Public Health and Preventive Medicine

- This EPA focuses on identifying, accessing, and interpreting existing data sources (qualitative and/or quantitative) used in the assessment of the health of a community or population. - The observation of this EPA is based on the preparation of a short written report or an oral presentation. - For the achievement of this EPA, the resident must use at least two sources of data and assess at least three domains. - Examples of data sources include: a community profile from StatsCan; data from the ministry of health or the public health unit; surveillance data; clinical databases; surveys. - Examples of the domains of the health of a community or population include determinants of health, health system utilization, risk behaviours, and incidence and prevalence of disease.

Review of report or oral presentation by supervisor or Core or TTP PHPM resident Use Form 1. Form collects information on - Domains (select all that apply): population demographics; health system utilization; incidence and prevalence of disease; assessment of wellness; comparison with other jurisdictions; determinants of health; risk behaviours; specific populations (e.g., structurally disadvantaged) - Data source (write in): PUBLIC HEALTH AND PREVENTIVE MEDICINE (2025) Collect 1 observation of achievement - At least 3 domains, of which one must be population demographics - At least 2 sources of data

Suggested observations: 1

- This EPA focuses on effective oral and written communication of simple public health issues in a manner appropriate to the audience. - This includes accurate inclusion and synthesis of relevant issues, effective presentation in written and oral form, and response to questions as needed. - At this stage, it is expected that the audience would be internal to the training context, such as submission of a report to a supervisor or presentation to other residents or a health unit committee meeting. - The observation of this EPA requires both review of a written document as well as observation of an oral presentation; this may be two different topics or the same topic in both formats.

Review of written report and/or direct observation of oral presentation by supervisor or Core or TTP PHPM resident Use Form 1. Form collects information on: - Format: report; oral presentation Collect 2 observations of achievement - At least 1 oral presentation - At least 1 written report

Suggested observations: 2

- This EPA focuses on the role of the PHPM specialist as a member of an interprofessional team. - This includes contributing to the work of the team, understanding and respecting the roles of other team members, and demonstrating appropriate professional behaviours. - The observation of this EPA is based on a period of time of at least one week.

Direct observation by supervisor with input from other members of the team Use Form 1 Collect 1 observation of achievement

Suggested observations: 1

- This EPA links the academic training of PHPM to public health practice. - The focus of this EPA is applying knowledge of various qualitative and quantitative methods to explain differences in health and health-related behaviours. - This includes selection and application of specific methods, and appraisal of their results and their limitations and biases. - It does not require the resident to perform the data collection nor the data analysis. - This EPA may be observed with any public health question, project, or initiative.

Direct observation and/or review of written report and discussion by supervisor Use Form 1. Form collects information on: - Method: qualitative; quantitative; mixed Collect 3 observations of achievement - At least 1 qualitative method - At least 1 quantitative method

Suggested observations: 3

- This EPA focuses on critical appraisal of literature as a basis for informed decisions. - This observation of this EPA is based on presentation of a critical paper review at journal club or other venue. - The paper(s) may include either quantitative or qualitative methods and may include systematic reviews as well as primary research papers.

Direct observation or review of written report by supervisor Use Form 1. Form collects information on: - Methods (select all that apply): qualitative; quantitative - Type of study: primary; systematic review; other type of study Collect at least 3 observations of achievement - At least 1 with qualitative methods - At least 1 with quantitative methods - At least 1 primary study - At least 1 systematic review

- This EPA links clinical training to the PHPM approach to health assessment. - This includes a formulation of the patient’s case that includes an assessment and analysis of the determinants of health, the patient’s ability to access services and resources, and considerations of health equity. - It includes applying knowledge of the effectiveness of individual versus population- based interventions. - The observation of this EPA is based on selection and preparation of a case, using the PHPM framework, for discussion with a supervisor.

Case discussion and review of resident’s reflection on the case by supervisor Use Form 1 Collect 3 observations of achievement

Suggested observations: 3

- This EPA focuses on risk reduction and preventive care in the primary care setting for patients of all ages. - This includes age-appropriate screening for cancer and risk factors for chronic disease, as well as prenatal screening, well-child visits, immunization, and substance use and mental health screening, and, as relevant, patient counselling. - This EPA includes applying the principles of culturally safe practice and trauma- informed care in patient interactions, collecting information about the patient’s determinants of health, and responding to the patient’s individual needs. - Examples of responding to the patient’s needs include adapting the treatment or care plan (e.g. due to finances, barriers to care), providing referral to community resources (e.g. for food insecurity or homelessness), and facilitating access to treatment or resources.

Direct observation and/or case discussion or chart review by supervisor Use Form 1. Form collects information on: - Issue (select all that apply): prenatal screening; well-child visit; immunization; substance use/mental health screening; disease screening; acute or chronic disease risk; other issue - Age group: infant; child; adolescent; adult; pregnancy; older adult - Structurally disadvantaged group: no; yes - Observation (select all that apply): direct; case discussion or chart review Collect 10 observations of achievement - A variety of issues - A variety of age groups - At least 3 observations in a patient from a structurally disadvantaged group - At least 4 direct observations

Suggested observations: 10

- This EPA focuses on direct patient care for patients presenting with diseases or exposures that have public health implications, including assessment, diagnosis using appropriate tests, and development of a management plan. - Examples include: STI; TB; travel-related diseases; blood-borne infections; vaccine- preventable disease; environmental exposures; animal exposures; food-borne disease; vector-borne disease; occupational exposure/injury; and chronic diseases. - This includes applying the principles of culturally safe practice and trauma-informed care in patient interactions. - This EPA may be observed in a primary care clinic, emergency department, specialized clinic (e.g., ID clinic, STD clinic, etc.), or inpatient setting.

Direct observation and/or case discussion by supervising physician Use Form 1. Form collects information on: - Setting: primary care clinic; ED; specialized clinic; inpatient; other - Presentation: STI; TB; travel-related disease; blood-borne infection; vaccine- preventable disease; environmental exposure; animal exposure; food-borne illness; vector-borne disease; occupational exposure/injury; chronic disease; adverse event following immunization; other - Contact tracing/public health follow-up: yes; no Collect 10 observations of achievement - At least 2 different settings - At least 4 different presentations - At least 2 cases in which contact tracing or public health follow-up was indicated

Suggested observations: 10

- This EPA focuses on the role of a member of an interprofessional team that may include residents, students, physicians, nurses, and other health care professionals. - This includes communicating and working effectively with other team members, exhibiting professional behaviours, and responding to requests for assistance. - The observation of this EPA is based on a period of time of at least one week. - This EPA may be observed in any clinical setting.

Direct observation by supervisor with input from other members of the team Use Form 1. Form collects information on: - Setting: inpatient; outpatient; other Collect 2 observations of achievement

Suggested observations: 2

- This EPA focuses on performance of the key steps of an assessment; it does not require completion of the assessment from start to finish. - Observation focuses on the following steps: plan the assessment strategy/ framework; collect and/or identify relevant data/information (quantitative and/or qualitative); analyze data/information; synthesize data/information from multiple sources; determine the gap and/or significance; recommend action. - This EPA may be observed in a variety of PHPM activities. Examples include population health status assessment, health surveillance and its determinants, health needs assessment, health impact assessment, environmental health risk assessment, and health equity audits.

Direct observation and review of documents by supervisor, with input from other members of the team if relevant Use Form 1. Form collects information on: - Type of assessment: population health status; health needs; health impact; environmental health risk; health equity; other assessment - Step completed (select all that apply): plan; collect; analyze; synthesize; determine; recommend - Placement: public health agency; health authority; environmental health; occupational health; other government setting; other Collect at least 2 observations of achievement - At least 2 different types of assessments - At least 1 observation of each step

- This EPA focuses on the key steps of designing and developing population health interventions; the resident may complete one or more of these steps for any specific project. - This EPA includes incorporating the perspectives and concerns of structurally disadvantaged populations into the development of interventions. - Observation focuses on the following steps: identify the scope of the problem or issue; perform a review for known interventions and appraise the evidence; analyze the potential options; consider the context, partners, and the resource implications; select a course of action and provide rationale for the choice. - This EPA must be observed in a variety of PHPM activities. Examples include a variety of proposed interventions including new policy development or revision of existing policy, new program development or a redesign of an existing program, educational programs, emergency planning, and health promotion campaigns.

Direct observation and review of documents by supervisor, with input from other members of the team if relevant Use Form 1. Form collects information on: - Types of intervention: new policy, program, or other intervention; modification/update/redesign of existing policy, program, or other intervention; other activity - Step completed (select all that apply): identify scope; appraise evidence for interventions; analyze options; context, partner, and/or resource implications; select course of action - Setting: local/community; regional; provincial; national - Placement: public health agency; health authority; environmental health; occupational health; other government setting; other Collect at least 2 observations of achievement - At least 2 different types of interventions or programs - At least 1 observation for each step

- This EPA focuses on applying the principles of change management and implementation science to implement public health interventions and program activities. - This EPA includes incorporating the perspectives and concerns of structurally disadvantaged populations into the implementation of interventions. - This may include any or all of the following aspects of this task: working with partners; knowledge translation; social marketing; developing measures to track outcome. - Project management may be an important part of this task, but those skills are a focus of another EPA. - This EPA must be observed in a variety of PHPM activities. Examples include a variety of proposed interventions including new policy development or revision of existing policy, new program development or a redesign of an existing program, educational programs, and health promotion and protection interventions.

Direct observation and review of documents by supervisor, with input from other members of the team and/or partners if relevant Use Form 1. Form collects information on: - Activity: new policy, program, or other intervention; modification/update/redesign of policy, program, or other intervention; other activity - Aspect of task (select all that apply): working with partners; knowledge translation; social marketing; developing measures to track outcomes - Setting: local/community; regional; provincial; national - Placement: public health agency; health authority; environmental health; occupational health; other government setting; other Collect at least 2 observations of achievement - At least 2 different activities - At least 1 observation of each of the aspects of the task - At least 2 different settings

- This EPA focuses on the key steps of program evaluation; the resident may complete one or more of these steps for any specific project. - This EPA includes incorporating the perspectives and concerns of structurally disadvantaged populations into the evaluation of interventions. - Observation focuses on the following steps: collect data/outcomes/partner feedback; analyze data/outcomes/feedback; interpret the findings and the reasons for the findings; appraise the intervention or program against the purpose of the intervention/program; and provide recommendations. - This EPA must be observed in a variety of PHPM activities. Examples include new policy development or revision of existing policy, new program development or a redesign of an existing program, marketing campaigns, educational programs, and health promotion campaigns.

Direct observation and review of documents by supervisor, with input from other members of the team and/or partners if relevant Use Form 1. Form collects information on: - Activity: new policy, program, or other intervention; modification/update/redesign of existing policy, program, or other intervention; other activity - Step completed (select all that apply): collect data/outcomes/feedback; analyze data/outcomes/feedback; interpret findings; appraise; provide recommendations - Setting: local/community; regional; provincial; national - Placement: public health agency; health authority; environmental health; occupational health; other government setting; other Collect at least 2 observations of achievement - At least 2 different activities - At least 1 observation for each step

- This EPA focuses on developing an understanding of an issue, including a strategic analysis of the environment and actors who are involved and providing options and recommendations using a conceptual frame. - It may include a health impact assessment approach as well as considerations of health equity, and may include quantitative or qualitative components (or both). - This EPA may be observed with a variety of issues, examples include urban planning, environmental health, and communicable disease/chronic disease prevention.

Direct observation and review of documents/written report by supervisor, which may include input from other public health team members Use Form 1. Form collects information on: - Portion completed (select all that apply): strategic analysis; partner analysis; health impact assessment; health equity impact; policy brief with recommendations; other - Issue (write in): Collect 2 observations of achievement - At least 1 of each portion completed - At least 2 different issues

Suggested observations: 2

- This EPA focuses on public health management involving individual cases and contacts. - This includes ascertaining the etiology and/or source and verifying the patient has received appropriate treatment (and/or provide recommendations), and any other case management actions with consideration to any relevant legal/regulatory or ethical issues. - It also includes determining whether the case has broader implications requiring contact tracing and/or treatment/prophylaxis, and may include handing over the case, ongoing management, and/or follow-up and any required reporting. - This EPA includes completing the documentation. - Examples include: transmittable infections (enteric, respiratory, TB, STI, blood- borne); vector-borne infections; vaccine-preventable illnesses; animal bites; and environmental exposures.

Case review and/or review of documentation by supervisor Use Form 1. Form collects information on: - Domains: enteric; vector-borne; blood-borne; sexually transmitted; respiratory; TB; animal bite; vaccine-preventable; environmental; adverse event following immunization; other - Case with contact implications: yes; no Collect 8 observations of achievement - At least 6 domains - At least 1 requiring contact follow-up

Suggested observations: 8

- This EPA includes all aspects of identifying and responding to a public health incident that impacts more than one person. - This includes (as appropriate to the event) investigation, risk assessment, risk mitigation (such as implementing control measures), making recommendations for case management, and immediate and longer-term actions with consideration to any relevant legal/regulatory or ethical issues. - This may include actions related to public health emergency response and recovery, if relevant, and includes outbreaks/events at the local or community level. - The role of the resident may vary depending on the nature and scope of the incident. - Examples include communicable disease outbreaks (e.g., flu outbreak at a nursing home), environmental health exposures (e.g., water contamination), non- communicable diseases (e.g., cancer cluster), and occupational incidents (e.g., carbon monoxide exposure).

Direct observation (e.g., team meetings), case review, and review of written report by supervisor Use Form 1. Form collects information on: - Type of event: communicable; non-communicable; environmental; occupational; other - Role of resident (write in): Collect 4 observations of achievement - At least 2 communicable - At least 2 environmental

Suggested observations: 4

- This EPA focuses on the various elements of program and project management: operational planning (e.g., timeline and deliverables); managing a budget; resource planning; business case development; risk management (time and deadlines, resource constraints, existing policies, deliverables (scope of what can be done)); and quality improvement.

Direct and indirect observation by supervisor, with input from project sponsor and team members. This may also include review of documents (e.g., budget) Use Form 1. Form collects information on: - Project or program (write in): - Portion observed (select all that apply): operational planning; budget management; human resource planning; business case development; risk management; process mapping/quality improvement; other Collect at least 2 observations of achievement - At least 3 different portions observed - At least 2 different topics

- This EPA focuses on conveying public health issues through a variety of written documentation and other communications. - This includes using structures and formats suitable for the purpose and appropriate to practice standards, synthesizing the material in a comprehensive yet concise manner, applying a logical flow of information and rhetoric to build a persuasive argument, and using language and terminology that is appropriate to the audience. - The observation of this EPA must include a variety of written formats.

Review of written documentation by supervisor Use Form 1. Form collects information on: - Format: report; medical decision documentation (e.g., file note or medical consultation note); policy brief; briefing note; issue note; media lines/message; email; other format Collect 3 observations of achievement - At least 1 briefing note - At least 1 medical decision documentation - At least 1 other format

Suggested observations: 3

- This EPA focuses on effective oral communication of information to the public, their elected representatives, and health system and intersectoral partners. - It includes effective use of briefings, presentations, and mass media techniques where appropriate (e.g., print, radio or TV interviews), and may include creating or contributing to the communication plan and identifying key messages. - At this stage this does not include unplanned, unanticipated, or complex issues; these are an EPA of the Transition to Practice stage. - This EPA may be observed in a simulation setting.

Direct observation and/or review of presentation materials by supervisor Use Form 1. Form collects information on: - Issue (write in): - Medium: briefing; media interview; public meeting; other presentation - Audience (select all that apply): lay public; news media; senior bureaucrat/elected official(s); intersectoral partner(s) - Communication strategy/plan developed: no; yes Collect 3 observations of achievement - At least 3 different audiences - At least 1 observation where the resident developed the communication strategy/plan

Suggested observations: 3

- This EPA focuses on the role of the chair in running an effective meeting. - This includes planning for the meeting, preparing the agenda, leading the discussion, attending to meeting flow and organization, and encouraging participation and integrating information from the team. - This includes managing group dynamics and conflicts should they occur. - This EPA includes meetings addressing routine as well as complex issues and internal as well as external partners, but achievement of this EPA does not require competence in running meetings regarding issues known to be contentious nor acting in the role of chair for external meetings.

Direct observation by supervisor, with input from others at the meeting Use Form 1. Form collects information on: ­ Meeting attendees (select all that apply): public health team; other health care professionals; lay public; senior bureaucrats/elected officials; intersectoral partners; others Collect 2 observations of achievement

Suggested observations: 2

- This EPA focuses on the role of the PHPM specialist as a member of an interprofessional team that may include other health care professionals as well as community partners and individuals working in other sectors. - This includes communicating and working effectively with other team members, exhibiting professional behaviours, demonstrating cultural humility, mediating conflict, and responding to requests for assistance. - The observation of this EPA is based on a period of time of at least one week.

Direct observation by supervisor, with input from other members of the team Use Form 1. Form collects information on: - Setting: public health or other interprofessional team; intersectoral partners; health care team Collect 2 observations of achievement - At least 1 observation with intersectoral partners

Suggested observations: 2

- This EPA focuses on preparing a presentation (selecting, synthesizing and organizing information relevant to the topic and audience) and demonstrating good presentation skills.

Direct observation of presentation by supervisor, which may include a review of presentation materials (e.g., slides) Use Form 1. Form collects information on: - Audience (select all that apply): peers; faculty; health professionals; senior decision makers; other partners; public - Topic (write in): Collect 3 observations of achievement - A variety of audiences - A variety of topics - At least 1 academic presentation

Suggested observations: 3

- This EPA focuses on the role of the PHPM specialist as the most responsible physician in a public health service, practice, team, or unit, including on-call response. - It includes responsibility for any issues that may arise as well as ongoing work, setting priorities when there are multiple competing tasks, delegating/ distributing work, and overseeing/supporting the work of other team members. - It also includes supporting and enhancing well-being within the team. - It should also include participation in the management of the service, including human resources, finance, and planning. - The observation of this EPA is based on a period of at least two weeks in any public health setting.

Direct and indirect observation by supervisor, which may include input from others Use Form 1 Collect 2 observations of achievement - 2 different observers

Suggested observations: 2

- This EPA focuses on the approach to complex and/or challenging issues in PHPM practice. - This may include: conditions of uncertainty; multiple partners; multiple ownership of issues; multiple sources of evidence; financial and/or human resource restrictions; and, interactions between problems (cross-overs). - These issues require a sophisticated approach encompassing political acumen and incorporating the perspectives and concerns of structurally disadvantaged populations, and include critical thinking, collaborative practices, innovation in response, and co-construction of solutions. - This EPA may be observed with any issue, in any setting, and at any phase of the involvement of the PHPM specialist.

Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Topic (write in): Collect 1 observation of achievement

Suggested observations: 1

- This EPA focuses on effective communication of information to the public, their elected representatives, and health system and intersectoral partners. - It includes creating or contributing to a communication plan and identifying key messages, and effective use of briefings, presentations, and mass media techniques where appropriate (e.g., TV interviews). - At this stage, this includes urgent, unanticipated, or complex issues. - This EPA may be observed in a simulation setting.

Direct observation and/or review of presentation materials by supervisor Use Form 1. Form collects information on: - Issue (write in): - Medium: briefing; media interview; public meeting; other presentation - Audience: lay public; news media; senior bureaucrats/elected officials; intersectoral partner - Simulation: no; yes Collect 2 observations of achievement - At least 2 different audiences - At least 1 media interview

Suggested observations: 2

- This EPA focuses on identifying and reflecting on opportunities for professional and leadership development based on gaps in knowledge and skills and/or personal interests or career plans. - This includes developing plans for addressing those learning needs as part of the first steps of ongoing lifelong learning, as well as planning for how to maintain wellness in practice. - The observation of this EPA is based on the resident’s submission of a professional development plan and discussion with a supervisor. - The plans should be SMART (specific, measurable, assessable, realistic, and timely), and must include the appropriate choice of clinical experiences and/or appropriate academic resources (journals, textbooks, conferences).

Review of resident’s plan by supervisor Use Form 4 Collect 1 observation of achievement

Suggested observations: 1

- This EPA includes all aspects of performing scholarly work: identification of a question for investigation, literature review, data gathering, data analysis, data synthesis, reflective critique and dissemination. - This may include scholarly research, quality assurance, or educational projects. - The assessment of this EPA is based on the submission of a completed scholarly project and may also include observation of the presentation of the scholarly work.

Direct and/or indirect observation by supervisor Use Form 1 Collect 1 observation of achievement

Suggested observations: 1