General Internal 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

Medical Expert

• □ME 1.4 Recognize problems that may need the involvement of more experienced colleagues and seek their assistance
• □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 diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop and implement initial management plans for common problems in General Internal Medicine
• □ME 1.4 Organize the clinical information for oral presentation and written documentation
• □ME 2.4 Prescribe medications appropriately, including medication reconciliation
• □ME 2.4 Determine appropriate patient disposition, which may include admission, referral or follow-up

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 3.1 Provide clear, accurate information and explanations to the patient and/or family

Professional

• □P 1.1 Complete assigned responsibilities

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 Recognize problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Develop and implement focused treatment strategies
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 4.1 Determine the necessity and timing of referral to another physician
• □ME 4.1 Determine the need and timing of transfer to another level of care

Communicator

• □COM 3.1 Provide clear, accurate information and explanations to the patient and/or family

Collaborator

• □COL 3.2 Provide safe and effective handover during transitions in 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 2.1 Establish priorities for the clinical encounter, incorporating the patient’s perspectives, preferences and care needs
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Identify social determinants of health that may impact on the patient’s care
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.4 Develop and implement management plans, incorporating consideration of the impact of multimorbidity and/or complexity as relevant
• □ME 1.6 Provide evidence-informed, patient-centred care of one or more conditions in the presence of one or more other conditions
• □ME 2.4 Anticipate common complications of disorders and their treatment, and incorporate these considerations in the management plan
• □ME 4.1 Coordinate care around the patient’s needs, including care provided by other physicians, health care professionals and services

Communicator

• □COM 2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan

Leader

• □L 2.1 Apply knowledge of the resources available in the care setting when developing and implementing management plans
• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Case description

Feedback provided

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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 1.3 Apply clinical and biomedical sciences to manage common patient presentations in General Internal Medicine
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves
• □ME 2.2 Ascertain the patient’s clinical status and response to treatment
• □ME 2.4 Adapt management plans, as needed, in response to new findings or changing clinical circumstances
• □ME 2.2 Ascertain the setting of care appropriate for the patient’s ongoing health needs
• □ME 2.3 Work with the patient and their family to understand relevant options for care
• □ME 4.1 Develop and implement plans for transition and ongoing care taking into consideration the patient’s clinical state and preferences as well as available resources in health care setting or home
• □ME 4.1 Coordinate care around the patient’s needs, including the care provided by other physicians, health care professionals and services

Communicator

• □COM 3.1 Share information, and validate understanding of the patient and family, with regard to diagnosis, prognosis and/or management

Collaborator

• □COL 3.2 Anticipate issues or questions in the patient’s transition to a different health care setting, professional or stage in care
• □COL 3.2 Communicate with the receiving physician, summarizing patient issues at time of transfer and clarifying after transition as needed

Health Advocate

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

Case description

Feedback provided

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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 clinic

1. ●GIM
2. ●other

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select and sequence investigations based on the priority of patient needs and the resources available in the outpatient setting
• □ME 2.4 Develop and implement initial management plans for common problems in General Internal Medicine
• □ME 4.1 Plan follow-up on results of investigation and response to treatment
• □ME 4.1 Coordinate care around the patient’s needs, including the care provided by other physicians, health care professionals and services

Communicator

• □COM 5.1 Document consultations to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.2 Establish the scope of overlapping and shared care responsibilities with the referring physician

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □HA 1.2 Select patient education resources relevant to common General Internal Medicine conditions

Scholar

• □S 1.2 Identify, record, prioritize and answer learning needs that arise in daily work

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

Complexity

1. ●social
2. ●undifferentiated condition
3. ●multi-system

Stage of care

1. ●transition planning
2. ●ongoing management

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage complex patient presentations in General Internal Medicine
• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves
• □ME 2.2 Integrate new findings and changing clinical circumstances into the assessment of the patient’s clinical status
• □ME 2.2 Evaluate the applicability of conflicting data and/or recommendations
• □ME 1.6 Provide evidence informed, patient centred care of one condition in the presence of one or more other conditions
• □ME 1.6 Provide care for patients with undifferentiated presentations
• □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 co-morbidities
• □ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □ME 4.1 Determine the need and timing of transfer to another level of care
• □ME 4.1 Establish plans for transition and ongoing care, taking into consideration all of the patient’s health problems and needs as well as clinical state and preferences

Communicator

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

Collaborator

• □COL 3.2 Provide safe, efficient and patient-centred transitions between health care providers as well as between different health care professionals

Case description

Feedback provided

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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. ●undifferentiated
2. ●new diagnosis
3. ●chronic medical condition

Medical Expert

• □ME 2.1 Establish priorities for the clinical encounter, incorporating the patient’s perspectives, preferences and care needs
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Integrate and synthesize the clinical information
• □ME 2.4 Develop and implement management plans for any GIM presentation, incorporating consideration of the impact of multimorbidity and/or complexity as relevant
• □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 strategies and skills that engage the patient and family in shared decision-making

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan

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: medium
2. ●high

Medical Expert

• □Part A: ME 2.2 Elicit perioperative history emphasizing information needed to provide risk stratification and reduction
• □Part A: ME 2.2 Perform a focused evidence-informed physical examination
• □Part A: ME 2.2 Select and/or interpret investigations
• □Part A: ME 2.2 Integrate and synthesize the clinical information to assess clinical status, peri-operative risk and opportunities for risk mitigation
• □Part A: ME 2.3 Work with the patient and family to understand the patient’s health needs, values and preferences for their care
• □Part A: ME 2.4 Anticipate perioperative issues and complications, and incorporate these considerations in the management plan
• □Part A: ME 2.4 Develop and implement a plan for medical perioperative care, including risk stratification and modification
• □Part A: ME 2.4 Develop and implement a plan for optimization of current clinical status and treatment
• □Part B: ME 1.4 Adapt the clinical assessment to the expectations and boundaries of the consultant role
• □Part B: ME 2.2 Select investigation strategies for patients in the perioperative period
• □Part B: ME 2.2 Integrate and synthesize the clinical information
• □Part B: ME 2.4 Develop and implement management plans for acute medical illnesses in the postoperative period, including pre-existing conditions and/or acute complications
• □Part B: ME 2.4 Develop and implement monitoring strategies for anticipated adverse events, illnesses and/or complications
• □Part B: ME 1.6 Provide evidence informed, patient-centred care of one or more conditions in the presence of one of more conditions
• □Part B: ME 4.1 Coordinate treatment and follow-up for new medical diagnoses uncovered during risk stratification and/or postoperative course

Communicator

• □Part A: COM 4.3 Use communication strategies and skills that engage the patient and family in shared decision making
• □Part A: COM 5.1 Prepare consultation notes that document all relevant findings and provide clear recommendations
• □Part B: COM 5.1 Prepare consultation notes that document all relevant findings and provide clear recommendations

Collaborator

• □Part A: COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □Part B: COL 1.2 Establish a clear understanding with the referring physician regarding role and responsibility for ongoing care
• □Part B: COL 1.3 Provide support and advice for ongoing management when in the consultant role
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals

Scholar

• □Part A: S 3.3 Identify relevant literature and evaluate its integrity, reliability and applicability
• □Part A: 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

Setting

1. ●inpatient
2. ●outpatient

Timing

1. ●antepartum
2. ●postpartum

Presentations

1. ●acute dyspnea
2. ●asthma
3. ●acute respiratory failure
4. ●chest pain
5. ●acute heart failure
6. ●dysrhythmias
7. ●edema
8. ●headache
9. ●Type 1 diabetes
10. ●Type 2 diabetes
11. ●gestational diabetes
12. ●pre-existing hypertension
13. ●gestational hypertension
14. ●thromboembolic disease
15. ●thrombocytopenia
16. ●other

Medical Expert

• □Part A: ME 1.3 Apply knowledge of the impact of pregnancy on the stability and progression of common medical conditions
• □Part A: ME 1.4 Perform clinical assessments that address all relevant issues, adapting to the expectation and boundaries of the consultant role
• □Part A: ME 2.2 Select investigation strategies that are safe and efficacious for the pregnant patient
• □Part A: ME 2.2 Interpret clinical information and investigations in the context of the physiology of pregnancy
• □Part A: ME 2.4 Incorporate considerations of the safety and efficacy of medication use in pregnancy into the management plan
• □Part A: ME 2.4 Incorporate considerations of the safety and efficacy of therapeutic interventions in pregnancy into the management plan
• □Part A: ME 2.4 Develop and implement monitoring strategies for anticipated adverse events, illnesses and/or complications
• □Part A: ME 2.4 Develop a plan to deal with clinical uncertainty
• □Part A: ME 2.4 Develop and implement management plan for medical problems occurring during pregnancy
• □Part A: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □Part B: ME 2.2 Assess the patient’s health literacy

Communicator

• □Part A: COM 4.3 Use communication skills and strategies that help the patient make informed decisions
• □Part B: COM 1.1 Communicate using a patient-centred approached that facilitates patient trust and autonomy and is characterized by empathy, respect and compassion
• □Part B: COM 1.4 Use appropriate non-verbal behaviours to enhance communication with patients
• □Part B: COM 2.1 Gather information about the patient’s beliefs and values regarding her pregnancy
• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □Part B: COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □Part A: COL 1.3 Provide support and advice for ongoing management when in the consultant role
• □Part A: COL 1.3 Engage in respectful shared decision making with other health care professionals

Health Advocate

• □Part B: HA 1.1 Work with the patient to address determinants of health that affect her and her pregnancy

Scholar

• □Part A: S 3.1 Generate focused questions to address practice uncertainty and knowledge gaps
• □Part A: S 3.3 Identify relevant literature and evaluate its integrity, reliability and applicability

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

Underlying condition

1. ●hypertension
2. ●diabetes
3. ●venous thromboembolism
4. ●other

Medical Expert

• □Part A: ME 2.1 Identify women for whom pregnancy may pose a health risk
• □Part A: ME 1.3 Apply knowledge of the effects of GIM conditions on fertility, pregnancy, and fetal outcomes
• □Part A: ME 1.4 Perform clinical assessments that address all relevant issues
• □Part A: ME 2.2 Integrate and synthesize the clinical information
• □Part A: ME 2.2 Provide an assessment of peripartum maternal and fetal risk
• □Part A: ME 2.4 Select and/or adjust medications with consideration of safety of use in women of childbearing age
• □Part A: ME 2.4 Optimize management of pre-existing conditions to reduce fetal and maternal risk
• □Part A: ME 4.1 Coordinate treatment and follow-up across care settings and amongst other physicians, health care professionals and services
• □Part A: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □Part B: ME 2.2 Assess the patient’s health literacy

Communicator

• □Part A: COM 4.3 Use communication skills and strategies that help the patient make informed decisions
• □Part B: COM 1.1 Communicate using a patient-centred approached that facilitates patient trust and autonomy and is characterized by empathy, respect and compassion
• □Part B: COM 1.4 Use appropriate non-verbal behaviours to enhance communication with patients
• □Part B: COM 2.1 Gather information about the patient’s beliefs and values regarding her pregnancy
• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □Part B: COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □Part A: COL 1.3 Engage in respectful shared decision-making with other health care professionals

Health Advocate

• □Part B: HA 1.1 Work with the patient to address determinants of health that affect her and her pregnancy

Professional

• □Part A: P 1.3 Recognize and respond to ethical issues encountered in the clinical setting

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 2.2 Assess an individual’s access to health care, food, security and other social determinants of health
• □Part A: ME 2.2 Assess the patient’s health literacy
• □Part A: ME 2.4 Integrate primary and secondary prevention strategies as part of the overall management plan
• □Part A: ME 4.1 Establish plans for ongoing care
• □Part B: ME 2.4 Integrate primary and secondary prevention strategies as part of the overall management plan
• □Part B: ME 2.4 Prescribe strategies for risk reduction

Communicator

• □Part A: COM 4.3 Use communication skills and strategies that help the patient make informed decisions

Collaborator

• □Part A: COL 1.2 Make effective use of the scope and expertise of other health care professionals

Health Advocate

• □Part A: HA 1.1 Facilitate timely patient access to services and resources
• □Part A: HA 1.2 Work with the patient to increase their understanding of their illness and health care needs
• □Part A: HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours
• □Part A: HA 1.2 Counsel and support patients regarding risk factor reduction
• □Part B: HA 1.2 Counsel and support patients regarding risk factor reduction
• □Part B: HA 1.3 Implement strategies for disease prevention, health promotion and health surveillance

Professional

• □Part A: P 1.1 Demonstrate respect for patient autonomy

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 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Identify patients whose condition has progressed to end stage
• □ME 2.1 Identify patients for whom the patient perceived burden of disease modifying therapy or investigations is greater than the clinical benefit.
• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease modifying approach
• □ME 2.3 Address the impact of the medical condition on the patients’ ability to pursue life goals and purposes
• □ME 2.3 Establish goals of care in collaboration with the patient and family
• □ME 3.1 Select investigations and therapies appropriate to the patient’s goals of care
• □ME 2.4 Develop and implement management plans that optimize symptom management and support achievement of the patient’s goals of care

Communicator

• □COM 2.1 Gather information about the patient’s beliefs, values, preferences, context, and expectations with regards to their care
• □COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner
• □COM 4.3 Use communication skills and strategies that help the patient and family 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

Ventilation

1. ●none
2. ●invasive
3. ●non-invasive

Vasopressor support

1. ●yes
2. ●no

Transfer required

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.6 Adapt care as the complexity, uncertainty and ambiguity of the patient’s clinical situation evolves
• □Part A: ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □Part A: ME 2.1 Triage and stabilize patients who are critically ill
• □Part A: ME 2.2 Focus the assessment of a critically ill patient, performing it in a time-effective manner without excluding key elements
• □Part A: ME 2.2 Select and/or interpret investigations
• □Part A: ME 2.2 Integrate and synthesize the clinical information
• □Part A: ME 2.3 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued
• □Part A: ME 2.4 Manage hemodynamic support and monitoring
• □Part A: ME 2.4 Manage non-invasive and/or invasive ventilation
• □Part A: ME 2.4 Develop and implement management plans for critically ill patients, including providing or arranging for definitive care
• □Part A: ME 2.4 Develop a plan to deal with clinical uncertainty
• □Part A: ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □Part A: ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part A: ME 2.4 Determine the setting of care appropriate for the patient’s current heath care needs
• □Part A: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □Part B: ME 2.2 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □Part B: ME 2.4 Assess the need and timing of transfer to another level of care
• □Part B: ME 4.1 Determine the appropriate medical transport for safe patient transition to another health care setting
• □Part B: ME 2.4 Provide anticipatory guidance for management of changes in the patient’s clinical status during medical transport

Communicator

• □Part A: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner

Collaborator

• □Part A: COL 3.2 Organize the handover of care to the most appropriate physician or health care setting
• □Part B: COL 3.2 Summarize the patient’s issue for the receiving care provider, including plans to deal with ongoing issues as well as anticipated changes in the clinical course
• □Part B: COL 3.2 Communicate with the receiving physician(s) or health care professional(s) clarifying issues after transfer as needed
• □Part C: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part C: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part C: COL 1.3 Apply closed loop communication in urgent or crisis situations to work effectively with physicians and other colleagues in the health care professions

Leader

• □Part B: L 2.1 Apply knowledge of the resources available in various health care settings
• □Part C: L 4.2 Establish clear leadership in resuscitative efforts, assuming the leadership role as appropriate

Health Advocate

• □Part B: HA 1.1 Work with other health care professionals to address access to limited critical care, inpatient and/or diagnostic resources

Professional

• □Part C: P 4.1 Maintain capacity for professional clinical performance in stressful 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

Document

1. ●consultations
2. ●discharge summary
3. ●progress notes

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 including clear roles for referant and GIM consultant
• □COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □COL 1.2 Identify the roles of the referring physician and the GIM consultant in the ongoing management plan clearly
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 1.3 Provide teaching points to improve quality of 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

Scenario

1. ●patient/family
2. ●other health care professional(s)

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.4 Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
• □COM 4.3 Answer questions regarding care delivery, treatment decisions and/or prognosis in a respectful manner

Collaborator

• □COL 2.2 Listen to understand and find common ground
• □COL 2.2 Manage differences and resolve conflicts

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □Part A: ME 1.3 Apply knowledge of anatomy, physiology and pathophysiology to interpret diagnostic cardiopulmonary investigations
• □Part A: ME 1.3 Demonstrate knowledge of principles, strengths and limitations of diagnostic cardiopulmonary investigations
• □Part A: ME 1.3 Demonstrate knowledge of the technical components of diagnostic cardiopulmonary testing including equipment and protocols
• □Part A: ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □Part A: ME 3.4 Provide interpretation of Holter monitor testing
• □Part A: ME 3.4 Provide interpretation of ABPM testing
• □Part A: ME 3.4 Provide interpretation of pulmonary function testing
• □Part A: ME 3.4 Summarize findings of clinical relevance, and suggestions for further testing and/or management as appropriate
• □Part C: ME 2.2 Perform a focused clinical assessment without excluding key elements
• □Part C: ME 2.2 Assess a patient’s suitability to proceed with cardiac exercise stress testing
• □Part C: ME 3.1 Select the stress test protocol relevant to the clinical question and patient condition
• □Part C: ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for a proposed procedure
• □Part C: ME 3.4 Supervise the stress test procedure
• □Part C: ME 4.1 Recognize and manage immediate complications of a procedure

Communicator

• □Part A: COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □Part A: COM 5.1 Communicate critical results urgently, as needed
• □Part C: COM 5.1 Communicate critical results urgently, 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

Role of observer

1. ●supervisor
2. ●nurse
3. ●other health care professional

Medical Expert

• □Part A: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part B: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part B: ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □Part B: ME 2.1 Prioritize cases on the basis of clinical acuity
• □Part B: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □Part B: ME 2.4 Develop plans for patient care that anticipate clinical response and progress to other settings of care, including home
• □Part B: ME 4.1 Coordinate investigation, treatment and followup when multiple physicians and health care professionals are involved
• □Part B: ME 4.1 Develop and implement plans for discharge that include appropriate ongoing care, arrangements for relevant community support services and follow- up on investigations
• □Part B: ME 5.2 Use systems to track and follow-up on clinical data such as investigations and laboratory tests

Communicator

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

Collaborator

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

Leader

• □Part A: L 4.2 Run the service efficiently, safely, and effectively
• □Part B: L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □Part B: L 4.1 Manage time and prioritize tasks
• □Part B: L 2.1 Allocate health care resources for optimal patient care
• □Part B: L 2.2 Optimize practice patterns for cost-effectiveness and cost control

Health Advocate

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

Scholar

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

Professional

• □Part A: P 1.1 Respond punctually to requests from patients or other health care providers
• □Part A: P 1.1 Demonstrate professional behaviours, such as punctuality, integrity and compassion
• □Part A: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Triage referrals on the basis of clinical acuity and need for GIM expertise
• □ME 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands

Collaborator

• □COL 1.3 Contribute to quality patient care by sharing medical expertise
• □COL 1.3 Communicate effectively with the consulting service
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care when there are differences in opinion and/or recommendations

Leader

• □L 4.1 Manage time and prioritize tasks
• □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

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

• □Part A: ME 2.2 Assess the suitability of requests for GIM consultation
• □Part A: ME 2.1 Prioritize cases on the basis of clinical acuity
• □Part B: ME 2.4 Formulate management plans that are suitable for implementation in the outpatient setting
• □Part B: ME 4.1 Select appropriate timing of next visit based on planned investigations, clinical status and/or anticipated clinical course
• □Part B: ME 5.2 Use systems to track and follow-up on clinical data, such as studies and laboratory tests
• □Part C: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part C: ME 5.2 Use systems to track and follow-up on clinical data, such as studies and laboratory tests

Collaborator

• □Part A: COL 1.3 Communicate with the referring physician, as needed, to clarify the referral request
• □Part A: COL 3.2 Recognize patient safety issues, such as indications for emergent intervention, and communicate with referring physician as appropriate
• □Part B: COL 1.3 Address the questions and concerns of the referring/primary care physician when acting in the consultant role
• □Part B: COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician
• □Part B: COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □Part B: COL 3.1 Determine when care should be transferred back to the referring physician
• □Part C: COL 2.1 Treat staff members and other health professionals with respect

Leader

• □Part A: L 2.1 Allocate duration of clinic visits based on consideration of patient complexity and health care needs
• □Part A: L 4.2 Organize clinic schedules to make efficient use of overall resources
• □Part A: L 4.2 Optimize the timeliness of patient assessment and management by anticipating and sequencing needed investigations
• □Part B: L 4.1 Review and act on test results in a timely manner
• □Part C: L 4.1 Manage time effectively in the outpatient clinic
• □Part C: L 4.1 Review and act on test results in a timely manner

Scholar

• □Part B: 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 3.1 Demonstrate an understanding of the requirements for clinical documentation in the outpatient setting
• □Part C: P 1.1 Respond punctually to requests from patients or other health care providers
• □Part C: P 1.1 Demonstrate professional behaviors, 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

Type of teaching

1. ●bedside
2. ●didactic

Collaborator

• □Part C: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Scholar

• □Part A: S 2.4 Identify the learning needs and desired learning outcomes of others
• □Part A: S 2.4 Develop learning objectives for a teaching activity
• □Part A: S 2.4 Present information in an organized manner to facilitate understanding
• □Part A: S 2.4 Use audiovisual aids effectively, as appropriate
• □Part A: S 2.5 Provide coaching to guide improvement of performance
• □Part A: S 2.4 Provide adequate time for questions and/or discussion
• □Part B: S 2.5 Identify behaviors to continue as well as those for improvement
• □Part B: S 2.5 Provide specific suggestions for improvement of performance
• □Part B: S 2.5 Provide examples of learner performance to support the overall assessment
• □Part B: S 2.5 Provide narrative comments that support the overall assessment
• □Part C: S 2.2 Create a positive learning environment
• □Part C: S 2.3 Provide opportunities for appropriate clinical responsibility
• □Part C: S 2.3 Be available and accessible to junior learners
• □Part C: S 2.4 Provide clinical teaching and/or other informal learning activities
• □Part C: S 2.5 Provide feedback to enhance learning and performance
• □Part C: S 2.1 Be a positive role model

Professional

• □Part B: P 1.1 Complete learner assessments in a timely fashion
• □Part C: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

• □L 4.1 Organize work to manage clinical, scholarly and other responsibilities

Scholar

• □S 4.4 Identify, consult and collaborate with content experts and others in the conduct of scholarly work
• □S 4.4 Generate focused questions for scholarly investigation
• □S 3.3 Identify relevant literature and evaluate its integrity, reliability and applicability
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.2 Identify ethical principles in research
• □S 4.4 Collect data for a scholarly work
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.4 Identify areas for further investigation

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●outpatient

Condition

1. ●acute
2. ●chronic

Type of observation

1. ●direct observation
2. ●case review
3. ●review of consult note/other documents

Medical Expert

• □ME 2.1 Prioritize which issues need to be addressed
• □ME 2.2 Integrate and synthesize the clinical information
• □ME 2.2 Revise the differential diagnosis in response to new clinical information, or response to treatment
• □ME 2.4 Demonstrate flexibility in clinical reasoning in the setting of clinical uncertainty
• □ME 2.4 Establish a patient-centred management plan despite limited, non- diagnostic, or conflicting clinical data
• □ME 2.4 Develop a plan to deal with clinical uncertainty
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional

Communicator

• □COM 3.1 Convey information related to the uncertainty in diagnosis and/or treatment in a clear, timely and transparent manner
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 4.3 Use communication strategies and skills that engage the patient and family in shared decision making

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians

Professional

• □P 1.1 Identify limits in one’s own expertise

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 Adjust educational experiences to gain competencies necessary for future independent practice

Health Advocate

• □HA 2.3 Identify and respond to unmet health care needs within one’s practice

Scholar

• □S 1.2 Identify a specific area for improvement related to the needs of their intended community and/or career goals
• □S 1.1 Create and implement a learning plan
• □S 1.1 Develop a structured approach to monitor progress of learning, including identifying timelines and accountabilities
• □S 1.1 Develop clear outcomes to assess progress of 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

Setting

1. ●clinical
2. ●simulation

Procedure

1. ●airway management & endotracheal intubation
2. ●non-invasive ventilation
3. ●invasive ventilation
4. ●arterial line catheter insertion
5. ●central line placement
6. ●thoracentesis
7. ●paracentesis
8. ●lumbar puncture
9. ●joint arthrocentesis

Site

1. ●not applicable
2. ●femoral
3. ●internal jugular
4. ●subclavian
5. ●knee

Use of ultrasound guidance

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure
• □Part A: ME 3.4 Perform pre-procedural tasks in a timely, skillful, and safe manner • Establish and maintain a sterile field • Maintain universal precautions • Handle sharps safely • Hand-cleanse, gown and glove
• □Part A: ME 3.4 Perform procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care
• □Part A: ME 3.4 Recognize and manage immediate complications of a procedure

Communicator

• □Part A: COM 3.1 Communicate effectively with patient throughout the procedure
• □Part A: COM 5.1 Document the encounter to convey the procedure and outcome

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 Prioritize among patients on the basis of clinical presentation

Leader

• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □L 2.1 Allocate health care resources for optimal patient care
• □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

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 Demonstrate an awareness of the context of practice, including what is required to practice safely and effectively

Leader

• □L 4.2 Reconcile expectations for practice with job opportunities and workforce needs
• □L 4.2 Adjust educational experiences to gain competencies necessary for future independent practice

Health Advocate

• □HA 2.3 Identify and respond to unmet health care needs within one’s practice

Scholar

• □S 1.2 Identify opportunities for learning and improvement by reflecting on and assessing performance using various internal and external data sources
• □S 1.1 Identify learning needs to enhance competence across all CanMEDS roles
• □S 3.1 Generate focused questions to address practice uncertainty and knowledge gaps
• □S 1.1 Create and implement a learning plan

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence
• □P 4.2 Develop a strategy to manage personal and professional demands for a sustainable independent practice
• □P 3.1 Fulfil professional standards of practice by participating in programs that record continuing professional development (e.g. Royal College Maintenance of Certification Program)

Case description

Feedback provided

Next steps