Colorectal 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

Setting

1. ●emergency department
2. ●inpatient
3. ●outpatient

Medical Expert

• □ME 2.2 Elicit a history and perform a physical exam relevant to the presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Develop a management plan
• □ME 4.1 Determine if there is a need for consultation with another specialist or service

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources (e.g. family, medical record)
• □COM 5.1 Document the clinical encounter

Professional

• □P 1.1 Complete assigned responsibilities in a timely fashion

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

Approach

1. ●anorectal
2. ●minimally invasive surgery
3. ●open

Type of procedure

1. ●anastomosis
2. ●colectomy
3. ●diverting ostomy
4. ●examination under anesthesia
5. ●ostomy
6. ●simple anorectal procedure

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, 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

Pathology

1. ●benign
2. ●malignant

Disorder

1. ●anal disorder
2. ●anorectal disorder
3. ●colon disorder
4. ●common colorectal emergency
5. ●Crohn’s disease
6. ●rectal disorder
7. ●ulcerative colitis

Diagnostic approach

1. ●anoscopy
2. ●biopsy
3. ●endorectal/endoanal ultrasound
4. ●flexible sigmoidoscopy
5. ●rigid sigmoidoscopy
6. ●N/A

Medical Expert

• □ME 2.2 Elicit a history and perform a physical exam relevant to the presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 3.4 Perform diagnostic procedures in a skilful and safe manner with attention to patient comfort
• □ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage, prognosis, and/or severity of the condition
• □ME 2.4 Develop a plan for management, which may include additional investigation, observation, surgery, and/or non-operative intervention
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 3.2 Obtain informed consent for the planned management

Communicator

• □COM 3.1 Provide information to the patient and/or family about the condition and plans for management clearly and compassionately
• □COM 4.3 Answer questions from the patient and/or family
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Professional

• □P 1.1 Behave in a professional 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

Maximal depth of insertion

1. ●rectum
2. ●sigmoid colon
3. ●descending colon
4. ●splenic flexure
5. ●transverse colon
6. ●hepatic flexure
7. ●ascending colon
8. ●cecum
9. ●terminal ileum
10. ●anastomosis

Obstacles to progression

1. ●management of loops
2. ●difficult sigmoid colon (e.g., diverticular disease, IBS, pelvic surgery)
3. ●abdominal wall hernia
4. ●N/A

Polypectomy

1. ●yes
2. ●no

Tattooing

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Prepare and position the patient, and use other techniques during the procedure to advance the endoscope safely
• □ME 3.4 Demonstrate torque steering and tip deflection for effective navigation of the GI tract
• □ME 3.4 Recognize and resolve loop formation
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Achieve clear visualization of the mucosa using a variety of techniques, including air, water, and suction
• □ME 3.4 Perform tissue biopsy and polypectomy (cold or hot) as appropriate to indication
• □ME 3.4 Demonstrate appropriate pace and progress during insertion and withdrawal
• □ME 3.4 Identify and respond to immediate complications of the procedure if applicable
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed

Communicator

• □COM 3.1 Convey the results of colonoscopy and further management plan to the patient/family

Collaborator

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

Health Advocate

• □HA 1.3 Counsel the patient regarding future management plans and need for family screening where appropriate

Professional

• □P 1.1 Work within personal limits, 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

Local anesthetic

1. ●yes
2. ●no

Condition

1. ●abscess
2. ●fissure
3. ●fistula
4. ●hemorrhoids
5. ●HPV-related lesions
6. ●pilonidal disease

Procedure

1. ●incision and drainage
2. ●lateral internal sphincterotomy
3. ●botox injection
4. ●fistulotomy
5. ●seton placement/exchange
6. ●rubber band ligation
7. ●sclerotherapy
8. ●infrared coagulation
9. ●hemorrhoidectomy
10. ●PPH
11. ●biopsy
12. ●topical treatment application
13. ●excision and fulguration
14. ●unroofing
15. ●excision
16. ●other

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for a proposed procedure or therapy
• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Select surgical approach and provide sedation and local anesthesia, as appropriate
• □ME 3.4 Perform the procedure in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Establish and implement a plan for post-procedure care

Collaborator

• □COL 1.2 Communicate effectively with patient and/or assistant(s) during the procedure

Professional

• □P 1.1 Work within personal limits, 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

Disease type

1. ●malignancy
2. ●other

Procedure

1. ●right colon
2. ●left colon
3. ●total

Technique

1. ●MIS
2. ●open

Special features

1. ●intracorporeal side to side anastomosis
2. ●splenic flexure mobilization
3. ●N/A

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre-operative assessments/consults
• □P 1.1 Work within personal limits, 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

Condition

1. ●diverticular disease
2. ●neoplasia
3. ●other

Surgical approach

1. ●MIS
2. ●open

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, 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. ●parastomal hernia repair
2. ●stoma creation
3. ●stoma closure
4. ●stoma revision

Approach

1. ●MIS
2. ●open

Medical Expert

• □ME 5.2 Verify there is an appropriate pre-operative stoma landmark
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, 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

Acuity of complication

1. ●acute
2. ●chronic

Type of complication

1. ●anastomotic leak-pelvic
2. ●anastomotic leak-other
3. ●bowel obstruction
4. ●enterocutaneous fistula
5. ●high output ostomy
6. ●other stoma-related problem
7. ●other (please specify)

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.4 Develop and implement a management plan
• □ME 3.3 Consider urgency and potential for deterioration in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and/or disclose patient safety incidents to the patient and/or family
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Professional

• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

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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 conference

1. ●cancer
2. ●IBD
3. ●pelvic floor
4. ●other (write in)

Medical Expert

• □ME 2.2 Synthesize cases for discussion at multidisciplinary rounds

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 2.2 Facilitate the development of consensus when there are differences in recommendations provided by other health care professionals

Health Advocate

• □HA 1.1 Advocate for the patient’s needs and concerns and the appropriate treatment plan

Scholar

• □S 2.4 Present the information in an organized manner

Professional

• □P 1.1 Behave in a professional 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

Presentation

1. ●anal cancer
2. ●anorectal disorder
3. ●colon cancer
4. ●diverticular disease
5. ●hereditary cancer syndrome
6. ●inflammatory bowel disease
7. ●low anterior resection syndrome
8. ●pouch dysfunction
9. ●rectal cancer
10. ●other (write in)

Complex features

1. ●locally invasive
2. ●fistulizing
3. ●recurrent
4. ●metastatic
5. ●obstructing
6. ●other (write in)

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Interpret investigations
• □ME 2.2 Integrate the patient’s other medical problems, overall functioning, and current health status into the assessment of suitability for intervention
• □ME 2.3 Establish goals of care with the patient and family
• □ME 2.4 Develop a plan for management which may include additional investigation, observation, and endoscopic, surgical, and/or non-operative intervention
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.2 Determine if the case warrants discussion at multidisciplinary rounds

Communicator

• □COM 3.1 Provide information about treatment options, including the choice of surgical technique and other treatment modalities
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Health Advocate

• □HA 1.2 Provide recommendations for resources for patient education and support

Scholar

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

Professional

• □P 1.1 Behave in a professional 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

Condition

1. ●fecal incontinence
2. ●outlet obstruction
3. ●rectal prolapse
4. ●other (write in)

Test

1. ●anorectal manometry
2. ●defecography
3. ●endoanal ultrasound
4. ●GI transit study
5. ●N/A

Medical Expert

• □ME 2.2 Elicit a history and perform a physical exam relevant to the presentation
• □ME 2.2 Determine if patient requires anorectal or pelvic floor physiology testing or imaging
• □ME 2.2 Interpret the results of clinical data, including anorectal or pelvic floor physiology testing, to establish the diagnosis
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context

Communicator

• □COM 3.1 Provide information to the patient and/or family about the condition and plans for management clearly and compassionately
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Health Advocate

• □HA 1.2 Provide recommendations for resources for patient education and support

Professional

• □P 1.1 Behave in a professional 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

Technique

1. ●submucosal injecting and lifting
2. ●clipping
3. ●endolooping
4. ●endoscopic mucosal resection
5. ●endoscopic submucosal dissection
6. ●dilation
7. ●colonic stenting
8. ●argon plasma coagulation
9. ●chromoendoscopy
10. ●combined laparoscopic/endoscopic procedures

Complexity

1. ●polypectomy >2cm
2. ●configuration/anatomic location of polyps
3. ●complications during polypectomy
4. ●complex lesions
5. ●inflammatory polyps
6. ●N/A
7. ●other (write in)

Medical Expert

• □ME 3.4 Manipulate endoscope appropriately, achieving stabilization, orientation and direction
• □ME 3.4 Assess the clinical findings and evaluate eligibility for advanced endoscopic removal
• □ME 3.4 Select and gather appropriate ancillary equipment
• □ME 3.4 Demonstrate appropriate and safe use of ancillary equipment (e.g. electrocautery, endoscopic injection therapies, endoscopic clips, hemospray, APC, balloon tamponade tubes, dilation equipment)
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Identify and respond to immediate challenges or complications of the procedure

Communicator

• □COM 5.1 Document findings of an endoscopic procedure in a complete and timely manner

Health Advocate

• □HA 1.3 Counsel the patient regarding future management plans and need for family screening where appropriate

Professional

• □P 1.1 Work within personal limits, 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

Approach

1. ●MIS
2. ●open

Procedure

1. ●coloanal anastomosis-handsewn
2. ●coloanal anastomosis-stapled
3. ●low anterior resection-handsewn
4. ●low anterior resection-stapled

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 1.3 Apply knowledge of the local, regional, and systemic factors relevant to performing an anastomosis
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre-operative assessments/consults
• □P 1.1 Work within personal limits, 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

Condition

1. ●malignant
2. ●benign

Approach

1. ●MIS
2. ●open

Procedure

1. ●low anterior resection
2. ●complete proctectomy with coloanal anastomosis
3. ●proctocolectomy
4. ●abdominoperineal resection for malignancy
5. ●complete proctectomy with end ostomy (low Hartmann’s)
6. ●rectopexy
7. ●multivisceral resection

Complex case

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre-operative assessments/consults

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

Approach

1. ●conventional
2. ●MIS
3. ●endoscopic microsurgery
4. ●endoscopic

Closure of proctotomy site

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults

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. ●sphincter preserving fistula repair (e.g., LIFT, or advancement flap)
2. ●other (write in)

Crohn’s disease

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre-operative assessments/consults
• □P 1.1 Work within personal limits, 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. ●anal sphincter repair
2. ●intersphincteric dissection
3. ●perineal excision of anal sphincter
4. ●rectal prolapse surgery (Delorme or Altemeier)
5. ●surgery for presacral disease

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults

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

Feature

1. ●malignancy
2. ●complicated inflammatory bowel disease
3. ●post-operative complication
4. ●reoperative surgery
5. ●other (e.g., radiation, desmoid)

Procedure

1. ●resection
2. ●stricturoplasty
3. ●bypass

Medical Expert

• □ME 3.4 Anticipate and make the operative team aware of potential complexity (e.g. conversion to open, potential need for blood transfusion)
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults

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

Disorder

1. ●diverticular disease
2. ●inflammatory bowel disease
3. ●malignancy
4. ●other (write in)

Feature

1. ●fistulizing
2. ●locally invasive
3. ●multivisceral resection
4. ●obstructing
5. ●reoperative
6. ●other (write in)

Medical Expert

• □ME 3.4 Anticipate and make the operative team aware of potential complexity (e.g. conversion to open, potential need for blood transfusion)
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Demonstrate intraoperative judgement to anticipate and respond to challenges
• □ME 3.4 Anticipate the need for intraoperative consultation with another surgical specialty

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR Team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, 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

Pouch type

1. ●ileal
2. ●colonic

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre-operative assessments/consults
• □P 1.1 Work within personal limits, 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

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 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 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.5 Summarize and communicate the findings of research and scholarly inquiry
• □S 4.4 Identify areas for further investigation

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. ●postgraduate half- day
5. ●other (write in)

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 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

Medical Expert

• □ME 1.4 Perform relevant clinical assessments
• □ME 2.4 Establish patient-centred management plans
• □ME 3.4 Perform procedures in a skilful and safe manner

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete, and timely manner

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.2 Book operative cases with appropriate urgency, duration, and equipment and patient preparation
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinic

Scholar

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

Professional

• □P 1.1 Behave in a professional 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

Medical Expert

• □ME 3.4 Anticipate and prepare for technical challenges and/or significant findings
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for a proposed procedure or therapy
• □ME 3.4 Perform endoscopic procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 4.1 Propose and implement plans for ongoing care, follow-up on investigations, and further treatment or referral

Communicator

• □COM 5.1 Convey a written summative impression and management plan to the referring physician

Leader

• □L 4.2 Demonstrate leadership skills in the colonoscopy suite
• □L 4.1 Manage time effectively to maintain patient flow

Professional

• □P 1.2 Prepare for the day, reviewing the list of planned procedures

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.4 Anticipate and prepare for technical challenges and/or significant findings
• □ME 3.4 Select appropriate materials and equipment for the procedure
• □ME 3.4 Perform surgical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure as appropriate
• □ME 4.1 Establish plans for post-operative care

Communicator

• □COM 3.1 Convey information about the procedure, operative findings, and patient status to the family clearly and compassionately
• □COM 5.1 Document surgical procedures in an accurate complete and timely manner

Leader

• □L 4.1 Manage time effectively to maintain patient flow

Scholar

• □S 2.3 Allocate appropriate time for junior learners’ educational activities while ensuring patient care, efficiency, resources, and safety are maintained

Professional

• □P 1.2 Prepare for the day, reviewing the list of planned procedures
• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps