Endocrinology and Metabolism (Pediatric)

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 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 and family comfort, dignity, privacy, engagement, and safety
• □COM 2.1 Conduct the interview in a patient-centred manner PEDIATRIC 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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. ●adrenal crisis
2. ●diabetes insipidus
3. ●diabetic ketoacidosis/HHS
4. ●differences in sexual development
5. ●electrolyte abnormalities
6. ●hypoglycemia
7. ●severe hypercalcemia
8. ●severe hypocalcemia, severe hyperthyroidism
9. ●other (write in)

Medical Expert

• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner without excluding key elements
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Develop a differential and most probable diagnosis
• □ME 2.2 Select and/or interpret appropriate initial investigations
• □ME 1.3 Apply knowledge of protocols for the care of emergencies related to endocrine conditions or their treatment
• □ME 2.4 Develop and implement a plan for initial management PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Communicator

• □COM 3.1 Provide the patient and/or family with information about the patient’s condition and plans for management clearly and compassionately

Collaborator

• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □COL 1.3 Communicate effectively with physicians and other health care professionals PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Leader

• □L 2.1 Identify local resources for optimal patient care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Observation

1. ●direct
2. ●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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.4 Perform 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Collaborator

• □COL 3.1 Determine if care should be transferred back to a primary care provider PEDIATRIC 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

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

Exam type

1. ●adrenal
2. ●growth assessment
3. ●metabolic bone disease
4. ●neonatal genital
5. ●pituitary
6. ●pubertal staging-female
7. ●pubertal staging – male
8. ●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 and family comfort, dignity, privacy, engagement, and safety

Professional

• □P 1.1 Behave in a professional manner PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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

Topic

1. ●disease/treatment education
2. ●disease prevention/health promotion

Adolescent patient

1. ●no
2. ●yes

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 or developmental stage
• □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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware

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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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. ●DKA/HHS
2. ●differences of sexual development
3. ●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 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Professional

• □P 4.1 Maintain professionalism while managing stressful situations PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.4 Perform 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

Collaborator

• □COL 1.2 Work effectively with members of the interprofessional team to implement a management plan PEDIATRIC 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

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.4 Perform 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

Communicator

• □COM 5.1 Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations PEDIATRIC 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025) condition and associated comorbidities, supporting their active role in disease management

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 report

1. ●dynamic testing
2. ●genetics
3. ●imaging
4. ●pathology

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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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 age group

1. ●infant
2. ●child
3. ●adolescent

Type of diabetes

1. ●congenital
2. ●cystic fibrosis-related
3. ●gestational
4. ●monogenic
5. ●post- pancreatic surgery
6. ●secondary diabetes
7. ●type 1
8. ●type 2

Treatment

1. ●CGM
2. ●multiple daily injections
3. ●insulin pump
4. ●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 backup plan
• □ME 4.1 Establish a follow-up plan

Communicator

• □COM 3.1 Educate and counsel patients about their condition and the treatment options PEDIATRIC 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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 documentation

1. ●new patient consultation note
2. ●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 PEDIATRIC 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

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

Origin of call

1. ●in-house
2. ●off-site
3. ●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 PEDIATRIC 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 PEDIATRIC 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

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

Complex case

1. ●yes
2. ●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 PEDIATRIC 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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 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 2.2 Assess the need, timing, and risk of transition from pediatric to adult care
• □ME 2.4 Anticipate, prevent, and manage changes in health status at the time of transition PEDIATRIC 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

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 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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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

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 PEDIATRIC ENDOCRINOLOGY AND METABOLISM (2025)

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 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