Emergency Medicine

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. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Clinical presentation

1. ●cardiorespiratory arrest
2. ●unstable dysrhythmia
3. ●shock
4. ●respiratory distress
5. ●altered neurologic status
6. ●other

Medical Expert

• □ME 2.1 Recognize a patient in cardio-pulmonary arrest, initiate basic life support interventions, and call for help
• □ME 2.1 Recognize patients with unstable dysrhythmias, shock, respiratory distress or altered neurologic status, and initiate appropriate early management
• □ME 2.2 Perform a brief initial assessment focused on gathering pertinent data to identify the unstable patient in need of urgent resuscitation
• □ME 2.2 Perform an airway assessment for predictors of difficult bag valve mask (BVM) ventilation
• □ME 3.4 Perform BVM ventilation
• □ME 3.4 Perform basic airway maneuvers and CPR
• □ME 3.4 Prepare the necessary equipment for basic airway maneuvers and CPR
• □ME 2.2 Interpret electrocardiogram (ECG) recognizing conditions requiring immediate intervention, including but not limited to ischemia or dysrhythmia
• □ME 2.4 Initiate appropriate monitoring, time-sensitive interventions, and management in the unstable patient, including obtaining cardiorespiratory monitoring and fluid resuscitation

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements

Collaborator

• □COL 1.2 Involve and engage in collaborative patient care with physicians and other health care professionals in the management of the critically ill patient
• □COL 1.2 Communicate the severity of the patient’s condition clearly to a senior clinician and seek supervision in a timely manner
• □COL 1.3 Summarize the patient’s condition and initial treatment priorities to the health care professionals involved in the resuscitation of a patient

Scholar

• □S 1.2 Use clinical encounters and evidence-based resources as opportunities to guide learning

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

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Clinical presentation

1. ●chest pain
2. ●shortness of breath
3. ●abdominal pain
4. ●minor trauma
5. ●other

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 2.1 Identify the chief complaint
• □ME 2.2 Elicit and present a focused history and physical exam
• □ME 2.2 Construct a differential diagnosis that recognizes both common and important uncommon diagnoses
• □ME 2.4 Develop a management plan to guide initial investigations and treatments
• □ME 4.1 Perform independent and timely follow-up of investigations, management plans, and reassessments
• □ME 5.1 Recognize potential patient safety issues, including but not limited to drug-drug interactions and/or inaccurate team communication
• □ME 5.2 Request supervision in unfamiliar situations in order to ensure patient safety

Communicator

• □COM 1.2 Optimize the physical environment to ensure comfort, dignity, privacy, engagement, and safety, including draping, use of curtains, and positioning of patient
• □COM 3.1 Communicate a care plan to the patient and family
• □COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements

Scholar

• □S 4.4 Formulate a basic clinical query and perform an efficient, appropriate point-of-care search of the evidence to create an evidence-informed answer

Professional

• □P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, such as honesty, integrity, humility, dedication, empathy, respect, respect for diversity, and maintenance of confidentiality

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

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Communicator

• □COM 1.1 Communicate using a patient-centred approach, recognizing barriers to such communication, demonstrating empathy, respect, and compassion, and using language appropriate to the needs of the patient
• □COM 1.4 Identify, verify, and validate non-verbal cues on the part of patients and their families
• □COM 3.1 Communicate a care plan to the patient, family, and caregivers, providing explanations and updates to the patient and family, as necessary
• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient's family, other physicians, first responders, and other health professionals
• □COM 5.3 Maintain patient confidentiality in collection and transfer of patient information

Collaborator

• □COL 1.1 Demonstrate appropriate interactions with other health care professionals, including seeking advice when appropriate

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●pediatric
2. ●adult

Clinical presentation

1. ●hemodynamic instability
2. ●cardiorespiratory arrest
3. ●respiratory distress
4. ●altered mental status
5. ●other

Medical Expert

• □ME 2.2 Perform a focused history and physical examination that is accurate and relevant to the patient presentation
• □ME 2.2 Develop a working and differential diagnosis while simultaneously providing symptom management
• □ME 4.1 Recognize when help is needed and call for the appropriate health care professionals
• □ME 2.1 Determine priorities in the initial resuscitation

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, other physicians, first responders, and other health professionals

Collaborator

• □COL 3.2 Present medical information appropriately to ensure safe transfer of care after initiation of resuscitation

Leader

• □L 4.2 Organize an interprofessional team in the initial phase of resuscitation
• □L 2.1 Practice the principles of crisis resource management in leading a health care team

Professional

• □P 1.3 Interpret advanced directives or care plans for patients

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

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Medical Expert

• □ME 1.3 Apply knowledge of clinical and biomedical sciences to manage uncomplicated patient presentations in Emergency Medicine
• □ME 1.4 Recognize problems that may need the involvement of more experienced colleagues and seek their assistance immediately
• □ME 2.2 Synthesize a working diagnosis and case-appropriate differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select appropriate investigations and interpret their results for the purpose of diagnosis and management
• □ME 2.4 Execute a plan for the management of a patient’s condition
• □ME 4.1 Reassess the patient and follow-up on results of investigations and response to treatment
• □ME 4.1 Determine if the patient is safe for discharge or requires further consultation or admission, in consultation with a supervising physician

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 5.1 Maintain clear, concise, accurate records of clinical encounters and plans
• □COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □COL 3.2 Summarize a patient’s issues in a case presentation, including the plan to deal with ongoing issues
• □COL 2.1 Actively listen to and engage in interactions with collaborators

Health Advocate

• □HA 1.1 Identify resources, agencies, and opportunities for patient education to address health needs of the patient, including the social determinants of health

Scholar

• □S 3.4 Integrate the best available evidence and best practices, including point of care resources to enhance the quality of care, patient safety, and resource utilization

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior Type of observer: consultant physician
6. ●off-service resident
7. ●nurse
8. ●RT
9. ●social worker
10. ●addictions worker
11. ●physiotherapist
12. ●occupational therapist
13. ●home care coordinator
14. ●ECG techs
15. ●paramedics
16. ●other health care worker

Medical Expert

• □ME 1.5 Manage personal clinical workload and follow each patient’s care through to appropriate disposition
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety when available
• □ME 5.1 Recognize and respond to complications, adverse events, and near misses

Communicator

• □COM 1.3 Recognize when patient and physician values, biases, or perspectives threaten the quality of care

Collaborator

• □COL 1.3 Solicit and respond to input from members of the health care team and keep the team informed of management plans
• □COL 2.2 Identify communication barriers and promote positive communication between health care professionals

Leader

• □L 1.4 Use clinical informatics to facilitate efficient, safe patient care by retrieving and manipulating information across digital platforms, while maintaining data security
• □L 4.2 Demonstrate leadership in the health care team as appropriate

Health Advocate

• □HA 1.1 Demonstrate an approach to working with patients and other health care professionals to advocate for beneficial services or resources

Professional

• □P 1.1 Demonstrate professionalism including but not limited to punctuality, privacy, confidentiality, and appropriate workplace attire
• □P 1.3 Recognize ethical issues in the clinical and academic setting
• □P 4.1 Regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●pediatric
2. ●adult

Clinical presentation

1. ●hemodynamic instability
2. ●cardiorespiratory arrest
3. ●respiratory failure
4. ●severe sepsis
5. ●altered mental status
6. ●other

Medical Expert

• □ME 2.2 Generate a preliminary differential diagnosis in the face of diagnostic uncertainty
• □ME 3.1 Choose and prioritize appropriate diagnostic investigations and therapeutic interventions for the situation, accounting for the patient’s condition
• □ME 4.1 Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Communicator

• □COM 3.1 Communicate bad news to the family and patient effectively
• □COM 5.1 Maintain clear, concise, and accurate resuscitation records

Collaborator

• □COL 1.2 Collaborate as needed with other health care professionals

Leader

• □L 2.1 Practice the principles of crisis resource management in leading a health care team

Professional

• □P 4.1 Use effective coping strategies to deal with the stressors of decision- making and prioritizing interventions in a leadership role
• □P 4.3 Support team members dealing with grief, or anxiety experienced during emotionally charged resuscitations through debriefing, coping strategies, and access to other resources

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Clinical presentation

1. ●blunt trauma
2. ●penetrating trauma
3. ●other

Critical or severe injuries

1. ●yes
2. ●no

Role

1. ●participant
2. ●leader

Medical Expert

• □ME 1.6 Use sound clinical reasoning and judgment to guide diagnosis and management, even in circumstances where complete clinical or diagnostic information is not immediately available
• □ME 2.2 Generate a preliminary differential diagnosis in the face of diagnostic uncertainty
• □ME 3.1 Choose and prioritize appropriate diagnostic investigations and therapeutic interventions for the situation, accounting for the patient’s condition
• □ME 3.3 Consider urgency and potential for deterioration in advocating for the timely execution of diagnostic and therapeutic procedures
• □ME 3.3 Triage and set appropriate priorities when dealing with single or multiple critically injured patients
• □ME 4.1 Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, other physicians, first responders, and other health professionals
• □COM 3.1 Communicate bad news to the family and patient effectively
• □COM 5.1 Maintain clear, concise, and accurate resuscitation records

Collaborator

• □COL 1.2 Collaborate as needed with other health care professionals

Leader

• □L 2.1 Practice the principles of crisis resource management in leading a health care team

Professional

• □P 4.1 Use effective coping strategies to deal with the stressors of decision- making and prioritizing interventions in a leadership role
• □P 4.3 Support team members dealing with grief, or anxiety experienced during emotionally charged resuscitations through debriefing, coping strategies, and access to other resources

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Predicted difficult airway

1. ●yes
2. ●no

Tracheal intubation

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Demonstrate knowledge of anatomy, physiology, and pharmacology in airway management and ventilation
• □ME 2.2 Perform appropriately timed clinical assessment of a patient who needs airway and/or ventilation assistance
• □ME 2.4 Develop a plan to recognize and manage a potentially difficult airway
• □ME 3.4 Perform the most appropriate approach to definitive airway management, including tracheal intubation, rescue devices, and surgical airway techniques in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Ventilate and sedate the patient in a safe manner, including management of post intubation mechanical ventilation and complications
• □ME 3.4 Recognize when to seek assistance in the management of a patient with a difficult airway or potentially difficult airway
• □ME 5.2 Adopt strategies that promote patient safety, including team leadership and communication, use of checklists, and appropriate PPE

Communicator

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

Setting

1. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 1.3 Apply knowledge of pharmacology and physiology in the delivery of emergency sedation and systemic analgesia
• □ME 3.1 Determine and provide the most appropriate analgesic therapy and/or sedation plan for the specific procedure using multimodal analgesia concepts and alternative pain/sedation strategies
• □ME 3.1 Determine when emergency sedation and systemic analgesia is inappropriate for the emergency department and should be performed in the operating room
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits and the rationale for procedural sedation in the emergency department
• □ME 3.3 Prioritize the need for procedural sedation and analgesia taking into account clinical urgency and available resources
• □ME 3.4 Perform procedural sedation in a skilful and safe manner, anticipating, planning for, and responding to complications associated with procedural sedation or changing clinical states of the patients
• □ME 5.2 Adopt strategies that promote patient safety and address human and system factors based on institutional policies and/or current guidelines

Communicator

• □COM 1.6 Adapt to the unique needs of each patient and to their clinical condition and circumstances
• □COM 3.2 Communicate near-misses or complications from the procedural sedation to the patient and/or family
• □COM 5.1 Document relevant clinical information regarding procedural sedation, including but not limited to patient risk, patient consent, monitoring, and discharge information, in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with physicians, nurses, respiratory therapists, and other health professionals regarding the delivery of procedural sedation
• □COL 3.1 Determine when care should be transferred to another physician or health care professional during the post-procedural recovery from procedural sedation

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●pediatric
2. ●adult

Clinical presentation

1. ●abdominal pain
2. ●chest pain
3. ●dysrhythmia
4. ●respiratory distress
5. ●altered mental status
6. ●headache
7. ●back pain
8. ●fever
9. ●other

Medical Expert

• □ME 1.6 Use sound clinical reasoning and judgment to guide diagnosis and management, even in circumstances where complete clinical or diagnostic information is not immediately available
• □ME 2.2 Perform a complete and appropriate, selective, accurate, and well- organized history and physical examination for the patient with an emergent medical or surgical illness
• □ME 2.2 Generate appropriate and complete differential diagnoses
• □ME 2.2 Order and interpret investigations (laboratory, diagnostic imaging) aiding in the diagnosis of the patient with an emergent condition
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context in collaboration with patients and their families and, when appropriate, the interprofessional team

Communicator

• □COM 1.1 Communicate effectively with patients and caregivers to establish goals of care and carry out a patient/family centred management plan

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 3.2 Demonstrate safe transfer of care, both verbal and written, during patient transitions to a different health care professional, setting, or stage in care

Health Advocate

• □HA 1.1 Advocate for optimal care for the patient with an emergent condition with respect to investigations, consultations, transport, admission, and final disposition

Scholar

• □S 3.2 Use clinical informatics decision support (e.g., clinical queries, smart prescribing etc.) to facilitate patient management

Professional

• □P 3.1 Fulfil the requirements of a physician’s duty to report including but not limited to communicable disease, suspected child, intimate partner or elder maltreatment, or clusters of unusual cases

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. ●emergency department
2. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Clinical presentation

1. ●fever
2. ●vomiting
3. ●rash
4. ●syncope
5. ●weakness
6. ●acute gynecological
7. ●other

Medical Expert

• □ME 1.6 Identify and manage clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making, including disposition plans
• □ME 2.2 Synthesize a working diagnosis and case-appropriate differential diagnosis relevant to the patient’s presentation
• □ME 2.3 Work with patients and their families to understand relevant options for care
• □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

Communicator

• □COM 4.1 Communicate using patient-centred strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan
• □COM 1.1 Communicate effectively with patients and caregivers to establish goals of care and carry out a patient/family centred management plan
• □COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □COL 1.1 Demonstrate appropriate interactions with other health care professionals, including seeking advice and consultation when appropriate

Leader

• □L 2.1 Consider appropriate resource utilization when choosing care options

Health Advocate

• □HA 1.1 Demonstrate an approach to working with patients and other health care professionals to advocate for beneficial services or resources
• □HA 1.1 Facilitate timely access to resources, agencies, and opportunities for patient education to address health needs of the patient including the social determinants of health
• □HA 1.1 Identify patients at risk and notify the appropriate authority and/or social agencies as required

Professional

• □P 2.1 Manage tensions between patient and societal expectations, and resource stewardship
• □P 3.1 Fulfil the requirements of a physician’s duty to report including but not limited to communicable disease, suspected child, intimate partner or elder maltreatment, or clusters of unusual cases
• □P 1.3 Recognize and respond to ethical concerns related to the care of the patient

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●youth
2. ●adult

Clinical presentation

1. ●first trimester bleeding
2. ●complications of pregnancy
3. ●vaginal delivery
4. ●post-partum hemorrhage
5. ●other

Medical Expert

• □ME 1.3 Establish and maintain clinical knowledge, skills, and attitudes necessary to rapidly assess and manage the full spectrum of disease or conditions in a pregnant or post-partum patient
• □ME 2.2 Select appropriate investigations for patient and fetus
• □ME 2.4 Implement appropriate management plans for the patient and fetus

Communicator

• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner to patient and their family

Collaborator

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

Health Advocate

• □HA 1.1 Advocate for access to appropriate prenatal care when necessary

Professional

• □P 1.1 Respect the patient’s privacy in accordance with privacy and confidentiality legislation, regulations, and policies

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Clinical presentation

1. ●acetaminophen toxidrome
2. ●sympathomimetic toxidrome
3. ●opioid toxidrome
4. ●antidepressant toxicity
5. ●toxic bradycardia
6. ●other

Medical Expert

• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion
• □ME 2.2 Order appropriate laboratory investigations when caring for a patient with an overdose, toxic ingestion, or exposure
• □ME 2.2 Perform an appropriate psychiatric history in conjunction with medical stabilization in cases of intentional overdose
• □ME 2.4 Initiate resuscitation and medical treatment of the patient with an overdose, toxic ingestion or exposure, including specific elimination strategies and antidote therapy
• □ME 1.3 Demonstrate understanding of the potential adverse outcomes, complications, toxidromes and expected period of observation associated with specific toxic ingestions or exposures

Communicator

• □COM 2.3 Use alternative sources of information to complete or substantiate clinical information as appropriate

Health Advocate

• □HA 1.2 In cases involving substance use, refer to addiction services as appropriate, and promote safer practices and harm reduction strategies
• □HA 1.3 In cases of accidental ingestion or overdose, promote safe medication use and storage and appropriate occupational health practices

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●child
2. ●youth
3. ●adult
4. ●senior

Clinical presentation

1. ●psychosis or mania
2. ●major depressive disorder
3. ●anxiety disorder
4. ●suicidality
5. ●personality disorder
6. ●other

Medical Expert

• □ME 2.2 Perform an appropriately detailed history of the patient presenting with a mental health emergency
• □ME 2.2 Perform an appropriate physical examination of the patient presenting with a mental health emergency, recognizing the need to rule out concomitant acute medical conditions
• □ME 2.2 Perform risk assessments, including for suicide, self-harm, and violence
• □ME 2.4 Initiate medical treatment of the patient presenting with a mental health emergency and concomitant acute medical condition including but not limited to overdose
• □ME 3.1 Recognize indications, contraindications, and monitoring requirements for chemical and physical restraints within the framework of provincial legislation/regulations
• □ME 4.1 Determine timing and necessity of referral to crisis team, psychiatry, social work, or medical services

Communicator

• □COM 1.1 Provide the patient with brief counseling or coping strategies as appropriate
• □COM 1.1 Communicate using a manner that encourages trust, and is characterized by empathy, respect, and compassion
• □COM 1.5 Use verbal de-escalation techniques when appropriate
• □COM 2.3 Obtain collateral history from other sources including but not limited to friends, family members, first responders, social workers, housing workers, and other community liaisons

Collaborator

• □COL 1.3 Collaborate as necessary with the patient’s primary care physician, psychiatrist, and/or community liaison(s) and services upon discharge

Professional

• □P 2.2 Ensure personal and team safety during the assessment and management of patients
• □P 3.1 Demonstrate knowledge and appropriate use of provincial mental health legislation as it pertains to involuntary psychiatric assessment in cases of imminent self-harm, harm to others, or inability to care for self

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. ●emergency department
2. ●other

Medical Expert

• □ME 2.2 Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate a well-organized differential diagnosis and/or management plan
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems, their social context, and their expressed wishes in collaboration with the interprofessional team
• □ME 4.1 Determine the timing and necessity of referral to crisis team, psychiatry, social work, addictions, or inpatient/outpatient medicine services

Communicator

• □COM 1.1 Provide the patient with brief counseling or coping strategies as appropriate
• □COM 1.1 Communicate using a manner that encourages trust, and is characterized by empathy, respect, and compassion
• □COM 1.5 Use verbal de-escalation techniques when appropriate
• □COM 1.6 Assess a patients decision-making capacity and tailor approaches to their capacity, values, and preferences

Collaborator

• □COL 1.3 Collaborate as necessary with the patient’s primary care physician, psychiatrist, and/or community liaison(s) and services upon discharge

Health Advocate

• □HA 1.1 Facilitate timely access to resources, agencies, and opportunities for patient education to address health needs of the patient including the social determinants of health
• □HA 1.1 Identify patients at risk and notify the appropriate authority and/or social agencies as required
• □HA 1.1 Describe risk factors that may indicate that a patient is the victim of intimate partner violence, child abuse or neglect, youth violence, sexual assault, elder abuse, or human trafficking

Professional

• □P 2.2 Ensure personal and team safety during the assessment and management of patients
• □P 3.1 Demonstrate knowledge and appropriate use of provincial mental health legislation as it pertains to involuntary psychiatric assessment in cases of imminent self-harm, harm to others, or inability to care for self

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Population

1. ●intimate partner violence
2. ●child abuse and neglect
3. ●sexual assault
4. ●elder abuse
5. ●human trafficking
6. ●other

Medical Expert

• □ME 2.4 Manage a patient who has been physically or sexually assaulted including arranging an appropriate clinical and forensic examination, treatment, and appropriate disposition that ensures the patient’s safety
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems, their social context and their expressed wishes in collaboration with the interprofessional team
• □ME 4.1 Determine timing and necessity of referral to crisis team, sexual assault team, child protective services, psychiatry, social work, or medical services
• □ME 2.2 Recognize, document, and appropriately report patients at risk of violence or neglect based on legislative requirements

Communicator

• □COM 1.1 Communicate using a manner that encourages trust, and is characterized by empathy, respect, and compassion
• □COM 1.6 Assess a patients decision-making capacity and tailor approaches to their capacity, values, and preferences
• □COM 5.1 Maintain clear, concise, accurate, and appropriate records of clinical encounters and plans

Health Advocate

• □HA 1.1 Facilitate timely access to resources, agencies, and opportunities for patient education to address health needs of the patient including the social determinants of health
• □HA 1.1 Describe risk factors that may indicate that a patient is the victim of intimate partner violence, child abuse or neglect, youth violence, sexual assault, elder abuse, or human trafficking

Professional

• □P 2.2 Ensure personal and team safety during the assessment and management of patients

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. ●emergency department
2. ●simulation
3. ●pre-hospital setting
4. ●other

Medical Expert

• □ME 2.2 Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate a well-organized differential diagnosis and/or management plan
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources when dealing with single or multiple critically injured patients
• □ME 5.1 Recognize and report patient safety incidents to appropriate prehospital services and transport medicine representatives

Collaborator

• □COL 1.2 Describe the scope of training and practice of prehospital services and transport medicine personnel and prehospital treatment algorithms
• □COL 1.2 Collaborate with prehospital services and transport medicine personnel in the ongoing resuscitation of acutely ill patients during initial resuscitation of the patient
• □COL 1.3 Work with others to assess, plan, provide, and integrate care for individuals and groups of patients
• □COL 1.2 Provide clear, concise, timely, and respectful direction and feedback to prehospital services and transport medicine personnel
• □COL 3.2 Convey appropriate medical information in a clear and organized manner to ensure safe transfer of care to another health care professional
• □COL 3.2 Communicate with prehospital services and transport medicine personnel in the transfer of care and provision of care in the prehospital setting

Leader

• □L 3.1 Demonstrate knowledge of prehospital services and transport medicine systems and the function and protocols of prehospital services and transport medicine dispatch

Professional

• □P 3.1 Fulfil and adhere to the protocols and standard practice governing shared care with prehospital services and transport medicine

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Procedure

1. ●simple wound repair
2. ●abscess drainage
3. ●immobilization of extremity
4. ●joint arthrocentesis
5. ●slit lamp and intraocular pressure measurement
6. ●anterior nasal packing
7. ●intraosseous access
8. ●complex wound repair
9. ●central venous access with ultrasound guidance
10. ●reduction of an extremity fracture
11. ●lumbar puncture
12. ●reduction of large joint dislocation
13. ●regional anesthesia
14. ●thoracostomy tube insertion
15. ●other

Medical Expert

• □ME 3.2 Describe the indications, contraindications, risks, alternatives, complications, and post-procedure management for a given procedure or therapy
• □ME 3.2 Obtain and document informed consent (verbal or written), explaining the risks and benefits of and the rationale for the proposed options
• □ME 3.4 Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □ME 3.1 Determine and provide the most appropriate analgesic therapy and/or sedation plan for the specific procedure using multimodal analgesia concepts and alternative pain/sedation strategies
• □ME 3.2 Use shared decision-making with the patient to obtain and document informed consent, explaining the risks and benefits of and the rationale for a proposed procedure or therapy
• □ME 3.4 Document procedures accurately
• □ME 3.4 Establish and implement a plan for post-procedure care including patient specific post-procedure instructions
• □ME 5.1 Recognize and respond to adverse events and near misses, taking action to prevent harm to the patient
• □ME 5.2 Apply appropriate measures for protection of health care professionals during the entire patient encounter including but not limited to the use of PPE to avoid exposure or contamination

Communicator

• □COM 3.2 Disclose adverse events to the patient
• □COM 3.1 Communicate information that is concise, relevant, useful, and respectful to a patient and the patient’s family, adapting explanations to the patient’s needs and level of understanding

Collaborator

• □COL 1.3 Review adverse events with the healthcare team

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. ●emergency department
2. ●simulation
3. ●other

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

POCUS application

1. ●FAST
2. ●identification of AAA
3. ●identification of first trimester IUP
4. ●thoracic ultrasound
5. ●focused cardiac ultrasound

Observation

1. ●direct
2. ●indirect review of stored images acquired by the resident

Medical Expert

• □ME 1.3 Apply knowledge of the clinical and biomedical sciences, including physics, to facilitate image acquisition and interpretation
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, limitations, and strengths in using point-of-care ultrasound versus alternative diagnostic strategies
• □ME 2.2 Integrate all sources of information to develop a diagnosis informed by point-of-care ultrasound that is safe, patient-centred, and considers the risks and benefits of all diagnostic approaches
• □ME 3.4 Demonstrate technical competence in image acquisition

Communicator

• □COM 5.1 Maintain clear, concise, accurate, and appropriate records related to point-of-care ultrasound
• □COM 5.1 Store and archive images appropriately

Collaborator

• □COL 1.2 Consult with other health care professionals, recognizing the limits of their expertise and the limits of point-of-care ultrasound

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. ●emergency department
2. ●simulation
3. ●other

Medical Expert

• □ME 2.1 Recognize a patient who may benefit from palliative care intervention, initiate the intervention, and partner in providing care as needed
• □ME 2.3 Collaborate with the patient and their family to confirm goals of care and if not previously determined, assist the patient and family in defining goals of care, incorporating their values and appropriate medical options
• □ME 2.2 Perform an assessment of a patient’s decision-making capacity
• □ME 2.4 Develop and implement management plans for control of pain
• □ME 2.4 Develop and implement management plans for non-pain symptom control

Communicator

• □COM 3.1 Communicate the patient’s prognosis, related uncertainty, and the differences between the goals of curative and palliative treatments to the patient and family clearly and compassionately
• □COM 5.1 Document the patient’s goals of care in an accurate, complete, timely, and accessible manner
• □COM 3.1 Clearly and compassionately communicate the news of the patient’s death to their family
• □COM 4.2 Provide resource support options for families in grief crisis

Collaborator

• □COL 2.2 Develop consensus between the patient, family, and care providers regarding the care plan for the patient in the emergency department, including recognition and mediation of conflicts

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. ●emergency department
2. ●ward
3. ●clinic
4. ●simulation
5. ●other

Patient demographic

1. ●pediatric
2. ●adult

Clinical presentation

1. ●alcohol
2. ●opioid
3. ●stimulant
4. ●sedative/hypnotic
5. ●other

Medical Expert

• □ME 1.6 Use sound clinical reasoning and judgment to guide diagnosis and management, even in circumstances where complete clinical or diagnostic information is not immediately available
• □ME 3.1 Recognize and respond to emergent illness arising from intoxication or withdrawal
• □ME 1.6 Recognize and respond to the complexity inherent to the care of the patient with an emergent illness and concomitant substance use
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion
• □ME 2.4 Initiate medical treatment of the patient with an overdose or substance poisoning, including specific antidote therapy
• □ME 5.2 Ensure patient safety including chemical and physical restraint and their associated risks
• □ME 5.2 Ensure safety of the health care team
• □ME 2.4 Initiate and/or refer patients for opioid agonist treatment if indicated
• □ME 2.4 Initiate and/or refer patients for treatment of alcohol use disorder if indicated

Communicator

• □COM 1.1 Use non-stigmatizing, person-first and respectful language when communicating with patients, families, and colleagues

Health Advocate

• □HA 1.1 Understand the role of historical, intergenerational, and personal trauma and incorporate the principles of healing-centered engagement into the care interaction
• □HA 1.2 Assist the patient in accessing addiction services as appropriate, and promote safer practices and harm reduction strategies
• □HA 1.1 Recognize and mitigate barriers to accessing care, including lack of housing, transportation, communication device, distrust of the health care system, lack of culturally appropriate services, etc.

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.5 Carry out other professional duties (e.g., supervision of learners) while working in the emergency department while responsible for multiple ill patients
• □ME 1.5 Provide quality patient-centred care when faced with overcrowding
• □ME 1.6 Prioritize clinical duties effectively when faced with multiple patients and problems
• □ME 4.1 Implement patient-centered care plans for patients discharged from the emergency department, ensuring primary-care and/or consultant follow-up and efficient flow through the emergency department

Collaborator

• □COL 1.2 Coordinate shared care responsibilities with physicians and other colleagues for patients in the emergency department including delegating tasks to other health care professionals
• □COL 1.3 Communicate effectively with nurses, other physicians, other health care professionals and other staff to optimize flow of patients through the emergency department
• □COL 3.2 Demonstrate safe transfer of care, both verbal and written, during patient transitions into and out of the emergency department

Leader

• □L 2.1 Manage unexpected surges in patient numbers and acuity
• □L 2.1 Coordinate medical and surgical specialties with hospital administration to problem solve resource issues in the emergency department (e.g., crisis events, bed block, malfunction of technology)

Professional

• □P 1.1 Maintain appropriate professional behaviours and demonstrate resilience in the face of high stress/intensity 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

Learner demographic

1. ●medical student
2. ●off service resident
3. ●EM resident
4. ●other

Learners

1. ●individual
2. ●multiple

Medical Expert

• □ME 1.5 Provide bedside teaching, including teaching procedural skills, in the face of competing clinical demands in the emergency department environment

Communicator

• □COM 2.1 Ensure learners recognize and respect the patient’s beliefs, values, preferences, context, or expectations during a patient encounter

Scholar

• □S 2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners
• □S 2.3 Ensure patient safety, dignity, and confidentiality are maintained when learners are involved
• □S 2.3 Describe the role and responsibility of the supervisor as determined by relevant local policies
• □S 2.3 Provide bedside teaching and supervision according to relevant local policies
• □S 2.4 Identify the level of the learner and their needs and adapt teaching strategies to match them
• □S 2.4 Choose appropriate content, teaching format, and strategies tailored to both the learner and the emergency department setting
• □S 2.5 Provide feedback to learners to enhance learning and performance
• □S 2.5 Provide feedback to learners who are performing below their level of training, being clear about areas that require immediate attention and providing guidance for future training
• □S 3.4 Teach learners to effectively find, select, and integrate evidence into decision making in their practice

Professional

• □P 4.3 Teach, role-model, and positively influence the behaviour of others to promote a positive and effective learning 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

Setting

1. ●emergency department
2. ●simulation

Demographic

1. ●patient interaction
2. ●family interaction
3. ●physician interaction
4. ●other health care professional interaction

Medical Expert

• □ME 2.3 Determine goals of care with patients with complex illness when this has not been previously discussed, conveying when treatment is inappropriate
• □ME 2.3 Set boundaries of therapeutic care with patients and/or families when there are unrealistic expectations (e.g., unnecessary diagnostic imaging, emergent referral etc.) or secondary gain contributing to the visit to the emergency department

Communicator

• □COM 1.3 Recognize when linguistic, cultural, social, religious, or ethnic issues or values are impacting an interaction and respond appropriately
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.5 Manage disagreements and emotionally charged conversations, including situations when patients and families disagree with the physician and/or each other
• □COM 1.5 Defuse situations with patients who demonstrate abusive or violent behaviour, and recognize when the situation exceeds the limits of normal communication, necessitating the intervention of law enforcement and/or the use of chemical or physical restraint
• □COM 3.1 Communicate clearly with patients and others in the setting of ethical dilemmas
• □COM 3.2 Disclose critical incidents involving patient safety and/or medical error to the patient and family accurately and according to institutional policy

Collaborator

• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture

Professional

• □P 3.1 Adhere to the professional and ethical codes, standards of practice, and laws governing practice

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

Patient demographic

1. ●infant
2. ●child
3. ●youth
4. ●adult
5. ●senior

Patient referred to ED

1. ●yes
2. ●no

Referral source

1. ●consulting service
2. ●community ED
3. ●outpatient clinic
4. ●family physician
5. ●other

Medical Expert

• □ME 1.6 Use sound clinical reasoning and judgment to guide diagnosis and management, even in circumstances where complete clinical or diagnostic information is not immediately available
• □ME 1.6 Recognize and respond to the complexity and uncertainty inherent to the care of the patient with appropriate intervention and consultation
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context in collaboration with patients and their families and, when appropriate, the interprofessional team
• □ME 4.1 Determine timing and necessity for referral
• □ME 4.1 Coordinate continuing care with referring physicians for patients discharged from the emergency department

Communicator

• □COM 5.2 Ensure accurate documentation of relevant information and medical orders when providing advice when appropriate
• □COM 5.3 Provide effective consultant reports to referring physician outlining findings, treatments, and follow up care plan

Collaborator

• □COL 1.3 When providing medical consultation, allow for shared decision- making by incorporating the clinical and situational input of other health care professionals
• □COL 3.2 Demonstrate safe transfer of care, both verbal and written, during patient transitions into and out of the emergency department

Professional

• □P 1.1 Exhibit professional behaviour when communicating about patient care with other physicians and health care professionals
• □P 1.5 Demonstrate secure and appropriate use of communication technology with referring physicians and other health care professionals

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Handover

1. ●EP to EP
2. ●other

Medical Expert

• □ME 4.1 Implement a collaborative patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

Communicator

• □COM 3.1 Inform the patient of the transition of care process and key elements

Collaborator

• □COL 3.1 Determine when care should be transferred to another physician or health care professional
• □COL 3.2 Communicate and negotiate, as appropriate, a plan for the patient’s care with the patient’s other health care professionals for patients discharged from the emergency department
• □COL 3.2 Demonstrate safe transfer of care, both verbal and written, during patient transitions to a different health care professional, setting, or stage in care

Scholar

• □S 3.4 Integrate best evidence surrounding handover practices

Professional

• □P 1.5 Demonstrate secure and appropriate use of communication technology with referring physicians and other health care professionals

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●emergency department
2. ●simulation

Medical Expert

• □ME 1.6 Use sound clinical reasoning and judgment to guide diagnosis and management, even in circumstances where complete clinical or diagnostic information is not immediately available
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during the emergency department visit or during future follow-up with other health care practitioners
• □ME 3.3 Respond to the urgency and potential for deterioration in advocating for the timely execution of diagnostic and therapeutic procedures or therapy
• □ME 4.1 Develop and implement a safe patient-centred care plan dealing with clinical uncertainty that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, other physicians, first responders, and other health professionals
• □COM 5.1 Maintain clear, concise, accurate records of clinical encounters and plans, indicating approaches that prioritize safe, symptomatic treatment and exclusion of key diagnoses, but that may not achieve a final diagnosis

Case description

Feedback provided

Next steps