Developmental Pediatrics

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Medical Expert

• □ME 2.2 Gather a history relevant to the presentation
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Demonstrate an organized, structured approach to the assessment
• □ME 2.2 Identify key features of the history and physical examination that inform the case formulation

Communicator

• □COM 1.2 Optimize the physical environment for child/youth and family comfort, dignity, and privacy
• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 1.4 Use appropriate non-verbal communication to demonstrate attentiveness, interest, and responsiveness to the child/youth and family
• □COM 2.2 Manage the flow of the encounter

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 Observe and/or elicit skills in the following domains: gross motor; fine motor; communication; cognitive; social/play
• □ME 2.2 Ask questions that clarify skill development, comparing what is seen at home or in the community with what is being observed
• □ME 1.3 Apply knowledge of developmental milestones in the following domains: gross motor; fine motor; communication; cognition; social/play
• □ME 2.2 Differentiate typical from atypical development
• □ME 2.2 Synthesize information for clear and succinct presentation to a supervisor

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Behaviour

1. ●high activity level
2. ●inhibited/anxious
3. ●dysregulated (e.g., irritable/aggressive)
4. ●other

Medical Expert

• □ME 2.2 Adapt the assessment to the child’s/youth’s age, developmental stage, and other relevant factors (e.g., visual or hearing impairment, behaviour)

Communicator

• □COM 1.2 Optimize the physical environment for child/youth and family comfort, dignity, and privacy
• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 1.1 Set the stage for the assessment, including building initial rapport and trust
• □COM 2.1 Use strategies to put the child/youth and family at ease, including incorporating developmentally appropriate activities, such as play, into the interaction
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 1.4 Respond to non-verbal communication and use appropriate non- verbal behaviours to enhance communication

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case presentation

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Complexity of case

1. ●standard
2. ●high

Interpreter

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Gather and review background information, including the medical record, reports from community care and/or service providers, and previous developmental screening
• □ME 2.2 Gather a history relevant to the presentation, including potential etiologic risk factors and concurrent conditions
• □ME 2.2 Explore the child’s/youth’s functioning and engagement in opportunities for fun, fitness, family activities, and friendships
• □ME 2.2 Gather information about the child’s/youth’s mental health and well- being
• □ME 2.2 Perform the assessment in a time-effective manner without excluding key elements
• □ME 2.2 Synthesize information for clear and succinct presentation to a supervisor

Communicator

• □COM 2.2 Provide a clear structure for and manage the flow of the encounter
• □COM 2.1 Explore the child’s/youth’s and family’s hopes and expectations for the future
• □COM 2.1 Explore caregiver wellness and family supports
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 2.1 Elicit information with a strengths-based approach

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Exam technique

1. ●dysmorphology
2. ●musculoskeletal
3. ●neurological
4. ●standardized neurological

Assessment performed

1. ●FASD
2. ●gait
3. ●hypotonia
4. ●hypertonia
5. ●muscle strength
6. ●other

Medical Expert

• □ME 2.2 Determine the need to perform a neurologic, musculoskeletal, and/or dysmorphology exam
• □ME 2.2 Perform neurologic, musculoskeletal, and/or dysmorphology exam techniques in a skilful manner
• □ME 2.2 Adapt the assessment to the child’s/youth’s age, developmental stage, and other relevant factors (e.g., visual or hearing impairment, behaviour)
• □ME 2.2 Identify findings as typical or atypical

Communicator

• □COM 1.2 Optimize the physical environment for child/youth and family comfort, dignity, and privacy

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Use of standardized tool

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Observe and/or elicit skills in the core developmental domains
• □ME 2.2 Demonstrate an organized, structured approach to the assessment
• □ME 2.2 Determine the need for a standardized assessment of one or more areas of the child’s/youth’s development
• □ME 2.2 Synthesize information gathered from observing the child/youth and, if used, from the standardized tool
• □ME 1.3 Apply knowledge of developmental milestones
• □ME 2.2 Differentiate typical from atypical development
• □ME 2.2 Determine the child’s/youth’s level of development

Communicator

• □COM 1.1 Advise the child/youth and family about the confidentiality of the assessment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Referred to

1. ●own practice setting
2. ●community-based service

Medical Expert

• □ME 4.1 Determine the need for and timing of referral to another physician, health professional, and/or community partner
• □ME 4.1 Formulate a clear and appropriate request for consultation

Collaborator

• □COL 1.2 Apply knowledge of the roles and scopes of practice of other professionals involved in the care of children/youth
• □COL 3.2 Summarize the child’s/youth’s condition for the consultant
• □COL 1.3 Communicate effectively with other members of the interprofessional team

Leader

• □L 3.1 Apply knowledge of the structure and function of the multisectoral developmental service system

Health Advocate

• □HA 1.1 Facilitate the child’s/youth’s/family’s access to health and social 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

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Medical Expert

• □ME 2.2 Synthesize the developmental pediatrics assessment for presentation to other members of the interprofessional team

Collaborator

• □COL 1.2 Apply knowledge of the roles and scopes of practice of other professionals involved in the care of children/youth
• □COL 1.1 Respond appropriately to input from others
• □COL 1.3 Communicate effectively with other members of the interprofessional team
• □COL 2.1 Actively listen to and engage in interactions with members of the interprofessional team

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

Type of observation

1. ●direct
2. ●case review
3. ●virtual care

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Medical Expert

• □ME 2.2 Gather a child-/youth- and family-centred history and perform a physical exam relevant to the presentation
• □ME 2.2 Make observations of family functioning
• □ME 2.2 Perform a developmental assessment
• □ME 2.2 Determine the need for a standardized assessment of one or more areas of the child’s/youth’s development
• □ME 2.2 Interpret the results of standardized assessments and other investigations
• □ME 2.2 Integrate factors such as family functioning, cultural and language background, and exposure to adverse childhood experiences into the interpretation of the developmental assessment
• □ME 2.2 Integrate all relevant sources of information to formulate a comprehensive overview of the child/youth and a developmental and, if possible, etiologic diagnosis(es)
• □ME 2.4 Establish a child-/youth- and family-centred management plan
• □ME 4.1 Determine the need for and timing of referral to another physician, health professional, and/or community partner

Communicator

• □COM 4.3 Engage the child/youth and family in goal setting and shared decision- making regarding recommendations for management

Collaborator

• □COL 1.3 Work effectively with other members of the interprofessional team

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. ●developmental/behavioural
2. ●neuromotor

Note incorporates

1. ●standardized assessment(s)
2. ●assessments by other member(s) of the interprofessional team
3. ●not applicable

Communicator

• □COM 5.1 Demonstrate awareness of the potential recipients of documentation (e.g., family, school, interprofessional team members, referring physician)
• □COM 5.1 Organize information appropriately
• □COM 5.1 Document all relevant findings, investigations, and standardized assessments
• □COM 5.1 Convey clinical reasoning and rationale for recommendations
• □COM 5.1 Emphasize the strengths of the child/youth and strategies for promoting the child’s/youth’s and family’s personal goals
• □COM 5.1 Provide a clear plan for ongoing management
• □COM 5.1 Complete documentation in a timely manner

Collaborator

• □COL 1.2 Identify the roles of the referring physician, the developmental pediatrics team, and/or other providers in the ongoing management plan

Scholar

• □S 1.3 Provide links to educational resources, when relevant

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. ●developmental/behavioural
2. ●neuromotor

Complexity

1. ●standard
2. ●high

Longitudinal clinic

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Perform an assessment that addresses all relevant issues
• □ME 2.4 Provide surveillance for, management, and monitoring of conditions co-existing with developmental disorders
• □ME 2.2 Synthesize information to assess progress and response to current recommendations and management
• □ME 2.2 Anticipate transitions and future health needs
• □ME 2.4 Develop recommendations for management, which may include modification of current therapy

Communicator

• □COM 4.3 Engage the child/youth and family in goal setting and shared decision-making regarding recommendations for management

Collaborator

• □COL 1.2 Work effectively with other physicians, colleagues, and those involved in the care of children/youth in the health care professions and other sectors

Health Advocate

• □HA 1.2 Work with the child/youth and family to increase their understanding of their condition and health care needs

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

Indication for pharmacotherapy

1. ●attention and hyperactivity/impulsivity
2. ●emotional regulation
3. ●tone management
4. ●other (please specify)

Combined/complex presentation

1. ●no
2. ●yes

Visit type

1. ●initiation
2. ●follow-up

Medical Expert

• □ME 2.4 Determine the most appropriate pharmacologic treatment
• □ME 3.2 Obtain and document informed consent, explaining the risk and benefits of, and the rationale for a proposed intervention
• □ME 2.4 Select or adjust dosage based on factors such as response, tolerability, age, and pharmacokinetic considerations
• □ME 2.4 Select, implement, and/or follow a monitoring strategy, including growth, vital signs, and laboratory monitoring as relevant
• □ME 4.1 Assess and manage treatment adherence
• □ME 2.2 Assess and monitor response to therapy

Communicator

• □COM 4.1 Explore the family’s beliefs and attitudes towards medications and other therapeutic options
• □COM 5.1 Document prescriptions accurately in the medical record, including the rationale for decisions

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

Age

1. ●infant
2. ●preschool
3. ●school-age
4. ●adolescent

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Challenging discussion

1. ●no
2. ●yes

Other interprofessional in attendance

1. ●no
2. ●yes

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 4.3 Provide information in a positively framed/strengths-based manner (e.g., focus on function, family, fitness, fun, friends, and future) and how they may relate to the management of the child’s/youth’s condition
• □COM 3.1 Verify and validate the child’s/youth’s and/or family’s understanding
• □COM 4.3 Answer questions in a respectful manner
• □COM 1.4 Identify, verify, and validate non-verbal cues
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 2.2 Summarize and close the encounter 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

Presentation

1. ●developmental/behavioural
2. ●neuromotor

Setting

1. ●daycare
2. ●preschool services
3. ●school-age services

Communicator

• □Part B: COM 5.1 Use language and terminology that is appropriate for the intended audiences
• □Part B: COM 5.1 Organize information appropriately
• □Part B: COM 5.1 Provide information that is accurate and appropriate for the purpose of the documentation
• □Part B: COM 5.1 Ensure documentation is clear, concise, and grammatically correct
• □Part B: COM 5.1 Complete documentation in a timely manner

Collaborator

• □Part A: COL 1.2 Apply knowledge of the scope of practice of community service providers involved in the care of children/youth
• □Part A: COL 1.1 Exchange information about the child’s/youth’s condition and recommendations for management
• □Part A: COL 1.3 Communicate effectively with other professionals involved in the care of children/youth
• □Part A: COL 1.1 Respond appropriately to input and questions from other members of the interprofessional team
• □Part A: COL 1.1 Provide education with respect to the child’s/youth’s disorder and its management
• □Part A: COL 1.2 Incorporate the perspective of community service providers in the development and/or implementation of a management plan
• □Part B: COL 1.1 Provide education with respect to the child’s/youth’s disorder and its management

Health Advocate

• □Part A: HA 1.1 Advocate for access to support services, community services, and/or equipment
• □Part B: HA 1.1 Advocate for appropriate benefits and accommodations

Professional

• □Part A: P 3.1 Obtain assent/consent from the child/youth and family to share information with community partners

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. ●developmental/behavioural
2. ●neuromotor

Difference of opinion

1. ●no
2. ●yes

Medical Expert

• □ME 1.4 Contribute clinical expertise to the discussion, as required

Communicator

• □COM 1.4 Manage one’s own non-verbal communication

Collaborator

• □COL 1.3 Demonstrate respect for the opinions of other meeting participants
• □COL 2.2 Apply knowledge of and manage group dynamics
• □COL 1.3 Develop a shared formulation of the results of the assessment and the management plan

Leader

• □L 3.1 Establish an agenda and set priorities
• □L 3.1 Facilitate the meeting, attending to flow, organization, and time management
• □L 3.1 Ensure engagement and participation of attendees
• □L 3.1 Summarize and clarify key points of the meeting

Health Advocate

• □HA 1.1 Advocate for the child’s/youth’s and/or family’s needs and concerns

Professional

• □P 1.1 Intervene when behaviours towards other attendees 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

• □Part A: ME 1.1 Demonstrate an awareness of what is required in the setting of future practice
• □Part B: ME 2.2 Administer a standardized assessment tool
• □Part B: ME 2.2 Perform the assessment in a time-effective manner, without excluding key elements
• □Part B: ME 2.2 Interpret the findings of a standardized assessment tool

Communicator

• □Part B: COM 1.2 Optimize the physical environment for child/youth and family comfort, dignity, and privacy
• □Part B: COM 1.1 Set the stage for the assessment, including building initial rapport and trust
• □Part B: COM 3.1 Convey the findings of the assessment to the child/youth and family in a clear understandable manner

Leader

• □Part A: L 4.2 Examine personal interests and career goals
• □Part A: L 4.2 Adjust educational experiences to gain competencies necessary for future practice

Scholar

• □Part A: S 1.1 Define learning needs related to personal practice and/or career goals
• □Part A: S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
• □Part A: S 1.1 Create a learning plan that is feasible and includes clear deliverables and a plan for monitoring ongoing achievement
• □Part A: S 1.1 Identify resources required to implement a personal learning plan

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●outpatient

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 2.1 Triage referrals on the basis of the child’s/youth’s condition and need for developmental pediatrics expertise
• □ME 1.4 Perform relevant and time-effective clinical assessments
• □ME 2.4 Establish child-/youth- and family-centred management plans
• □ME 1.5 Carry out professional duties in the face of multiple competing demands

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

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

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 Establish child-/youth- and family-centred management plans
• □ME 2.4 Prepare the child/youth/family for transitions in the child’s/youth’s development and care
• □ME 4.1 Coordinate the services provided by the interprofessional team

Collaborator

• □COL 1.2 Work effectively with other physicians, colleagues, and those involved in the care of children/youth in the health care professions and other sectors

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.1 Follow up 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 and/or concerns from children/youth, families, and other health care professionals
• □P 1.1 Make arrangements for coverage by another physician when absent or unavailable

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 Work effectively with other physicians, colleagues, and those involved in the care of children/youth in the health care professions and other sectors

Leader

• □L 3.1 Demonstrate leadership skills to enhance health care

Health Advocate

• □HA 2.2 Improve clinical practice by applying a process of continuous quality improvement
• □HA 2.3 Contribute to a process to improve health in the communities or populations served

Scholar

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

Professional

• □P 2.1 Demonstrate a commitment to active participation in the activities of the profession

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 4.2 Examine professional interests and career goals
• □L 4.2 Adjust educational experiences to gain competencies necessary for future practice

Scholar

• □S 1.1 Define learning needs related to professional practice and/or career goals
• □S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
• □S 3.1 Generate focused questions that address knowledge gaps
• □S 1.1 Create a learning plan that is feasible and includes clear deliverables and a plan for monitoring ongoing achievement
• □S 1.1 Identify resources required to implement a personal learning plan

Professional

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

Case description

Feedback provided

Next steps