General Surgery

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 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.1 Determine the acuity of the issue and establish priorities for patient care
• □ME 2.2 Elicit a history and perform a physical exam that informs the diagnosis
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations, including imaging
• □ME 2.4 Develop and implement a plan for initial management
• □ME 4.1 Recognize potential post-operative complications

Communicator

• □COM 3.1 Provide information to the patient and/or family clearly and compassionately
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals

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. ●laparotomy
2. ●laparoscopic procedure

Surgical tasks

1. ●laparotomy (opening)
2. ●laparotomy (closing)
3. ●placement of laparoscopic ports (e.g., gaining initial access)
4. ●closure of laparoscopic access
5. ●Veress needle insertion

Medical Expert

• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Collaborator

• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.1 Work within personal limits, asking for help 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

Setting

1. ●emergency
2. ●clinic
3. ●OR
4. ●ICU

Type of procedure

1. ●elective
2. ●emergency

Complex case

1. ●yes
2. ●no

Medical Expert

• □ME 1.7 Seek assistance when appropriate
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner without excluding key elements in complex patients
• □ME 2.2 Synthesize patient information to assess indications and risk of surgery
• □ME 2.4 Develop a plan for management which may include observation, surgical intervention and/or non-operative intervention
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of and the rationale for a proposed procedure or therapy

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 3.1 Convey information about diagnosis, prognosis, and/or current health status clearly and compassionately
• □COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Communicate effectively with other physicians and health care professionals

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

Patient condition

1. ●stable
2. ●unstable

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 2.1 Prioritize the clinical assessment of a patient with traumatic injury, applying ATLS guidelines
• □ME 2.2 Select and/or interpret appropriate investigations, including imaging
• □ME 2.4 Develop a plan for management which may include observation, surgical intervention, and/or non-operative intervention

Communicator

• □COM 3.1 Convey information about diagnosis, prognosis, and/or current health status clearly and compassionately
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Communicate effectively with other physicians and health care professionals
• □COL 3.2 Provide safe transfer of care, both verbal and written, during patient transitions to a different health care professional, setting, or stage of care

Leader

• □L 4.2 Apply leadership skills and situational awareness in trauma resuscitation

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

Service

1. ●acute care surgery (ACS)
2. ●non-ACS

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 2.4 Develop and implement plans for ongoing care, discharge, and follow-up
• □ME 4.1 Determine the need for future investigations and/or referral to other health care professionals

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations with patients and/or families

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Manage time and prioritize tasks
• □L 4.2 Run the service efficiently, safely, and effectively

Health Advocate

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

Professional

• □P 1.1 Exhibit appropriate professional behaviors

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complex case

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Integrate the patient’s other medical problems, overall functioning, and current health status into the decision regarding plan of care
• □ME 2.4 Develop and implement a plan which may include further investigation, surveillance, medical treatment, and/or surgical intervention
• □ME 4.1 Determine the need for future investigations and/or referral to other health care professionals
• □ME 2.3 Share concerns about goals of care that are not felt to be achievable with the patient in a constructive and respectful manner

Communicator

• □COM 3.1 Convey information about diagnosis, prognosis and/or current health status clearly and compassionately

Health Advocate

• □HA 1.3 Incorporate prevention, health promotion, and health surveillance into patient interactions

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

Presentation

1. ●malignant
2. ●benign

Procedure

1. ●anti-reflux surgery
2. ●partial/total gastrectomy
3. ●gastrostomy/PEG
4. ●paraoesophageal hernia
5. ●bariatric and metabolic surgery
6. ●distal esophagectomy
7. ●Whipple’s procedure
8. ●surgical treatment of peptic ulcer disease and acute complications
9. ●traumatic injury of stomach and duodenum
10. ●other (write in)

Surgical tasks

1. ●mobilization of stomach, including hiatus
2. ●control of hemorrhage and/or perforation
3. ●resection of stomach
4. ●anastomosis to stomach
5. ●kocherization of duodenum

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Presentation

1. ●benign
2. ●malignant

Procedure

1. ●lysis of adhesions
2. ●small bowel resection with or without anastomosis
3. ●ileostomy creation
4. ●ileostomy closure
5. ●feeding jejunostomy
6. ●gastrostomy
7. ●stricturoplasty
8. ●repair of enterotomy
9. ●trauma repair

Surgical tasks

1. ●lysis of adhesions
2. ●resection and anastomosis
3. ●stoma creation
4. ●stoma closure
5. ●repair of enterotomy

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Perforated

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Presentation

1. ●benign
2. ●malignant

Type of procedure

1. ●urgent
2. ●elective

Approach

1. ●minimally invasive
2. ●open

Procedure

1. ●ileocolic resection
2. ●right hemicolectomy
3. ●left hemicolectomy
4. ●sigmoid colon resection
5. ●subtotal colectomy
6. ●colostomy creation
7. ●colostomy reversal
8. ●proctocolectomy
9. ●traumatic injury of colon

Surgical tasks

1. ●mobilization
2. ●vascular control
3. ●anastomosis
4. ●colon resection
5. ●colostomy creation

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●proctectomy/low anterior resection
2. ●abdominal perineal resection
3. ●proctocolectomy
4. ●rectal prolapse procedures
5. ●rectal foreign body removal
6. ●traumatic injury to the rectum

Surgical tasks

1. ●mobilization of the rectum
2. ●vascular control
3. ●resection
4. ●anastomosis

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●abscess drainage
2. ●examination under anesthesia
3. ●hemorrhoidectomy
4. ●hemorrhoid banding
5. ●sphincterotomy
6. ●surgical management of anorectal fistula
7. ●transanal excision of lesions
8. ●traumatic injury to the anus

Surgical tasks

1. ●abscess drainage
2. ●excision of benign lesions
3. ●hemorrhoidectomy
4. ●hemorrhoid banding
5. ●sphincterotomy
6. ●fistulotomy
7. ●seton placement

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Setting

1. ●OR
2. ●simulation

Procedure

1. ●hepatic resection
2. ●cholecystectomy
3. ●CBD exploration
4. ●CBD resection and biliary reconstruction
5. ●Whipple
6. ●organ procurement
7. ●liver transplantation
8. ●repair of traumatic injury to liver and common bile ducts
9. ●other (write in)

Surgical tasks

1. ●mobilization of liver
2. ●wedge resection/biopsy of liver
3. ●dissection of biliary tree
4. ●dissection of gallbladder
5. ●intraoperative cholangiogram
6. ●CBD drainage

Complex case

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●Whipple
2. ●operative management of pancreatic pseudocystic lesions
3. ●distal pancreatectomy
4. ●total pancreatectomy
5. ●surgical management of chronic pancreatitis
6. ●traumatic injury of pancreas
7. ●other (write in)

Surgical tasks

1. ●surgical exposure of the pancreas
2. ●drainage of peripancreatic fluid collections

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Setting

1. ●OR
2. ●simulation

Type of procedure

1. ●elective
2. ●emergency

Surgical tasks

1. ●mobilization of spleen
2. ●control of hemorrhage
3. ●splenectomy

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●sentinel lymph node biopsy
2. ●surgical lymph node biopsy
3. ●modified radical mastectomy
4. ●ALND
5. ●neck dissection
6. ●groin dissection
7. ●other procedure

Surgical tasks

1. ●lymph node biopsy and/or excision
2. ●sentinel lymph node biopsy

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●drainage of abscess
2. ●duct excision
3. ●lumpectomy with or without localization
4. ●mastectomy
5. ●modified radical mastectomy
6. ●core needle biopsy
7. ●other procedure

Surgical tasks

1. ●drainage of abscess
2. ●complete resection of breast
3. ●partial resection of breast with localization
4. ●partial resection of breast without localization

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of procedure

1. ●elective
2. ●emergency

Procedure

1. ●inguinal hernia
2. ●femoral hernia
3. ●incisional hernia
4. ●umbilical hernia
5. ●complex abdominal hernia
6. ●temporary abdominal wall closure
7. ●management of abdominal compartment syndrome
8. ●management of loss of abdominal domain
9. ●repair of recurrent groin hernia

Surgical tasks

1. ●identification and dissection of sac/hernia orifice
2. ●repair of defect (+/- prosthetic)
3. ●preservation of spermatic cord
4. ●temporary abdominal wall closure

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help as needed

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. ●necrotizing skin
2. ●soft tissue infection
3. ●benign or malignant skin lesion

Procedure

1. ●excision of benign skin lesion
2. ●excision of malignant non-melanoma skin lesion
3. ●excision of malignant melanoma
4. ●excision of benign soft tissue lesion
5. ●surgical treatment of pilonidal disease
6. ●debridement of complicated soft tissue infection
7. ●incision and drainage of soft tissue abscess

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●neck exploration for trauma
2. ●tracheostomy
3. ●thyroidectomy
4. ●parathyroidectomy
5. ●other

Simulation

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●trauma laparotomy
2. ●trauma resuscitation
3. ●tracheostomy
4. ●other (write in)

Surgical tasks

1. ●trauma laparotomy
2. ●control and management of visceral injury
3. ●control and management of intraabdominal vascular bleeding
4. ●control and management of pelvic vascular bleeding
5. ●damage control laparotomy
6. ●exposure of the retroperitoneum
7. ●repair of diaphragm
8. ●simple bladder repair
9. ●chest tube in a complex patient (obese, redo, unstable)
10. ●resuscitative thoracotomy

Simulation

1. ●yes
2. ●no

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of procedure

1. ●elective
2. ●non-elective

Procedure

1. ●hemostasis
2. ●dilation
3. ●polypectomy
4. ●foreign body removal
5. ●endoluminal stent insertion
6. ●other (write in)

Medical Expert

• □ME 3.4 Provide analgesia and sedation to ensure patient safety and comfort
• □ME 3.4 Assemble, verify, and clean endoscopy equipment appropriately
• □ME 3.4 Intubate the esophagus under direct vision
• □ME 3.4 Achieve clear visualization of the mucosa using a variety of techniques, including air, water, and suction
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Perform tissue biopsies in quantity and quality as appropriate to indication
• □ME 3.4 Use therapeutic techniques appropriately and safely
• □ME 3.4 Demonstrate appropriate pace and progress during insertion and withdrawal
• □ME 3.4 Identify and respond to immediate complications of the procedure if applicable

Communicator

• □COM 3.1 Convey the results of endoscopy and further management plan to the patient/family
• □COM 5.1 Document findings of an endoscopic procedure in a complete and timely manner

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants

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 procedure

1. ●elective
2. ●non-elective

Procedure

1. ●colonoscopy
2. ●terminal ileal intubation
3. ●simple polypectomy
4. ●complex polypectomy
5. ●hemostasis
6. ●other (write in)

Medical Expert

• □ME 3.4 Provide analgesia and sedation to ensure patient safety and comfort
• □ME 3.4 Assemble, verify, and clean endoscopy equipment appropriately
• □ME 3.4 Use torque steering appropriately
• □ME 3.4 Recognize and resolve loop formation
• □ME 3.4 Use position change and abdominal pressure to aid luminal views
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Achieve clear visualization of the mucosa using a variety of techniques, including air, water, and suction
• □ME 3.4 Use therapeutic techniques appropriately and safely
• □ME 3.4 Demonstrate appropriate pace and progress during insertion and withdrawal
• □ME 3.4 Identify and respond to immediate complications of the procedure if applicable

Communicator

• □COM 3.1 Convey the results of endoscopy and further management plan to the patient/family
• □COM 5.1 Document findings of an endoscopic procedure in a complete and timely manner

Collaborator

• □COL 1.2 Communicate effectively with nurses and/or assistants

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 Identify a knowledge gap or research interest and develop a plan/proposal for a scholarly project
• □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
• □S 4.5 Summarize and communicate the findings of research and scholarly inquiry

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 activity

1. ●journal club
2. ●grand rounds
3. ●case presentation
4. ●other activity

Scholar

• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Develop learning objectives for a teaching activity
• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health- related research and literature
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present the information in an organized manner to facilitate understanding
• □S 2.4 Use audiovisual aids effectively
• □S 2.4 Provide adequate time for questions and discussion

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 2.4 Establish patient centered-management plans
• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of and the rationale for a proposed procedure or therapy
• □ME 1.7 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete, and timely manner

Leader

• □L 4.1 Manage time effectively in the ambulatory clinic
• □L 4.2 Book operative cases with appropriate urgency, duration, and equipment and patient preparation
• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Review and act on test results in a timely manner

Health Advocate

• □HA 1.1 Work with patients to address the determinants of health that affect them and their access to needed health services or resources

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 3.4 Anticipate and prepare for technical challenges and/or significant findings
• □ME 3.4 Select appropriate materials and equipment for the procedure
• □ME 3.4 Perform surgical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure as appropriate
• □ME 4.1 Establish plans for post-operative care

Communicator

• □COM 3.1 Convey information about the procedure, operative findings, and patient status to the family clearly and compassionately
• □COM 5.1 Document surgical procedures in an accurate, complete, and timely manner

Professional

• □P 1.2 Prepare for the day, reviewing the list of planned procedures
• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps