Cardiac Surgery

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

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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

Case complexity

1. ●low
2. ●medium
3. ●high

Side

1. ●right
2. ●left

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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

Setting

1. ●clinic
2. ●ward

Presentation

1. ●coronary artery disease
2. ●valvular heart disease
3. ●other

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □Part A: ME 2.2 Elicit a history pertinent to the clinical presentation, without omitting key features
• □Part A: ME 2.2 Perform and interpret findings of a physical exam relevant to the cardiovascular system
• □Part B: ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in Cardiac Surgery • Pathology and pathophysiology as relevant to cardiovascular diseases and conditions
• □Part B: ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □Part B: ME 2.2 Select and interpret appropriate investigations and imaging techniques • ECG • Coronary angiography/CT angiogram • Non-invasive testing • Viability – Nuclear, PET, MRI • Echo/Stress Echo • Radiography (CXR) • Pulmonary function tests
• □Part B: ME 2.2 Apply patient risk scores to determine perioperative risk
• □Part B: ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □Part B: ME 2.4 Integrate clinical assessment, results of investigations and risk assessment to recommend a medical and/or surgical management plan for common problems in Cardiac Surgery
• □Part B: ME 2.4 Develop a plan for cardiac surgery, including, as appropriate, strategies for myocardial protection, coronary revascularization and conduit selection
• □Part B: ME 2.4 Develop and implement plans for perioperative optimization of the patient who is a candidate for cardiac surgery
• □Part B: ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □Part A: 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
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □Part B: 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

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

Case complexity

1. ●low
2. ●medium
3. ●high

Complications of MI

1. ●arrhythmia
2. ●heart failure
3. ●shock
4. ●other

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in Cardiac surgery • Anatomy and physiology of the cardiovascular system • Pathology and pathophysiology as relevant to cardiovascular diseases and conditions • Pharmacology of medications used for coronary insufficiency, anticoagulation, arrhythmia management and inotropic support
• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical management of common cardiac presentations
• □ME 1.5 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.1 Identify medical emergencies and prioritize response
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations and imaging techniques
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Identify patients that would benefit from coronary revascularization and consult with senior colleagues for timely referral

Communicator

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

Collaborator

• □COL 3.1 Identify patients requiring handover to another physician or health care setting
• □COL 3.2 Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Leader

• □L 2.1 Consider costs when choosing care options

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

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

Service

1. ●cardiology
2. ●cardiac surgery

Medical Expert

• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical management of common cardiac presentations
• □ME 1.5 Perform focused clinical assessments
• □ME 2.2 Select and interpret appropriate investigations and imaging techniques
• □ME 2.4 Develop medical management plans including but not limited to medication, dietary, and lifestyle modifications as appropriate
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment

Communicator

• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Health Advocate

• □HA 1.3 Apply appropriate secondary prevention strategies for cardiac vascular diseases, according to current guidelines

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

Presentation

1. ●acute limb ischemia
2. ●chronic limb ischemia
3. ●internal carotid artery stenosis

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in Cardiac Surgery • Anatomy and physiology of the cardiovascular system • Pathology and pathophysiology as relevant to cardiovascular diseases and conditions
• □ME 2.2 Elicit a history pertinent to the clinical presentation, without omitting key features
• □ME 2.2 Perform and interpret findings of a physical exam relevant to the cardiovascular system
• □ME 2.2 Interpret the results of diagnostic tests
• □ME 2.4 Develop and implement initial management plans
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan

Health Advocate

• □HA 1.3 Apply appropriate secondary prevention strategies for cardiac vascular diseases, according to current guidelines

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 3.4 Adjust echocardiographic instrument settings appropriately to optimize image quality
• □ME 3.4 Obtain standard echocardiographic parasternal, apical, and subcostal views
• □ME 3.4 Assess left and right ventricular size, ascending aorta diameter, and inferior vena cava size by echocardiogram
• □ME 3.4 Evaluate central filling pressures using the inferior vena cava
• □ME 2.2 Recognize clinically significant findings in a transthoracic 2D-echocardiogram
• □ME 3.4 Perform echocardiographic guidance of pericardiocentesis

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 issue

1. ●shock
2. ●coagulopathy
3. ●stroke
4. ●seizure
5. ●renal failure
6. ●GI emergency (ischemic/bleed)
7. ●respiratory failure
8. ●supraventricular tachycardia
9. ●ventricular arrhythmia

Intra-aortic balloon pump

1. ●no
2. ●yes

Temporary epicardial pacing

1. ●no
2. ●yes

Medical Expert

• □ME 1.5 Perform focused clinical assessments
• □ME 1.5 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop and implement management plans for complications in cardiac surgery patients
• □ME 4.1 Identify patients that would benefit from referral to other specialists
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan
• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □COL 3.1 Identify patients requiring handover to another physician or health care setting

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. ●mechanical valve
2. ●biologic valve
3. ●bypass
4. ●other

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in Cardiac Surgery
• □ME 1.4 Apply knowledge of the principles of foundational therapeutic modalities relevant to Cardiac Surgery
• □ME 1.5 Perform focused clinical assessments
• □ME 2.1 Identify factors which place patients at risk for disease recurrence and/or adverse outcomes
• □ME 2.4 Develop medical management plans including but not limited to medication, dietary, and lifestyle modifications as appropriate

Communicator

• □COM 2.1 Integrate and synthesize information about the patient’s beliefs, values, preferences, context, and expectations with biomedical and psychosocial information
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan
• □COM 4.1 Explore the perspectives of the patient and others when developing care plans
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.3 Consult other health professionals appropriately with regard to patients’ social, rehabilitative, and nutritional concerns
• □COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care

Health Advocate

• □HA 1.1 Assess patients for risk factors for cardiovascular disease and advise appropriate interventions
• □HA 1.2 Select patient education resources related to Cardiac Surgery
• □HA 1.2 Educate the patient and family about information and communication technologies to improve health
• □HA 1.3 Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection
• □HA 1.3 Apply appropriate secondary prevention strategies for cardiac vascular diseases, according to current guidelines

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 1.4 Apply knowledge of the principles of use of Cardiopulmonary Bypass (CPB) • Use and pathophysiology of CPB • Design and function of components of CPB circuits including alternate types of pumps and oxygenators • Catastrophic complications of CPB • Effects of CPB on inflammatory, coagulation and hematological systems as well as end organ damage
• □ME 1.5 Perform focused clinical assessments
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop and implement plans to trouble shoot problems and/or complications in patients on cardiopulmonary bypass
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Collaborator

• □COL 1.1 Respect established rules of their team
• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 1.2 Work effectively with other physicians and health care professionals

Professional

• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

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. ●chest tube (open)
2. ●chest tube (pigtail)
3. ●sternotomy and closure
4. ●multisegment saphenous vein harvest
5. ●radial artery harvest
6. ●internal thoracic artery harvest
7. ●internal jugular line insertion
8. ●femoral artery access and sheath insertion
9. ●single atrial cannulation for CPB

Ultrasound guided

1. ●not applicable
2. ●yes
3. ●no

Clinical setting

1. ●OR
2. ●ICU
3. ●other

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 scholarly project

1. ●basic science research
2. ●clinical science research
3. ●quality improvement
4. ●educational
5. ●other

Scholar

• □S 4.3 Compare and contrast the roles and responsibilities of members of a research team and describe how they differ from clinical and other practice roles and responsibilities
• □S 4.4 Describe and compare the common methodologies used for scholarly inquiry in Cardiac Surgery
• □S 4.4 Generate focused questions for scholarly investigation
• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health- related research and literature
• □S 3.3 Determine the validity and risk of bias in a source of evidence
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.2 Identify ethical principles in research
• □S 4.3 Secure a supervisor’s commitment for a scholarly project

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. ●outpatient
2. ●inpatient

Condition

1. ●coronary disease
2. ●aortic valve disease
3. ●mitral valve disease
4. ●tricuspid valve disease
5. ●aortic disease
6. ●pericardial disease
7. ●atrial myxoma
8. ●uncomplicated atrial septal defects/patent foramen ovale
9. ●arrhythmias requiring pacemaker insertion or surgical ablation
10. ●left ventricular outflow obstruction
11. ●acute pulmonary embolus

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □Part A: ME 1.5 Perform clinical assessments that address the breadth of issues in each case
• □Part A: ME 2.2 Select and interpret appropriate investigations
• □Part A: ME 2.2 Synthesize patient information to assess indications and risk of surgery
• □Part A: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part A: ME 2.3 Share concerns, in a constructive and respectful manner, about goals of care when they are not felt to be achievable
• □Part A: ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches including, as appropriate, surgical or other therapeutic procedures and myocardial protection
• □Part A: ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part A: ME 4.1 Determine the necessity and appropriate timing of referral to other health care professionals
• □Part B: ME 1.4 Apply knowledge of the indications, techniques, and complications for surgical procedures
• □Part B: ME 3.2 Explain the risks and benefits of, and the rationale for a proposed procedure
• □Part B: ME 2.3 Share concerns, in a constructive and respectful manner, about goals of care when they are not felt to be achievable

Communicator

• □Part A: COM 2.1 Integrate the biopsychosocial information obtained from a patient- centred interview
• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □Part B: COM 3.1 Provide information on diagnosis, prognosis, and plan of care in a clear and compassionate manner
• □Part B: COM 4.3 Use effective communication skills and strategies, such as body posture, language at the appropriate level, and periodic checks for understanding
• □Part B: COM 2.1 Actively listen and respond to patient cues
• □Part B: COM 4.3 Answer questions from the patient and family
• □Part B: COM 5.1 Document the consent discussion in an accurate and complete manner
• □Part C: COM 5.1 Organize information in appropriate sections
• □Part C: COM 5.1 Document all relevant findings and investigations
• □Part C: COM 5.1 Convey clinical reasoning and the rationale for decisions
• □Part C: COM 5.1 Document the plan for ongoing management
• □Part C: COM 5.1 Complete clinical documentation in a timely manner

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

Age

1. ●neonate
2. ●child
3. ●adult

Diagnosis

1. ●ductal dependent circulation
2. ●single ventricle physiology
3. ●intra-cardiac shunt (cyanotic/non-cyanotic)
4. ●coronary anomalies
5. ●pediatric/adult coarctation and/or arch coarctation and/or arch anomalies

Medical Expert

• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical and surgical management of cardiac presentations • Congenital cardiac defects
• □ME 1.4 Apply knowledge of the indications, techniques, and complications for core surgical procedures • Repair of simple and complex congenital cardiac defects
• □ME 1.5 Perform clinical assessments that address the breadth of issues
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Recommend an appropriate surgical, medical, or percutaneous approach, or appropriate combination of approaches

Communicator

• □COM 1.6 Tailor approaches to decision-making to patient (or family) capacity, values, and preferences
• □COM 3.1 Provide information on diagnosis, prognosis, and plan of care in a clear and compassionate manner
• □COM 4.3 Answer questions from the patient and family

Health Advocate

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

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

Treatment recommendation

1. ●IABP
2. ●ECMO
3. ●VAD
4. ●transplant

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Cardiac Surgery • Immunology of rejection • Pharmacology of immunosuppression
• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical and surgical management of cardiac presentations • Heart failure, including end-stage heart failure
• □ME 1.4 Apply knowledge of the indications, techniques, and complications for core surgical procedures • Mechanical circulatory support, including IABP, ECMO, VAD • Surgical therapy for heart failure including valve surgery, ventricular reconstruction, VAD insertion and transplantation
• □ME 1.4 Apply knowledge of Intermacs classification (Interagency Registry for Mechanically Assisted Circulatory Support)
• □ME 1.4 Apply knowledge of the Canadian Cardiac Transplant Network: Eligibility and listing criteria in Canada
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.1 Select appropriate procedure and/or device for heart failure patients

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □COM 3.1 Provide information on diagnosis, prognosis, and plan of care in a clear and compassionate manner
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Leader

• □L 2.1 Allocate limited resources among individual patients considering utility and efficacy

Health Advocate

• □HA 2.3 Distinguish between potentially competing health interests of the individuals, communities, and populations that they serve

Scholar

• □S 3.4 Incorporate evidence and guideline recommendations into clinical decision making

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. ●papillary muscle rupture
2. ●ventricular septal defect
3. ●other

Medical Expert

• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical and surgical management of cardiac presentations
• □ME 1.5 Perform clinical assessments that address the breadth of issues
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context in collaboration with the interprofessional team
• □ME 2.4 Recommend an appropriate surgical approach, as relevant
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

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

Chest reopening

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Apply knowledge of the principles of diagnosis, natural history, and medical and surgical management of cardiac presentations
• □ME 1.4 Apply knowledge of the principles of therapeutic modalities relevant to Cardiac Surgery • Intensive care management of adult patients including but not limited to ventilator management, inotropes, treatment of arrhythmias, and the manipulation of the pulmonary and systemic circulations
• □ME 2.1 Identify patients in need of resuscitation and initiate appropriate measures
• □ME 2.1 Concurrently diagnose and manage life threatening emergencies
• □ME 2.1 Adapt management plans as the clinical situation evolves
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Monitor clinical response, identifying the appropriateness of continuing, modifying, or discontinuing treatment
• □ME 4.1 Determine the necessity and appropriate timing of referral to other healthcare professionals

Collaborator

• □COL 1.1 Apply a team approach to patient care
• □COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □L 4.2 Assume a leadership role in the management of complex cases

Professional

• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

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 complication

1. ●superficial infection
2. ●deep infection
3. ●dehiscence
4. ●other

Medical Expert

• □Part A: ME 1.5 Perform clinical assessments that address the breadth of issues
• □Part A: ME 1.7 Seek assistance in situations that are complex or new
• □Part A: ME 2.2 Select and interpret appropriate investigations
• □Part A: ME 2.2 Synthesize patient information to assess indications and risk of surgery
• □Part A: ME 2.4 Recognize and treat wound complications including but not limited to infections, dehiscence, and mediastinitis
• □Part A: ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □Part A: ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part A: ME 3.4 Document procedures accurately
• □Part B: ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Appropriate complete post procedure plan
• □Part B: ME 3.4 Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □Part A: COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □Part A: COM 5.1 Adapt record keeping to the specific guidelines of their discipline and the clinical context

Collaborator

• □Part A: COL 1.2 Consult as needed with other health care professionals, including other physicians
• □Part A: COL 1.3 Communicate effectively with physicians and other health care professionals
• □Part B: COL 1.3 Professional and effective communication/utilization of staff

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

Patient issue

1. ●post-op followup
2. ●other

Decision

1. ●ongoing followup
2. ●operative management
3. ●discharge from clinic

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Cardiac Surgery
• □ME 1.5 Perform clinical assessments that address the breadth of issues in each case
• □ME 2.2 Select and interpret appropriate investigations
• □ME 4.1 Establish plans for ongoing care
• □ME 4.1 Determine the necessity and appropriate timing of referral to other health care professionals

Communicator

• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □COM 4.3 Answer questions from the patient and family

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 3.1 Determine if/when care should be transferred back to the referring/primary care physician

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

Role of observer

1. ●attending staff
2. ●nurse
3. ●clinical assistant
4. ●other health professional
5. ●other trainee (e.g. fellow
6. ●resident
7. ●medical student)

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □ME 1.6 Carry out professional duties in the face of multiple, competing demands
• □ME 1.6 Prioritize patients on the basis of clinical presentations
• □ME 2.4 Develop and implement management plans

Collaborator

• □COL 1.2 Delegate responsibilities to members of the health care team appropriate to their scope of practice and level of expertise
• □COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □L 4.2 Run the service efficiently, safely, and effectively

Health Advocate

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

Scholar

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

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. ●clinic
3. ●ward
4. ●consult
5. ●simulation

Collaborator

• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Scholar

• □Part A: S 2.2 Ensure a safe learning environment for all members of the team
• □Part A: S 2.3 Supervise learners to ensure they work within their limitations
• □Part A: S 2.4 Provide clinical teaching and/or other informal learning activities
• □Part A: S 2.5 Provide feedback to enhance learning and performance
• □Part B: S 2.2 Create a positive learning environment
• □Part B: S 2.3 Provide opportunities for appropriate clinical responsibility
• □Part B: S 2.3 Is available and accessible to junior learners
• □Part B: S 2.5 Provide feedback to enhance learning and performance
• □Part B: S 2.1 Is a positive role model

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

Cannulation site (check all that apply)

1. ●atrial
2. ●bicaval
3. ●axillary
4. ●femoral
5. ●ascending aorta
6. ●arch
7. ●other

Cardioplegia

1. ●retrograde
2. ●other

Type of surgery (check all that apply)

1. ●coronary artery bypass surgery
2. ●aortic valve
3. ●mitral valve
4. ●tricuspid valve
5. ●cannulation for arch surgery
6. ●other ascending aorta surgery

Medical Expert

• □ME 1.3 Consolidate the competencies of Surgical Foundations
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Cardiac Surgery
• □ME 1.4 Apply knowledge of the principles of use of Cardiopulmonary Bypass (CPB) • Use and pathophysiology of CPB • Design and function of components of CPB circuits including alternate types of pumps and oxygenators • Catastrophic complications of CPB • Effects of CPB on inflammatory, coagulation and hematological systems as well as end organ damage
• □ME 3.1 Review, and revise as appropriate, the plan for surgical approach, conduit vessel and/or myocardial protection
• □ME 3.4 Demonstrate effective procedure preparation, including the use of a pre-procedure time-out or safety checklist as appropriate
• □ME 3.4 Perform common procedures in a skilful, fluid, and safe manner with minimal assistance • Sternotomy • Institution of CPB using a variety of cannulation techniques and devices • Appropriate conduct of CPB
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 3.4 Recognize CPB related complications at initiation

Collaborator

• □COL 1.3 Convey plan for surgical approach to the operating team
• □COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □L 4.2 Apply leadership skills to enhance patient care in the operating room

Professional

• □P 1.1 Exhibit appropriate professional behaviours

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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

LITA

1. ●yes
2. ●no

Total number of grafts

1. ●1
2. ●2
3. ●3
4. ●4
5. ●other

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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. ●simple mitral valve replacement
2. ●mitral annulopasty

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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. ●implantation of transvenous single chamber pacemaker
2. ●implantation of transvenous dual chamber pacemaker
3. ●placement of epicardial pacemaker
4. ●surgical ablation
5. ●battery change

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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. ●ASD repair
2. ●PFO repair

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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. ●pericardial window
2. ●pericardiectomy

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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

Technique for access

1. ●central
2. ●peripheral
3. ●other

Type of ECMO

1. ●venous-venous
2. ●arterio-venous

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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. ●cannulation of coronary ostium
2. ●crossing aortic valve
3. ●passing wire up pulmonary artery

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.4 Apply knowledge of the principles of use of Cardiopulmonary Bypass (CPB) in adults • Use and pathophysiology of CPB • Design and function of components of CPB circuits including alternate types of pumps and oxygenators • Complications of CPB • Effects of CPB on inflammatory, coagulation and hematological systems as well as end organ damage • Use of profound hypothermia and circulatory arrest
• □ME 3.4 Initiate algorithms for weaning from CPB
• □ME 2.1 Recognize instability and medical acuity
• □ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.4 Adapt weaning protocols to patient status, including but not limited to hemostasis related issues
• □ME 1.7 Adapt care as the complexity of the patient’s clinical situation evolves
• □ME 4.1 Establish plans for ongoing care

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals

Professional

• □P 1.1 Exhibit appropriate professional behaviours

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

Observer role

1. ●cardiac surgeon
2. ●intensive care physician

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.4 Develop and implement management plans for weaning sedative, vasoactive, and/or inotropic agents as well as mechanical ventilation
• □ME 3.4 Establish and implement a plan for post-procedure care

Collaborator

• □COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with ongoing issues
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.2 Delegate responsibilities to members of the health care team appropriate to their scope of practice and level of expertise
• □COL 3.2 Recognize and act on patient safety issues in the transfer of care

Professional

• □P 1.1 Exhibit appropriate professional behaviours

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

Setting

1. ●journal club
2. ●academic rounds (grand rounds, QA rounds)

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □S 3.2 Identify, select, and navigate pre-appraised resources
• □S 3.3 Interpret study findings, including a critique of their relevance to their practice
• □S 3.3 Determine the validity and risk of bias in a source of evidence
• □S 3.4 Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present the information in an organized manner to facilitate understanding
• □S 2.4 Use audiovisual aids effectively

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

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

Leader

• □L 4.1 Organize work to manage clinical, scholarly, and other responsibilities

Scholar

• □S 4.4 Identify, consult, and collaborate with content experts and others in the conduct of scholarly work
• □S 4.4 Generate focused questions for scholarly investigation
• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health- related research and literature
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.2 Identify ethical principles in research
• □S 4.3 Actively participate as a research team member, balancing the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician
• □S 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.4 Identify areas for further investigation
• □S 4.5 Summarize and communicate the findings of research and scholarly inquiry

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 patient safety or near miss incidents
• □ME 5.1 Identify potential improvement opportunities arising from harmful patient safety incidents and near misses
• □ME 5.2 Consider system factors in the analysis of the safety event

Leader

• □L 1.3 Analyze harmful patient safety incidents and near misses to enhance systems of care

Scholar

• □S 3.3 Evaluate the applicability (external validity or generalizability) of evidence from a resource

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment
• □P 3.3 Prepare a morbidity and mortality report or chart review

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 ECMO

1. ●arterio-venous
2. ●venous-venous

Medical Expert

• □Part A: ME 1.5 Perform appropriately timed clinical assessments
• □Part A: ME 2.2 Synthesize and interpret the clinical information
• □Part A: ME 3.1 Determine the patient’s eligibility and suitability for ECMO
• □Part A: ME 3.3 Determine the appropriate timing and type of ECMO
• □Part A: ME 2.3 Provide information to the family about the expectation of benefit and risks of ECMO, and align with the goals of care
• □Part A: ME 4.1 Establish a plan for ongoing monitoring and care
• □Part B: ME 1.5 Perform appropriately timed clinical assessments
• □Part B: ME 3.4 Assess adequacy of perfusion and cannula placement
• □Part B: ME 2.4 Manage the course of therapy with ECMO, including access, anticoagulation/ hemostasis and any complications
• □Part B: ME 2.4 Determine the timing and procedure for weaning from ECMO
• □Part B: ME 2.3 Provide information to the family about the expectation of benefit and risks of ECMO, and align with the goals of care

Collaborator

• □Part A: COL 1.3 Engage in respectful shared decision-making with physicians and other health care professionals
• □Part B: COL 1.3 Engage in respectful shared decision-making with physicians and other health care professionals

Leader

• □Part A: L 2.1 Allocate health care resources for optimal patient care

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

Case acuity

1. ●emergent
2. ●urgent
3. ●routine

Medical Expert

• □ME 2.2 Interpret clinical information gathered by another health professional, along with the results of investigations, for the purposes of diagnosis and management
• □ME 2.4 Establish a patient centered plan for management and/or patient disposition

Collaborator

• □COL 3.1 Determine when a patient should be transferred to ensure optimal patient care
• □COL 3.2 Provide appropriate advice for immediate management, and in preparation for transfer, as relevant
• □COL 1.2 Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions

Leader

• □L 2.1 Apply knowledge of the available local health care resources

Scholar

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

Professional

• □P 1.1 Respond punctually to requests from patients or other health care providers

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

Case complexity

1. ●low
2. ●medium
3. ●high

Procedure

1. ●coronary artery bypass graft
2. ●aortic valve replacement
3. ●mitral valve replacement
4. ●mitral annulopasty
5. ●resection of atrial myxoma
6. ●ascending aorta surgery
7. ●simple redo sternotomy
8. ●chest re-opening (post-op bleed or tamponade)
9. ●sternal rewiring

Medical Expert

• □ME 1.1 Demonstrate a commitment to high-quality care of their patients
• □ME 3.1 Select appropriate materials and equipment
• □ME 3.4 Institute cardiopulmonary bypass
• □ME 3.4 Institute appropriate myocardial protection
• □ME 3.4 Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Wean cardiopulmonary bypass
• □ME 3.4 Adapt weaning protocols to patient status, including but not limited to hemostasis related issues

Collaborator

• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.2 Demonstrate leadership skills in surgical practice

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 4.1 Exhibit self-awareness and effectively manage influences on personal well- being and professional performance

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 dissection
2. ●Bentall
3. ●emergency CABG
4. ●reoperations
5. ●simple mitral valve repair
6. ●transcatheter valve

Medical Expert

• □ME 1.4 Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Appropriate complete post procedure plan
• □ME 3.4 Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff

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 1.6 Prioritize referrals on the basis of clinical urgency
• □ME 2.2 Select investigations to facilitate timely patient assessment and triage

Collaborator

• □COL 1.3 Address the questions and concerns of the referring/primary care physician when acting in the consultant role
• □COL 1.3 Provide accurate, timely, and relevant written information to the referring/primary care physician
• □COL 1.2 Make effective use of the scope and expertise of other health care professionals 11 COL 2.1Delegate tasks and responsibilities in an appropriate and respectful manner

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.2 Manage OR booking and scheduling
• □L 4.1 Manage time effectively in the ambulatory clinic
• □L 4.1 Review and act on test results in a timely manner

Professional

• □P 1.1 Respond punctually to requests from patients or other health care providers
• □P 1.1 Exhibit appropriate professional behaviours

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 potential improvement opportunities arising from performance data
• □ME 5.2 Adopt strategies that address system factors in clinical practice

Scholar

• □S 1.2 Seek and interpret multiple sources of performance data to continuously improve performance

Professional

• □P 1.2 Maintain a log of procedures and their outcomes
• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

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

Role of observer

1. ●cardiac surgeon
2. ●cardiologist
3. ●anesthesiologist
4. ●other physician
5. ●other health care professional

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Cardiac Surgery
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 2.2 Achieve consensus when there are differences in recommendations provided by other health care professionals

Leader

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

Scholar

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

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps