General Pathology

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 assessment

1. ●direct
2. ●indirect

Organ system or tissue

1. ●breast
2. ●bone & soft tissue
3. ●gynecology
4. ●gastrointestinal
5. ●genitourinary
6. ●head & neck
7. ●endocrine
8. ●skin
9. ●cardiovascular
10. ●thoracic
11. ●neuropathology
12. ●blood, bone marrow, lymph nodes & spleen
13. ●placenta

Medical Expert

• □ME 3.4 Perform basic microscope maintenance
• □ME 1.3 Apply knowledge of microscope use including Kohler illumination, polarization, and use of oil objectives
• □ME 3.4 Use a light microscope to examine slides
• □ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues
• □ME 1.3 Apply knowledge of the principles of digital photography

Collaborator

• □COL 1.3 Discuss the roles and responsibilities of a general pathologist within the context of tumor board rounds

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 Identify basic principles of specimen adequacy
• □Part A: ME 3.3 Recognize and discuss the importance of the triaging and timing of specimen collection
• □Part A: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk

Collaborator

• □Part A: COL 1.2 Discuss trouble-shooting issues with colleagues in the pathology department including MLAs/MLTs
• □Part A: COL 1.2 Discuss the role and responsibilities of a specialist in General Pathology
• □Part A: COL 1.2 Describe the roles and scopes of practice of other health care providers related to General Pathology
• □Part A: COL 2.1 Respond to requests and feedback in a respectful and timely manner

Leader

• □Part A: L 1.1 Apply knowledge of the principles of quality assurance pertinent to laboratory medicine
• □Part A: L 1.4 Describe the data available from health information systems to optimize patient care

Professional

• □Part A: P 1.1 Complete assigned responsibilities
• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

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

Lab discipline

1. ●surgical pathology
2. ●cytopathology
3. ●autopsy pathology
4. ●hematopathology

Medical Expert

• □ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry
• □ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states
• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Interpret history and relevant investigations in light of the clinical question
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 2.3 Seek and integrate relevant information from other sources

Health Advocate

• □HA 1.1 Analyze a given patient’s needs for health services or resources related to the scope of General Pathology

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 Set priorities and manage time to integrate practice and personal life

Scholar

• □S 1.1 Create a learning plan in collaboration with a designated supervisor identifying learning needs related to General Pathology
• □S 1.1 Describe physicians’ obligations for lifelong learning and ongoing enhancement of competence
• □S 1.1 Use technology to develop, record, monitor, revise, and report on learning in medicine
• □S 1.1 Demonstrate a structured approach to monitoring progress of learning in the clinical setting
• □S 3.1 Recognize uncertainty and knowledge gaps in clinical and other professional encounters relevant to General Pathology

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 observation of history
2. ●direct observation of communication with patients
3. ●case discussion or chart review

Setting

1. ●medicine
2. ●surgery
3. ●oncology
4. ●pediatrics
5. ●other

Medical Expert

• □ME 1.1 Demonstrate compassion for patients
• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
• □ME 2.4 Identify and/or monitor key clinical features in the implementation of a management plan

Communicator

• □COM 2.1 Use patient-centred interviewing skills
• □COM 3.1 Convey information to the patient and/or family clearly and compassionately
• □COM 3.1 Verify and validate the patient’s and/or family’s understanding of their care
• □COM 4.1 Document the essential elements of a clinical encounter using a structured approach

Collaborator

• □COL 1.2 Work effectively as a member of the clinical team

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

• □Part A: ME 1.6 Seek assistance in situations that are complex or new
• □Part A: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 3.2 Describe the provincial and institutional rules governing consent for autopsy
• □Part A: ME 3.2 Identify the features of an appropriate autopsy consent
• □Part A: ME 4.1 Recognize when a case requires involvement of the medical examiner
• □Part A: ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
• □Part B: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part B: ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry
• □Part B: ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues
• □Part B: ME 1.3 Apply knowledge of the principles of embryologic development and common variations of normal development
• □Part B: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part B: ME 2.2 Perform a pathological examination that is focused and relevant
• □Part B: ME 3.4 Perform basic procedures in autopsy pathology
• □Part B: ME 1.6 Seek assistance in situations that are complex or new
• □Part B: ME 3.4 Photograph specimens

Collaborator

• □Part A: COL 1.3 Communicate with clinical staff regarding issues of consent and clinical questions that need to be addressed

Scholar

• □Part A: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □Part B: S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

Professional

• □Part A: P 3.1 Describe local regulations regarding the reporting of deaths to the medical examiner or coroner

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 5.2 Ensure safe practices in the laboratory including applying universal precautionary measures, using PPE, and maintaining an organized workstation
• □ME 1.3 Apply knowledge of normal anatomy and gross appearances of tissues
• □ME 1.3 Apply knowledge of the principles of tissue fixation, decalcification, processing, and the potential impact of improper handling of fresh tissues
• □ME 2.2 Gather a relevant clinical history
• □ME 3.4 Perform appropriate dissection, description, and sampling of surgical specimens for routine and ancillary procedures
• □ME 3.4 Photograph specimens
• □ME 3.4 Work efficiently, ensuring appropriate fixation in a timely manner
• □ME 3.4 Seek assistance as needed

Communicator

• □COM 4.1 Document using standardized grossing templates and/or descriptions and protocols as much as possible

Leader

• □L 4.1 Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

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

Organ system or tissue

1. ●breast
2. ●bone & soft tissue
3. ●gynecology
4. ●gastrointestinal
5. ●genitourinary
6. ●head & neck
7. ●endocrine
8. ●skin
9. ●lymph nodes
10. ●placenta

Medical Expert

• □ME 1.3 Apply knowledge of the principles of tissue fixation, decalcification, processing, and the potential impact of improper handling of fresh tissues
• □ME 1.3 Apply knowledge of routine histochemical staining
• □ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues
• □ME 1.3 Apply knowledge of the principles of and indications for immunohistochemistry and special histochemical stains
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Perform a pathological examination that is focused and relevant
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 3.4 Seek assistance as needed
• □ME 4.1 Ensure follow-up on results of ancillary tests, as relevant

Communicator

• □COM 4.1 Document microscopic assessment accurately
• □COM 4.1 Document information about patients and their pertinent medical history as it relates to the case
• □COM 4.1 Generate a clear, concise report that enhances patient management
• □COM 4.1 Identify and correct vague or ambiguous documentation
• □COM 4.1 Integrate information from ancillary studies and other sources into the pathology report if applicable
• □COM 4.1 Incorporate the data available from health information systems in the formation of a differential diagnosis and final report

Collaborator

• □COL 1.3 Provide timely and necessary written information to colleagues to enable effective relationship-centered care

Leader

• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Scholar

• □S 1.2 Identify, record, prioritize and address learning needs that arise in daily work, using various strategies (e.g., scanning the literature, or attending formal or informal education sessions)
• □S 3.1 Recognize uncertainty and knowledge gaps in clinical and other professional encounters relevant to General Pathology

Professional

• □P 1.1 Complete assigned responsibilities
• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Specimen type

1. ●tissue
2. ●blood
3. ●microbiological sample
4. ●other

Ancillary tests required or anticipated

1. ●immunohistochemistry
2. ●cytogenetics
3. ●molecular
4. ●in situ hybridization
5. ●immunofluorescence
6. ●flow cytometry
7. ●electron microscopy

Lymphoma protocol

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.6 Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation
• □ME 3.1 Recognize when a specimen might require ancillary studies
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given test
• □ME 2.2 Assess specimen adequacy for ancillary testing
• □ME 3.3 Prioritize routine and ancillary studies when specimen adequacy is limited
• □ME 3.4 Maintain the integrity required for the specific ancillary study (e.g., nucleic acid integrity for molecular testing, cell membrane for flow cytometry, viable cells for cytogenetics, etc.)

Collaborator

• □COL 1.3 Consult with clinical colleagues, when appropriate, to ascertain if ancillary studies would be of value
• □COL 1.1 Receive and appropriately respond to input from other health care professionals (e.g., pathology assistants, technologists)

Leader

• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

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

Pediatric/fetal/perinatal case

1. ●no
2. ●yes

Medical Expert

• □Part A: ME 3.2 Ensure autopsy consent has been obtained and documented correctly
• □Part A: ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry
• □Part A: ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □Part A: ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □Part A: ME 1.6 Seek assistance in situations that are complex or new
• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Perform a pathological examination that is focused and relevant
• □Part A: ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner
• □Part A: ME 3.4 Perform a complete autopsy, with appropriate full description and diagnosis at gross and microscopic levels
• □Part A: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part A: ME 2.2 Interpret the findings of autopsy in the context of the relevant clinical history
• □Part A: ME 3.4 Document procedures accurately
• □Part B: ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry
• □Part B: ME 1.6 Seek assistance in situations that are complex or new
• □Part B: ME 3.4 Perform organ evisceration
• □Part B: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part C: ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states
• □Part C: ME 1.3 Apply knowledge of normal gross, light microscopic, and ultrastructural appearance of tissues
• □Part C: ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □Part C: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part C: ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant
• □Part C: ME 3.4 Utilize other areas of laboratory medicine, including microbiology, for diagnostic purposes
• □Part C: ME 2.2 Interpret the findings of autopsy in the context of the relevant clinical history
• □Part C: ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion

Communicator

• □Part A: COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations
• □Part B: COM 3.2 Convey and document issues arising from a breach in quality or safety of laboratory practice
• □Part C: COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations
• □Part C: COM 4.1 Integrate information from ancillary studies and other sources into the pathology report

Collaborator

• □Part A: COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance
• □Part B: COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance
• □Part C: COL 1.2 Consult as needed with other health care professionals, including other physicians

Leader

• □Part B: L 1.2 Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations

Scholar

• □Part B: S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance
• □Part C: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

Professional

• □Part C: P 3.1 Fulfil the requirements of the physician’s duty to report
• □Part C: P 3.3 Prepare an autopsy for presentation at M&M rounds or departmental autopsy rounds

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

Manner of death

1. ●natural
2. ●accidental
3. ●suicide
4. ●undetermined

Special dissections performed

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 3.2 Ensure autopsy consent has been obtained and documented correctly
• □Part A: ME 2.2 Perform a pathological examination that is focused and relevant
• □Part A: ME 2.2 Recognize common forensic artifacts
• □Part A: ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner
• □Part A: ME 3.4 Perform a complete forensic autopsy, including toxicological examination and the submission of specimens to the forensic sciences laboratory
• □Part A: ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □Part A: ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □Part A: ME 1.6 Seek assistance in situations that are complex or new
• □Part A: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part A: ME 2.2 Interpret the findings of autopsy in the context of the relevant clinical history
• □Part B: ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □Part B: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part B: ME 2.2 Interpret the findings of autopsy in the context of the relevant clinical history

Communicator

• □Part B: COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations
• □Part B: COM 4.1 Integrate information from ancillary studies and other sources into the pathology report

Collaborator

• □Part A: COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance

Scholar

• □Part A: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □Part B: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

Professional

• □Part A: P 3.1 Demonstrate understanding of the laws and policies relevant to conducting forensic investigations
• □Part A: P 3.1 Adhere to requirements related to reportable diseases
• □Part A: P 3.1 Describe local regulations regarding the reporting of deaths to the medical examiner or coroner
• □Part B: P 2.1 Demonstrate a commitment to the promotion of the public good in health care, including stewardship of resources
• □Part B: P 3.1 Demonstrate understanding of the laws and policies relevant to conducting forensic investigations
• □Part B: P 3.1 Adhere to requirements related to reportable diseases

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

Organ system or tissue

1. ●breast
2. ●bone & soft tissue
3. ●cardiovascular
4. ●endocrine
5. ●gynecology
6. ●gastrointestinal
7. ●genitourinary
8. ●head & neck
9. ●lymph nodes or spleen
10. ●respiratory
11. ●skin

Medical Expert

• □Part A: ME 1.3 Apply knowledge of normal gross examination
• □Part A: ME 2.2 Perform a pathological examination that is focused and relevant
• □Part A: ME 2.2 Review clinical history, imaging and other relevant data as necessary
• □Part A: ME 3.4 Perform gross dissection, description, and sampling of surgical specimens, applying meticulous attention to block selection and mapping using diagrams and images and demonstrating awareness of downstream synoptic reporting and staging parameters, and the need to save tissue for research, tissue bank, and other indications, as necessary
• □Part A: ME 5.2 Organize workstation to ensure safe practices in the laboratory
• □Part A: ME 5.2 Adhere to universal precautions to minimize hazardous exposures including potential infectious and chemical agents
• □Part A: ME 5.2 Use personal protective measures, including gowns, goggles, and slash resistant gloves
• □Part A: ME 3.4 Work efficiently, ensuring appropriate fixation in a timely manner
• □Part A: ME 3.4 Seek assistance as needed
• □Part A: ME 3.4 Take high quality photographs of specimens
• □Part A: ME 2.2 Formulate a differential diagnosis based on the pathological examination
• □Part B: ME 1.3 Apply knowledge of normal gross examination
• □Part B: ME 2.2 Perform a pathological examination that is focused and relevant
• □Part B: ME 2.2 Review clinical history, imaging and other relevant data as necessary
• □Part B: ME 3.4 Perform gross dissection, description, and sampling of surgical specimens, applying meticulous attention to block selection and mapping using diagrams and images and demonstrating awareness of downstream synoptic reporting and staging parameters, and the need to save tissue for research, tissue bank, and other indications as necessary
• □Part B: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part B: ME 3.4 Seek assistance as needed
• □Part B: ME 3.4 Take high quality photographs of specimens
• □Part B: ME 2.2 Formulate a differential diagnosis based on the pathological examination

Communicator

• □Part A: COM 4.1 Communicate findings in a timely fashion, with appropriate documentation
• □Part B: COM 4.1 Communicate findings in a timely fashion, with appropriate documentation

Collaborator

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

Leader

• □Part A: L 1.1 Participate in quality management, including appropriate use of standardized grossing templates and protocols, and use of judgment when submitting blocks regarding quality and quantity of sections
• □Part B: L 1.1 Participate in quality management by minimizing cross contamination and using standardized grossing templates and protocols as appropriate

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant
• □ME 1.6 Seek assistance in situations that are complex or new
• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Formulate a differential diagnosis based on the pathological examination
• □ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner
• □ME 3.4 Use digital microscopy and interpret gross and microscopic digital images, including digitized and scanned slides
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion
• □ME 1.4 Complete pathology reports within appropriate turnaround times

Communicator

• □COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for surgical pathology
• □COM 4.1 Integrate information from ancillary studies and other sources into the pathology report
• □COM 4.1 Use synoptic and other standardized reporting formats as appropriate

Collaborator

• □COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

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 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant
• □ME 1.6 Seek assistance in situations that are complex or new
• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Formulate a differential diagnosis based on the pathological examination
• □ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner
• □ME 3.4 Use digital microscopy and interpret gross and microscopic digital images, including digitized and scanned slides
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion
• □ME 1.4 Complete pathology reports within appropriate turnaround times

Communicator

• □COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for surgical pathology
• □COM 4.1 Integrate information from ancillary studies and other sources into the pathology report
• □COM 4.1 Use synoptic and other standardized reporting formats as appropriate

Collaborator

• □COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

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 1.3 Apply knowledge of indications, contraindications and limitations of frozen sections
• □ME 2.2 Gather a relevant clinical history
• □ME 1.3 Apply knowledge about most appropriate method of intraoperative assessment (gross examination only vs frozen sections vs cytologic examination)
• □ME 2.2 Assess specimen adequacy in surgical and cytology specimens
• □ME 3.4 Select representative tissue from larger specimens for intraoperative consultation and embed appropriately
• □ME 3.4 Prepare frozen sections, including imprint cytology specimens when relevant, and review for diagnosis
• □ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □ME 1.3 Apply knowledge of the appearance of normal cells in cytologic preparations
• □ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states
• □ME 1.3 Apply knowledge of cytological appearance of cells in disease states
• □ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □ME 2.2 Formulate a differential diagnosis based on the pathological examination
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 3.4 Establish and implement a plan for post-procedure handling of tissue

Collaborator

• □COL 1.2 Discuss indications for appropriate use of intra-operative and urgent consultations
• □COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance
• □COL 1.2 Interact effectively with surgeons during intraoperative consultations
• □COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management
• □COL 1.3 Convey diagnostic uncertainty and discuss deferral of diagnosis when 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 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 1.4 Synthesize cases for discussion at multidisciplinary rounds
• □ME 2.3 Provide diagnostic and prognostic information to help clinicians establish goals of care
• □ME 2.2 Select and interpret appropriate investigations based on a differential diagnosis
• □ME 2.4 Guide therapy decisions with a complete and accurate pathology report

Collaborator

• □COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
• □COL 1.3 Contribute effectively at multidisciplinary rounds, presenting and discussing pathology findings

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issue as part of patient care

Scholar

• □S 3.3 Critically evaluate the literature
• □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

Microorganism

1. ●bacteriology
2. ●virology
3. ●parasitology
4. ●mycology
5. ●serology

Specimen type

1. ●blood
2. ●CSF
3. ●urine
4. ●other body fluids
5. ●stool
6. ●genital
7. ●respiratory
8. ●wound/skin swab
9. ●surgical/tissue specimen

Type of activity

1. ●specimen workup
2. ●antimicrobial sensitivity
3. ●performance of gram stain
4. ●performance of other procedure
5. ●test interpretation
6. ●quality control/assurance

Medical Expert

• □Part A: ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □Part A: ME 1.3 Apply knowledge of the microscopic appearance and culture characteristics of bacterial organisms, and the use of diagnostic and antimicrobial susceptibility testing
• □Part A: ME 1.3 Apply knowledge of common viral, fungal, and parasitic organisms and the use of serologic and culture investigations for diagnosis
• □Part A: ME 2.2 Perform morphologic assessment of microorganisms
• □Part A: ME 2.2 Analyze microbiologic data and correlate to clinical information
• □Part A: ME 2.4 Identify microorganisms, and report antimicrobial susceptibility
• □Part A: ME 4.1 Determine the need to send out a specimen for further testing
• □Part A: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part A: ME 5.1 Adhere to standard operating procedures (SOP)
• □Part A: ME 5.1 Take appropriate actions to address a breach in quality or safety
• □Part B: ME 2.2 Gather and synthesize patient information to establish the clinical question
• □Part B: ME 2.2 Develop a differential diagnosis
• □Part B: ME 2.2 Analyze microbiologic data and correlate to clinical information
• □Part B: ME 2.4 Provide advice regarding appropriate use of diagnostic testing
• □Part B: ME 2.4 Provide an interpretation of the clinical significance of test results

Communicator

• □Part A: COM 4.1 Convey critical values or unexpected results in a timely manner

Collaborator

• □Part B: COL 1.1 Establish positive relationships with other members of the health care team
• □Part B: COL 1.3 Provide advice to clinical colleagues regarding specimen procurement and handling
• □Part B: COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
• □Part B: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Health Advocate

• □Part B: HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Professional

• □Part A: P 3.1 Adhere to regulations regarding mandatory reporting of communicable disease
• □Part B: P 3.1 Adhere to regulations regarding mandatory reporting of communicable disease

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 a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □Part A: ME 2.2 Select and/or interpret investigations
• □Part A: ME 2.2 Perform morphologic assessment of peripheral blood smears
• □Part A: ME 2.2 Formulate a differential diagnosis based on the morphologic assessment
• □Part A: ME 1.3 Demonstrate an approach to the diagnosis of anemia
• □Part A: ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □Part A: ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □Part A: ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion
• □Part B: ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □Part B: ME 2.2 Perform morphological assessment of bone marrow specimens, including differential cell counts
• □Part B: ME 2.2 Formulate a differential diagnosis based on the morphological assessment
• □Part B: ME 1.3 Demonstrate an approach to the diagnosis of anemia
• □Part B: ME 2.2 Assess specimen adequacy for ancillary testing
• □Part B: ME 2.2 Select ancillary studies based on an appreciation of the diagnostic possibilities, the clinical context, and the relevance and capabilities of available technologies
• □Part B: ME 2.2 Interpret the results of flow cytometry
• □Part B: ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □Part B: ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion
• □Part B: ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □Part C: ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □Part C: ME 2.2 Perform morphologic assessment of lymph node and lymphoid associated tissue
• □Part C: ME 2.2 Formulate a differential diagnosis based on the morphologic assessment
• □Part C: ME 2.2 Assess specimen adequacy for ancillary testing
• □Part C: ME 2.2 Select ancillary studies based on an appreciation of the diagnostic possibilities, the clinical context, and the relevance and capabilities of available technologies
• □Part C: ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □Part C: ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □Part C: ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion

Communicator

• □Part A: COM 4.1 Formulate comprehensive and clinically meaningful reports
• □Part B: COM 4.1 Formulate comprehensive and clinically meaningful reports
• □Part C: COM 4.1 Formulate comprehensive and clinically meaningful reports
• □Part C: COM 4.1 Integrate information from ancillary studies and other sources into the pathology report

Collaborator

• □Part A: COL 3.1 Determine when a case should be transferred to another pathologist with differing expertise
• □Part A: COL 1.3 Convey information from the diagnostic assessment in a manner that enhances patient care
• □Part B: COL 1.3 Convey information from the diagnostic assessment in a manner that enhances patient care
• □Part C: COL 1.3 Convey information from the diagnostic assessment in a manner that enhances patient care

Leader

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

Professional

• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives
• □Part B: P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives
• □Part C: P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives

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

Category

1. ●normal
2. ●hemoglobinopathy
3. ●enzymopathy
4. ●membranopathy

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 1.3 Apply knowledge of the principles of test methodology and instrumentation in a hematology laboratory
• □ME 2.2 Select and interpret investigations based on a differential diagnosis
• □ME 2.2 Select ancillary studies based on an appreciation of the diagnostic possibilities, the clinical context, and the relevance and capabilities of available technologies
• □ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion

Communicator

• □COM 4.1 Formulate comprehensive and clinically meaningful reports

Collaborator

• □COL 1.3 Convey information from the diagnostic assessment in a manner that enhances patient care

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives

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. ●bleeding
2. ●thrombosis
3. ●drug monitoring
4. ●asymptomatic
5. ●abnormal lab value

Category

1. ●platelet disorder
2. ●factor disorder
3. ●vascular disorder
4. ●multifactorial

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 1.3 Demonstrate an approach to the diagnosis of bleeding and thrombotic disorders
• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 1.3 Apply knowledge of the principles of test methodology and instrumentation in a hematology laboratory
• □ME 2.2 Select and interpret investigations based on a differential diagnosis
• □ME 2.2 Select ancillary studies based on an appreciation of the diagnostic possibilities, the clinical context, and the relevance and capabilities of available technologies
• □ME 3.3 Triage investigations, taking into account clinical urgency and available resources
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion

Communicator

• □COM 4.1 Formulate comprehensive and clinically meaningful reports
• □COM 4.1 Convey critical values or unexpected results in a timely manner

Collaborator

• □COL 1.3 Convey information from the diagnostic assessment in a manner that enhances patient care

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives

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

Inventory

1. ●blood component
2. ●blood product

Category

1. ●clinical
2. ●laboratory
3. ●collection
4. ●storage
5. ●modification
6. ●distribution
7. ●utilization/stewardship

Medical Expert

• □Part A: ME 1.3 Apply knowledge of immunohematology, including major blood group systems and the role of the human leukocyte antigen (HLA) system
• □Part A: ME 1.3 Apply knowledge of common problems of blood-banking, including incompatible cross match, auto- and alloimmune antibodies and their differentiation, and neonatal blood banking issues
• □Part A: ME 1.3 Apply knowledge of standards as they apply to the testing and release of blood products
• □Part A: ME 1.3 Apply knowledge of current Canadian Blood Services (CBS) policies, procedures, and products, including autologous and directed donations
• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.4 Review and supervise bench level tests, including manual, semi-automated, and automated tests
• □Part A: ME 2.2 Select and/or interpret investigations
• □Part A: ME 2.4 Assess transfusion orders in relation to appropriateness, risks, and alternatives to transfusion
• □Part A: ME 2.4 Modify and/or release blood components and products for clinical use
• □Part B: ME 2.2 Gather and synthesize patient information to establish the clinical question
• □Part B: ME 2.2 Select and interpret investigations based on a differential diagnosis
• □Part B: ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □Part B: ME 1.3 Apply knowledge of the therapeutic use of blood components
• □Part B: ME 2.4 Assess transfusion orders in relation to appropriateness, risks, and alternatives to transfusion
• □Part C: ME 1.3 Apply knowledge of the principles of investigation and classification of adverse reactions to blood component therapy
• □Part C: ME 2.2 Gather a relevant clinical history
• □Part C: ME 2.2 Perform a product review
• □Part C: ME 2.2 Select and/or interpret investigations
• □Part C: ME 2.2 Determine the classification of the adverse reaction to blood component therapy
• □Part C: ME 2.4 Establish the probable cause of the adverse reaction to blood component therapy
• □Part C: ME 5.1 Report the adverse reaction, completing the relevant documentation

Communicator

• □Part C: COM 2.3 Seek and synthesize relevant information from other sources, including the physician(s) involved

Collaborator

• □Part A: COL 1.3 Work effectively with clinical colleagues to assist in the interpretation of laboratory findings in the clinical context
• □Part B: COL 1.3 Work effectively with clinical colleagues to assist in the interpretation of laboratory findings in the clinical context
• □Part B: COL 1.1 Establish positive relationships with other members of the health care team
• □Part B: COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate

Leader

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

Health Advocate

• □Part B: HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Professional

• □Part C: P 3.1 Adhere to regulations governing the safety and surveillance of the blood supply system

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

Activity

1. ●test selection
2. ●result interpretation

Specimen type

1. ●formalin fixed paraffin embedded (FFPE) tissue
2. ●fresh/frozen tissue
3. ●blood/bone marrow
4. ●other

Test type/methodology

1. ●Polymerase Chain Reaction (PCR)
2. ●next generation sequencing (NGS)
3. ●karyotype
4. ●fluorescence in situ hybridization (FISH) /chromogenic in situ hybridization (CISH)
5. ●ploidy

Case

1. ●hematology
2. ●microbiology
3. ●biochemistry
4. ●surgical pathology
5. ●other

Medical Expert

• □ME 1.3 Apply knowledge of the principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states
• □ME 1.3 Apply knowledge of general concepts related to the human genome, human genes, and inheritance of DNA
• □ME 1.3 Apply knowledge of general concepts of inherited and somatic disease
• □ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □ME 1.3 Apply knowledge of appropriate sample requirements and handling
• □ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □ME 2.2 Select additional testing based on an appreciation of the diagnostic possibilities, the clinical context, and the relevance and capabilities of available technologies
• □ME 4.1 Coordinate the use of multiple diagnostic investigations so as to ensure complementarity and efficiency
• □ME 3.3 Prioritize routine and ancillary investigations when specimen adequacy is limited
• □ME 5.1 Recognize sources of analytical error for various molecular tests
• □ME 2.2 Interpret molecular diagnostic test results together with available clinical and laboratory data

Communicator

• □COM 4.1 Integrate molecular results into the laboratory report

Leader

• □L 2.1 Utilize genetic testing resources effectively to balance costs with potential utility of results

Health Advocate

• □HA 1.2 Describe the role of molecular methods used to screen for inherited/familial cancer syndromes

Professional

• □P 1.3 Describe the role and demonstrate an understanding of the ethics of genetic screening in family planning and for hereditary cancers
• □P 3.1 Ensure compliance with privacy regulations as they apply to the use of genetic information
• □P 3.1 Recognize the medicolegal implications in the practice of genetics

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

Specimen type

1. ●gynecological
2. ●FNA
3. ●fluid (pleural, peritoneal, urine, CSF etc.)
4. ●endoscopic ultrasound (EUS)
5. ●endobronchial ultrasound (EBUS)

Medical Expert

• □Part A: ME 2.1 Determine if cytology specimens and requisitions meet adequacy criteria
• □Part A: ME 2.1 Describe reasons for specimen rejection and the process of rejection documentation
• □Part A: ME 5.1 Resolve issues related to specimen misidentification
• □Part A: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical handling of a cytopathology case
• □Part A: ME 2.2 Assess specimen adequacy in surgical and cytology specimens
• □Part A: ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □Part A: ME 3.4 Prepare gynecological and non-gynecological cytology specimens, including staining, cover-slipping, triaging, and storage
• □Part A: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk
• □Part B: ME 1.3 Apply knowledge of the appearance of normal cells in cytologic preparations
• □Part B: ME 1.3 Apply knowledge of cytological appearance of cells in disease states
• □Part B: ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques
• □Part B: ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
• □Part B: ME 2.2 Assess specimen adequacy in surgical and cytology specimens
• □Part B: ME 2.2 Describe common pitfalls in diagnosis of cytopathological specimens
• □Part B: ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □Part B: ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion

Communicator

• □Part B: COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for cytopathology consultations
• □Part B: COM 4.1 Use standardized terminology for reporting results, as relevant
• □Part B: COM 4.1 Provide educational notes and recommendations when needed in the report
• □Part B: COM 4.1 Convey critical values or unexpected results in a timely manner

Collaborator

• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Leader

• □Part A: L 2.1 Use clinical judgment to minimize wasteful practices
• □Part A: L 1.1 Participate in quality control, quality assurance, and quality improvement initiatives

Scholar

• □Part B: 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

Lab discipline

1. ●anatomical pathology
2. ●hematopathology
3. ●medical microbiology
4. ●medical biochemistry

Trigger for review

1. ●routine monitoring
2. ●error
3. ●complaint
4. ●other

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology

Communicator

• □COM 4.1 Convey critical values or unexpected results in a timely manner
• □COM 3.2 Convey and document issues arising from a breach in quality or safety of laboratory practices

Leader

• □L 1.4 Apply knowledge of the metrics and measurement systems used to track quality management and safety activities
• □L 1.1 Review quality control data
• □L 1.1 Identify when a finding or occurrence requires action to ensure quality of laboratory services
• □L 1.4 Identify variation/gaps between actual and targeted performance using thresholds
• □L 1.1 Apply knowledge of process improvement methodologies
• □L 1.1 Formulate and carry out a plan of action
• □L 1.1 Reassess the results in the context of quality improvement
• □L 2.1 Use clinical judgment to minimize wasteful practices

Scholar

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

Professional

• □P 3.1 Adhere to the relevant codes, policies, standards, and laws governing laboratory practice including accreditation standards, standard operating procedures, and Clinical and Laboratory Standards Institute (CLSI) standards
• □P 3.3 Participate in intra- and extra-departmental reviews of diagnostic pathology material

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

Aspect

1. ●clinical utility
2. ●analytical (total allowable error/precision/reference range, etc.)
3. ●financial
4. ●setting up QC
5. ●investigating proficiency testing options
6. ●other

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 1.3 Apply knowledge of method comparison, method validation, and instrument selection

Collaborator

• □COL 1.3 Work effectively with individuals responsible for laboratory management and/or hospital administration

Leader

• □L 1.4 Map the flow of information in the delivery of laboratory services to identify opportunities to improve or enhance laboratory practice
• □L 2.2 Determine cost discrepancies between best practice and current practice
• □L 2.1 Demonstrate knowledge of resource-efficient laboratory equipment selection
• □L 3.1 Provide recommendations regarding equipment selection and purchasing
• □L 3.1 Evaluate emerging technologies with a view to the possibility of integration in the laboratory

Health Advocate

• □HA 2.2 Evaluate laboratory practices and test selection to ensure they meet community needs
• □HA 2.3 Recognize and respond to situations where health advocacy and application of health care resources is required, including the introduction of improved instrumentation and methodologies to augment community health care

Scholar

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

Professional

• □P 3.1 Adhere to the relevant codes, policies, standards, and laws governing laboratory practice including accreditation standards, standard operating procedures, and Clinical and Laboratory Standards Institute (CLSI) standards

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

Category

1. ●clinical consult
2. ●laboratory initiated

Lab discipline

1. ●anatomical pathology
2. ●hematopathology
3. ●medical microbiology
4. ●medical biochemistry

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 3.1 Integrate all sources of information to develop an investigational plan that is safe, patient-centred, cost effective, and considers the risks and benefits of all approaches
• □ME 3.3 Advocate for evidence informed use of investigations with consideration of urgency and available resources

Collaborator

• □COL 1.3 Provide consultative services to clinical colleagues regarding appropriate investigations

Leader

• □L 2.1 Apply practice-based and system-based rules for resource allocation
• □L 2.1 Use clinical judgment to minimize wasteful practices
• □L 2.2 Optimize practice patterns for cost-effectiveness and cost control

Health Advocate

• □HA 1.1 Respond to the health needs of individual patients

Professional

• □P 2.1 Demonstrate a commitment to the promotion of the public good in health care, including stewardship of 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

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences relevant to General Pathology
• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 2.4 Provide advice regarding appropriate use of diagnostic testing
• □ME 1.3 Apply knowledge of the availability of testing in community or regional hospital laboratories
• □ME 2.4 Provide an interpretation of the clinical significance of test results

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Provide advice to clinical colleagues regarding specimen procurement and handling
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of 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

Specimen type

1. ●serum protein electrophoresis
2. ●urine protein electrophoresis
3. ●joint crystal
4. ●urine crystal
5. ●therapeutic drug monitoring
6. ●clinical toxicology
7. ●other

Medical Expert

• □ME 2.2 Interpret protein electrophoresis and immunofixation studies
• □ME 2.2 Interpret therapeutic drug monitoring or clinical toxicology studies
• □ME 2.2 Perform morphologic assessment of urine and body fluids
• □ME 2.2 Establish a diagnosis that takes into account clinical correlations
• □ME 5.2 Adhere to quality management processes throughout the pre-analytic, analytic, and post-analytic phases
• □ME 1.3 Apply knowledge of reflexive/reflective testing and test pathways

Communicator

• □COM 4.1 Convey critical values or unexpected results in a timely manner

Collaborator

• □COL 1.3 Work effectively with clinical colleagues to assist in the interpretation of laboratory findings in the clinical context

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

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 3.3 Critically evaluate the literature
• □Part A: S 3.4 Integrate best evidence and clinical expertise
• □Part A: S 2.4 Present the information in an organized manner
• □Part A: S 2.4 Use audiovisual aids effectively
• □Part A: S 2.4 Provide adequate time for questions and discussion
• □Part B: S 2.1 Use strategies for deliberate, positive role-modelling
• □Part B: S 2.2 Create a positive learning environment
• □Part B: S 2.4 Identify the learning needs and desired learning outcomes of others
• □Part B: S 2.3 Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed
• □Part B: S 2.4 Present the information in an organized manner
• □Part B: S 2.4 Provide adequate time for questions and discussion
• □Part B: S 2.4 Provide useful, timely, constructive feedback

Professional

• □Part B: 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 Critically evaluate the literature
• □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 project
• □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

Procedure

1. ●bone marrow
2. ●Fine Needle Aspirate (FNA)

Specimen type

1. ●surgical
2. ●cytology
3. ●hematopathology
4. ●microbiology
5. ●general

Simulation

1. ●yes
2. ●no

Medical Expert

• □ME 3.1 Determine the safety and appropriateness of the procedure
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Demonstrate effective procedure preparation, including patient identification or safety checklist as appropriate
• □ME 3.4 Set up and position the patient for the procedure
• □ME 3.4 Prepare and cleanse the procedural site
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Perform procedures in a skilful and safe manner
• □ME 3.4 Seek assistance as needed
• □ME 3.4 Document procedures accurately, including adequacy of specimen obtained and the presence/absence of complications
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

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

Lab discipline

1. ●surgical pathology
2. ●cytopathology
3. ●autopsy pathology
4. ●biochemistry
5. ●microbiology
6. ●hematopathology
7. ●transfusion medicine
8. ●hemostasis and coagulation
9. ●molecular pathology

Medical Expert

• □Part A: ME 1.1 Demonstrate a commitment to high-quality care
• □Part A: ME 1.5 Set priorities, triage, and manage the workload within accepted turnaround times
• □Part A: ME 1.5 Carry out professional duties in the face of multiple competing demands
• □Part A: ME 5.1 Resolve issues related to a breach in quality or safety of laboratory practices
• □Part A: ME 1.4 Perform timely, accurate diagnostic assessments
• □Part A: ME 1.6 Demonstrate insight into their own limits of expertise and seek consultation as necessary
• □Part B: ME 1.1 Demonstrate a commitment to high-quality care
• □Part B: ME 5.2 Adhere to quality management processes throughout the pre-analytic, analytic, and post-analytic phase
• □Part B: ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk

Communicator

• □Part A: COM 4.1 Formulate comprehensive and clinically meaningful reports

Collaborator

• □Part A: COL 1.2 Work effectively with other health professionals
• □Part B: COL 1.2 Recognize and respect the scope of practice and expertise of other health professionals in the laboratory
• □Part B: COL 1.3 Communicate effectively with other health care professionals

Leader

• □Part A: L 4.2 Describe the principles of workload measurement within the laboratory
• □Part A: L 2.1 Allocate health care resources for optimal patient care
• □Part A: L 3.1 Supervise and provide clinical direction of the laboratory
• □Part B: L 3.1 Provide guidance and support for questions arising in the laboratory

Scholar

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

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours
• □Part A: P 4.3 Provide mentorship to residents and colleagues
• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives
• □Part B: P 1.1 Exhibit appropriate professional 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

Lab discipline

1. ●anatomical pathology
2. ●biochemistry
3. ●microbiology
4. ●hematopathology

Medical Expert

• □Part A: ME 2.2 Gather and synthesize patient information to establish the clinical question
• □Part A: ME 1.6 Demonstrate insight into their own limits of expertise and seek consultation as necessary

Collaborator

• □Part A: COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
• □Part B: COL 2.1 Respond to requests and feedback in a respectful and timely manner
• □Part B: COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
• □Part B: COL 1.3 Communicate effectively with other health care professionals

Leader

• □Part A: L 3.1 Provide guidance and support for questions arising in the laboratory
• □Part A: L 2.1 Use clinical judgment to allocate resources, such as investigations, blood products or staffing
• □Part B: L 3.1 Provide guidance and support for questions arising in the laboratory

Health Advocate

• □Part A: HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Scholar

• □Part A: S 3.4 Integrate best evidence and clinical expertise into decision-making
• □Part C: S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing personal performance using various internal and external data sources
• □Part C: S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours
• □Part B: P 1.1 Exhibit appropriate professional 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

Lab discipline

1. ●anatomical pathology
2. ●biochemistry
3. ●microbiology
4. ●hematopathology

Medical Expert

• □ME 1.3 Apply knowledge of the principles of quality assurance pertinent to General Pathology

Collaborator

• □COL 1.2 Work effectively with other health care professionals

Leader

• □L 1.4 Apply knowledge of the metrics and measurement systems used to track quality management and safety activities
• □L 1.1 Apply knowledge of process improvement methodologies
• □L 3.1 Develop and review quality control data, and take action
• □L 1.1 Provide leadership for quality control, quality assurance, and quality improvement initiatives

Scholar

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

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of clinical laboratory practice
• □P 3.1 Fulfil and adhere to the standards regulating laboratory practice and accreditation

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 Examine personal interests and career goals
• □L 4.2 Adjust educational 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 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □S 1.1 Create a learning plan that is feasible, includes clear deliverables and a plan for monitoring ongoing achievement
• □S 1.1 Identify resources required to implement a personal learning plan

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

Case description

Feedback provided

Next steps