General Surgical Oncology

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 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □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 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

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Entrustment (how much supervision did this activity need?)

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

Type of cancer

1. ●early breast cancer
2. ●early melanoma
3. ●early upper rectal cancer
4. ●uncomplicated colon cancer
5. ●other uncomplicated cancer (write in)

Medical Expert

• □ME 2.2 Elicit a history and perform a physical exam relevant to the presentation
• □ME 2.2 Integrate the clinical data to establish stage and prognosis of the condition
• □ME 2.4 Develop a plan for management, which may include additional investigations, surgery, and/or non-operative intervention
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 3.2 Obtain informed consent for the planned management

Communicator

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

Case description

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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

Case type

1. ●breast
2. ●colorectal
3. ●endocrine
4. ●sarcoma
5. ●skin/soft tissue
6. ●upper GI/HPB

Complexity

1. ●routine
2. ●complex

Visit components observed

1. ●complex wound management
2. ●discussion of pathology
3. ●multi-modal treatment planning
4. ●post-operative symptom management
5. ●surveillance strategy
6. ●other

Medical Expert

• □ME 2.4 Develop a plan to manage any post-operative symptoms and/or complications
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.2 Interpret the results of investigations done for diagnosis and/or staging (pathology, imaging, tumour markers)
• □ME 2.2 Determine if the case warrants discussion at multidisciplinary rounds
• □ME 2.4 Develop a plan for management, which may include surveillance, additional investigations, medical treatment, or further surgical intervention

Communicator

• □COM 3.1 Provide information to the patient and/or family about the condition and plans for management clearly and compassionately
• □COM 4.3 Answer questions from the patient and/or family

Health Advocate

• □HA 1.2 Provide recommendations for resources for patient education and support

Case description

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

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care

Collaborator

• □COL 1.2 Delegate responsibilities to members of the health care team appropriate to their scope of practice and level of expertise
• □COL 1.3 Communicate effectively with other members of the health care team

Leader

• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Health Advocate

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

Scholar

• □S 3.4 Demonstrate an evidence-based approach to clinical management

Professional

• □P 1.1 Behave in a professional manner

Case description

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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

Disease site

1. ●breast
2. ●cutaneous
3. ●low rectal cancer
4. ●metastatic/recurrent cancer
5. ●peritoneal
6. ●retroperitoneal sarcoma
7. ●stomach/HPB

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Integrate the clinical data to establish stage and prognosis of the condition
• □ME 3.1 Identify and evaluate the available options for treatment, including surgical intervention, systemic therapy, and/or radiation therapy, or best supportive care
• □ME 2.3 Establish goals of care with the patient and family
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.2 Determine if the case warrants discussion at multidisciplinary rounds
• □ME 2.4 Develop a management plan, including the timing and sequence for multi-modal treatments

Communicator

• □COM 3.1 Provide information about prognosis and treatment options, including the choice of surgical technique and other treatment modalities

Health Advocate

• □HA 1.2 Provide recommendations for resources for patient education and support

Case description

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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

Suspected genetic syndrome

1. ●BRCA
2. ●CDH1
3. ●Lynch
4. ●MEN
5. ●other (write in)

Medical Expert

• □ME 2.2 Assess the likelihood that the patient has a hereditary cancer syndrome
• □ME 2.2 Determine the need for referral for genetic testing and/or genetic counselling
• □ME 2.4 Provide recommendations regarding surveillance and risk-reducing treatment options

Communicator

• □COM 3.1 Share information and explanations clearly and compassionately

Health Advocate

• □HA 1.3 Discuss the implications of genetic testing for family members

Case description

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2. ●I had to talk them through
3. ●I needed to prompt
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5. ●I didn’t need to be there

Presentation

1. ●bleeding
2. ●malignant GI obstruction
3. ●metabolic/hormonal
4. ●perforation
5. ●other (write in)

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Synthesize information about the type and stage of the cancer and any previous surgical, radiation, and/or medical treatment
• □ME 2.4 Develop and implement a management plan with appropriate consideration for future definitive cancer management
• □ME 2.3 Review goals of care and realign if needed

Communicator

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

Case description

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Presentation

1. ●malignant bowel obstruction
2. ●perforated incurable GI malignancy
3. ●treatment of incurable symptomatic malignancy
4. ●other

Medical Expert

• □ME 2.2 Synthesize information about the type and stage of the cancer and any previous surgical, radiation, and/or medical treatment
• □ME 3.1 Identify and evaluate the available options for treatment, including surgical intervention, systemic therapy, and/or radiation therapy, or best supportive care
• □ME 2.3 Share concerns about goals that may not be achievable and initiate discussion about addressing these concerns
• □ME 2.4 Develop a management plan consistent with the patient’s goals of care

Communicator

• □COM 3.1 Provide the patient/family with information about prognosis and treatment options, including potential outcomes and adverse effects
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Case description

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

Medical Expert

• □ME 2.2 Select and/or interpret investigations in context of most likely diagnosis
• □ME 2.4 Develop and implement a management plan
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 3.3 Consider urgency and potential for deterioration in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and/or disclose adverse events to the patient and/or family
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Case description

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2. ●I had to talk them through
3. ●I needed to prompt
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5. ●I didn’t need to be there

Medical Expert

• □ME 2.4 Identify the role and availability of clinical trial participation as a therapeutic option
• □ME 2.4 Discuss the degree of uncertainty inherent to the clinical situation

Communicator

• □COM 3.1 Convey information about the treatment options (including rationale, adverse effects, expected outcomes, and alternative treatments) clearly and accurately
• □COM 3.1 Verify understanding of the information conveyed

Scholar

• □S 4.2 Incorporate ethical principles of research in discussions regarding enrollment for a clinical trial
• □S 4.2 Advise regarding the right not to participate
• □S 4.3 Balance the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician

Case description

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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

Procedure

1. ●skin-sparing mastectomy
2. ●nipple-sparing mastectomy
3. ●level 2 oncoplastic breast reconstruction
4. ●level 2 axillary dissection

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical approach

1. ●laparoscopic
2. ●open
3. ●robotic

Procedure

1. ●esophagojejunostomy
2. ●gastrectomy-total
3. ●gastrectomy-subtotal
4. ●gastric resection-wedge/partial
5. ●gastrojejunostomy
6. ●D2 lymphadenectomy

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical approach

1. ●laparoscopic
2. ●open
3. ●robotic

Location

1. ●proximal jejunal resection
2. ●mid-distal small bowel

Complexity

1. ●routine
2. ●complex

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical approach

1. ●laparoscopic
2. ●open
3. ●robotic

Site

1. ●colon
2. ●rectum/anus

Surgical skill

1. ●total mesorectal excision
2. ●pelvic side wall dissection
3. ●multivisceral resection
4. ●major vascular dissection
5. ●low rectal anastomosis
6. ●perineal resection

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 1.3 Apply knowledge of pelvic sidewall, vascular, nerve, perineal, and nodal anatomy
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical skill

1. ●HIPEC
2. ●Krukenberg resection
3. ●major peritonectomy
4. ●PCI calculation

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical approach

1. ●laparoscopic
2. ●open
3. ●robotic

Surgical skill

1. ●mobilization of the liver
2. ●portal dissection
3. ●biliary-enteric anastomosis
4. ●transection of pancreatic parenchyma

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Tumour type

1. ●early stage
2. ●locally advanced
3. ●in-transit

Task

1. ●axillary lymph node dissection (level III)
2. ●inguinal lymph node dissection-superficial
3. ●inguinal lymph node dissection-deep
4. ●management of in- transit disease
5. ●N/A

Flap

1. ●simple
2. ●complex
3. ●none

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, local procedure, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Case

1. ●truncal/extremity
2. ●advanced GIST
3. ●retroperitoneal sarcoma
4. ●other

Multivisceral resection

1. ●no
2. ●yes

Surgical skill

1. ●abdominal wall resection
2. ●bladder resection
3. ●diaphragm resection
4. ●major nerve dissection
5. ●major vascular dissection
6. ●nephrectomy
7. ●pancreatectomy
8. ●splenectomy

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Surgical approach

1. ●laparoscopic
2. ●open
3. ●robotic

Procedure

1. ●adrenalectomy
2. ●parathyroidectomy
3. ●paraganglioma resection
4. ●thyroidectomy

Lymph node dissection

1. ●no
2. ●yes

Medical Expert

• □ME 3.4 Plan most appropriate incision, obtain surgical exposure, identify key landmarks and mobilize tissue as appropriate
• □ME 3.4 Assess disease burden and evaluate ability to complete the proposed procedure
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Perform dissection, mobilization, and/or radical resection of affected structure(s) and/or appropriate reconstruction
• □ME 3.4 Anticipate, recognize, and respond to situations that require change in operative plan or management

Collaborator

• □COL 1.2 Work effectively with operative assistants and members of 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

Cancer type

1. ●breast
2. ●colorectal
3. ●cutaneous
4. ●gastric
5. ●hepatobiliary
6. ●peritoneal
7. ●sarcoma
8. ●other

Procedure

1. ●complex breast cancer resection/reconstruction
2. ●cytoreductive surgery
3. ●extended liver resection
4. ●multivisceral resection
5. ●pelvic exenteration
6. ●soft tissue resection/reconstruction
7. ●Whipple’s procedure

Medical Expert

• □ME 2.2 Determine whether the patient’s cancer is resectable with curative intent
• □ME 3.1 Integrate all sources of information to develop the surgical approach
• □ME 3.1 Anticipate challenges to and pitfalls and complications of the planned approach
• □ME 3.1 Develop back-up plan and establish indications to abort the procedure
• □ME 3.1 Ascertain requirements for special equipment, positioning, or anesthetic management
• □ME 2.4 Anticipate peri-procedural issues and complications, and incorporate these considerations in the management plan
• □ME 3.4 Establish plans for post-operative care

Collaborator

• □COL 1.3 Consult with colleagues with different expertise, as needed

Case description

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Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Triage referrals on the basis of the patient’s condition
• □ME 2.4 Establish patient-centred management plans
• □ME 3.1 Identify operative cases with appropriate urgency, duration, and equipment and patient preparation

Communicator

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

Collaborator

• □COL 1.2 Work effectively with outpatient clinic staff

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinic

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.1 Behave in a professional manner

Case description

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Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Synthesize cases for discussion at multidisciplinary rounds

Collaborator

• □COL 1.3 Encourage discussion, questions, and interaction relevant to the case
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 2.2 Contribute to the development of consensus when there are differences in recommendations provided by other health care professionals

Health Advocate

• □HA 1.1 Advocate for the patient’s needs and concerns

Scholar

• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present the information in an organized manner

Case description

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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

Teaching activity

1. ●journal club
2. ●bedside/clinic
3. ●operative
4. ●academic half-day
5. ●other formal rounds
6. ●other

Scholar

• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 3.3 Critically evaluate the literature
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.2 Create a positive learning environment
• □S 2.4 Present the information in an organized manner
• □S 2.4 Provide adequate time for questions and discussion

Case description

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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 Select appropriate methods of addressing a given scholarly question
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.5 Summarize and communicate the findings of research and scholarly inquiry

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