Endocrinology and Metabolism (Adult)
Royal College of Physicians and Surgeons of Canada · 1.0 · 17 EPAs
Also available in French.
Every EPA in the published guide, shown as the form DebriefMD fills in, with its fields and answer options.
Transition to Discipline
TTD-1A
Assessing patients with a known endocrine condition
Key features and assessment plan
- This EPA focuses on the application of Internal Medicine competencies related to clinical assessment and management to the care of patients with a previously diagnosed endocrine condition. - This includes taking an organized history, performing a targeted physical examination, and synthesizing findings to formulate an assessment of the patient. - This EPA may be observed in any setting.
Direct observation and/or case review by supervisor or Core or TTP resident Use Form 1 Collect 4 observations of achievement - At least 2 different observers
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 2.2 Gather a relevant clinical history
- ME 2.2 Perform a physical exam relevant to the presentation
- ME 2.2 Synthesize patient information from the clinical assessment for the purpose of written or oral summary to a supervisor
Communicator
- COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
- COM 2.1 Conduct the interview in a patient-centred manner ADULT ENDOCRINOLOGY AND METABOLISM (2025)
- COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in the patient’s care
Professional
- P 1.1 Behave in a professional manner ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
Foundations
F-1A
Assessing and managing individuals with an uncomplicated presentation of an endocrine condition
Key features and assessment plan
- This EPA includes all aspects of a consultation: gathering information from the history, physical exam and other sources, and developing a management plan which may include treatment as well as further investigation. - This EPA may be observed in any care setting (e.g., clinic, hospital). - At this stage, this EPA includes individuals whose presentation is typical or common and is not further complicated by multiple medical comorbidities or management challenges, including those due to social determinants of health and geographic and/or cultural complexities.
Direct and/or indirect observation by supervisor, clinical fellow, or TTP resident Use Form 1. Form collects information on: - Observation (select all that apply): direct; indirect - Presentation (write in): Collect 4 observations of achievement - At least 1 direct observation - A variety of presentations - No more than 2 presentations of diabetes
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Observation
- direct
- indirect
Medical Expert
- ME 2.2 Elicit a history and perform a relevant physical exam
- ME 2.2 Select and/or interpret investigations
- ME 2.2 Develop a differential and most probable diagnosis
- ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
- ME 2.4 Develop and implement a management plan
Communicator
- COM 3.1 Communicate the diagnosis and plan to the patient and/or family ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
F-2A
Providing ongoing care for individuals with an uncomplicated presentation of an endocrine condition
Key features and assessment plan
- This EPA includes clinical reassessment, further investigation and/or modification of treatment, screening or monitoring for adverse effects or complications of the condition or its treatment, and making decisions about discharge and/or timing of ongoing follow-up.
Direct and/or indirect observation by supervisor, clinical fellow, or TTP resident Use Form 1. Form collects information on: - Presentation (write in): Collect 4 observations of achievement - At least 1 presentation of diabetes - At least 3 different presentations other than diabetes - At least 2 different observers
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 1.4 Perform a clinical assessment that addresses all relevant issues
- ME 2.2 Assess adherence to, response to, and adverse effects of therapy as well as complications of the underlying disorder
- ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
- ME 2.2 Determine if there is a need to adapt the management plan based on response to therapy and/or disease progression
- ME 4.1 Determine the frequency and timing of future investigations and visits
Communicator
- COM 5.1 Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Collaborator
- COL 3.1 Determine if care should be transferred back to a primary care provider ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Health Advocate
- HA 1.2 Work with the patient/family to increase their understanding of the condition and associated comorbidities, supporting their active role in disease management
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
F-3A
Performing endocrine focused physical examinations
Key features and assessment plan
- The focus of this EPA is the integration of the knowledge of endocrine anatomy and physiology and the pathophysiology and complications of endocrine diseases with physical examination skills to identify and recognize the significance of clinical findings. - This EPA includes the assessment of one or more endocrine systems or diseases (e.g., pituitary, thyroid, diabetes, pubertal staging, etc.), as well as attention to patient comfort and privacy/draping during the physical exam. - The observation of this EPA requires the supervisor to directly observe the performance of the physical examination of a patient not previously known to the resident.
Direct observation by supervisor Use Form 1. Form collects information on: - Exam type (select all that apply): adrenal; diabetes foot exam; genital/breast; metabolic disease; osteoporosis exam; pituitary; pubertal staging; thyroid Collect 4 observations of achievement - At least 4 different exam types - At least 1 genital/breast exam or pubertal staging - At least 2 different observers
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Exam type
- adrenal
- diabetes foot exam
- genital/breast
- metabolic disease
- osteoporosis exam
- pituitary
- pubertal staging
- thyroid
Medical Expert
- ME 2.2 Demonstrate an organized approach to the physical examination
- ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
- ME 2.2 Interpret the findings of the physical exam in the context of the patient’s presentation
Communicator
- COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
Professional
- P 1.1 Behave in a professional manner ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
F-4A
Counselling patients and families for the purposes of patient education, disease prevention, and/or health…
Key features and assessment plan
- This EPA focuses on sharing information and engaging the patient and/or family in their care. - It includes being sensitive to patient specific factors (age, gender, religion, culture, preferences, etc.), applying a patient/family centred approach, using plain language, providing clear explanations, engaging in shared decision-making, respecting patient autonomy, and assessing the patient’s/family’s understanding of the discussion. - Examples of scenarios relevant to this EPA include disclosing a diagnosis, teaching the patient and/or family about their condition, its management, and/or preventive measures, discussing pharmacologic and non-pharmacologic therapies, and discharge planning.
Direct observation by supervisor, which may include input from other health care professionals or the patient/family Use Form 1. Form collects information on: - Topic: disease/treatment education; disease prevention/health promotion Collect 3 observations of achievement - At least 1 of each topic - At least 2 different observers
Suggested observations: 3
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Topic
- disease/treatment education
- disease prevention/health promotion
Communicator
- COM 1.1 Establish rapport with the patient and/or family
- COM 1.1 Engage the patient in the discussion as appropriate for their health literacy
- COM 3.1 Provide accurate information about the medical condition and management plan
- COM 3.1 Use plain language and avoid medical jargon
- COM 4.3 Solicit and answer questions from the patient and/or family
- COM 3.1 Verify and validate the understanding of the patient and/or family
- COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Health Advocate
- HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs
- HA 1.2 Provide the patient and/or family with education resources
Professional
- P 1.1 Demonstrate respect for patient autonomy ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
Core
C-1A
Managing patients presenting with an emergency related to an endocrine condition or its treatment
Key features and assessment plan
- This EPA focuses on timely assessment and management, including consulting with or referring to other services for definitive management of the problem. - Examples of emergent/urgent presentations include diabetic ketoacidosis/HHS, severe hyper/hypocalcemia, thyroid storm/severe hyperthyroidism, myxedema coma, adrenal crisis, and diabetes insipidus. - This EPA may be observed in simulation or in case discussion.
Direct and/or indirect observation by supervisor or clinical fellow Use Form 1. Form collects information on: - Presentation: DKA/HHS; other (write in) Collect 4 observations of achievement - No more than 1 DKA or HHS - At least 1 observation by supervisor
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Presentation
- DKA/HHS
- other (write in)
Medical Expert
- ME 2.1 Determine the acuity of the issue and the priorities for patient care
- ME 1.4 Perform a clinical assessment that addresses all relevant issues
- ME 2.2 Select and/or interpret investigations
- ME 2.2 Integrate the clinical data to establish the diagnosis
- ME 2.4 Determine the setting of care appropriate for the patient’s health needs
- ME 2.4 Develop a management plan
Communicator
- COM 5.1 Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations
Collaborator
- COL 1.2 Consult as needed with other health care professionals, including other physicians
- COL 1.2 Work effectively with members of the interprofessional team to implement a management plan ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Professional
- P 4.1 Maintain professionalism while managing stressful situations ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-2A
Assessing and managing patients with complex and/or atypical presentations
Key features and assessment plan
- This EPA includes all aspects of a consultation: gathering information from the history, physical exam, and other sources, working effectively with other members of the interprofessional team (as well as with the referring service if relevant), and developing a management plan which may include treatment as well as further investigation. - This may require scholarly review of treatment options and/or multidisciplinary collaboration or consultation with external experts. - This EPA may be observed in any care setting (e.g., clinic, hospital, emergency department), including virtual care. - At this stage, this EPA includes the full range of endocrine conditions and presentations that are complex or atypical due to patient factors (e.g., pregnancy, other medical conditions, peri-operative timing) or complicated by management challenges, including those due to social determinants of health and geographic and/or cultural variability.
Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Presentation (write in): Collect 4 observations of achievement - At least 3 different presentations - At least 2 different observers
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 1.4 Perform a clinical assessment that addresses all relevant issues
- ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
- ME 2.4 Develop and implement a management plan
- ME 2.2 Identify whether the case warrants discussion at multidisciplinary case conference
- ME 4.1 Determine the need and timing of referral to another physician ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Collaborator
- COL 1.2 Work effectively with members of the interprofessional team to implement a management plan ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Leader
- L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options
Scholar
- S 3.4 Integrate best evidence and clinical expertise into decision-making
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-3A
Providing ongoing care
Key features and assessment plan
- This EPA includes clinical reassessment, further investigation, adjustment, or modification of treatment based on changes in the individual’s condition, response to therapy or goals of care, screening or monitoring for adverse effects or complications of the condition or its treatment and making decisions about discharge and/or timing of ongoing follow-up. - The observation of this EPA is based on a single patient in any general, specialized, or longitudinal clinic.
Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Patient presentation (write in): - Issue (select all that apply): progressive condition; initiate and/or change therapy; manage complications; arrange/review surveillance; supportive/preventive care; counsel/educate; discharge; other issue Collect 6 observations of achievement - At least 1 diabetes presentation - At least 4 different presentations other than diabetes
Suggested observations: 6
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 1.4 Perform a clinical assessment that addresses all relevant issues
- ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
- ME 2.2 Determine if there is a need to adapt the management plan based on response to therapy and/or disease progression
- ME 2.3 Integrate the patient’s and family’s perspective and context into the care plan
- ME 4.1 Implement a plan for ongoing care, follow-up on investigations, response to treatment and monitoring for disease progression ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Communicator
- COM 5.1 Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Leader
- L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options
Health Advocate
- HA 1.2 Work with the patient/family to increase their understanding of the condition and associated comorbidities, supporting their active role in disease management
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-4A
Interpreting investigations
Key features and assessment plan
- This EPA focuses on the interpretation of investigations such as dynamic testing (e.g., cosyntropin, DDAVP stimulation, petrosal sinus sampling, water deprivation test, supervised fast, oral glucose load, aldo/renin level, adrenal vein sampling, growth hormone stimulation, GnRH), and genetics, pathology, and imaging investigations. - This includes identifying possible confounders and recognizing the limits of the diagnostic technique and its interpretation.
Direct or indirect observation by supervisor Use Form 1. Form collects information on: - Type of report: dynamic testing; genetics; imaging; other pathology; thyroid cytology - Specific test (write in): Collect 5 observations of achievement - At least 2 dynamic testing - At least 1 imaging - At least 1 pathology - At least 1 thyroid FNA-B cytology
Suggested observations: 5
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Type of report
- dynamic testing
- genetics
- imaging
- other pathology
- thyroid cytology
Medical Expert
- ME 2.2 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
- ME 1.3 Apply knowledge of the principles, strengths, and limitations of diagnostic investigations
- ME 2.2 Interpret the results of the investigation(s) in the context of the clinical presentation
- ME 2.2 Summarize findings of clinical relevance and, as appropriate, provide suggestions for further testing or management
Collaborator
- COL 1.3 Engage in respectful shared decision-making with physicians and other colleagues in the health care professions ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-5A
Managing diabetes with insulin therapy and the use of diabetes technologies
Key features and assessment plan
- This EPA focuses on prescribing insulin therapy for individuals with type 1 and type 2 diabetes, gestational diabetes, and other forms of diabetes. - This includes ensuring that the individual has appropriate follow-up to assist with titration of insulin and providing appropriate monitoring for side effects (e.g., hypoglycemia and DKA). - It also includes demonstrating expertise in transitioning patients from basal-bolus insulin to a continuous subcutaneous insulin infusion system/insulin pump therapy. - It also includes interpretation of continuous glucose monitoring (CGM).
Direct and/or indirect observation by supervisor or diabetes or pump educator Use Form 1. Form collects information on: - Type of diabetes: congenital; cystic fibrosis-related; diabetes in pregnancy; monogenic; post-pancreatic surgery; secondary diabetes; type 1; type 2 - Treatment: CGM; multiple daily injections; insulin pump; transition to pump Collect 10 observations of achievement - At least 2 diabetes in pregnancy - At least 1 individual with congenital, cystic fibrosis-related, monogenic, post- pancreatic surgery or secondary diabetes - At least 3 continuous glucose monitoring - At least 3 multiple daily injections - At least 3 insulin pumps - At least 1 transition to pump - At least 2 different observers
Suggested observations: 10
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Type of diabetes
- congenital
- cystic fibrosis-related
- diabetes in pregnancy
- monogenic
- post-pancreatic surgery
- secondary diabetes
- type 1
- type 2
Treatment
- CGM
- multiple daily injections
- insulin pump
- transition to pump
Medical Expert
- ME 1.3 Apply knowledge of intensive diabetes management, including the use of diabetes technologies
- ME 2.2 Interpret the results of glucose monitoring
- ME 3.4 Select and prescribe an insulin regimen based on individual needs and glycemic targets
- ME 3.4 Provide anticipatory guidance for management of diabetes- technology malfunction, including a back-up plan
- ME 4.1 Establish a follow-up plan
Communicator
- COM 3.1 Educate and counsel patients about their condition and the treatment options ADULT ENDOCRINOLOGY AND METABOLISM (2025)
- COM 3.1 Provide written and/or visual materials to supplement health teaching
Collaborator
- COL 1.2 Work effectively with diabetes nurse educators
Health Advocate
- HA 1.1 Facilitate patient access to needed resources and services ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-6A
Documenting patient encounters
Key features and assessment plan
- This EPA focuses on writing a high-quality consultation note using any format: handwritten, dictated, electronic medical record. - This includes a synthesis of the pertinent clinical findings, investigations, and management plan, as well as clear articulation of the role of the endocrinologist and the referring physician in further care. It may include linking the recommendations to evidence-based guidelines or other educational references for the referring physician. - The documents submitted for review must be the sole work of the resident. - This EPA may be observed in any care setting and with any patient presentation.
Review of clinical documentation by supervisor Use Form 1. Form collects information on: - Type of documentation: new patient consultation note; returning patient note Collect 4 observations of achievement - At least 1 new patient consultation note - At least 1 returning patient note - At least 2 different observers
Suggested observations: 4
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Type of documentation
- new patient consultation note
- returning patient note
Medical Expert
- ME 2.2 Synthesize and interpret information from the clinical assessment
Communicator
- COM 5.1 Organize information in appropriate sections
- COM 5.1 Document all relevant findings and investigations
- COM 5.1 Convey clinical reasoning and the rationale for decisions
- COM 5.1 Provide a clear plan for ongoing management
- COM 5.1 Complete clinical documentation in a timely manner ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Collaborator
- COL 1.2 Identify clearly the roles of the referring physician and/or other relevant care providers and the endocrinologist in the ongoing management plan
- COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-7A
Providing indirect patient management recommendations to other health care professionals
Key features and assessment plan
- This EPA focuses on in-house or off-site calls or electronic communication with a requesting physician or other health care professional and provision of medical recommendations. - This includes collecting the information necessary to provide recommendations for patient management including interpretation of labs, triage to an outpatient clinic for assessment, or transfer to an appropriate setting based on acuity. - This EPA may be observed in simulation (e.g., OSCE).
Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Origin of call: in-house; off-site; e-consult - Patient presentation (write in): Collect 5 observations of achievement - A variety of patient presentations - At least 2 observers
Suggested observations: 5
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Origin of call
- in-house
- off-site
- e-consult
Medical Expert
- ME 2.2 Integrate information from the clinical assessment and/or investigations to determine the patient’s clinical status and health care needs
- ME 2.1 Determine the acuity of the issue and the priorities for patient care
- ME 2.4 Determine the setting of care appropriate for the patient’s health needs
- ME 2.4 Support the referring physician in developing a plan for ongoing care in the local setting and/or for care prior to endocrinology assessment ADULT ENDOCRINOLOGY AND METABOLISM (2025)
- ME 2.4 Provide anticipatory guidance for management of potential changes in the patient’s clinical status
Communicator
- COM 2.3 Gather relevant patient information from another health professional
- COM 5.1 Document advice provided to other health care providers ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Collaborator
- COL 1.3 Communicate effectively with physicians and other health care professionals
Leader
- L 2.1 Apply knowledge of the health care resources available in other care settings
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-8A
Providing unplanned advice to patients
Key features and assessment plan
- This EPA focuses on unplanned interactions occurring outside of scheduled planned patient encounters and may include responding to calls from patients and/or family members (i.e., on-call) or contacting patients about results. - This includes providing appropriate and timely advice about management and/or patient disposition, recognizing conditions that can be managed remotely (e.g., virtual) versus those that require in-person assessment, and documenting the encounter.
Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Complex case: yes; no Collect 2 observations of achievement - At least 1 complex case - At least 2 different observers
Suggested observations: 2
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Complex case
- yes
- no
Medical Expert
- ME 2.2 Gather information required to clarify the patient’s issue or status
- ME 2.2 Integrate information from the clinical assessment and/or investigations to determine the patient’s clinical status and health care needs
- ME 2.4 Determine if an in-person visit is required
- ME 2.4 Develop a management plan
- ME 2.4 Provide anticipatory guidance for management of potential changes in the patient’s clinical status
Communicator
- COM 3.1 Convey information to the patient and/or family clearly and compassionately
- COM 3.1 Verify and validate the understanding of the patient and/or family ADULT ENDOCRINOLOGY AND METABOLISM (2025)
- COM 5.1 Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations
- COM 5.3 Use technology in a manner that respects patient privacy and confidentiality ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-9A
Supporting adolescents/young adults with endocrine conditions in the transition from the pediatric to adul…
Key features and assessment plan
- This EPA focuses on the unique aspects of developmental readiness and risks that occur as adolescents/young adults progress to autonomy for their health care needs. - The nature of the endocrine condition is not relevant for this EPA.
Direct and/or indirect observation by supervisor Use Form 1. Form collects information on: - Patient condition (write in): Collect 2 observations of achievement - At least 2 different patient conditions - At least 2 different observers
Suggested observations: 2
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 2.2 Assess the patient’s health literacy and developmental readiness for the demands of the adult care setting
- ME 2.2 Assess psychosocial issues that may affect health and/or access to services
- ME 2.2 Assess adherence to treatment and monitoring plans
- ME 2.4 Anticipate, prevent and manage changes in health status at the time of transition
- ME 4.1 Establish plans for ongoing care that include monitoring health status and managing adherence ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Communicator
- COM 4.3 Use communication skills and strategies that foster effective patient-physician relationships
Health Advocate
- HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs
- HA 1.2 Work with the patient to increase autonomy in their care
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
C-10A
Leading patient care on an inpatient consultation service
Key features and assessment plan
- This EPA includes all aspects of leading a consultation service, including triaging referrals, delegating to, organizing, and teaching and supervising junior members of the team, making decisions for patient care, and working effectively with referring physicians and members of the interprofessional endocrinology team. - The observation of this EPA is based on a period of at least one week.
Direct and/or indirect observation by supervisor(s) which may include input from others Use Form 1 Collect 2 observations of achievement - At least 2 different observers
Suggested observations: 2
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role
- ME 1.5 Prioritize patients based on clinical urgency
- ME 2.4 Establish management plans that consider all relevant aspects of the patient’s care
Collaborator
- COL 1.3 Communicate effectively with the consulting service
- COL 2.2 Work effectively with other health care professionals when there are differences in opinion
Leader
- L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
- L 4.2 Run the service efficiently, safely, and effectively ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Scholar
- S 3.4 Integrate best evidence and clinical expertise into decision-making
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
Transition to Practice
TTP-1A
Managing an endocrinology practice
Key features and assessment plan
- This EPA focuses on managing the caseload of an endocrinologist: providing quality care for individual patients, triaging and prioritizing between patients and amongst patients and other occupational demands, and demonstrating judicious use of resources. - It includes managing a longitudinal clinic and/or inpatient service. - It also includes completing medical documentation in a timely manner, and completing administrative responsibilities which may include billing, triaging referrals, and completing insurance forms. - This EPA should be observed in a longitudinal clinic over a period of two months and/or one week of inpatient service.
Direct and/or indirect observation by supervisor Use Form 1 Collect 2 observations of achievement
Suggested observations: 2
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Medical Expert
- ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care at the level of the most responsible physician
- ME 2.4 Establish management plans that consider all relevant aspects of the patient’s care
Communicator
- COM 5.1 Document clinical encounters in an accurate, complete, and timely manner
Leader
- L 4.2 Manage bookings and triage consultation requests to optimize clinic scheduling based on clinical acuity
- 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 in demanding or stressful clinical settings ADULT ENDOCRINOLOGY AND METABOLISM (2025)
Case description
Feedback provided
Next steps
Copyright © 2025 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission.
TTP-2A
Developing a plan for continuing professional development
Key features and assessment plan
- This EPA is meant to address the resident’s professional development needs in early practice and may include a variety of scenarios. Examples include a plan to act on identified performance gaps; a plan to correct educational gaps in training; a plan to prepare for fellowship training; a plan to prepare for practice in a specific setting (i.e., academic vs community). - Achievement of this EPA is based on submission of a document which includes a) the rationale for a learning plan, b) self-reflection, c) personal needs assessment, and d) identification of the methods to achieve the personal learning plan, such as literature review, clinical training, and/or conference attendance. - The plan should be SMART (specific, measurable, assessable, realistic, and timely), and must include the appropriate choice of clinical experiences and/or appropriate academic resources (journals, textbooks, conferences).
Review of resident’s submission of a professional development plan by supervisor, academic advisor, or mentor Use Form 4 Collect 1 observation of achievement
Suggested observations: 1
Entrustment (how much supervision did this activity need?)
- I had to do
- I had to talk them through
- I needed to prompt
- I needed to be there just in case
- I didn’t need to be there
Leader
- L 4.2 Articulate personal interests and career goals
- L 4.2 Plan for continuing medical education experiences to gain competencies necessary for future practice
Scholar
- S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
- S 1.1 Define learning needs related to personal practice and/or career goals
- S 1.1 Create a personal learning plan that is feasible, includes clear deliverables, timelines, resources, and a plan for monitoring ongoing achievement
Professional
- P 2.1 Demonstrate a commitment to maintaining and enhancing competence
Case description
Feedback provided
Next steps
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