Clinical Pharmacology and Toxicology

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 1.4 Recognize urgent problems and seek assistance CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)
• □ME 2.2 Elicit a history and perform a physical exam that informs the diagnosis
• □ME 2.2 Elicit a comprehensive history of drug/toxin exposure
• □ME 2.2 Select appropriate initial diagnostic tests
• □ME 2.2 Develop a differential diagnosis
• □ME 1.4 Perform the assessment in a timely manner

Communicator

• □COM 1.1 Establish rapport with the patient
• □COM 2.1 Conduct the interview in a patient-centred manner

Collaborator

• □COL 1.3 Communicate effectively with other physicians and health care professionals CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Communicator

• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Document all relevant findings
• □COM 5.1 Convey clinical reasoning, and rationale for decisions and/or recommendations
• □COM 5.1 Document the plan for ongoing management
• □COM 5.1 Complete clinical documentation in a timely manner CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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 Perform a focused clinical assessment
• □ME 2.2 Determine if specialized testing is indicated
• □ME 2.2 Select the most appropriate testing strategy, including follow-up testing
• □ME 3.3 Triage testing, taking into account clinical urgency, potential for deterioration, and available resources

Leader

• □L 2.1 Consider costs when selecting specialized testing CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Medical Expert

• □ME 1.3 Apply knowledge of pharmacology, toxicology and clinical sciences to manage patient presentations involving adverse drug reactions and toxic exposures
• □ME 1.4 Recognize urgent problems and seek assistance
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Distinguish a potentially toxic from assuredly non-toxic exposure
• □ME 2.4 Recommend or implement initial supportive and specific management

Communicator

• □COM 5.1 Document the clinical assessment and management plan CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Medical Expert

• □ME 2.2 Gather a complete history, including full medication history and adherence
• □ME 2.2 Identify significant drug interactions
• □ME 2.2 Recommend appropriate testing, including pharmacogenetics and drug concentration levels
• □ME 2.2 Assess likelihood of benefit and harm for all medications
• □ME 2.4 Develop a management plan
• □ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □ME 2.4 Discuss with the patient and family the degree of diagnostic uncertainty inherent to the clinical situation

Communicator

• □COM 5.1 Document the clinical assessment and management plan
• □COM 4.1 Explore the perspectives of the patient and others when developing care plans, including identifying barriers to adherence

Collaborator

• □COL 1.3 Convey information to the referring health care provider in a manner that enhances patient management CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Scholar

• □S 3.1 Recognize knowledge gaps arising from a clinical encounter
• □S 3.3 Apply knowledge of available resources to select appropriate sources
• □S 3.3 Develop and execute an effective search strategy
• □S 3.3 Critically evaluate the reliability and quality of resources
• □S 3.4 Integrate findings to address the clinical question CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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 article

1. ●case-control
2. ●cohort
3. ●randomized control trial
4. ●systematic review
5. ●other study design

Scholar

• □S 3.2 Identify and select relevant high-quality articles pertinent to the field
• □S 3.3 Apply the concepts of internal and external validity
• □S 3.3 Recognize and evaluate sources of bias, including conflicts of interest
• □S 3.3 Assess the level of evidence quality
• □S 3.1 Identify remaining gaps in knowledge and questions for further investigation
• □S 3.4 Integrate best evidence and clinical expertise
• □S 3.3 Interpret study findings and critique their relevance to clinical practice
• □S 2.4 Present the information in an organized manner CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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 laboratory methodologies in CPT
• □ME 3.2 Describe proposed specialized testing to the patient/family, including the benefits, harms, and cost effectiveness of each testing option
• □ME 2.4 Discuss with the patient and family the degree of diagnostic uncertainty inherent to the clinical situation

Communicator

• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Verify understanding of the information conveyed
• □COM 4.3 Answer questions from the patient and family
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make an informed decision
• □COM 5.1 Document the consent discussion CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Feedback from recipient of consult included

1. ●yes
2. ●no

Type of observation

1. ●direct
2. ●case review

Medical Expert

• □ME 2.1 Establish the nature of the clinical question
• □ME 1.1 Demonstrate responsibility and accountability for patient care

Collaborator

• □COL 1.1 Establish positive relationships with referring physicians
• □COL 1.2 Convey the role of the CPT consultant, and if relevant, the boundaries applicable to the consultant role
• □COL 1.3 Convey information to the referring health care provider in a manner that enhances patient management
• □COL 1.3 Encourage discussion, questions and interaction relevant to the case

Health Advocate

• □HA 1.1 Facilitate access to specialized testing, resources, and services

Professional

• □P 1.1 Exhibit appropriate professional behaviours CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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 Pose questions that are appropriately constructed and amenable to scholarly inquiry
• □S 3.3 Evaluate the applicability (external validity or generalizability) of evidence
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a scholarly question
• □S 4.2 Apply the principles of research ethics, as appropriate to the scholarly project
• □S 4.4 Propose a research question that is medically and scientifically relevant and demonstrates societal benefit
• □S 4.3 Work effectively with other members of the project team, including project supervisor

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of scholarly activity CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Gather information about medications, use of complementary and alternative medicines and the underlying condition(s)
• □ME 2.2 Evaluate causality and differential diagnosis
• □ME 2.4 Develop a management plan CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)
• □ME 2.4 Identify risk of drug re-challenging and provide advice on continuation/discontinuation of drugs

Communicator

• □COM 3.1 Provide information on diagnosis and prognosis to the patient/family clearly and compassionately
• □COM 4.3 Answer questions from the patient and family
• □COM 5.1 Document the clinical encounter to adequately convey the assessment, recommendations and the rationale for decisions CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

Collaborator

• □COL 1.3 Convey information from the CPT consultation in a manner that enhances patient management

Health Advocate

• □HA 1.1 Facilitate access to specialized testing, resources, and services

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Gather information about the exposure/causal entity, including extent of exposure, timing, and any concomitant exposures or ingestions
• □ME 2.2 Gather information about any co-morbidities and other factors that may impact the patient’s outcome
• □ME 2.1 Assess the clinical urgency and potential for deterioration
• □ME 2.4 Develop a plan for supportive care, decontamination, antidotal therapy and/or enhanced elimination as appropriate CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)
• □ME 2.4 Determine the need to transfer/transport the patient

Communicator

• □COM 3.1 Provide information on diagnosis and prognosis to the patient/family clearly and compassionately
• □COM 4.3 Answer questions from the patient and family

Collaborator

• □COL 1.3 Convey information from the CPT consultation in a manner that enhances patient management
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

Health Advocate

• □HA 1.1 Facilitate access to specialized testing, resources, and services

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

Demographic

1. ●pediatric
2. ●adult
3. ●geriatric
4. ●bariatric
5. ●maternal- fetal
6. ●critically ill
7. ●anesthesia
8. ●other

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Identify potentially inappropriate medications and significant drug interactions
• □ME 2.2 Recommend appropriate testing, including pharmacogenetics and drug concentration levels
• □ME 3.4 Apply pharmacological principles to guide therapeutic management
• □ME 2.4 Develop a plan for rational prescribing and management based on individual drug and patient characteristics
• □ME 4.1 Establish plans for monitoring the patient and treatment efficacy

Communicator

• □COM 4.3 Answer questions from the patient and family CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)
• □COM 5.1 Document the clinical encounter to adequately convey the assessment, recommendations and the rationale for decisions CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

Collaborator

• □COL 1.3 Convey information from the CPT consultation in a manner that enhances patient management

Health Advocate

• □HA 1.1 Facilitate access to specialized testing, resources, and services

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 test

1. ●therapeutic drug monitoring
2. ●toxicologic testing
3. ●pharmacogenetic testing
4. ●other test

Type of observation

1. ●direct
2. ●case review

Medical Expert

• □ME 2.1 Establish the nature of the clinical question
• □ME 3.4 Provide guidance on the most appropriate selection, sequence and/or timing of pharmacologic, toxicologic and/or pharmacogenomics testing

Communicator

• □COM 2.3 Gather patient information from another health professional

Collaborator

• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 1.3 Communicate effectively with other physicians and health care professionals

Leader

• □L 2.1 Use specialized tests in a cost-effective manner

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Leader

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

Scholar

• □S 4.4 Consult and collaborate with content experts and other members of the team in the conduct of scholarly work
• □S 4.2 Apply the principles of research ethics, as appropriate to the scholarly project
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis as appropriate
• □S 4.5 Prepare interim reports suitable for review

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of scholarly activity CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

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 2.4 Adapt the vocabulary and presentation to the audience
• □S 2.4 Present the information in an organized manner
• □S 2.4 Use audiovisual aids effectively
• □S 2.4 Provide adequate time for questions and discussion
• □S 2.2 Create a positive and safe learning environment CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Reporting system

1. ●Health Canada
2. ●local hospital
3. ●Institute for Safe Medication Practices (ISMP)
4. ●manufacturer
5. ●other

Medical Expert

• □ME 5.1 Recognize and diagnose an adverse drug reaction
• □ME 5.1 Mitigate further injury from an adverse event, as appropriate
• □ME 1.3 Apply knowledge of the Canadian framework for pharmacovigilance and reporting requirements
• □ME 5.1 Report an adverse event as per institutional process and/or governmental regulations

Communicator

• □COM 3.2 Disclose a patient safety incident and/or unanticipated clinical outcomes to a patient/family
• □COM 4.3 Answer questions from the patient and family

Leader

• □L 1.3 Analyze an adverse drug event to guide process improvement CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

Professional

• □P 3.1 Fulfill professional regulatory and legal requirements regarding reporting adverse drug events

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. ●inpatient
2. ●outpatient
3. ●poison centre
4. ●other setting

Medical Expert

• □ME 1.5 Triage consultation requests based on clinical acuity
• □ME 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role
• □ME 4.1 Coordinate investigation, treatment and follow-up when multiple physicians and health care professionals are involved

Collaborator

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

Leader

• □L 4.2 Carry out clinical, administrative, supervisory and teaching responsibilities in a time-effective manner
• □L 2.1 Allocate health care resources for optimal patient care

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
• □S 2.3 Balance supervision and graduated responsibility, ensuring the safety of patients and learners
• □S 2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners CLINICAL PHARMACOLOGY AND TOXICOLOGY (2021)

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

Leader

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

Scholar

• □S 4.4 Consult and collaborate with content experts and other members of the team in the conduct of scholarly work
• □S 4.2 Apply the principles of research ethics, as appropriate to the scholarly project
• □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
• □S 4.5 Prepare a completed work suitable for dissemination in an appropriate medium/forum

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of scholarly activity

Case description

Feedback provided

Next steps