Critical Care Medicine (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

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 2.1 Prioritize issues to address in the patient’s assessment and management
• □ME 1.4 Recognize urgent problems and one’s own limitations, and seek assistance as needed
• □ME 1.6 Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making
• □ME 2.3 Ascertain the patient’s goals of care and ensure care is aligned with those goals, as the patient’s situation evolves
• □ME 2.2 Develop an initial diagnosis relevant to the patient’s presentation

Communicator

• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 5.1 Document relevant information

Collaborator

• □COL 1.2 Seek and respond to input from other health care professionals
• □COL 1.3 Communicate clearly and directly to promote understanding in the health care team

Leader

• □L 2.1 Consider health care resources and costs when determining the investigation and management plan

Health Advocate

• □HA 1.1 Facilitate timely access to limited health care resources ADULT CRITICAL CARE MEDICINE (2024)

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. ●cardiac arrest
2. ●respiratory failure
3. ●sepsis
4. ●shock
5. ●other (write in)

Context

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.2 Provide assessment and initial stabilization of ABCs (Airway, Breathing, and Circulation)
• □ME 1.4 Recognize urgent problems and one’s own limitations and seek assistance as needed

Collaborator

• □COL 1.3 Communicate with the health care team using clear language, knowledge sharing and summarizing clinical evolution
• □COL 2.2 Communicate orders clearly citing names (or other identification) and using closed loop communication ADULT CRITICAL CARE MEDICINE (2024)

Leader

• □L 4.2 Lead the resuscitation team effectively, ensuring clear roles and responsibilities for team members, setting priorities, providing constructive intervention when required, and re-evaluating patient and situation frequently

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 1.2 Identify the roles and scopes of practice of health care providers related to Critical Care Medicine and utilize their expertise appropriately
• □COL 2.1 Actively listen to and engage in interactions with collaborators

Health Advocate

• □HA 1.1 Facilitate equitable access to needed services and resources for patients and families

Scholar

• □S 2.3 Assign and prioritize tasks for junior residents
• □S 2.3 Supervise learners to ensure they work within their limitations, ensuring patient safety

Professional

• □P 2.1 Role-model behaviours that demonstrate accountability to patients, society and the profession
• □P 1.1 Complete assigned responsibilities, including following up with junior residents on tasks that they were assigned ADULT CRITICAL CARE MEDICINE (2024)

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

Observation

1. ●single patient handover
2. ●entire unit handover

Medical Expert

• □ME 4.1 Establish plans for ongoing care, including follow-up on investigations and response to treatment

Communicator

• □COM 5.1 Organize information systematically within an electronic or written medical record
• □COM 5.1 Maintain accurate and up-to-date problem lists
• □COM 5.1 Document information about patients and their medical conditions in a manner that enhances intra- and interprofessional care

Collaborator

• □COL 3.2 Describe specific information required for safe and effective handover during transitions in care
• □COL 3.2 Summarize patient issues, including plans to deal with ongoing concerns
• □COL 3.2 Provide anticipatory guidance for issues that are likely to arise
• □COL 1.3 Communicate clearly and directly to promote understanding in the health care team ADULT CRITICAL CARE MEDICINE (2024)

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 1.1 Introduce oneself and explain one’s role in the interprofessional team
• □COM 1.1 Communicate using a patient-centered approach that facilitates patient trust and autonomy and that is characterized by empathy, respect, and compassion
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 3.1 Convey information about medical course and management plan clearly and accurately
• □COM 3.1 Use language tailored to the health literacy level of patients and families
• □COM 1.4 Identify, verify and validate non-verbal cues on the part of the patient and/or family ADULT CRITICAL CARE MEDICINE (2024)
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family.
• □COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions

Professional

• □P 1.2 Ensure that the patient and family are informed about the diagnosis and plan of care
• □P 1.1 Respect diversity and difference, including but not limited to the impact of socio-economic background, gender, religion and cultural beliefs on decision making ADULT CRITICAL CARE MEDICINE (2024)

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. ●initial assessment
2. ●daily care

Presentation

1. ●surgical
2. ●medical

Medical Expert

• □ME 1.3 Apply knowledge of basic physiology to the management of common ICU conditions
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 1.6 Develop a plan that considers the current complexity, uncertainty and ambiguity in a clinical situation
• □ME 2.2 Select and interpret the results of investigations and imaging ADULT CRITICAL CARE MEDICINE (2024)
• □ME 2.3 Work with the patient and family to establish goals of care
• □ME 2.4 Develop and implement initial and/or ongoing management plans for patients with common ICU conditions
• □ME 2.4 Develop plans to monitor the evolution of the clinical course and/or the patient’s response to treatment
• □ME 3.1 Integrate planned procedures or therapies into the overall plan of care
• □ME 4.1 Determine the need and timing of consultation with other specialists
• □ME 5.2 Organize safe intrahospital transport of patient to and from ICU, using all necessary human and equipment resources, recognizing when it may be inappropriate to transport patient

Collaborator

• □COL 1.2 Implement a multidisciplinary approach to the care of ICU patients
• □COL 1.3 Engage in respectful shared decision-making with physicians and colleagues in other health care professions

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures ADULT CRITICAL CARE MEDICINE (2024)

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

Ventilation technique

1. ●invasive
2. ●non-invasive

Reason for resp support

1. ●pulmonary
2. ●non-pulmonary

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology and cardiopulmonary interactions
• □ME 1.6 Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation
• □ME 2.2 Interpret diagnostic imaging of the respiratory system
• □ME 2.4 Develop and implement an initial management plan for uncomplicated patients requiring non-invasive or invasive ventilation
• □ME 3.2 Ensure that the patient and family are informed about the risks and benefits of each treatment options in the context of best evidence and guidelines ADULT CRITICAL CARE MEDICINE (2024)
• □ME 5.2 Use cognitive aids such as clinical care paths to enhance patient safety

Communicator

• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.2 Seek and respond to input from other health care professionals ADULT CRITICAL CARE MEDICINE (2024)

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 1.2 Assign tasks and responsibilities to other team members, commensurate with their skills and patient complexity
• □COL 2.1 Delegate tasks and responsibilities in a respectful manner

Scholar

• □S 2.1 Use strategies for deliberate, positive role-modelling
• □S 2.2 Create a positive learning environment
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.3 Provide learners with opportunities for appropriate clinical responsibility
• □S 2.3 Supervise learners to ensure they work within their limitations, ensuring patient safety
• □S 2.5 Provide feedback to enhance learning and performance ADULT CRITICAL CARE MEDICINE (2024)
• □S 2.3 Identify unsafe clinical situations involving learners and manage them appropriately ADULT CRITICAL CARE MEDICINE (2024)

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

Activity observed

1. ●family discussion/meeting
2. ●note written after meeting
3. ●simulated activity
4. ●other (write in)

Medical Expert

• □ME 2.3 Work with the patient and family to establish goals of care
• □ME 2.4 Develop palliative care management plans that align with patient and family goals of care

Communicator

• □COM 1.1 Develop trusting and supportive relationships with families in distress
• □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 understanding of the patient and/or family ADULT CRITICAL CARE MEDICINE (2024)
• □COM 4.1 Ask about and integrate rituals and end-of-life practices in keeping with the patient’s and family’s cultural, spiritual and religious beliefs
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 1.5 Manage emotionally charged conversations including breaking bad news and end of life conversations
• □COM 1.5 Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state
• □COM 5.1 Document the clinical encounter to accurately reflect discussion and decisions

Health Advocate

• □HA 1.1 Facilitate access to bereavement support for a patient’s family, as appropriate

Professional

• □P 1.3 Recognize and respond to the moral and ethical challenges in end-of- life care
• □P 4.1 Exhibit self-awareness, recognizing and managing the impact of end-of-life care on personal well-being and professional performance ADULT CRITICAL CARE MEDICINE (2024)

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 Prioritize among patients based on clinical acuity
• □ME 3.1 Integrate planned procedures and therapies into the overall plan of care

Collaborator

• □COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □COL 2.1 Delegate tasks and responsibilities in a respectful manner
• □COL 1.3 Contribute to quality patient care by sharing medical expertise
• □COL 1.3 Communicate effectively with other physicians and health professionals
• □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 ADULT CRITICAL CARE MEDICINE (2024)
• □COL 1.3 Actively seek out and consider diverse perspectives within the multidisciplinary team

Leader

• □L 4.1 Manage time and prioritize tasks
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □L 2.1 Allocate health care resources for optimal patient care

Professional

• □P 1.1 Demonstrate appropriate professional behaviours
• □P 1.1 Respond punctually to requests from other health care professionals ADULT CRITICAL CARE MEDICINE (2024)

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

ARDS

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology and cardiopulmonary interactions
• □ME 1.6 Adapt care to address complexity in the patient situation
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 2.2 Integrate information from the clinical assessment to formulate an understanding of the patient’s condition
• □ME 2.2 Interpret diagnostic imaging of the respiratory system
• □ME 2.4 Develop and implement management plans for patients requiring non-invasive or invasive ventilation, including weaning from prolonged and/or complicated mechanical ventilation ADULT CRITICAL CARE MEDICINE (2024)
• □ME 3.1 Determine the need for and timing of tracheostomy

Collaborator

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

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making ADULT CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.4 Develop, in collaboration with the patient and family, a plan to deal with clinical uncertainty
• □ME 2.4 Establish a patient-centred management plan that considers all of the patient’s health problems
• □ME 2.2 Prescribe and adjust medications in the setting of organ dysfunction
• □ME 3.3 Prioritize a procedure or therapy, considering clinical urgency and potential for deterioration
• □ME 4.1 Implement a patient-centred plan that supports ongoing monitoring of clinical status and response to treatment
• □ME 4.1 Ensure detailed and complete follow-up and handover of all patients under the resident’s care ADULT CRITICAL CARE MEDICINE (2024)
• □ME 4.1 Determine the need and timing of referral to other specialists
• □ME 2.1 Identify patients for whom the patient perceived 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

Communicator

• □COM 5.1 Document management plans in an accurate, complete, timely and accessible manner

Collaborator

• □COL 1.2 Consult effectively and in a timely manner with other members of the health care team and other services

Leader

• □L 2.1 Use clinical judgement to make optimal use of limited resources

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making ADULT CRITICAL CARE MEDICINE (2024)

Professional

• □P 1.3 Manage ethical issues encountered in the clinical setting

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●cardiac arrest
2. ●respiratory failure
3. ●sepsis
4. ●shock
5. ●trauma
6. ●other (write in)

Medical Expert

• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess, re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 5.2 Demonstrate situational awareness, avoid fixation error
• □ME 4.1 Ask for additional assistance and/or other services when indicated
• □ME 1.4 Act decisively and maintain control of crisis situations ADULT CRITICAL CARE MEDICINE (2024)
• □ME 2.2 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued
• □ME 2.4 Manage hemodynamic support and monitoring
• □ME 2.4 Manage non-invasive and/or invasive ventilation
• □ME 3.1 Integrate planned procedures or therapies into resuscitative efforts
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Collaborator

• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.3 Use closed loop communication
• □COL 1.2 Seek and respond to input from other health care professionals ADULT CRITICAL CARE MEDICINE (2024)

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●OPA
2. ●BVM
3. ●intubation
4. ●bronchoscopy
5. ●cricothyrotomy

Complex/unstable scenario

1. ●yes
2. ●no

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.1 Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended ADULT CRITICAL CARE MEDICINE (2024)
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Postprocedure plan: Appropriate complete post procedure plan

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff ADULT CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●arterial line
2. ●central venous line
3. ●dialysis catheter

Complex/unstable

1. ●yes
2. ●no

Site

1. ●jugular
2. ●subclavian
3. ●femoral
4. ●radial

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.1 Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues ADULT CRITICAL CARE MEDICINE (2024)
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Postprocedure plan: Appropriate complete post procedure plan

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff ADULT CRITICAL CARE MEDICINE (2024)

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. ●chest tube (open)
2. ●chest tube (Seldinger)
3. ●lumbar puncture
4. ●paracentesis
5. ●temporary transvenous pacemaker insertion

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.1 Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended ADULT CRITICAL CARE MEDICINE (2024)
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Postprocedure plan: Appropriate complete post procedure plan

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff ADULT CRITICAL CARE MEDICINE (2024)

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

POCUS study

1. ●lung
2. ●cardiac and volume status
3. ●abdominal

Medical Expert

• □ME 3.4 Adjust instrument settings appropriately to optimize image quality
• □ME 3.4 Obtain standard views
• □ME 2.2 Recognize clinically significant findings in a POCUS examination ADULT CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Identify patients for whom the patient perceived 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 Work with the patient and family to establish goals of care
• □ME 2.2 Select investigations and therapies appropriate to the patient’s goals of care
• □ME 2.4 Develop and implement management plans that support achievement of the patient’s goals of care
• □ME 4.1 Coordinate ongoing care when multiple physicians and health care professionals are involved

Communicator

• □COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regards to their care
• □COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, and respectful manner ADULT CRITICAL CARE MEDICINE (2024)
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources ADULT CRITICAL CARE MEDICINE (2024)

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

Etiology

1. ●Death by circulatory criteria (DCC)
2. ●death by neurological criteria (DNC)

Medical Expert

• □ME 2.2 Recognize and respond to clinical features that identify opportunities for organ donation
• □ME 2.4 Develop and implement management plans to maintain organ donor homeostasis with appropriate hemodynamic, respiratory, temperature, urine output, fluid, electrolyte, and glucose targets ADULT CRITICAL CARE MEDICINE (2024)
• □ME 4.1 Establish plans for ongoing care of potential organ donors, incorporating considerations of patient comfort and family concerns
• □ME 2.2 Exclude reversible causes of coma
• □ME 2.2 Assess brainstem reflexes and response to pain
• □ME 2.2 Perform an apnea test
• □ME 2.2 Use ancillary testing when appropriate
• □ME 1.3 Apply guidelines for the determination of death by neurological criteria (DNC) and death by circulatory criteria (DCC)

Communicator

• □COM 3.1 Convey the option of organ and tissue donation as part of end-of- life discussions with family members
• □COM 4.1 Communicate with patients and families in a manner that is respectful, non-judgmental, and culturally aware
• □COM 5.1 Document the organ donation assessment and discussion, completing all required documentation

Collaborator

• □COL 1.2 Work effectively with organ procurement organization personnel, transplant surgeons, and in-hospital diagnostic services to ensure complete evaluation of individual organ/tissue suitability for transplant

Health Advocate

• □HA 1.1 Facilitate access to bereavement support for a patient’s family, as appropriate

Professional

• □P 1.3 Manage ethical issues encountered in the clinical setting
• □P 3.1 Adhere to regulations regarding DNC and DCC declaration ADULT CRITICAL CARE MEDICINE (2024)

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

Transport context

1. ●in-hospital
2. ●interhospital

Medical Expert

• □ME 2.2 Interpret clinical information gathered by another health professional, along with the results of investigations, for the purposes of diagnosis and management
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Plan the logistics of transfer including stabilization and procedures prior to transfer, equipment and personnel requirements, methods of monitoring and assessment during transport

Communicator

• □COM 5.1 Document telephone advice provided, and the care provided during transport ADULT CRITICAL CARE MEDICINE (2024)

Collaborator

• □COL 3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in the ICU
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □ME 2.4 Establish patient centered management plans

Collaborator

• □COL 2.1 Delegate tasks and responsibilities in a respectful manner

Leader

• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service ADULT CRITICAL CARE MEDICINE (2024)
• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Manage time and prioritize tasks

Scholar

• □S 2.4 Demonstrate basic skills in teaching others
• □S 3.4 Integrate best evidence and clinical expertise into decision-making ADULT CRITICAL CARE MEDICINE (2024)

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

Scholar

• □S 2.5 Identify learner behaviors to support / continue as well as those for improvement
• □S 2.5 Provide specific suggestions for improvement of performance
• □S 2.5 Provide narrative comments that support coaching / assessment ADULT CRITICAL CARE MEDICINE (2024)

Professional

• □P 1.1 Complete learner assessments 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

Collaborator

• □COL 1.3 Convey the purpose of debriefing an event to the health care team
• □COL 1.3 Facilitate discussions within the health care team, ensuring everyone has the opportunity to participate

Leader

• □L 1.2 Establish a safe environment for debriefing critical events
• □L 1.2 Encourage all members of the team to identify opportunities to improve patient care
• □L 1.1 Summarize debriefing discussions, identifying potential improvements in health care delivery

Scholar

• □S 2.5 Role model self-assessment and feedback seeking behaviour

Professional

• □P 4.3 Recognize, support and respond effectively to colleagues in need ADULT CRITICAL CARE MEDICINE (2024)

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
• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 4.1 Coordinate the involvement of consulting services in patient care

Collaborator

• □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 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Manage time and prioritize tasks ADULT CRITICAL CARE MEDICINE (2024)
• □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

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