, while acting in the best interest of the patient

Objective ID  
G MA 5   The physician shows awareness of possible conflict between health needs of individual patients and the health needs of the community
G MA 6   The physician demonstrates and adequately applies in daily work knowledge of the economical and legal basis of the Swiss social security and healthcare systems.
G MA 7   The physician assesses effectiveness, appropriateness and efficiency of medical practice and acts accordingly.

... work effectively and efficiently in a healthcare organization

Objective ID  
G MA 8   The physician explains the roles and responsibilities of physicians (including her/his own) and other professionals in the Swiss healthcare system.
G MA 9   The physician gives in broad terms an overview of the structure and organization of the Swiss healthcare system.

... effectively utilize information technology for patient care, self-learning and other activities

Objective ID  
G MA 10   The physician explains the principles of medical data and information management, especially measures for security of data.
G MA 11   The physician retrieves patient-specific information from the clinical data system at her/his workplace.
G MA 12   The physician searches, collects, organizes and interprets health and biomedical information from different databases and sources.
G MA 13   The physician describes examples for use of information and communication technology to assist in diagnostic, therapeutic and preventive measures for the patient, and for surveillance and monitoring health status (E-Health).

... assure and improve the quality of care and patient safety

Objective ID  
G MA 14   The physician shows awareness of the limits of medical care.
G MA 15   The physician demonstrates basic knowledge of detection and appropriate management of medical errors
G MA 16   The physician recognizes personal limits of expertise and decides appropriately if and when other professionals are needed to contribute to a patient’s care
G MA 17   The physician seeks and welcomes appraisal from patients and colleagues on the quality of her/his work and copes with feedback, even when negative
G MA 18   The physician gives examples of how the quality of health care is monitored, advanced and assured.

3.6 Health Advocate (HA)

Description:

At the end of undergraduate education and the beginning of postgraduate training physicians recognize their duty and ability to improve the overall health of their patients and the society they serve. Doctors identify advocacy activities as important for the individual patient, for populations of patients and for communities.

Competencies: The physician is able to...

... identify the important determinants of health that affect individual and population health, so as to have basic abilities to contribute to improving individual and societal health in Switzerland

Objective ID  
G HA 1   The physician recognizes and assesses the risk factors and the positive, healing resources of a specific patient and takes action to foster the resources and coping abilities and to minimize the risks.
G HA 2   The physician recognizes and assesses the health and illness behavior of a specific patient and integrates health promotion on an individual basis as part of the encounter.
G HA 3   The physician demonstrates knowledge of her/his role and ability to take appropriate action in disease, injury and accident prevention and protecting, maintaining and promoting the health of individuals, families and community.
G HA 4   The physician appreciates the potential conflict between the roles of health advocate for a patient or the community with that of gatekeeper.

... recognize issues, settings, circumstances, or situations which require advocacy on behalf of patients, professions, or society

Objective ID  
G HA 5   The physician identifies health needs of a community based on epidemiological data.
G HA 6   The physician describes in broad lines how current public policies affect the health of the populations served.
G HA 7   The physician strives for equity in the provision of health care

3.7 Scholar (SC)

Description:

At the end of undergraduate education and the beginning of postgraduate training phy- sicians engage in a lifelong pursuit of mastery of their domain of professional expertise. They recognize the need to be continually learning.

Competencies: The physician is able to...

... develop, implement, and document a personal continuing education strategy

Objective ID  
G SC 1   The physician regularly assesses personal learning needs and plans her/his education, recognizes errors and attempts to learn from them.
G SC 2   The physician strives to evaluate the outcome of learning and implements new competencies in her/his practice.

... apply basic principles of critical appraisal to sources of medical information. This involves developing scientific curiosity and use of scientific evidence in clinical decision making

Objective ID  
G SC 3   The physician demonstrates knowledge of general principles and methods of scientific medical research and their evolution over time.
G SC 4   The physician demonstrates knowledge of principles of critical appraisal and basic statistics.
G SC 5   The physician demonstrates awareness of the scientific base and conceptual framework of modern medicine, its perception in society and its historical evolution over time
G SC 6   The physician demonstrates up-to-date knowledge of the evidence-based standard of medical care for common ailments and illnesses and of the basic urgent interventions
G SC 7   The physician, starting from a patient problem, elaborates an appropriate clinical question and efficiently searches for an answer in the literature, using appropriate sources of information
G SC 8   The physician actively accesses relevant evidence and demonstrates basic ability to appraise the quality of evidence from different sources in the literature and proposes appropriate conclusions for patient care to the supervising physician
G SC 9   The physician seeks out opportunities to discuss the evidence base of clinical decision making and clinical care with colleagues and other health professionals
G SC 10   The physician shows ability to work with local / national guidelines and protocols and demonstrates a critical approach in doing this.
G SC 11   The physician demonstrates understanding that decisions in medical practice often are complex and based on uncertainty and probability data.

... facilitate the learning of patients, students and other health professionals

Objective ID  
G SC 12   The physician shows basic teaching skills in presentations for students and other health professionals.
G SC 13   The physician assesses and reflects on a teaching encounter and provides constructive feedback.

... contribute to the development, dissemination, and translation of new knowledge and practices

Objective ID  
G SC 14   The physician shows readiness and ability to participate in collaborative research projects.
G SC 15   The physician participates in the dissemination of new knowledge and practices among colleagues and other collaborators and its translation into daily practice.

3.8 Professional (PR)

Description:

At the end of undergraduate education and the beginning of postgraduate training phy- n and the beginning of postgraduate training physicians have a distinctive societal role as professionals who are dedicated to the health and caring of others.
The Professional Role is guided by codes of ethics and a commitment to clinical com- petence and the embracing of appropriate attitudes and behavior. Physicians are ac- countable to the society they serve.

Competencies: The physician is able to...

... deliver under supervision high quality care, exhibiting appropriate personal and interpersonal professional behavior

Objective ID  
G PR 1   The physician maintains and enhances appropriate knowledge, skills and professional behavior.
G PR 2   The physician shows awareness of cultural, societal and spiritual/religious issues that impact on the delivery of care.
G PR 3   The physician shows awareness that in the course of history the perception in society and by the patients of the role of the physician is changing.
G PR 4   The physician shows interest in the patient’s experiences relating to illness, care and interactions with the healthcare system.
G PR 5   The physician demonstrates knowledge and respect of the rights of all patients.
G PR 6   The physician demonstrates understanding of the threats to autonomy and dignity of patients that may result from the illness setting.
G PR 7   The physician recognizes that the patient’s wishes and preferences are central for medical decision making.
G PR 8   The physician takes into account the principles and limits of patient confidentiality as defined by professional practice standards and the law, e.g. only shares clinical information, whether spoken or written, with the patient’s consent and respects the patient’s right not to know.
G PR 9   The physician demonstrates an appropriate, caring attitude with consistently high standards of professional behavior, including honesty, integrity, accountability, commitment, compassion, empathy and altruism.
G PR 10   The physician maintains an appropriate balance between personal and professional roles and shows awareness of possible conflicts of interest.
G PR 11   The physician strives for equity in the provision of health care

... practice medicine in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a – in many respects - self-regulating body

Objective ID  
G PR 12   The physician shows awareness of the ethical dimension of medical practice and clinical decision-making.
G PR 13   The physician shows understanding of the function of ethics and appreciates the difference between ethics and morality as well as between ethics, politics and law.
G PR 14   The physician shows knowledge that there are ethical codes issued by the Swiss Academy of Medical Sciences relevant to her/his daily practice and that there is a professional code of conduct issued by the Swiss Medical Association and she/he demonstrates the ability to find these codes when needed and to apply them to pertinent problems.
G PR 15   The physician demonstrates knowledge of legal regulations and professional codes of conduct relevant for her/his daily clinical practice and the ability to apply them to pertinent problems.
G PR 16   The physician fulfills the regulatory and legal obligations required for daily clinical practice.
G PR 17   The physician shows awareness of possible conflict between health needs of individual patients and the health needs of the community
G PR 18   The physician continuously develops her or his sensitivity to ethical issues arising in the health care context and reflects on her or his own position and its premises especially concerning end of life issues.
G PR 19   The physician shows knowledge that there are different theoretical approaches to medical ethics (such as contractualist-based, principlist-based, patient rights-based, virtue-based or care ethics-based approaches).
G PR 20   The physician searches for an appropriate solution to an ethical problem considering the perspectives of others.
G PR 21   The physician copes with misconduct in an appropriate manner.
G PR 22   The physician identifies the ethical principles and values emerging in a given clinical situation or in a research-project and identifies the conflicts of ethical principles and values.
G PR 23   The physician identifies the ethical principles in decisions regarding discontinuation or withholding of life-support measures.