Cardiology (Adult)

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

Observers providing input

1. ●other cardiologist
2. ●other physician
3. ●nurse
4. ●resident or student
5. ●other observer

Complexity of call

1. ●low
2. ●medium
3. ●high

Type of call

1. ●weeknight
2. ●weekend

Medical Expert

• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 1.4 Recognize urgent problems and seek assistance, as needed

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.1 Demonstrate respect for team members
• □COL 3.2 Summarize and prioritize patient issues for handover to an accepting physician

Leader

• □L 2.1 Apply knowledge of local protocols and resources

Scholar

• □S 2.3 Supervise and support learners to ensure they work within their limits

Professional

• □P 1.1 Respond punctually to requests from other health care professionals
• □P 1.1 Complete assigned responsibilities

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. ●chest pain
2. ●dyspnea
3. ●loss of consciousness
4. ●palpitation/rhythm disturbances

Medical Expert

• □ME 2.1 Determine the acuity of the issue and establish priorities for patient care
• □ME 2.2 Elicit a history and perform a relevant physical exam in a time – effective manner
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Focus the clinical encounter performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Develop and implement initial management plans
• □ME 2.3 Establish goals of care

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources
• □COM 5.1 Document the clinical encounter to convey clinical reasoning and the rationale for decisions and/or recommendations

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. ●arrhythmia
2. ●hemodynamic compromise
3. ●STEMI
4. ●respiratory distress

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.2 Elicit a history and perform a relevant physical exam, in a time- effective manner
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Develop and implement initial management plans
• □ME 3.4 Perform the sequence of cardiac resuscitation as per established protocols
• □ME 4.1 Determine the appropriate disposition and/or setting for ongoing care

Collaborator

• □COL 1.2 Integrate the skills of other health care professionals in the resuscitation

Leader

• □L 2.1 Apply knowledge of local protocols and resources

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

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. ●obtaining central venous access
2. ●placing arterial catheter
3. ●performing transcutaneous pacing
4. ●using electrical cardioversion

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale forthe procedure
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Set up and position the patient for the procedure
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Perform 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-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the encounter to convey the procedure and outcome

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. ●dyspnea
2. ●chest pain
3. ●loss of consciousness
4. ●palpitations
5. ●undifferentiated troponin rise

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Select additional investigations, as appropriate
• □ME 2.2 Apply the clinical implication of test results, sensitivity/specificity, and pre- and post-test probabilities
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Synthesize clinical information to formulate a summary of the case
• □ME 4.1 Determine the need and urgency of referral to another physician
• □ME 2.4 Develop and implement initial management plans

Communicator

• □COM 2.1 Conduct the interview in a patient-centered manner
• □COM 2.3 Seek and synthesize relevant information from other sources (e.g. family, medical record)
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Communicate effectively with physicians and 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

Presentation

1. ●uncomplicated ACS
2. ●uncomplicated CHF
3. ●stable arrhythmias
4. ●syncope
5. ●undifferentiated elevated troponin

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Integrate new findings and changing clinical circumstances into the assessment of the patient’s clinical status
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and monitoring for disease progression
• □ME 2.4 Apply strategies for cardiovascular disease prevention
• □ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Consult as needed with other physicians

Leader

• □L 2.1 Demonstrate resource stewardship in clinical care

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources
• □HA 1.2 Work with the patient to increase opportunities to adopt healthy behaviours

Scholar

• □S 3.4 Demonstrate an evidence-based approach to clinical management

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. ●clinical
2. ●simulation

Type of discussion

1. ●simple
2. ●complex

Medical Expert

• □ME 2.3 Establish goals of care in collaboration with the patient and family

Communicator

• □COM 1.1 Develop trusting and supportive relationships with patients and families
• □COM 3.1 Convey information about medical course and management plan clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 1.5 Recognize when strong emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions
• □COM 4.3 Answer questions from the patient and/or family
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware

Health Advocate

• □HA 1.3 Work the patient to increase opportunities to adopt healthy 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 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 2.4 Develop and implement patient centered discharge and follow-up plans
• □ME 4.1 Coordinate investigation, treatment and followup when multiple physicians and health care professionals are involved

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

Scholar

• □S 3.4 Demonstrate an evidence-based approach to clinical management

Professional

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

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. ●temp wire
2. ●pericardiocentesis
3. ●left heart angiogram +/-PCI
4. ●TEE
5. ●cardioversion
6. ●right heart catheter

Case complexity

1. ●none
2. ●patient unable to give consent
3. ●language barrier
4. ●other issue

Portion observed

1. ●case review
2. ●consent discussion

Medical Expert

• □ME 2.2 Integrate and synthesize clinical information to assess clinical status, peri-procedural risk and opportunities for risk mitigation
• □ME 1.3 Apply knowledge of the indications, techniques and complications of cardiac tests and procedures
• □ME 2.2 Assess a patient’s capacity to provide consent
• □ME 3.2 Explain the risks and benefits of and the rationale and alternatives for a proposed test or procedure

Communicator

• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 4.3 Use effective communication skills and strategies
• □COM 4.3 Answer questions from the patient and/or family
• □COM 5.1 Document the consent discussion in an accurate and complete manner, as appropriate

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. ●bedside
2. ●echo lab

Medical Expert

• □Part A: ME 1.3 Apply knowledge of cardiovascular anatomy, physiology and pathophysiology
• □Part A: ME 1.3 Apply knowledge of the physical principles of ultrasound, including 2D and Doppler echocardiography
• □Part A: ME 3.4 Adjust echocardiographic instrument settings appropriately to optimize image quality
• □Part A: ME 3.4 Obtain standard echocardiographic parasternal, apical, and subcostal views
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part B: ME 1.3 Apply knowledge of cardiovascular anatomy, physiology and pathophysiology
• □Part B: ME 2.2 Recognize clinically significant findings in a transthoracic 2D- echocardiogram
• □Part B: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part B: ME 3.4 Summarize findings of clinical relevance, and suggestions for further testing and/or management as appropriate

Communicator

• □Part A: COM 5.1 Record high quality images of significant findings
• □Part B: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part B: COM 5.1 Communicate critical results urgently, as needed

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

Collaborator

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

Scholar

• □S 2.1 Be a positive role model
• □S 2.2 Create a positive learning environment
• □S 2.3 Provide opportunities for appropriate graded clinical responsibility
• □S 2.3 Be available and accessible to junior learners
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Provide clinical teaching and/or other informal learning activities
• □S 2.5 Provide feedback to enhance learning and performance

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

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 cardiovascular anatomy, physiology and pathophysiology
• □ME 2.2 Assess the JVP
• □ME 2.2 Assess carotid waveform and peripheral pulses
• □ME 2.2 Assess blood pressure in both arms
• □ME 2.2 Inspect and palpate the precordium
• □ME 2.2 Evaluate heart sounds
• □ME 2.2 Evaluate systolic and/or diastolic murmurs, including maneuvers for dynamic auscultation as appropriate (e.g. positional change, Valsalva strain)
• □ME 2.2 Perform a relevant focused exam of the chest, abdomen and extremities
• □ME 2.2 Interpret the findings of the physical exam in the context of the patient’s presentation

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, and safety

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. ●complicated ACS
2. ●refractory heart failure
3. ●shock
4. ●adult congenital heart disease
5. ●pregnancy
6. ●multivalve disease
7. ●significant complications from procedures
8. ●unstable rhythm abnormality
9. ●pulmonary hypertension
10. ●end stage cardiac disease

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 3.3 Balance risk, effectiveness and priority of interventions in the presence of multiple co-morbidities and/or other features of case complexity
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and needs
• □ME 4.1 Determine the need and urgency of referral to another physician
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression

Communicator

• □COM 4.3 Use communication strategies and skills that help the patient make informed decisions

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.3 Work effectively with other health care professionals to plan and provide integrated care

Health Advocate

• □HA 1.1 Identify barriers to access and care for individual patients

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

Presentation

1. ●complicated acute coronary syndrome
2. ●refractory heart failure
3. ●shock
4. ●adult congenital heart disease
5. ●pregnancy
6. ●multivalve disease
7. ●significant complications from procedures
8. ●unstable rhythm abnormalities
9. ●pulmonary hypertension
10. ●end stage cardiac disease

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Synthesize patient information to determine clinical status and/or response to treatment
• □ME 2.2 Integrate the patient’s other medical problems and current health status into the clinical assessment
• □ME 2.4 Adjust management plans based on clinical status and/or response to treatment
• □ME 4.1 Determine the need and timing of referral to another physician

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient make informed decision

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.3 Work effectively with other physicians and health care professionals to plan and provide integrated care

Health Advocate

• □HA 1.3 Incorporate prevention, health promotion and health surveillance into patient interactions

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

Perioperative

1. ●yes
2. ●no

Active bleeding/high risk of bleeding

1. ●yes
2. ●no

Comorbidity

1. ●cancer
2. ●bleeding
3. ●renal failure
4. ●infection
5. ●pregnancy
6. ●other comorbidity

Medical Expert

• □ME 1.4 Adapt the clinical assessment to the expectations and boundaries of the consultant role
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and needs

Communicator

• □COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □COL 1.3 Communicate effectively with the consulting service
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care when there are differences in opinion and/or recommendations

Leader

• □L 4.1 Manage time and prioritize tasks

Scholar

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

Professional

• □P 1.1 Exhibit appropriate professional behaviors

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. ●pericardial
2. ●myocardial
3. ●coronary
4. ●valve
5. ●vascular
6. ●conduction/arrhythmia
7. ●congenital
8. ●perioperative
9. ●non-cardiac chest pain
10. ●pregnancy
11. ●end stage cardiac disease

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select, sequence and prioritize investigations based on patient needs and the resources available in the outpatient setting
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and needs
• □ME 2.4 Determine the setting of care appropriate for the patient’s current heath care needs, including admission to hospital, ongoing outpatient followup or discharge to referring physician

Communicator

• □COM 3.1 Convey information about the medical course and management plan clearly and accurately
• □COM 5.1 Document consultations to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Work effectively with other health care professionals to plan and provide integrated care

Health Advocate

• □HA 1.2 Select relevant patient education 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

Presentation

1. ●pericardial
2. ●myocardial
3. ●coronary
4. ●valve
5. ●vascular
6. ●conduction/arrhythmia
7. ●congenital
8. ●perioperative
9. ●non-cardiac chest pain
10. ●pregnancy
11. ●end stage cardiac disease

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Synthesize patient information to determine clinical status and/or response to treatment
• □ME 2.4 Adjust management plans based on clinical status and/or response to treatment
• □ME 2.4 Develop a plan for management, which may include continuation of current treatment, change in therapy, escalation of therapy or a palliative approach
• □ME 4.1 Determine the need and timing of referral to another health care professional
• □ME 4.1 Determine the frequency and timing of future investigations and visits

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □COL 3.1 Determine when care should be transferred back to the primary health care professional

Health Advocate

• □HA 1.3 Incorporate prevention, health promotion and health surveillance into patient interactions

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

Presentation

1. ●resuscitated arrest
2. ●complicated acute coronary syndrome (ACS) and its spectrums
3. ●shock
4. ●life threatening arrhythmias (i.e. brady or tachy)
5. ●mechanical/anatomical complications
6. ●aortic syndromes
7. ●acute pericardial disorders
8. ●uni- or biventricular failure
9. ●valvular dysfunction (native and prosthetic)
10. ●pulmonary embolism

Renal replacement therapy required

1. ●yes
2. ●no

Ventilation required

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner without excluding key elements
• □ME 2.4 Manage hemodynamic support and monitoring
• □ME 2.4 Manage non-invasive and/or invasive ventilation, in collaboration with other specialists
• □ME 2.4 Develop and implement management plans for critically ill patients, including providing or arranging for definitive care
• □ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □ME 4.1 Determine the need and urgency of referral to another physician

Communicator

• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately

Collaborator

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

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

Medical Expert

• □ME 2.1 Identify patients for whom the burden of disease modifying therapy or investigations is greater than the clinical benefit
• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease modifying approach
• □ME 2.3 Address the impact of the medical condition on the patients’ ability to pursue life goals and purposes
• □ME 2.3 Establish goals of care in collaboration with the patient and/or family
• □ME 3.1 Select investigations and therapies appropriate to the patient’s goals of care
• □ME 2.4 Develop and implement management plans that optimize symptom management and support achievement of the patient’s goals of care
• □ME 2.4 Develop management plans that align with the goals of care

Communicator

• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regards to their care
• □COM 1.5 Recognize when strong emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
• □COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions

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 2.2 Assess risk factors for disease progression as well as a patient’s need for health promotion
• □ME 2.2 Assess the patient’s functional and performance status, and the effect of their underlying condition on their tolerance for physical activity
• □ME 2.2 Assess an individual’s access to health care, food, security, social support and other social determinants of health
• □ME 2.4 Integrate primary and secondary prevention strategies as part of the overall management plan

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting health behaviours
• □HA 1.2 Work with the patient to increase their understanding of their illness and health care needs
• □HA 1.2 Select relevant patient education resources
• □HA 1.1 Facilitate timely patient access to services and resources

Professional

• □P 1.1 Demonstrate respect for patient autonomy

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

Urgency of procedure

1. ●elective
2. ●urgent
3. ●emergent

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, gown and glove
• □ME 3.4 Perform the insertion of a transvenous pacemaker, using ultrasound guidance as appropriate
• □ME 3.4 Order and review post procedure imaging
• □ME 3.4 Adjust device settings
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the procedure

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

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

Urgency of procedure

1. ●elective
2. ●urgent
3. ●emergent

Complexity

1. ●simple
2. ●difficult

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 1.3 Apply knowledge of key anatomic relationships
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, gown and glove
• □ME 3.4 Perform pericardiocentesis, using ultrasound guidance as appropriate
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 2.2 Interpret the results of diagnostic investigations in the context of the clinical presentation
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the procedure

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

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 2.2 Perform an assessment of the patient’s airway
• □ME 2.2 Assess a patient’s suitability to proceed with electrical cardioversion
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Select and provide sedation, as appropriate
• □ME 3.4 Perform electrical cardioversion
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the procedure

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants during the procedure

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. ●right heart cath
2. ●left heart cath
3. ●bedside insertion of PA catheter

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, gown and glove
• □ME 3.4 Perform the insertion of a pulmonary artery catheter
• □ME 3.4 Order and review post procedure imaging
• □ME 3.4 Establish and implement a plan for post-procedure care

Communicator

• □COM 5.1 Document the procedure

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

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

Bedside

1. ●yes
2. ●no

Images obtained by resident

1. ●yes
2. ●no

Findings

1. ●normal heart
2. ●cardiomyopathy
3. ●ventricular dysfunction
4. ●diastolic dysfunction
5. ●valvular heart disease
6. ●pericardial disease
7. ●aortic disease
8. ●intracardiac mass
9. ●intracardiac shunt
10. ●prosthetic valve
11. ●other finding

Medical Expert

• □Part A: ME 3.4 Adjust echocardiographic instrument settings appropriately to optimize image quality
• □Part A: ME 3.4 Obtain standard echocardiographic parasternal, apical, and subcostal views
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part A: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part A: ME 1.3 Apply knowledge of cardiovascular anatomy, physiology and pathophysiology
• □Part A: ME 2.2 Recognize clinically significant findings in a transthoracic echocardiogram
• □Part A: ME 3.4 Provide interpretation of transthoracic echocardiography
• □Part A: ME 3.4 Summarize findings of clinical relevance, and suggestions for further testing and/or management as appropriate

Communicator

• □Part A: COM 5.1 Record high quality images of significant findings
• □Part A: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part A: COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □Part A: COL 1.2 Communicate effectively with nurses and/or assistants during the procedure

Professional

• □Part A: P 1.1 Work within personal limitations, asking for assistance as needed

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

Indication for testing

1. ●ischemia
2. ●arrhythmia
3. ●functional capacity
4. ●exercise prescription
5. ●valvular disease

Study stopped/altered due to patient factors

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.2 Perform a focused clinical assessment without excluding key elements
• □Part A: ME 2.2 Assess a patient’s suitability to proceed with cardiac stress testing
• □Part A: ME 3.1 Select the stress test protocol relevant to the clinical question and patient condition
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part A: ME 3.4 Modify or adjust the procedure as needed to optimize study quality
• □Part A: ME 3.4 Manage immediate complications of the procedure, as relevant
• □Part B: ME 1.3 Apply knowledge of the principles, strengths and limitations of diagnostic investigations
• □Part B: ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □Part B: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part B: ME 3.4 Summarize findings of clinical relevance, and suggestions for further testing and/or management as appropriate

Communicator

• □Part A: COM 5.1 Communicate critical results urgently, as needed
• □Part B: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part B: COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □Part A: COL 1.2 Communicate effectively with nurses and/or technologists during the procedure

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 2.2 Perform a focused clinical assessment without excluding key elements
• □Part A: ME 2.2 Assess a patient’s suitability to proceed with cardiac stress testing
• □Part A: ME 3.1 Select the stress test protocol relevant to the clinical question and patient condition
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part A: ME 3.4 Modify or adjust the procedure as needed to optimize study quality
• □Part A: ME 3.4 Manage immediate complications of the procedure, as relevant
• □Part B: ME 1.3 Apply knowledge of cardiovascular anatomy, physiology and pathophysiology
• □Part B: ME 1.3 Apply knowledge of the principles, strengths and limitations of diagnostic investigations
• □Part B: ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □Part B: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part B: ME 3.4 Summarize findings of clinical relevance, and provide suggestions for further testing and/or management as appropriate

Communicator

• □Part A: COM 5.1 Communicate critical results urgently, as needed
• □Part B: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part B: COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □Part A: COL 1.2 Communicate effectively with nurses and/or technologists during the procedure

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 1.3 Apply knowledge of cardiac electrophysiology
• □Part A: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part B: ME 1.3 Apply knowledge of cardiac electrophysiology
• □Part B: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part B: ME 3.4 Summarize findings of clinical relevance, and provide suggestions for further testing and/or management as appropriate

Communicator

• □Part A: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part A: COM 5.1 Communicate critical results urgently, as needed
• □Part B: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part B: COM 5.1 Communicate critical results urgently, as needed

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

Device

1. ●ICD
2. ●CRT
3. ●pacemaker

Medical Expert

• □ME 2.2 Perform a focused clinical assessment without excluding key elements
• □ME 1.3 Apply knowledge of device therapies, including equipment and modalities
• □ME 3.4 Interrogate permanent pacemakers and implanted devices
• □ME 2.2 Interpret the results of diagnostic investigations in the context of the clinical presentation
• □ME 2.4 Manage device and/or lead problems

Communicator

• □COM 5.1 Document the encounter to convey the procedure and outcome

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

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

Intracoronary imaging or physiology

1. ●yes
2. ●no

Hemodynamic tracings

1. ●yes
2. ●no

Post bypass surgery

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 1.3 Apply knowledge of cardiovascular anatomy, physiology and pathophysiology
• □ME 2.2 Recognize clinically significant findings in a diagnostic coronary angiogram
• □ME 2.2 Identify indications for adjunctive intracoronary physiology and imaging
• □ME 2.2 Interpret the results of diagnostic investigations in the context of the clinical presentation
• □ME 2.4 Provide recommendations for further testing and/or management
• □ME 4.1 Determine the need and timing of referral for cardiac intervention

Collaborator

• □COL 1.2 Consult as needed with other physicians

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

Type of activity

1. ●journal club
2. ●grand rounds
3. ●case presentation
4. ●other

Scholar

• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Develop learning objectives for a teaching activity
• □S 3.3 Critically evaluate the integrity, reliability and applicability of health related research and literature
• □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
• □S 2.4 Provide adequate time for questions and discussion

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

Professional

• □P 1.1 Exhibit honesty, integrity and respect for the privacy of clinical information in the conduct of scholarly work

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 responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 2.4 Assess the need and timing of patient transfer to another level of care
• □ME 4.1 Coordinate the involvement of consulting services in patient care

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □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 4.1 Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings

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 responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 4.1 Formulate and implement plans for discharge that include appropriate ongoing care and followup

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

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

Medical Expert

• □ME 1.5 Carry out professional duties in the face of multiple, competing demands

Collaborator

• □COL 1.3 Communicate effectively with the consulting service
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care when there are differences in opinion and/or recommendations

Leader

• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □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

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 2.2 Select investigation strategies demonstrating awareness of availability and access in the outpatient setting
• □ME 2.4 Formulate treatment plans that are suitable for implementation in the outpatient setting

Collaborator

• □COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.1 Review and act on test results in a timely manner

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 professionals

Case description

Feedback provided

Next steps