Anesthesiology

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgical procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●urology
8. ●other surgery

Type of observation

1. ●direct
2. ●chart/case review

Medical Expert

• □ME 2.2 Elicit a history including relevant past medical history, review of old records, anesthetic history and functional review of systems
• □ME 2.2 Perform a pre-anesthetic physical examination, including an airway assessment
• □ME 2.2 Identify relevant investigations required prior to the scheduled minor procedure
• □ME 2.2 Synthesize clinical information for presentation to a supervisor in an organized manner

Communicator

• □COM 1.1 Communicate in a way that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.4 Identify, verify and validate non-verbal cues on the part of patients and their families
• □COM 2.2 Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 3.1 Communicate the plan of care in a clear, compassionate, respectful, and accurate manner to the patient and family
• □COM 3.1 Recognize when to seek help in providing clear explanations to the patient and family
• □COM 4.1 Communicate with cultural awareness and sensitivity
• □COM 4.3 Demonstrate steps to obtaining informed consent
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record

Collaborator

• □COL 2.1 Convey information thoughtfully (editorial revision 2023)
• □COL 2.1 Respond to requests and feedback in a respectful and timely manner

Scholar

• □S 1.1 Describe physicians’ obligations for lifelong learning and ongoing enhancement of competence

Professional

• □P 1.1 Prioritize the needs of patients and others to ensure a patient’s legitimate needs are met
• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities in a timely fashion (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgical procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●urology
8. ●other surgery

Type of anesthesia

1. ●general
2. ●regional

Medical Expert

• □ME 1.1 Demonstrate compassion for patients
• □ME 1.3 Apply the CAS Guidelines to the Practice of Anesthesia in preparing an operating room for patient care, including preparation of the required monitoring equipment
• □ME 1.3 Apply knowledge of the normal and abnormal physiologic values for adult patients during general or regional anesthesia
• □ME 1.5 Demonstrate awareness of limitations and seek help as needed in a timely manner (editorial revision 2023)
• □ME 3.4 Ensure that the OR is adequately prepared and that all necessary equipment and medications are readily available for the patient and proposed procedure
• □ME 3.1 Apply appropriate monitors for the planned surgical procedure
• □ME 5.2 Prepare medications and label syringes in a manner that optimizes patient safety and minimizes adverse events
• □ME 5.2 Apply the principles of proper sharps disposal in an operating room environment
• □ME 5.2 Demonstrate situational awareness
• □ME 3.4 Demonstrate knowledge of appropriate setting of visual and auditory alarms in the continued monitoring of the adult ASA1 or 2 patient under general or regional anesthesia undergoing a minor elective surgical procedure
• □ME 5.2 Apply the principles of universal precautions and importance of infection prevention and control in preparing an operating room for a patient and proposed procedure

Communicator

• □COM 5.1 Document anesthetic care and physiologic values at appropriate intervals during the continued monitoring under general or regional anesthesia

Collaborator

• □COL 1.1 Describe the role of respiratory therapists/anesthesia assistants in the preparation of an OR for patient care
• □COL 1.2 Negotiate overlapping and shared responsibilities of preparing an operating room with respiratory therapists/anesthesia assistants/RNs/RPNs
• □COL 1.3 Work with the team by communicating abnormal physiologic values that require attention

Leader

• □L 4.1 Demonstrate awareness of the organization of operating room preparation such that it efficiently uses the time available in the operating room for the patient and proposed procedure

Professional

• □P 1.1 Prioritize the needs of patients and others to ensure the patient’s legitimate needs are met
• □P 1.2 Ensure that operating rooms are always prepared appropriately before engaging in patient care (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●urology
8. ●other surgery

Type of anesthesia

1. ●general
2. ●regional
3. ●monitored anesthesia care (MAC)

Medical Expert

• □ME 5.1 Recognize the occurrence of a patient safety incident
• □ME 5.2 Describe and demonstrate the principles of situational awareness and their implications for medical practice, among other by ensuring that the patient is stable before leaving the post anesthetic care unit
• □ME 2.4 Describe the various levels of patient care available in their center (step down, remote oximetry, ICU, etc.)

Communicator

• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record
• □COM 5.1 Complete clinical documentation in a timely manner, including documenting patient status on arrival to PACU
• □COM 5.1 Write orders clearly and legibly, using pre-printed order sets where appropriate (editorial revision 2023)

Collaborator

• □COL 2.1 Convey information thoughtfully
• □COL 2.1 Respond to requests and feedback in a respectful and timely manner
• □COL 3.2 Provide information required for safe and effective handover during transitions in care, specifically, relating the necessary information to the receiving nurse
• □COL 3.2 Ensure receiving nurse is comfortable with the level of care required by the patient

Health Advocate

• □HA 1.1 Analyze a given patient’s needs for health services or resources related to the scope of anesthesiology

Professional

• □P 1.1 Complete assigned responsibilities in a timely fashion (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●trauma
8. ●urology
9. ●other surgery

Type of observation

1. ●direct
2. ●indirect

Observation of consent

1. ●[select all that apply] not done
2. ●done
3. ●language barrier
4. ●cognitive impairment
5. ●substitute decision maker

Medical Expert

• □ME 1.1 Demonstrate compassion for patients
• □ME 1.3 Apply clinical and biomedical sciences to manage patient presentations in anesthesiology, internal medicine, and surgery
• □ME 1.3 Demonstrate an understanding of common non-complex surgical procedures and how surgical requirements impact upon anesthetic management
• □ME 1.5 On the basis of patient-centered priorities, seek assistance to prioritize multiple competing tasks that need to be addressed
• □ME 2.2 Synthesize patient information into prioritized anesthetic considerations, including considerations relevant to the surgical procedure
• □ME 2.4 Establish patient-centred anesthetic management plans, including preoperative investigations and optimization, intraoperative monitoring, use of regional anesthesia, or need for blood products, and the postoperative period
• □ME 3.1 Determine the most appropriate anesthetic management in relation to patient’s condition and surgical procedure
• □ME 3.2 Demonstrate knowledge of the potential risks and benefits of the procedure and/or intervention, and the specific risks for the patient

Communicator

• □COM 1.6 Assess patient’s capacity to understand and appreciate the issues and risks, participate in decision-making and provide informed consent
• □COM 3.1 Convey information about the procedure, risks, benefits and alternatives to the patient clearly
• □COM 4.3 Answer questions from the patient and family
• □COM 5.1 Document informed consent for commonly performed anesthesia procedures and therapies
• □COM 5.1 Ensure the anesthetic chart is legible and well organized

Collaborator

• □COL 2.2 Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts

Scholar

• □S 1.1 Recognize gaps in competencies and seek corrective solutions 16 S 1.1Accept feedback readily and incorporate suggestions for improvement
• □S 1.1 Engage in self-reflection and self- assessment to improve performance (editorial revision 2023)
• □S 3.4 Incorporate evidence-based medicine into clinical practice

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing consent (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgical procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●trauma
8. ●urology
9. ●other surgery

Type of anesthesia

1. ●general
2. ●neuraxial
3. ●regional
4. ●monitored anesthesia care (MAC)

Priority of surgery

1. ●elective
2. ●urgent

Observation

1. ●direct
2. ●indirect

Medical Expert

• □Part A: ME 2.2 Perform a focused history, including a review of electronic medical records, and physical exam including regional areas where invasive procedures may be planned, review investigations, and interpret their results for the purpose of preoperative assessment and optimization of patient prior to surgery
• □Part A: ME 2.2 Synthesize patient information into prioritized anesthetic considerations, including important considerations relevant to the proposed surgical procedure
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and alternatives for the anesthetic management of the patient
• □Part A: ME 3.1 Determine the most appropriate anesthetic management in relation to patient’s condition and surgical procedure
• □Part A: ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □Part A: ME 3.3 Determine the urgency of the procedure
• □Part A: ME 2.2 Determine the patient’s readiness for surgery and judge the appropriate optimization of the emergency patient
• □Part A: ME 3.4 Perform all case management skills with appropriate proficiency including adapting to unanticipated findings or changing clinical circumstances, anticipation and management of issues around induction, maintenance, emergence of anesthesia, and pain management
• □Part A: ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety
• □Part A: ME 5.2 Demonstrate situational awareness
• □Part A: ME 5.2 Demonstrate an understanding of the anesthetic guidelines of practice and their appropriate application
• □Part B: ME 5.2 Demonstrate situational awareness

Communicator

• □Part A: COM 1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion (editorial revision 2023)
• □Part A: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part A: COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements
• □Part B: COM 1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part B: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part B: COM 5.2 Write orders clearly and legibly, using pre-printed order sets where appropriate (editorial revision 2023)

Collaborator

• □Part A: COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □Part A: COL 3.2 Provide handover of anesthetic care to the recovery unit and communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed
• □Part B: COL 1.1 Receive and appropriately respond to input from other health care professionals
• □Part B: COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □Part B: COL 2.1 Actively listen to and engage in interactions with collaborators
• □Part B: COL 2.2 Listen to understand and find common ground with collaborators
• □Part B: COL 3.2 Provide handover of anesthetic care to the recovery unit and communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Leader

• □Part A: L 4.2 Demonstrate leadership skills in the peri-operative environment including participation in “time-out” sessions
• □Part B: L 1.1 Demonstrate leadership skills in the peri-operative environment including participation in “time-out” sessions

Scholar

• □Part A: S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions
• □Part A: S 1.2 Review post-operative patient follow-up as a source of information on one’s own performance and opportunities for learning and improvement
• □Part A: S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing one’s own performance using various internal and external data sources

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours
• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □Part A: P 4.1 Manage the impact of physical and environmental factors on performance and on patient well-being during anesthetic management
• □Part B: P 1.1 Exhibit appropriate professional behaviours
• □Part B: P 1.5 Exhibit professional behaviours in the use of technology-enabled communication (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Procedure

1. ●arterial line
2. ●central line
3. ●spinal

Use of ultrasound

1. ●yes
2. ●no

Anatomical site of central line

1. ●not applicable
2. ●jugular
3. ●subclavian
4. ●femoral
5. ●PICC

Setting

1. ●operating room
2. ●ICU
3. ●ER
4. ●other setting

Medical Expert

• □Part A: ME 3.1 Describe the indications, contraindications, risks and alternatives for basic procedures
• □Part A: ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning
• □Part A: ME 3.4 Perform procedural tasks in a timely, fluid, skillful, and safe manner
• □Part A: ME 3.4 Identify changing clinical circumstances or unanticipated findings and seek assistance as needed
• □Part A: ME 3.4 Recognize and manage common complications of basic procedures

Communicator

• □Part A: COM 1.2 Optimize the clinical environment for patient comfort, privacy, engagement and safety
• □Part A: COM 5.1 Document the encounter to convey the procedure and outcome (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply knowledge of airway anatomy and physiology
• □ME 1.3 Apply knowledge of the indications, contraindications, basic pharmacology and risks of sedation during airway management
• □ME 1.4 Perform focused clinical assessments
• □ME 2.2 Synthesize clinical data to identify patients with the potential for a difficult airway and/or bag mask ventilation (editorial revision 2023)
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.3 Apply knowledge of the criteria for a safe extubation
• □ME 1.3 Apply knowledge of difficult airway management algorithms and cognitive aids
• □ME 1.3 Apply knowledge of the indications, contraindications, risks and alternatives for the different airway management tools
• □ME 1.3 Apply knowledge of the differences between adult and pediatric difficult airway management
• □ME 2.4 Develop an airway management plan, and alternatives, for patients with an anticipated difficult airway
• □ME 3.2 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □ME 3.4 Prepare equipment and supplies for airway management
• □ME 3.3 Consider urgency, and potential for deterioration, in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □COM 5.1 Document information about the airway difficulty in a manner that enhances intra- and inter-professional care

Collaborator

• □COL 1.1 Respect established rules of their team
• □COL 2.1 Actively listen to and engage in interactions with collaborators

Leader

• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Scholar

• □S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgical procedure

1. ●general surgery
2. ●gynecology
3. ●ophthalmology
4. ●orthopedic surgery
5. ●otolaryngology
6. ●plastic surgery
7. ●urology
8. ●spine surgery
9. ●neurosurgery
10. ●other surgery

Positioning of patient

1. ●supine
2. ●supine with laparoscopic surgery
3. ●gynecologic positioning/lithotomy
4. ●lateral decubitus
5. ●prone
6. ●sitting/semi-sitting
7. ●other

Medical Expert

• □ME 1.3 Apply basic anatomy and physiology to manage patient positioning and related complications during surgery
• □ME 2.4 Develop and implement management plans for common problems or issues related to patient positioning during surgery
• □ME 3.2 Describe the indications, contraindications, risks, and alternatives for a given positioning during surgery
• □ME 3.4 Position the patient for the procedure in a skillful, fluid, and safe manner
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans related to positioning injury considering potential involvement of multiple physicians and healthcare professionals (editorial revision 2023)
• □ME 5.1 Recognize near-misses in real time and respond to correct them, preventing them from reaching the patient
• □ME 5.1 Incorporate, as appropriate, into a differential diagnosis, postoperative complications related to patient positioning

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 1.2 Coordinate and lead the work of all team members involved in patient positioning for surgery
• □COL 2.2 Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □Part A: ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □Part A: ME 2.4 Develop and implement initial management plans
• □Part A: ME 4.1 Establish appropriate follow-up for common intraoperative problems
• □Part A: ME 2.2 Anticipate the most likely intraoperative events and physiologic changes based on the patients’ medical history and type of surgery
• □Part A: ME 2.4 Develop strategies, including optimal monitoring, to favour prevention and early diagnosis of intraoperative events and physiologic changes
• □Part A: ME 3.3 Consider urgency, and potential for deterioration, in advocating for the timely execution of a procedure or therapy
• □Part A: ME 3.4 Perform common procedures in a skillful, fluid, and safe manner including appropriate infection control measures and using protective equipment
• □Part A: ME 5.2 Demonstrate situational awareness
• □Part B: ME 5.1 Differentiate outcomes of medical conditions and diseases from complications related to the inherent risks of treatments and from patient safety incidents (editorial revision 2023)

Communicator

• □Part A: COM 5.1 Organize information in appropriate sections within an electronic or written medical record
• □Part A: COM 5.1 Record intraoperative events in a complete and accurate manner
• □Part A: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □Part A: COL 1.3 Apply effective communication strategies with members of the operating room team to optimize response to perioperative events in a timely manner
• □Part A: COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues

Scholar

• □Part B: S 2.3 Identify unsafe clinical situations involving learners and manage them appropriately

Professional

• □Part A: P 1.1 Complete assigned responsibilities in a timely fashion (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●OR
2. ●PACU
3. ●ICU
4. ●ward
5. ●other location

Medical Expert

• □ME 1.3 Apply knowledge of physiology and pathophysiology of blood loss
• □ME 2.2 Recognize signs and symptoms of acute hemorrhage and predict volume of blood loss
• □ME 2.4 Develop strategies for perioperative management to minimize blood loss (editorial revision 2023)
• □ME 1.3 Apply best evidence and guidelines for the transfusion of blood products
• □ME 3.2 Obtain and properly document informed consent for administration of blood products
• □ME 3.2 Describe the indications, contraindications and risks for crystalloid and/or colloid fluid administration and the replacement of blood products such as: RBC, frozen plasma (FP), prothrombin complex concentration (PCC), platelets, cryoprecipitate

Communicator

• □COM 4.1 Explore the patient preferences and cultural practices regarding blood products when developing care plans
• □COM 5.1 Document information about fluid and blood products administered and the response of the patient

Collaborator

• □COL 1.3 Seek out and respond to input from the surgical team when fluid resuscitating a critically ill patient

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 2.2 Consider costs of blood products when choosing care options
• □L 1.1 Improve clinical practice by applying a process of continuous quality improvement to the perioperative optimization of anemia

Scholar

• □S 3.4 Incorporate evidence-based medicine into clinical practice

Professional

• □P 3.1 Adhere to ABO blood compatibility and blood product administration guidelines (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of issue

1. ●pain
2. ●nausea and/or vomiting
3. ●hypotension
4. ●hypertension
5. ●arrhythmias
6. ●cardiac ischemia
7. ●hypoxemia
8. ●respiratory depression
9. ●bronchospasm
10. ●pulmonary edema
11. ●deep venous thrombosis
12. ●delirium
13. ●slow awakening
14. ●decreased urine output
15. ●other issue

Location

1. ●PACU
2. ●surgical ward
3. ●ICU
4. ●other location

Type of observation

1. ●direct
2. ●indirect

Type of surgical procedure

1. ●general surgery
2. ●gynecology
3. ●neurosurgery
4. ●ophthalmology
5. ●orthopedic surgery
6. ●otolaryngology
7. ●plastic surgery
8. ●thoracic surgery
9. ●urology
10. ●vascular surgery
11. ●other surgery

Medical Expert

• □ME 1.3 Apply knowledge of the anatomy and physiology of acute pain
• □ME 1.4 Perform focused clinical assessments
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.4 Develop and implement management plans for common postoperative problems diagnosed in the post-anesthesia care unit or the surgical ward
• □ME 1.3 Apply knowledge of the pharmacology of various groups of analgesics available for management of acute pain
• □ME 2.4 Develop and implement initial management plans
• □ME 3.3 Prioritize and advocate for the timely execution of a procedure or therapy, taking into account clinical urgency and available resources
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □ME 5.1 Prioritize the initial medical response to adverse events to mitigate further injury
• □ME 2.2 Develop and prioritize differential diagnosis
• □ME 5.1 Incorporate, as appropriate, into a differential diagnosis, harm from health care delivery
• □ME 2.2 Establish the diagnosis of common complications in the post- anesthesia care unit or the surgical ward in a timely manner
• □ME 2.2 Integrate the patient’s medical history, type of surgery and perioperative factors to anticipate which patients are at higher risk for postoperative surgical or medical complications
• □ME 5.2 Apply strategies and ensure optimal specific monitoring to prevent complications

Communicator

• □COM 4.1 Explore the perspectives of the patient and others when developing care plans
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions (editorial revision 2023)

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 1.2 Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care
• □COL 3.2 Communicate with the attending physician or other appropriate member of the health care team about the patient’s condition and care
• □COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with ongoing issues

Leader

• □L 1.1 Seek data to inform practice and engage in an iterative process of improvement
• □L 4.1 Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

Health Advocate

• □HA 2.2 Improve clinical practice by identifying patients or populations that are not being optimally treated for pain

Scholar

• □S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 2.2 Monitor institutional and clinical environments and respond to issues that can harm patients or the impact the delivery of health care (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●PACU
2. ●surgical ward
3. ●medical ward
4. ●ICU
5. ●ER
6. ●OR
7. ●other location

Type of condition

1. ●respiratory distress
2. ●cardiac event
3. ●shock
4. ●neurologic condition
5. ●cardiac arrest
6. ●other condition

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.5 On the basis of patient-centred priorities, seek assistance to prioritize multiple competing tasks that need to be addressed
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement initial management plans, prioritizing issues to be addressed, in a time appropriate manner
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved (editorial revision 2023)

Communicator

• □COM 3.1 Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Contribute effectively in interprofessional teams (e.g. nurses, RTs)
• □COL 1.3 Communicate appropriately with supervising staff (supervising resident or attending physician) if significant concerns are identified during patient assessment
• □COL 1.2 Participate in debriefing, post critical incident

Scholar

• □S 3.4 Incorporate evidence-based medicine into clinical practice

Professional

• □P 4.2 Report any medical/psychological/substance abuse/fatigue concerns that may limit one’s ability to provide optimal patient care
• □P 1.1 Accept feedback readily and incorporate suggestions for improvement
• □P 4.1 Demonstrate the ability to remain calm and professional in stressful situations
• □P 2.2 Pay close attention to the continuing care of the patient beyond the technical execution of resuscitation, reliably and conscientiously (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●surgical ward
2. ●medical ward
3. ●coronary care unit
4. ●ICU
5. ●ER
6. ●other location

Type of condition

1. ●surgical condition
2. ●chest pain
3. ●shortness of breath
4. ●altered LOC
5. ●fever
6. ●hemodynamic instability
7. ●other condition

Observer

1. ●staff
2. ●senior resident

Focus of observation

1. ●(select all that apply) patient assessment and management
2. ●communication with patient
3. ●handover

Type of observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage patient presentations in anesthesiology, internal medicine and surgery
• □ME 1.3 Apply knowledge of the pathophysiology and clinical presentations of common medical and/or surgical conditions
• □ME 1.4 Perform focused clinical assessments
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Communicator

• □COM 2.2 Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □COM 1.1 Communicate in a way that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.5 Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state
• □COM 3.1 Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family
• □COM 3.1 Use language free of medical jargon
• □COM 4.3 Answer questions from the patient and family (editorial revision 2023)
• □COM 5.1 Document information about patients and their medical conditions in focused, clear, coherent, legible progress notes, handover notes, and/or discharge summaries

Collaborator

• □COL 1.1 Contribute effectively in interprofessional teams by respecting established rules of their team, eliciting, engaging and valuing input from all healthcare professionals.
• □COL 1.2 Describe the roles and scopes of practice of other health care providers related to the discipline: e.g. role of general surgeon when on general surgery rotation
• □COL 2.2 Listen to understand and find common ground with collaborators
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □COL 3.2 Communicate with physicians or health care professionals during transitions in care, clarifying issues after transfer as needed
• □COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues
• □COL 3.2 Recognize and act on patient safety issues in the transfer of care
• □COL 3.2 Summarize patient issues for concise, prioritized presentation to other team members.
• □COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care

Health Advocate

• □HA 1.3 Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection (editorial revision 2023)

Scholar

• □S 2.4 Demonstrate basic skills in teaching others, including peers
• □S 3.4 Incorporate evidence-based medicine into clinical practice

Professional

• □P 1.1 Independently manage specialty-specific issues surrounding confidentiality, intervening when confidentiality is breached
• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Issue

1. ●routine prenatal
2. ●routine initial assessment during labour
3. ●acute medical
4. ●acute surgical
5. ●acute obstetric

Setting

1. ●prenatal clinic
2. ●labour and delivery
3. ●other setting

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage presentations in pregnant patients
• □ME 1.4 Perform focused clinical assessments
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance immediately
• □ME 2.4 Develop and implement initial management plans (editorial revision 2023)
• □ME 2.4 Diagnose and initiate management of common obstetric emergencies such as antepartum haemorrhage, post-partum haemorrhage, placental abruption and placenta previa
• □ME 2.4 Diagnose and initiate management of common medical and surgical conditions during pregnancy such as diabetes, hypertension, sepsis, appendicitis or kidney stones
• □ME 2.4 Develop management plans that integrate basic fetal physiology, potential fetal effects of acute medical and obstetrical conditions, and basic principles of fetal heart rate monitoring, including intrauterine resuscitation
• □ME 3.2 Describe the indications, contraindications, risks, and alternatives for fluid therapy and for transfusion of blood products in the perioperative or periobstetrical context
• □ME 2.2 Synthesize the clinical information for clear and succinct presentation to supervising residents or consultants

Communicator

• □COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Collaborator

• □COL 2.2 Manage differences in opinion and conflict situations arising in the interdisciplinary team effectively and constructively

Scholar

• □S 3.4 Incorporate evidence-based medicine into clinical practice

Professional

• □P 1.1 Demonstrate reliability and conscientiousness in comprehensive patient centered care (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of analgesia provided

1. ●epidural
2. ●other analgesia

Type of observation

1. ●direct
2. ●case review

Medical Expert

• □Part A: ME 1.3 Apply clinical and biomedical sciences to manage presentations in pregnant patients
• □Part A: ME 1.4 Perform focused clinical assessments of a parturient during labor, acknowledge limitations of the assessment in this specific context and demonstrate strategies to overcome those limitations
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy to provide optimal labour analgesia
• □Part A: ME 2.4 Integrate all sources of information to develop and initiate a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □Part A: ME 2.2 Analyze fetal heart rate monitoring before and after provision of labour analgesia
• □Part A: ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning
• □Part A: ME 3.4 Perform labour epidural analgesia or other common procedures to provide labour analgesia in a skillful, fluid, and safe manner, including appropriate sterile technique
• □Part A: ME 4.1 Ensure adequate follow up of the parturient receiving labour analgesia
• □Part A: ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part B: ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □Part B: ME 1.4 Perform focused clinical assessments of a parturient during labor, acknowledge limitations of the assessment in this specific context and demonstrate strategies to overcome those limitations
• □Part B: ME 2.4 Develop and implement initial management plans
• □Part B: ME 3.4 Seek assistance as needed when unanticipated findings, difficulties or changing clinical circumstances are encountered

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □Part A: COM 4.1 Communicate with cultural awareness and sensitivity
• □Part A: COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements
• □Part B: COM 4.1 Communicate with cultural awareness and sensitivity
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □Part A: COL 1.1 Receive and appropriately respond to input from other health care professionals (editorial revision 2023)
• □Part A: COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □Part B: COL 1.1 Receive and appropriately respond to input from other health care professionals

Leader

• □Part A: L 4.1 Organize work using strategies that address strengths and identify areas to improve in personal effectiveness
• □Part B: L 4.1 Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

Health Advocate

• □Part A: HA 1.2 Select patient education resources related to obstetrical analgesia and anesthesia

Scholar

• □Part A: S 3.3 Interpret study findings, including a critique of their relevance to their practice

Professional

• □Part B: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of anesthesia

1. ●spinal
2. ●use of epidural previously inserted for labor analgesia
3. ●GA

Priority of surgery

1. ●scheduled
2. ●urgent

Medical Expert

• □ME 1.1 Demonstrate compassion for patients
• □ME 1.3 Apply clinical and biomedical sciences to manage presentations in pregnant patients
• □ME 1.4 Perform focused clinical assessment
• □ME 2.4 Develop and implement initial management plans
• □ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □ME 3.4 Perform common procedures in a skillful, fluid, and safe manner including appropriate infection control measures and using protective equipment
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered (editorial revision 2023)
• □ME 4.1 Diagnose and initiate management of common neuraxial anesthesia complications such as inadequate anesthesia, high spinals and hypotension
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □COM 4.1 Communicate with cultural awareness and sensitivity
• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.1 Respect established rules of their team
• □COL 2.2 Manage differences in opinion and conflict situations arising in the interdisciplinary team effectively and constructively
• □COL 3.2 Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Scholar

• □S 1.1 Demonstrate a structured approach to monitoring progress of learning in the clinical setting

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgical procedure

1. ●general surgery
2. ●ophthalmology
3. ●orthopedic surgery
4. ●otolaryngology
5. ●plastic surgery
6. ●urology
7. ●other surgery

Type of anesthesia

1. ●general
2. ●neuraxial
3. ●regional

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Perform a focused history, including a review of electronic medical records, and physical exam including regional areas where invasive procedures may be planned, review investigations, and interpret their results for the purpose of preoperative assessment and optimization of patient prior to surgery
• □ME 2.2 Synthesize patient information to determine anesthetic considerations, including considerations relevant to the surgical procedure
• □ME 2.4 Develop and implement initial management plans
• □ME 3.1 Determine the most appropriate anesthetic management in relation to patient’s condition and surgical procedure
• □ME 3.4 Perform the anesthetic management plan (editorial revision 2023)
• □ME 3.2 Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies
• □ME 3.4 Perform common procedures in a skillful, fluid, and safe manner including appropriate infection control measures and using protective equipment
• □ME 5.1 Incorporate, as appropriate, into a differential diagnosis, harm from health care delivery
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Communicator

• □COM 3.1 Use language that is clear and avoid medical jargon
• □COM 1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Collaborator

• □COL 3.2 Communicate with physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Scholar

• □S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

Professional

• □P 1.1 Exhibit appropriate professional behaviours (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of observation

1. ●direct
2. ●case review

Type of complication

1. ●pain
2. ●nausea
3. ●vomiting
4. ●tachycardia
5. ●bradycardia
6. ●hypotension
7. ●hypoxemia
8. ●respiratory depression
9. ●laryngospasm
10. ●post op stridor
11. ●postoperative bleeding
12. ●delirium
13. ●other complication

Setting

1. ●PACU
2. ●surgical ward
3. ●other setting

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage presentations in pediatric patients
• □ME 1.4 Perform focused clinical assessments
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.4 Develop and implement initial management plans
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment (editorial revision 2023)

Communicator

• □COM 3.1 Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
• □COM 3.2 Disclose patient safety incidents to patients and their families accurately and appropriately with staff guidance if appropriate
• □COM 5.1 Document information about patients and their medical conditions in focused, clear, coherent, legible progress notes, handover notes, and/or discharge summaries
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 2.2 Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts
• □COL 3.2 Communicate with the attending physician or other appropriate member of the health care team about the patient’s condition and care

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Condition

1. ●upper/lower respiratory tract infections
2. ●urinary tract infections
3. ●minor injuries
4. ●febrile illness
5. ●other condition

Medical Expert

• □ME 1.1 Demonstrate compassion for patients
• □ME 1.3 Apply clinical and biomedical sciences to manage presentations in pediatric patients
• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of developing a differential diagnosis and an initial management plan
• □ME 2.4 Discuss with the patient and family the degree of uncertainty inherent in all clinical situations
• □ME 2.4 Integrate all sources of information to develop and initiate a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches (editorial revision 2023)
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered

Communicator

• □COM 1.6 Assess patients’ decision-making capacity taking into account patient age and developmental stage, include parents and other caregivers in discussion
• □COM 2.2 Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent

Collaborator

• □COL 1.1 Differentiate between task and relationship issues among health care professionals
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □COL 3.2 Communicate with physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Scholar

• □S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 1.3 Recognize and respond to ethical issues encountered in practice, including competence, consent, and confidentiality (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of co-morbidity

1. ●cancer: cardiovascular disease
2. ●connective tissue disease
3. ●diabetes mellitus
4. ●end organ disease
5. ●endocrine disorders
6. ●frailty
7. ●significant hematological disorders
8. ●infectious diseases
9. ●morbid obesity
10. ●neurological diseases
11. ●neuromuscular and musculoskeletal disease
12. ●obstructive sleep apnea (OSA)
13. ●organ transplantation
14. ●advanced significant respiratory disease

Type of procedure

1. ●cardiac surgery
2. ●general surgery
3. ●gynecology
4. ●neurosurgery
5. ●ophthalmology
6. ●orthopedic surgery
7. ●otolaryngology
8. ●plastic surgery
9. ●thoracic surgery
10. ●urology
11. ●vascular surgery

Type of observation

1. ●direct
2. ●indirect

Location

1. ●preop clinic
2. ●ward, OR

Timing of surgery

1. ●elective
2. ●urgent
3. ●emergent

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage perioperative assessment in complex patients
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 1.6 Seek assistance in situations that are complex or new
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in identifying and resolving conflicting anesthetic priorities
• □ME 2.2 Select and interpret relevant perioperative investigations and integrate the results to assess risk and to appropriately modify perioperative management plan
• □ME 2.4 Develop an anesthetic management plan, demonstrating sound judgment and insight
• □ME 2.4 Assess perioperative risk and apply risk reduction strategies
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration

Communicator

• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 1.6 Tailor approaches to decision-making to a patient’s and/or family’s capacity, values, and preferences
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours (editorial revision 2023)

Scholar

• □S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of critical life support [select all that apply]

1. ●circulatory
2. ●respiratory
3. ●renal
4. ●other life support

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.3 Apply knowledge of advanced life support to optimize and prepare the patient and operating room for surgical intervention in the critically ill patient
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 1.3 Apply knowledge of physiologic derangements and their impact on anesthesia care in considering the risks and benefits of all approaches
• □ME 3.4 Establish and implement a plan for post-anesthesia care (editorial revision 2023)
• □ME 2.4 Develop an anesthetic management plan, demonstrating sound judgment and insight
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with physician and other colleagues in the health care professions
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 1.2 Contribute to a culture that promotes patient safety
• □L 4.3 Implement processes to ensure personal practice improvement

Health Advocate

• □HA 1.1 Respond to an individual patient’s health needs

Professional

• □P 1.1 Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of cardiac disease

1. ●coronary disease
2. ●mitral stenosis
3. ●mitral regurgitation
4. ●aortic stenosis
5. ●aortic regurgitation
6. ●cardiomyopathy
7. ●left ventricular dysfunction
8. ●right ventricular dysfunction
9. ●other (write in)

Type of surgery

1. ●cardiac
2. ●other surgery

Intraoperative hemodynamic monitors used

1. ●none
2. ●central line
3. ●pulmonary artery catheter
4. ●TEE
5. ●other (write in)

Hemodynamic support

1. ●none
2. ●vasopressors
3. ●inotropes
4. ●anti-dysrhythmic
5. ●other (write in)

Medical Expert

• □ME 1.3 Apply knowledge of the clinical and biomedical sciences relevant to anatomy, physiology, pharmacology and embryology of the cardiac system
• □ME 2.2 Interpret the summary reports of cardiac investigations and appropriately use the data in the anesthetic management (editorial revision 2023)
• □ME 2.2 Synthesize patient information to determine indications for invasive and non- invasive monitoring
• □ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 3.1 Integrate all sources of information to develop an anesthetic induction plan that is safe with specific hemodynamic goals adapted to the pre-existing cardiac disease
• □ME 3.4 Establish invasive monitoring in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 4.1 Establish plans for ongoing and postoperative care
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □COL 1.3 Convey the anesthetic plan to the interprofessional team
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of practice (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●OR
2. ●ICU
3. ●ward
4. ●ER

Medical Expert

• □ME 1.4 Perform an appropriate history and physical assessment to identify patients with the potential for a difficult airway
• □ME 2.2 Synthesize patient information to identify a difficult airway, including identifying co-morbidities placing the patient at a higher risk of having a difficult airway, in a timely manner (editorial revision 2023)
• □ME 2.2 Identify those patients and disease states which are at higher risk of a difficult airway
• □ME 2.4 Formulate and implement management plans that consider all of the patient’s health problems and context, in a timely manner, in collaboration with patients and their families and, when appropriate, the interprofessional team
• □ME 2.4 Integrate all sources of information to develop a clear and safe plan, including extubation and post-operative care
• □ME 3.4 Competently and safely provide airway management in a timely manner
• □ME 4.1 Establish plans for ongoing and postoperative care
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 5.2 Adopt strategies that promote patient safety and address human and system factors

Communicator

• □COM 3.1 Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Communicate with the health care team using closed loop communication and clear language

Leader

• □L 4.2 Assume a leadership role, and delegate tasks and responsibilities in an appropriate and respectful manner

Scholar

• □S 1.2 Keep a log of difficult airway cases and include techniques and airway adjuncts to guide future required learning experiences

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence
• □P 4.1 Demonstrate the ability to remain calm and professional in stressful situations (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of patient

1. ●adult
2. ●pediatric

Setting

1. ●OR
2. ●PACU

Type of condition [select all that apply]

1. ●cardiac arrest
2. ●unstable arrhythmia
3. ●polytrauma
4. ●massive hemorrhage
5. ●severe burn
6. ●sepsis, shock
7. ●other condition

Medical Expert

• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.2 Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management
• □ME 2.1 Prioritize issues to be addressed (editorial revision 2023)
• □ME 2.4 Recognize possibility of unknown diagnosis and unpredictable clinical course and take actions to avoid or mitigate potential problems
• □ME 1.4 Act decisively and maintain control of critical situations
• □ME 1.6 Seek assistance in situations that are complex or new
• □ME 2.2 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess clinical status and response to treatment, to re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 3.4 Competently perform resuscitation protocols
• □ME 5.2 Demonstrate situational awareness, avoiding fixation errors

Communicator

• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 3.2 Demonstrate safe handover of care, both verbal and written
• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.3 Communicate with the health care team using closed loop communication and clear language

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts, supporting others when needed

Professional

• □P 4.1 Demonstrate the ability to remain calm and professional in stressful situations (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of exam

1. ●cardiac
2. ●pulmonary
3. ●cardiopulmonary
4. ●other exam

Technique

1. ●transthoracic
2. ●transesophageal

Location

1. ●preoperative
2. ●intraoperative
3. ●ICU
4. ●emergency room

Purpose of the exam

1. ●normal standard views
2. ●answering a clinical question

Clinical situation

1. ●stable patient
2. ●unstable patient

Medical Expert

• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 1.3 Apply clinical and theoretical knowledge of echography to anesthesiology and critical care practice
• □ME 3.4 Adjust echocardiographic instrument settings appropriately to optimize image quality
• □ME 3.4 Acquire images of focused transthoracic echocardiography exam and pulmonary echographic exam (editorial revision 2023)
• □ME 2.2 Interpret focused transthoracic echocardiography exam for common pathologies including hypovolemia, left and right ventricular failure and pericardial effusion and tamponade
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.4 Document procedures accurately
• □ME 4.1 Determine the need and timing of consultation with other specialists

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □COM 2.1 Actively listen and respond to patient cues
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Pre-existing comorbidity [select all that apply]

1. ●none
2. ●cardiac
3. ●obesity
4. ●other comorbidity

Pregnancy related comorbidity [select all that apply]

1. ●none
2. ●hemorrhage
3. ●pre- eclampsia
4. ●pre-term
5. ●fetal distress
6. ●other comorbidity

Type of anesthesia

1. ●spinal
2. ●epidural
3. ●combined spinal/epidural
4. ●general
5. ●other anesthesia

Medical Expert

• □Part A: ME 1.6 Adapt care as the patient’s clinical condition evolves
• □Part A: ME 2.1 Consider clinical urgency, feasibility, availability of resources, comorbidities and the second patient (fetus) in determining priorities to be addressed (editorial revision 2023)
• □Part A: ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □Part A: ME 2.4 Formulate and implement management plans that consider all of the patient’s health problems and context, in a timely manner, in collaboration with patients and their families and, when appropriate, the interprofessional team
• □Part A: ME 3.1 Integrate all sources of information to develop an anesthetic management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □Part A: ME 3.4 Document procedures accurately
• □Part A: ME 3.4 Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □Part A: ME 4.1 Establish plans for ongoing and postoperative care
• □Part A: ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □Part A: COM 1.4 Respond to patients’ non-verbal communication and use appropriate non- verbal behaviours to enhance communication with patients
• □Part A: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part A: COM 3.1 Share information and explanations that are clear, accurate, and timely while checking for patient and family understanding
• □Part B: COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □Part B: COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □Part B: COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part A: COL 3.2 Demonstrate safe handover of care, both verbal and written
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals (editorial revision 2023)
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □Part B: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part B: COL 3.2 Demonstrate safe handover of care, both verbal and written

Health Advocate

• □Part B: HA 1.1 Facilitate timely patient access to services and resources

Professional

• □Part B: P 1.1 Respond punctually to requests from families or other health care providers
• □Part B: P 1.1 Exhibit appropriate professional behaviours (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of condition

1. ●hemorrhagic shock
2. ●sepsis
3. ●other shock
4. ●embolic event
5. ●eclampsia
6. ●HELLP syndrome
7. ●trauma
8. ●other issue

Medical Expert

• □ME 1.6 Adapt care as the patient’s clinical condition evolves
• □ME 1.4 Act decisively and maintain control of critical situations
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, comorbidities and the second patient (fetus) in determining priorities to be addressed
• □ME 2.1 Prioritize issues to be addressed
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess clinical status and response to treatment, to re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 3.1 Integrate appropriate monitoring, including monitoring of the fetus, into global assessment and management plans (editorial revision 2023)
• □ME 3.4 Competently perform resuscitation protocols, including intra-uterine resuscitation
• □ME 3.4 Perform the management and all related technical procedures in a skillful and safe manner
• □ME 5.2 Demonstrate situational awareness, avoiding fixation errors

Communicator

• □COM 3.1 Share information and explanations that are clear, accurate and timely while checking for patient and family understanding

Collaborator

• □COL 1.3 Communicate with the health care team using closed loop communication and clear language
• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 4.2 Apply the principles of crisis resource management
• □L 4.2 Establish clear leadership in resuscitative efforts, supporting others when needed

Professional

• □P 4.1 Demonstrate the ability to remain calm and professional in stressful situations (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of observation

1. ●direct
2. ●indirect

Type of comorbidity

1. ●cardiovascular disease
2. ●endocrine disorders
3. ●respiratory disease
4. ●obstructive sleep apnea (OSA)
5. ●neuromuscular and musculoskeletal disease
6. ●neurological diseases
7. ●hematological disorders
8. ●infectious diseases

Type of surgery

1. ●general surgery
2. ●urology
3. ●otolaryngology
4. ●orthopedic surgery
5. ●plastic surgery
6. ●ophthalmology
7. ●dental surgery
8. ●other surgery

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage perioperative assessment in complex patients
• □ME 1.4 Perform clinical assessments that address the breadth of issues in each case.
• □ME 2.2 Select and interpret appropriate preoperative investigations based on the planned procedure and patient’s comorbidities (editorial revision 2023)
• □ME 2.2 Synthesize patient information to determine the most appropriate anesthetic management plan
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable
• □ME 2.4 Assess perioperative risk and apply risk reduction strategies
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy 10 ME 4.1.2 Determine the need and timing of consultation with other specialists

Communicator

• □COM 1.1 Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.4 Respond to patients’ non-verbal communication and use appropriate non- verbal behaviours to enhance communication with patients
• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 2.1 Actively listen and respond to patient cues
• □COM 1.5 Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Timing

1. ●emergency
2. ●elective

Type of surgery

1. ●general surgery
2. ●urology
3. ●otolaryngology
4. ●orthopedic surgery
5. ●plastic surgery
6. ●ophthalmology
7. ●dental surgery
8. ●other surgery

Patient comorbidity

1. ●cardiovascular disease
2. ●endocrine disorders
3. ●respiratory disease, obstructive sleep apnea (OSA), neuromuscular and musculoskeletal disease, neurological diseases
4. ●hematological disorders
5. ●infectious diseases
6. ●none

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.3 Apply clinical and biomedical sciences to manage presentations in pediatric patients
• □ME 1.6 Adapt care as the patient’s clinical condition evolves
• □ME 1.6 Seek assistance in situations that are complex or new (editorial revision 2023)
• □ME 2.4 Establish a comprehensive perioperative anesthetic management plan, taking into consideration the wishes of the patient and their family, the impact of the patient’s co-morbidities, available resources, and the needs and urgency of the procedure
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.2 Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care
• □COL 1.3 Engage in respectful shared decision-making with physicians and other colleagues in the health care professions.
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflict in a manner that supports a collaborative culture
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 2.1 Allocate health care resources for optimal patient care.

Health Advocate

• □HA 1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours

Scholar

• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 2.1 Demonstrate accountability to patients, their families, society, and the profession by responding to societal expectations of physicians. (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location of block

1. ●upper limb
2. ●lower limb
3. ●trunk
4. ●other location

Type of block

1. ●interscalenic
2. ●supra-clavicular
3. ●infra-clavicular
4. ●axillary
5. ●peripheral block
6. ●transversus abdominis plane block
7. ●sciatic nerve
8. ●femoral nerve
9. ●popliteal sciatic
10. ●ankle block
11. ●other block

Medical Expert

• □Part A: ME 1.3 Apply knowledge of the pharmacology of local anesthetics with respect to mechanism of action, toxicity, kinetics and adjuvants, to the selection of appropriate pharmacologic agents (editorial revision 2023)
• □Part A: ME 1.3 Apply knowledge of anatomy to regional anesthesia technique
• □Part A: ME 2.2 Synthesize patient information to determine the most appropriate anesthetic management plan
• □Part A: ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □Part A: ME 3.1 Select the most appropriate regional anesthesia technique in the context of local guidelines, the patient, the procedure and the surgeon
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning
• □Part A: ME 3.4 Establish and implement a plan for post-anesthesia care
• □Part A: ME 3.4 Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □Part A: ME 3.4 Perform peripheral nerve block regional anesthesia and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □Part A: COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □Part A: COL 1.3 Engage in respectful shared decision-making with physician and other colleagues in the health care professions

Health Advocate

• □Part A: HA 1.2 Use information booklets, websites, and other communication technologies to improve patient understanding of the planned regional technique and post procedure care

Scholar

• □Part A: S 1.1 Use technology or personal documentation to record, monitor, and report on your procedural log

Professional

• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of regional anesthesia

1. ●upper limb nerve block
2. ●lower limb nerve block
3. ●trunk block
4. ●Bier block

Category of event

1. ●failed block
2. ●cardiac
3. ●respiratory
4. ●neurologic
5. ●other event

Timing of event

1. ●preoperative
2. ●intraoperative
3. ●postoperative

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.6 Seek assistance in situations that are complex or new
• □ME 2.2 Elicit a history, perform a physical exam, use appropriate information from ongoing monitoring, select appropriate investigations and interpret their results for the purpose of diagnosis and management of an unexpected perioperative event
• □ME 2.2 Identify and diagnose anesthesia complications encountered during the perioperative period
• □ME 2.4 Manage the encountered complications of regional anesthesia and consider the risk factors, presentation, diagnosis and treatment. (editorial revision 2023)
• □ME 3.1 Determine and implement the most appropriate procedures or therapies for the purpose of management of unexpected perioperative events
• □ME 3.4 Competently perform resuscitation protocols
• □ME 3.4 Perform the management and all related technical procedures in a skillful and safe manner
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation
• □ME 5.1 Report patient safety incidents to appropriate institutional representatives
• □ME 5.1 Recognize near-misses in real time and respond to correct them, preventing them from reaching the patient
• □ME 5.1 Identify potential improvement opportunities arising from harmful patient safety incidents and near misses
• □ME 5.1 Participate in an analysis of patient safety incidents
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 3.1 Share information and explanations that are clear, accurate and timely while checking for patient and family understanding
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □COM 3.2 Apologize appropriately for a harmful patient safety incident
• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 1.3 Engage in respectful shared decision-making with physician and other colleagues in the health care professions
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner (editorial revision 2023)

Leader

• □L 1.2 Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations
• □L 4.2 Apply the principles of crisis resource management

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 3.1 Describe how to respond to, cope with, and constructively learn from a complaint or legal action (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●MRI
2. ●interventional cardiology
3. ●interventional radiology
4. ●brachytherapy
5. ●ECT
6. ●invasive procedures
7. ●other location

Complexity of case

1. ●low
2. ●moderate
3. ●high

Type of anesthesia

1. ●general
2. ●regional
3. ●monitored anesthesia care (MAC)
4. ●other anesthesia

Medical Expert

• □ME 1.4 Perform appropriately-timed preoperative clinical assessments with recommendations that are well-organized and properly documented in written and/or oral form
• □ME 1.6 Adapt care as the patient’s clinical condition evolves
• □ME 2.4 Establish a comprehensive perioperative anesthetic management plan, taking into consideration the wishes of the patient and their family, the impact of the patient’s co-morbidities, available resources, and the needs and urgency of the procedure
• □ME 2.4 Develop anesthetic management plans that acknowledge and mitigate the added risk of managing anesthetics in remote locations (editorial revision 2023)
• □ME 3.1 Ensure standard monitors are immediately available in the environment as outlined in the CAS guidelines
• □ME 4.1 Establish plans for ongoing and postoperative care
• □ME 5.2 Adopt strategies that promote patient safety and address human and system factors

Collaborator

• □COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 2.2 Analyze team dynamics
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 1.2 Contribute to a culture that promotes patient safety
• □L 2.2 Optimize practice patterns for cost-effectiveness and cost control

Professional

• □P 1.1 Intervene when behaviours toward colleagues and learners undermine a respectful environment (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Location

1. ●clinical
2. ●simulation

Type of airway and/or ventilation management

1. ●spontaneously breathing patient
2. ●spontaneously breathing with airway adjunct
3. ●use of rigid laryngoscopy or bronchoscopy
4. ●use of endotracheal tube
5. ●use of jet ventilation
6. ●other management

Medical Expert

• □ME 1.4 Perform clinical assessments that address the breadth of issues in each case
• □ME 1.6 Seek assistance in situation that are complex or new
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.2 Synthesize information from the preoperative workup to prepare for a patient with a complicated airway
• □ME 2.4 Assess risk for, anticipate, and prepare for loss of airway
• □ME 3.1 Integrate all sources of information to develop an anesthetic management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.4 Provide anesthesia for invasive airway procedures (editorial revision 2023)

Collaborator

• □COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □COL 1.3 Demonstrate efficiency in giving feedback on the patient status to the surgical team during the procedure
• □COL 2.1 Delegate tasks and responsibilities and communicate a clear plan of action to an assistant before a procedure
• □COL 3.2 Demonstrate safe handover of care, both verbal and written (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of procedure

1. ●aortic surgery
2. ●carotid surgery
3. ●peripheral vascular surgery

Context of procedure

1. ●open surgery
2. ●radiological procedure

Timing

1. ●elective
2. ●emergency

Type of anesthetic

1. ●general
2. ●regional
3. ●combination
4. ●MAC

Type of monitors (check all that apply)

1. ●arterial line
2. ●central line
3. ●spinal cord protection
4. ●cerebral monitoring, lung isolation

Hemodynamic support & transfusion (check all that apply)

1. ●vasopressors, inotropes, transfusion, cell salvage use, heparin use
2. ●protamine use

Medical Expert

• □ME 1.3 Apply clinical knowledge of indications and specific surgical considerations for vascular surgery
• □ME 2.2 Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management (editorial revision 2023)
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 2.4 Develop a plan to optimize the patient’s medical condition preoperatively.
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 1.3 Apply knowledge of transfusion principles, use of heparin, protamine and blood conservation strategies
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 3.4 Manage hemodynamics and complications during aortic surgery depending on the level of clamping on the aorta including hemodynamic instability, spinal ischemia, bleeding and renal dysfunction

Communicator

• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 1.2 Communicate effectively with the surgeon and other members of the team
• □COL 3.2 Demonstrate safe handover of care, both verbal and written (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgery

1. ●lumbar surgery
2. ●thoracic surgery
3. ●cervical surgery
4. ●scoliosis surgery
5. ●unstable cervical spine surgery
6. ●other surgery

Spinal cord injury

1. ●yes
2. ●no

Neurologic monitoring

1. ●yes
2. ●no

Timing

1. ●elective
2. ●emergency

Medical Expert

• □ME 1.3 Apply knowledge of the clinical and biomedical sciences relevant to anesthesia for spinal diseases and injury, and neurological monitoring
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during preoperative evaluation and determination of timing for surgery
• □ME 2.2 Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management
• □ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches (editorial revision 2023)
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Manage perioperative fluid delivery including blood replacement strategies
• □ME 3.4 Manage the airway of a patient with an unstable c-spine presenting for a surgical procedure
• □ME 3.4 Document procedures accurately
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 5.1 Adapt record keeping to the specific guidelines of anesthesiology and the clinical context

Collaborator

• □COL 1.2 Interact effectively with surgeons during all aspects of the procedure
• □COL 1.2 Work with the OR team effectively to ensure patient safety during prone positioning
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Leader

• □L 4.2 Assume a leadership role in managing complex cases in the OR

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of neurosurgical procedure

1. ●tumour
2. ●pituitary tumour
3. ●vascular intracranial surgery
4. ●functional neurosurgery
5. ●neuroradiology
6. ●other procedure

Increased intracranial pressure

1. ●yes
2. ●no

Timing of surgery

1. ●elective
2. ●emergency

Medical Expert

• □ME 1.3 Apply knowledge of neurophysiology relevant to optimal anesthetic agents choice, management of increased intracranial pressure and basic principles of neuroprotection
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during preoperative evaluation and determination of timing for surgery
• □ME 2.2 Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management
• □ME 2.2 Synthesize patient information to determine indications for invasive and non- invasive monitoring (editorial revision 2023)
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Optimize the patient and surgical conditions throughout the procedure, anticipating, preventing and treating complications in relation with the specific procedure
• □ME 3.4 Establish and implement a plan for post-anesthesia care

Communicator

• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 4.3 Obtain and document informed consent for the planned anesthetic management in a manner that engages the patients and their families using established principles of effective communication

Collaborator

• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Leader

• □L 1.2 Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations
• □L 4.2 Assume a leadership role in managing complex cases in the OR (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of surgery

1. ●thoracotomy
2. ●thoracoscopy
3. ●other surgery

Type of procedure

1. ●lung resection
2. ●pneumonectomy
3. ●esophagectomy
4. ●mediastinoscopy
5. ●surgery for anterior mediastinal mass
6. ●other procedure

Timing

1. ●elective
2. ●emergency

Technique for lung isolation

1. ●none
2. ●double lumen tube
3. ●bronchial block
4. ●other technique

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.3 Apply knowledge of anatomy to lung isolation technique
• □ME 1.4 Perform appropriately-timed preoperative clinical assessments with recommendations that are well-organized and properly documented in written and/or oral form (editorial revision 2023)
• □ME 2.2 Select and interpret appropriate preoperative investigations based on the planned procedure and patient’s comorbidities
• □ME 3.1 Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.1 Integrate all sources of information to develop a plan for lung isolation and considers the risks and benefits of all approaches
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 3.4 Demonstrate effective procedure preparation, including gathering required equipment, and patient monitoring and positioning
• □ME 3.4 Optimize the patient and surgical conditions throughout the procedure, anticipating, preventing and treating complications in relation with the specific procedure

Communicator

• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 4.3 Obtain and document informed consent for the planned anesthetic management in a manner that engages the patients and their families using established principles of effective communication
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions
• □COM 5.1 Adapt record keeping to the specific guidelines of anesthesiology and the clinical context

Collaborator

• □COL 1.2 Interact effectively with surgeons during all aspects of the procedure
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Leader

• □L 3.1 Assume a leadership role in managing complex cases in the OR

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours

Scholar

• □S 3.4 Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services. (editorial revision 2023)

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence
• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of issue

1. ●initial management
2. ●follow-up care

Patient category

1. ●post-operative
2. ●trauma
3. ●medical

Complications of pain management

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply knowledge of the anatomy, physiology and pharmacology in the development of a pain management strategy (editorial revision 2023)
• □ME 2.4 Diagnose and manage the complications of various acute pain management strategies
• □ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of diagnosis and management of a patient with acute pain
• □ME 2.2 Develop a differential diagnosis for pain, with appropriate consideration of rare but serious conditions.
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of management of acute pain
• □ME 3.4 Perform the pain management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation
• □ME 2.2 Identify patients who may be at risk of chronic post-surgical pain or substance use disorder, and intervene appropriately

Communicator

• □COM 2.2 Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Leader

• □L 4.2 Manage time and priorities efficiently to provide safe, timely care (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of pain

1. ●back
2. ●neuropathic
3. ●phantom limb
4. ●complex regional pain syndromes (CRPS)
5. ●cancer
6. ●other pain

Medical Expert

• □ME 2.2 Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of diagnosis of chronic pain syndrome.
• □ME 2.4 Formulate a basic management plan that consider all of the patient’s health problems and context, in a timely manner, in collaboration with patients and their families and, when appropriate, the interprofessional team.
• □ME 3.4 Demonstrate optimal and safe use of fluoroscopy and ultrasound equipment
• □ME 4.1 Diagnose and manage the complications of various chronic pain management strategies
• □ME 4.1 Diagnose emergencies in the context of chronic pain, and manage and refer patient appropriately (editorial revision 2023)
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.2 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview

Communicator

• □COM 2.1 Actively listen and respond to patient cues
• □COM 2.2 Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals
• □COM 4.3 Use communication skills and strategies that help patients and their families make informed decisions regarding their health (editorial revision 2023)

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Provide timely and necessary written information to colleagues to enable effective relationship-centered care

Health Advocate

• □HA 1.1 Facilitate timely patient access to disability or other insurance benefits

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Primary diagnosis [select all that apply]

1. ●cardiac disease
2. ●neurologic disease
3. ●respiratory disease
4. ●sepsis
5. ●trauma
6. ●shock
7. ●postoperative
8. ●other diagnosis

Setting

1. ●ICU
2. ●NICU
3. ●PICU
4. ●coronary unit

Timing

1. ●daytime
2. ●evening
3. ●overnight
4. ●weekend/holiday

Setting

1. ●initial assessment
2. ●daily care

Medical Expert

• □Part A: ME 1.5 Prioritize patient care on the basis of acuity and available resources
• □Part A: ME 1.6 Adapt care as the patient’s clinical condition evolves
• □Part A: ME 2.2 Select and interpret the results of investigations and imaging
• □Part A: ME 2.2 Synthesize patient information to determine diagnosis
• □Part A: ME 2.3 Work with the patients and family to establish goals of care
• □Part A: ME 2.4 Develop and implement plans for the use of appropriate life-sustaining therapies (e.g. NIPPV, IPPV, dialysis, hemodynamic supports)
• □Part A: ME 3.1 Integrate planned procedures or therapies into the overall plan of care
• □Part A: ME 2.4 Develop and implement initial and/or ongoing management plans for patients with common ICU conditions
• □Part A: ME 4.1 Determine the need and timing of consultation with other specialists

Communicator

• □Part A: COM 3.1 Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner
• □Part A: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions
• □Part B: COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □Part B: COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe (editorial revision 2023)

Collaborator

• □Part A: COL 3.2 Organize safe intrahospital transport of patient to and from ICU, using all necessary human and equipment resources, recognizing when it may be inappropriate to transport patient
• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part A: COL 3.2 Organize the handover of care to the most appropriate physician or health care professional
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □Part B: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part B: COL 3.2 Demonstrate safe handover of care, both verbal and written

Health Advocate

• □Part B: HA 1.1 Facilitate timely patient access to services and resources

Professional

• □Part A: P 1.2 Demonstrate a commitment to excellence in all aspects of practice
• □Part B: P 1.1 Respond punctually to requests from families or other health care providers
• □Part B: P 1.1 Exhibit appropriate professional behaviours (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of condition [select all that apply]

1. ●cardiac event
2. ●neurologic event
3. ●respiratory failure
4. ●sepsis
5. ●shock
6. ●other condition.

Location

1. ●ICU
2. ●ER
3. ●ward

Patient age

1. ●adult
2. ●pediatric

Medical Expert

• □ME 1.6 Adapt care as the patient’s clinical condition evolves
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements (editorial revision 2023)
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess clinical status and response to treatment to re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 3.4 Competently perform resuscitation protocols
• □ME 4.1 Ask for additional assistance and/or other services when indicated
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 2.2 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued

Communicator

• □COM 3.1 Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner

Collaborator

• □COL 1.3 Communicate with the health care team using closed loop communication and clear language
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Leader

• □L 4.2 Apply the principles of crisis resource management
• □L 4.3 Improve personal practice by evaluating a problem, setting priorities, executing a plan, and analyzing the results

Scholar

• □S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance
• □S 2.3 Balance clinical supervision and graduated responsibility, ensuring patient safety and optimal learner experience (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of setting

1. ●perioperative
2. ●ICU
3. ●ward
4. ●other setting

Medical Expert

• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.3 Work with the patient and family to establish goals of care.
• □ME 2.4 Formulate and implement management plans that are relevant to the patient and context, in collaboration with patients and their families and the health care team (editorial revision 2023)
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context, in collaboration with patients and their families and, when appropriate, the interprofessional team
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration

Communicator

• □COM 3.1 Provide information on diagnosis, risks and benefits of options, and prognosis in a clear, compassionate, respectful, and objective manner
• □COM 4.3 Answer questions from the patient and family
• □COM 1.1 Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.3 Recognize when the values, biases, or perspectives 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
• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 1.6 Tailor approaches to decision-making to a patient’s and/or family’s capacity, values, and preferences
• □COM 2.1 Actively listen and respond to patient cues
• □COM 1.5 Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals
• □COM 5.1 Document clinical encounters and care plans to adequately convey clinical reasoning and the rationale for decisions

Professional

• □P 1.3 Recognize the role the Anesthesiologist might play in the provision of Medical Assistance in Dying
• □P 1.3 Manage ethical issues encountered in the clinical and academic setting (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 5.1 Identify a patient safety incident (adverse event or near miss) in a timely manner
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Establish a patient-centered management plan 4 ME 5.1Identify the clinical circumstances contributing to an adverse event
• □ME 5.1 Report patient safety incidents to appropriate institutional representatives (editorial revision 2023)
• □ME 5.1 Participate in an analysis of patient safety incidents
• □ME 5.1 Prioritize the initial medical response to adverse events to mitigate further injury
• □ME 5.1 Identify changes in practice/clinical care to prevent similar events

Communicator

• □COM 1.5 Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals
• □COM 3.1 Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □COM 3.2 Apologize appropriately for a harmful patient safety incident
• □COM 5.1 Document harmful patient safety incidents as per institutional processes

Leader

• □L 1.1 Participate in a patient safety and/or quality improvement initiative
• □L 1.1 Seek data to inform practice and engage in an iterative process of improvement

Health Advocate

• □HA 2.2 Improve individual and discipline clinical practice by applying a process of continuous quality improvement to prevent complications

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 3.3 Prepare a morbidity and mortality report or chart review
• □P 4.1 Recognize the effect of a patient safety incident on one’s own emotional well-being, and use strategies to mitigate them (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable
• □ME 2.4 Ensure treatment plans align with the patient’s expressed goals of care
• □ME 3.3 Advocate for timely access for palliative surgical procedures

Communicator

• □COM 1.1 Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety (editorial revision 2023)
• □COM 3.1 Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family
• □COM 3.1 Discuss end of life care planning as it relates to anesthetic care when appropriate

Professional

• □P 1.3 Manage ethical issues encountered in the clinical and academic setting
• □P 1.3 Consider the impact of one’s own values, attitudes, beliefs, context and biases when dealing with ethical challenges and counselling patients
• □P 3.1 Describe and apply the relevant codes, policies, standards, and laws governing physicians and the profession relevant to Anesthesiology and Critical Care Medicine including: capacity; substitute decision makers, guardianship, next of kin; living wills, legal directives; end of life care; spectrum & implications of do not resuscitate orders; withdrawal of care; and medical assistance in dying
• □P 3.2 Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care profession (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □Part A: ME 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role (editorial revision 2023)
• □Part A: ME 1.4 Perform appropriately-timed preoperative clinical assessments with recommendations that are well-organized and properly documented in written and/or oral form
• □Part A: ME 1.5 Carry out professional duties in the face of multiple, competing demands and prioritize various tasks optimally
• □Part A: ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key element
• □Part A: ME 2.4 Establish a plan for optimal management of the proposed procedure, including appropriate investigation, request for consultation and preoperative medical optimization
• □Part A: ME 5.2 Apply strategies to mitigate perioperative complications for individual patients
• □Part B: ME 1.4 Perform clinical assessments that address the breadth of issues in each case
• □Part B: ME 2.1 Identify and resolve conflicting anesthesia priorities for complex patients for any surgical procedure
• □Part B: ME 2.4 Establish a plan for optimal management of the proposed procedure including appropriate investigation, request for consultation and preoperative medical optimization.
• □Part B: ME 5.2 Apply strategies to mitigate perioperative complications for individual patients

Communicator

• □Part A: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their perioperative anesthetic management
• □Part A: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part B: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their perioperative anesthetic management
• □Part B: COM 5.2 Communicate effectively using a written health record, electronic medical record or other digital technology

Collaborator

• □Part A: COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □Part A: COL 1.3 Communicate effectively with other consultants and surgeons.
• □Part B: COL 1.3 Identify complex and/or controversial issues that require verbal communication with colleague anesthesiologists or other physicians and convey that information effectively

Leader

• □Part A: L 2.2 Apply evidence and management processes to achieve cost-appropriate care
• □Part A: L 4.1 Manage time and prioritize tasks
• □Part A: L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □Part A: L 4.2 Run the preoperative clinic efficiently, safely and effectively
• □Part B: L 2.2 Apply evidence and management processes to achieve cost-appropriate care (editorial revision 2023)

Health Advocate

• □Part A: HA 1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours

Scholar

• □Part A: S 3.4 Integrate best evidence and clinical expertise into decision-making
• □Part A: S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing one’s own performance using various internal and external data sources
• □Part A: S 2.3 Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed
• □Part B: S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of observation

1. ●direct
2. ●indirect

Type of procedure

1. ●general surgery
2. ●gynecology
3. ●neurosurgery
4. ●ophthalmology
5. ●orthopedic surgery
6. ●otolaryngology
7. ●plastic surgery
8. ●spinal surgery
9. ●thoracic surgery
10. ●urology
11. ●vascular surgery
12. ●out-of-OR procedures

Complexity of cases (check all that apply)

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.1 Demonstrate a commitment to high-quality care of their patients
• □ME 1.4 Perform appropriately-timed clinical assessments and case- managements addressing the breadth of anesthesiology, with recommendations that are well-organized and properly documented
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in anesthesiology practice (editorial revision 2023)
• □ME 2.4 Establish a comprehensive perioperative anesthetic management plan, taking into consideration the wishes of the patients and their families, the impact of the patient’s co-morbidities, available resources, and the needs and urgency of the surgical or diagnostic procedure
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 5.2 Adopt strategies that promote patient safety and address human and system factors

Communicator

• □COM 1.6 Adapt to the unique needs and preferences of each patient, and to his or her clinical condition and circumstances
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □COL 3.2 Demonstrate safe handover of care, both verbal and written. ,

Leader

• □L 2.1 Apply leadership and time management skills to ensure appropriate use of resources
• □L 2.2 Apply evidence and management processes to achieve cost-appropriate care
• □L 4.2 Assume a leadership role in managing complex cases in the OR
• □L 4.2 Run an operating room efficiently, safely, and effectively (editorial revision 2023)

Scholar

• □S 2.3 Balance clinical supervision and graduated responsibility, ensuring patient safety and optimal learner experience
• □S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing one’s own performance using various internal and external data sources
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 1.2 Demonstrate a commitment to excellence in all aspects of practice
• □P 4.1 Monitor wellbeing and fatigue, taking reasonable breaks as needed (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.1 Demonstrate a commitment to high quality care of their patients
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands and prioritize various tasks optimally
• □ME 1.4 Perform appropriately-timed clinical assessments and case- managements addressing the breadth of anesthesiology
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in providing care for emergency cases
• □ME 3.3 Prioritize among surgical cases taking into account clinical urgency, potential for deterioration, and available resources (editorial revision 2023)
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-anesthesia care
• □ME 5.2 Adopt strategies that promote patient safety and address human and system factors safety
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations
• □COM 5.1 Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with physician and other colleagues in the health care professions
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 4.2 Assume a leadership role in managing complex cases in the OR

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □P 4.1 Exhibit self-awareness and effectively manage influences on personal well- being and professional performance
• □P 4.1 Integrate skills that support adaption and recovery in challenging situations including skills to perform under stress requiring quick decision-making and procedures (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Level of complexity

1. ●low
2. ●medium
3. ●high

Time

1. ●day
2. ●night

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in obstetric anesthesiology
• □ME 2.4 Establish patient-centred anesthesiology management plans for all patients in the peripartum period
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.3 Prioritize the provision of obstetric anesthesiology services, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 3.4 Perform the anesthetic management and all related technical procedures in a skillful, efficient and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands and prioritize various tasks optimally

Communicator

• □COM 1.6 Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances (editorial revision 2023)
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

Collaborator

• □COL 1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions
• □COL 1.3 Engage in respectful shared decision-making with physicians and other colleagues in the health care professions
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □COL 3.2 Demonstrate safe handover of care, both verbal and written

Leader

• □L 2.1 Allocate health care resources for optimal patient care

Scholar

• □S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing one’s own performance using various internal and external data sources
• □S 2.3 Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed
• □S 2.5 Role-model regular self-assessment and feedback-seeking behaviour

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 1.2 Demonstrate a commitment to excellence in all aspects of practice
• □P 4.1 Maintain capacity for professional clinical performance in stressful situations (editorial revision 2023)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □Part C: ME 1.4 Demonstrate an awareness of the context of practice, including what is required to practice safely and effectively in a community practice, and exercise the ability to adapt to that context
• □Part C: ME 5.2 Adopt strategies that promote patient safety and address human and system factors safety

Leader

• □Part B: L 4.1 Ensure optimal time management in daily activities in order to meet all deadlines
• □Part C: L 4.1 Set priorities and manage time to integrate practice and personal life
• □Part C: L 4.2 Reconcile expectations for practice with job opportunities and workforce needs
• □Part C: L 4.2 Adjust educational experiences to gain competencies necessary for future independent practice
• □Part C: L 4.2 Manage a career and practice
• □Part C: L 4.3 Implement processes to ensure personal practice improvement

Scholar

• □Part A: S 2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners
• □Part A: S 2.2 Promote a safe learning environment
• □Part A: S 2.3 Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed
• □Part A: S 2.3 Balance clinical supervision and graduated responsibility, ensuring patient safety and optimal learner experience
• □Part A: S 2.3 Ensure patient safety is maintained when learners are involved
• □Part A: S 2.4 Identify the learning needs of a learner
• □Part A: S 2.4 Plan, prepare and deliver a learning activity
• □Part A: S 2.4 Define specific learning objectives for a teaching activity
• □Part A: S 2.4 Adapt learning activities to the level of the learner
• □Part A: S 2.5 Provide feedback to enhance learning and performance
• □Part A: S 2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner
• □Part A: S 3.4 Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services
• □Part A: S 3.4 Summarize the scientific knowledge on a topic or a clinical question and integrate evidence into decision-making in clinical practice
• □Part B: S 3.2 Identify, select, and navigate pre-appraised resources
• □Part B: S 3.3 Evaluate the applicability (external validity or generalizability) of evidence from a resource
• □Part B: S 3.3 Interpret study findings, including a critique of their relevance to their practice
• □Part B: S 3.3 Determine the validity and risk of bias in a source of evidence
• □Part B: S 3.3 Describe study results in both quantitative and qualitative terms
• □Part B: S 4.4 Select appropriate methods of addressing a given scholarly question (editorial revision 2023)
• □Part B: S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature
• □Part C: S 1.1 Develop, implement, monitor, and revise a personal learning plan to enhance professional practice
• □Part C: S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources
• □Part C: S 1.3 Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice
• □Part C: S 2.5 Role-model regular self-assessment and feedback-seeking behavior
• □Part C: S 3.1 Generate focused questions to address practice uncertainty and knowledge gaps
• □Part C: S 3.4 Integrate best evidence and expertise into decision-making in their practice

Professional

• □Part C: P 1.2 Demonstrate a commitment to excellence in all aspects of practice
• □Part C: P 2.1 Demonstrate accountability to patients, society, and the profession by recognizing and responding to societal expectations of the profession
• □Part C: P 3.1 Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing practice (editorial revision 2023)
• □Part C: P 4.1 Develop a personal plan for managing stress and maintaining physical and mental well-being during independent practice
• □Part C: P 4.2 Develop a strategy to manage personal and professional demands for a sustainable independent practice

Case description

Feedback provided

Next steps