Gastroenterology (Adult)

Entrustment (how much supervision did this activity need?)

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

Type of presentation

1. ●acute GI bleed
2. ●acute cholangitis
3. ●severe/fulminant colitis
4. ●esophageal foreign body/caustic ingestion
5. ●acute liver failure
6. ●other

Endoscopy required

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage emergency patient presentations in Gastroenterology
• □ME 2.1 Determine the acuity of the issue and establish priorities for patient care
• □ME 2.2 Perform a history and physical exam relevant to the patient’s presentation, in a time-effective manner
• □ME 2.2 Develop a differential and provisional diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.4 Develop and implement initial management plans for gastrointestinal emergencies
• □ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning, rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals

Leader

• □L 2.1 Apply knowledge of local resources for optimal patient care

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □Part A: ME 1.3 Apply knowledge of the indications and techniques for endoscopic procedures
• □Part A: ME 3.2 Explain the risks and benefits of, and the rationale for, a proposed procedure
• □Part A: ME 3.2 Use shared decision-making in the consent process
• □Part B: ME 1.4 Perform clinical assessments that address all relevant issues
• □Part B: ME 2.2 Select and interpret appropriate investigations
• □Part B: ME 2.2 Integrate and synthesize the clinical information to assess clinical status, peri-procedural risk and opportunities for risk mitigation
• □Part B: ME 2.4 Anticipate peri-procedural issues and complications, and incorporate these considerations in the management plan
• □Part B: ME 2.4 Adjust current therapy to mitigate risks of the endoscopic procedure and optimize current clinical status and treatment
• □Part B: ME 3.1 Order the preparation for the endoscopic procedure, to optimize procedural outcomes
• □Part B: ME 2.4 Determine the appropriate need and level of monitoring
• □Part B: ME 3.4 Select the appropriate location and sedation for the patient’s procedure
• □Part B: ME 3.4 Develop a plan for the appropriate disposition of the patient post procedure, as applicable

Communicator

• □Part A: COM 1.6 Tailor approaches to decision-making to patient capacity
• □Part A: COM 3.1 Provide information clearly and compassionately, checking for patient/family understanding
• □Part A: COM 4.3 Answer questions from the patient and/or family
• □Part A: COM 4.3 Use communication skills and strategies that help the patient make informed decisions
• □Part A: COM 5.1 Document the consent discussion in an accurate and complete manner
• □Part B: COM 5.1 Document the clinical encounter to adequately convey clinical reasoning, rationale for decisions and/or recommendations

Collaborator

• □Part B: COL 1.3 Communicate effectively with other health care professionals

Scholar

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

Professional

• □Part A: P 3.1 Apply knowledge of the laws governing capacity for 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

Observed

1. ●history
2. ●physical
3. ●both

Medical Expert

• □Part A: ME 2.2 Elicit an accurate, relevant history
• □Part A: ME 2.2 Perform a physical examination that informs the diagnosis
• □Part A: ME 2.2 Develop a differential and provisional diagnosis relevant to the patient’s presentation
• □Part A: ME 2.2 Select and interpret appropriate investigations
• □Part B: ME 1.3 Apply knowledge of basic science to digestive system diseases
• □Part B: ME 2.2 Synthesize information from the clinical assessment
• □Part B: ME 2.2 Develop a differential and provisional diagnosis relevant to the patient’s presentation
• □Part B: ME 2.2 Select and interpret appropriate investigations
• □Part B: ME 3.1 Determine the most appropriate procedures or therapies for the purposes of assessment and/or management
• □Part B: ME 2.4 Develop and implement management plans
• □Part B: ME 3.3 Triage an investigation, procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Communicator

• □Part A: COM 2.1 Conduct the interview in a patient-centred manner
• □Part A: COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in a given patient’s care
• □Part B: COM 5.1 Document the clinical encounter to adequately convey clinical reasoning, rationale for decisions and/or recommendations

Collaborator

• □Part B: COL 1.3 Communicate effectively with other health care professionals

Leader

• □Part B: L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □Part A: HA 1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours

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 Elicit a diet and nutritional history
• □ME 2.2 Perform a physical examination that informs the diagnosis
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Select and utilize nutritional assessment tools and methodologies appropriate to the patient context, recognizing their clinical utility and limitations
• □ME 2.2 Synthesize patient information to determine a patient’s nutritional status, including macronutrient and micronutrient sufficiency
• □ME 2.2 Estimate nutritional requirements in an uncomplicated patient
• □ME 4.1 Develop and implement a plan for monitoring and follow-up
• □ME 4.1 Anticipate the risk and recommend interventions to prevent and treat refeeding syndrome

Communicator

• □COM 3.1 Provide information related to the patient’s health status, care and needs clearly and compassionately

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and 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

Medical Expert

• □Part A: ME 3.4 Prepare and position the patient for the procedure
• □Part A: ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □Part A: ME 3.4 Assemble and optimize endoscope function
• □Part A: ME 3.4 Apply knowledge of anatomy, key landmarks and the endoscopic procedure
• □Part A: ME 3.4 Manipulate endoscope appropriately, achieving stabilization, orientation and direction
• □Part A: ME 3.4 Use appropriate strategies for endoscope advancement
• □Part A: ME 3.4 Achieve clear visualization of the lumen for safe navigation and complete mucosal evaluation
• □Part A: ME 3.4 Perform tissue biopsies, as appropriate
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part A: ME 3.4 Identify and react to immediate complications of the procedure, if applicable
• □Part A: ME 3.4 Demonstrate appropriate care of the instrument

Communicator

• □Part B: COM 5.1 Document the encounter to accurately convey the procedure and outcome
• □Part B: COM 5.1 Document the quality and findings of the endoscopic procedure, using instruments with strong validity evidence as appropriate
• □Part B: COM 5.1 Record high quality images of significant findings
• □Part B: COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □Part A: COL 1.1 Respond appropriately to input from other health care professionals

Professional

• □Part A: P 1.1 Work within personal limitations, asking for assistance as needed

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 3.4 Prepare and position the patient for the procedure
• □ME 3.4 Assemble and optimize endoscope function
• □ME 3.4 Manipulate the endoscope shaft, head and angulation control knobs for effective navigation of the GI tract
• □ME 3.4 Achieve optimal visualization using a variety of appropriate techniques such as air, water and suction
• □ME 3.4 Use torque steering appropriately
• □ME 3.4 Demonstrate fine tip control
• □ME 3.4 Recognize loop formation and use loop reduction techniques appropriately
• □ME 3.4 Use position change and other techniques, as appropriate, to advance the endoscope safely
• □ME 3.4 Demonstrate appropriate pace and progress during insertion and withdrawal
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Assess the quality of the bowel preparation using standardized scales
• □ME 3.4 Identify and react to immediate complications of the procedure, if applicable
• □ME 3.4 Demonstrate appropriate care of the instrument

Collaborator

• □COL 1.2 Communicate effectively with nurses and assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Setting

1. ●inpatient
2. ●outpatient

Case mix

1. ●atypical presentation
2. ●ambiguity in presentation, investigations and/or treatment
3. ●anticoagulation issues
4. ●multiple comorbid diseases
5. ●extraintestinal manifestations of intestinal disease
6. ●extrahepatic manifestations of liver disease
7. ●pregnancy
8. ●potential drug interaction
9. ●significant family history of malignancy
10. ●significant social barriers to health care
11. ●cultural, language and/or religious barriers to communication and/or care

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Integrate the patient’s other medical problems, overall functioning, and current health status into the decision regarding plan of care
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and needs
• □ME 3.3 Balance risk, effectiveness and priority of interventions in the presence of multiple comorbidities and/or other features of case complexity
• □ME 4.1 Implement a plan for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression
• □ME 4.1 Coordinate treatment and follow-up across care settings and amongst other physicians, health care professionals and services

Communicator

• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □COL 1.3 Work effectively with other health care professionals to plan and provide care for individual patients

Health Advocate

• □HA 1.1 Identify barriers to access and care for individual patients

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

Case mix

1. ●chronic liver disease and/or liver transplant recipient
2. ●chronic pancreatobiliary disease
3. ●inflammatory bowel disease (IBD)
4. ●refractory disease such as GERD, H Pylori, cystic fibrosis
5. ●celiac disease/eosinophilic disorders
6. ●functional abdominal pain/irritable bowel syndrome (IBS-D, IBS-C)
7. ●hereditary disorder (e.g., familial adenomatous polyposis, hereditary non-polyposis colon cancer)
8. ●post- bariatric surgery
9. ●motility disorders

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.1 Prioritize which issues need to be addressed
• □ME 2.2 Administer and interpret disease-specific questionnaires, as appropriate
• □ME 2.2 Assess treatment adherence, efficacy and/or toxicity
• □ME 2.2 Select and interpret the results of investigations performed to monitor treatment and clinical status
• □ME 2.2 Synthesize patient information to determine clinical status and/or response to therapy
• □ME 2.4 Develop and implement monitoring strategies for anticipated adverse events, illnesses and/or complications
• □ME 4.1 Coordinate treatment and follow-up plans

Communicator

• □COM 5.1 Document clinical information in a manner that supports intra- and interprofessional care

Collaborator

• □COL 1.3 Work effectively with other physicians and health care professionals to provide integrated care
• □COL 3.1 Determine when care should be transferred back to the primary health care professional
• □COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care

Health Advocate

• □HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into patient interactions
• □HA 1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Setting

1. ●inpatient
2. ●outpatient

Diagnosis

1. ●inflammatory bowel disease
2. ●chronic liver disease
3. ●pancreatic disease
4. ●esophageal disease
5. ●intestinal failure
6. ●other

Issue

1. ●disease exacerbation
2. ●disease progression
3. ●complication of therapy

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.1 Prioritize which issues need to be addressed
• □ME 2.2 Select and interpret the results of investigations performed to monitor treatment and clinical status
• □ME 2.2 Differentiate signs and symptoms of disease and/or disease progression from adverse effects of treatment
• □ME 2.2 Synthesize patient information to determine clinical course, response to treatment and/or toxicity, and short- and long-term prognosis
• □ME 2.4 Adjust management plans based on clinical status and/or response to treatment
• □ME 2.4 Prevent and manage complications of GI disease and its treatment
• □ME 4.1 Determine the need and timing of referral to another health care professional
• □ME 4.1 Coordinate treatment and follow-up plans

Communicator

• □COM 3.1 Provide information related to the patient’s health status, care and needs clearly and compassionately
• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □COL 1.3 Engage in respectful decision-making with other physicians and/or health care professionals

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

Scholar

• □S 3.4 Integrate best evidence and clinical experience 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

Type of observation

1. ●direct
2. ●case review

Case mix

1. ●urgent
2. ●elective

Type of referral

1. ●advanced GI care
2. ●other service

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Synthesize information from the clinical assessment and investigations to determine the patient’s clinical status and health care needs
• □ME 2.2 Integrate the patient’s other medical problems, overall functioning, and current health status into the decision regarding plan of care
• □ME 2.3 Establish goals of care
• □ME 2.4 Develop and implement management plans
• □ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information related to the patient’s health status, care and needs clearly and compassionately
• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Leader

• □L 2.1 Apply knowledge of local resources for optimal patient care

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and 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

Observer role

1. ●physician
2. ●registered dietician
3. ●other

Nutritional intervention prescribed

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Estimate nutritional requirements in a complex patient
• □ME 2.2 Identify complications of nutritional deficiency
• □ME 2.4 Develop and implement a plan for nutritional support by any route; oral, enteral, parenteral
• □ME 2.2 Identify indications for pharmacologic intervention
• □ME 2.3 Work with the patient and family to understand relevant options for care
• □ME 4.1 Develop and implement a plan for monitoring and follow-up
• □ME 4.1 Anticipate the risk and recommend interventions to prevent and treat refeeding syndrome
• □ME 2.4 Identify and manage complications of nutritional support (medical, and device and access related)

Communicator

• □COM 3.1 Provide information related to the patient’s health status, care and needs clearly and compassionately

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals
• □COL 1.2 Work effectively within an interprofessional team

Leader

• □L 2.1 Consider costs when choosing care options

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and 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

Difficult

1. ●no
2. ●yes (please specify):

Maximal depth of insertion

1. ●rectum
2. ●sigmoid
3. ●splenic flexure
4. ●transverse colon
5. ●hepatic flexure
6. ●ascending colon
7. ●cecum
8. ●terminal ileum
9. ●anastomosis

DOPS used

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □ME 3.4 Prepare and position the patient for the procedure
• □ME 3.4 Manipulate the endoscope shaft, head and angulation control knobs for effective navigation of the GI tract
• □ME 3.4 Achieve optimal visualization using a variety of appropriate techniques such as air, water and suction
• □ME 3.4 Use torque steering appropriately
• □ME 3.4 Demonstrate fine tip control
• □ME 3.4 Recognize loop formation and use loop reduction techniques appropriately
• □ME 3.4 Use position change and other techniques, as appropriate, to advance the endoscope safely
• □ME 3.4 Demonstrate appropriate pace and progress during insertion and withdrawal
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Assess the quality of the bowel preparation using standardized scales
• □ME 3.4 Identify and react to immediate complications of the procedure, if applicable

Collaborator

• □COL 1.2 Communicate effectively with nurses and assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●Crohn's
2. ●ulcerative colitis
3. ●upper GI malignancy
4. ●lower GI malignancy
5. ●peptic ulcer disease
6. ●Barrett's
7. ●celiac
8. ●polyps
9. ●portal hypertension (e.g., varices)
10. ●vascular lesion
11. ●other significant

Medical Expert

• □ME 3.4 Identify clinically significant findings of endoscopic procedures
• □ME 2.2 Interpret the clinical significance of findings of endoscopic procedures
• □ME 2.4 Integrate endoscopic findings to develop a provisional diagnosis and management plan
• □ME 3.1 Determine the most appropriate intervention for the purposes of ongoing assessment and/or management
• □ME 4.1 Propose and implement plans for ongoing care and/or follow-up on investigations
• □ME 4.1 Determine the need and timing for referral to another health care professional (for surgery or advanced endoscopic procedures)

Communicator

• □COM 3.1 Provide information related to the patient’s health status and care needs clearly and compassionately
• □COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●variceal hemostasis
2. ●non-variceal hemostasis
3. ●dilation
4. ●polypectomy
5. ●foreign body removal

Actively bleeding

1. ●yes
2. ●no

Size of polyp

1. ●<1 cm
2. ●1-2 cm
3. ●>2 cm
4. ●N/A

Medical Expert

• □Part A: ME 3.4 Prepare and position the patient for the procedure
• □Part A: ME 3.1 Determine a plan for sedation and monitoring appropriate to the patient’s condition and the clinical setting
• □Part A: ME 3.4 Assemble and optimize endoscope function
• □Part A: ME 3.4 Select and gather appropriate ancillary equipment
• □Part A: ME 3.4 Apply knowledge of anatomy, key landmarks and the endoscopic procedure
• □Part A: ME 3.4 Manipulate endoscope appropriately, achieving stabilization, orientation and direction
• □Part A: ME 3.4 Use appropriate strategies for endoscope advancement
• □Part A: ME 3.4 Preserve tissue vitality when handling tissue and instruments
• □Part A: ME 3.4 Demonstrate appropriate and safe use of ancillary equipment (e.g., electrocautery, endoscopic injection therapies, endoscopic clips, hemospray, APC, rubber band ligation, balloon tamponade tubes)
• □Part A: ME 3.4 Determine that the procedure is complete, e.g., hemostasis achieved
• □Part A: ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part A: ME 3.4 Identify and react to immediate complications of the procedure, if applicable

Communicator

• □Part B: COM 5.1 Complete clinical documentation in a timely manner
• □Part B: COM 5.1 Document the encounter to accurately convey the procedure and outcome
• □Part B: COM 5.1 Document the quality and findings of the endoscopic procedure, using instruments with strong validity evidence as appropriate
• □Part B: COM 5.1 Document all relevant findings

Professional

• □Part A: P 1.1 Work within personal limitations, asking for assistance as needed
• □Part A: P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Role of observer

1. ●supervisor
2. ●nurse
3. ●other health care professional
4. ●junior resident
5. ●student

Medical Expert

• □Part A: ME 1.4 Perform relevant and time-effective clinical assessments
• □Part A: ME 2.4 Establish patient-centred management plans
• □Part A: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □Part A: ME 4.1 Determine the need and timing for referral to another health care professional
• □Part A: ME 4.1 Coordinate care when multiple physicians and health care professionals are involved
• □Part B: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of junior attending

Communicator

• □Part A: COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner
• □Part B: COM 1.5 Manage disagreements and emotionally charged conversations with patients and/or families

Collaborator

• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 1.1 Respond appropriately to input from other health care professionals
• □Part B: COL 1.3 Communicate effectively with other health care professionals
• □Part B: COL 2.1 Show respect toward collaborators

Leader

• □Part A: L 2.1 Allocate health care resources for optimal patient care
• □Part B: L 4.2 Run the service efficiently, safely, and effectively

Health Advocate

• □Part A: HA 1.2 Work with patients and their families to increase opportunities to adopt healthy behaviours
• □Part B: HA 1.1 Facilitate timely patient access to services and resources

Scholar

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

Professional

• □Part B: P 1.1 Respond punctually to requests from patients or other health care providers
• □Part B: P 1.1 Demonstrate professional behaviours, such as punctuality, integrity and compassion

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 3.4 Anticipate and prepare for technical challenges and/or significant findings
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of , and the rationale for, a proposed procedure or therapy
• □ME 3.4 Perform endoscopic procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Identify clinically significant findings of endoscopic procedures
• □ME 3.1 Determine the most appropriate intervention for the purpose of ongoing assessment and/or management
• □ME 4.1 Propose and implement plans for ongoing care, follow-up on investigations, and further treatment or referral

Communicator

• □COM 5.1 Convey a written summative impression and management plan to the referring physician

Leader

• □L 4.2 Adhere to occupational safety procedures to ensure patient, personal and team safety
• □L 4.2 Demonstrate leadership skills in the endoscopy suite
• □L 4.1 Manage time effectively to maintain patient and endoscopy flow
• □L 4.2 Demonstrate appropriate use and care of endoscopic equipment

Professional

• □P 1.2 Prepare for the day, reviewing the list of planned procedures

Case description

Feedback provided

Next steps