Geriatric Medicine

Entrustment (how much supervision did this activity need?)

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

Case presentation

1. ●cognitive impairment
2. ●mood disorders
3. ●functional impairment/decline
4. ●frailty/multicomplexity
5. ●mobility/falls/gait disorders
6. ●bone health
7. ●orthostatic hypotension
8. ●dizziness
9. ●sarcopenia and deconditioning
10. ●incontinence
11. ●weight loss and optimal nutrition
12. ●optimal prescribing
13. ●pressure ulcers/injuries
14. ●driving safety awareness

Setting

1. ●inpatient consult
2. ●geriatric unit
3. ●outpatient clinic
4. ●day hospital
5. ●outreach

Supervisor role

1. ●geriatrician
2. ●TTP resident
3. ●care of the elderly physician

Medical Expert

• □Part A: ME 2.2 Elicit an accurate, relevant comprehensive history including functional, medication and social history
• □Part A: ME 2.2 Perform a physical examination at the level of an internist, including a comprehensive musculoskeletal and neurological examination, targeted to the presentation
• □Part A: ME 2.2 Identify frailty, cognitive impairment, mood disorders, and/or functional impairment
• □Part A: ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
• □Part B: ME 2.2 Complete and score all required elements of a validated cognitive assessment tool

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □Part A: COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part A: COM 2.3 Seek and summarize relevant information from other sources, including the patient’s family, and medical records
• □Part A: COM 5.1 Organize the clinical information from a CGA within a written document
• □Part A: COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care
• □Part B: COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □Part B: COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part B: COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.5 Prioritize patients based on the urgency of clinical presentation
• □ME 1.4 Recognize problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.4 Perform complete and appropriate assessments of older patients with common internal medicine presentations
• □ME 2.2 Interpret the results of investigations and develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select additional investigations as appropriate
• □ME 1.3 Apply clinical and biomedical sciences to manage older adult patients with internal medicine presentations
• □ME 2.4 Develop and implement management plans for older adults with common internal medicine conditions
• □ME 2.4 Determine appropriate patient disposition, which may include admission, referral or follow-up
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 5.1 Organize the clinical information from a CGA within a written document
• □COM 3.1 Convey the diagnosis, prognosis, and plan of care in a clear, compassionate, respectful, and accurate manner
• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions

Collaborator

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

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

Case presentation

1. ●cognitive impairment
2. ●mood disorders
3. ●functional impairment/decline
4. ●frailty/multicomplexity
5. ●mobility/falls/gait disorders
6. ●bone health
7. ●orthostatic hypotension
8. ●dizziness
9. ●sarcopenia and deconditioning
10. ●incontinence
11. ●weight loss and optimal nutrition
12. ●optimal prescribing
13. ●pressure ulcers/injuries
14. ●driving safety awareness

Type of observation

1. ●direct
2. ●indirect

Setting

1. ●inpatient
2. ●outpatient

Medical Expert

• □ME 1.4 Identify, diagnose, and address common geriatric syndromes
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in common geriatric syndromes
• □ME 1.3 Apply knowledge of optimal nutrition as it pertains to older adult patients
• □ME 1.3 Apply knowledge of driving safety awareness as it pertains to older adult patients ∗ STACER is not available on ePortfolio platform
• □ME 2.2 Elicit an accurate, relevant, and comprehensive history, including the components of a comprehensive geriatric assessment such as function and nutrition
• □ME 2.2 Perform a physical examination at the level of a geriatrician that informs the diagnosis, including screening for vision, hearing, gait, and balance
• □ME 2.2 Perform a mental status assessment, including the use of recognized cognitive/mental screening tools
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Synthesize patient information, incorporating caregiver and interprofessional team input, to determine a diagnosis
• □ME 2.4 Develop a preliminary management plan
• □ME 2.3 Establish goals of care that take into consideration the level of caregiver stress when applicable
• □ME 4.1 Develop and prioritize well-defined questions to be addressed with a medical and interprofessional team
• □ME 5.2 Reconcile current and prior medication lists to enhance patient safety

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions
• □COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and 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

Case mix

1. ●hypertension
2. ●coronary artery disease
3. ●CHF
4. ●arrhythmia
5. ●stroke
6. ●diabetes
7. ●chronic kidney disease
8. ●anemia
9. ●Parkinson’s Disease
10. ●movement disorders
11. ●COPD
12. ●pain
13. ●osteoporosis
14. ●gout
15. ●osteoarthritis
16. ●polymyalgia rheumatica
17. ●spinal stenosis
18. ●infections
19. ●thromboembolic disease
20. ●common rheumatological conditions
21. ●other

Observation

1. ●direct
2. ●indirect

Setting

1. ●inpatient consult
2. ●geriatric unit
3. ●outpatient clinic
4. ●day hospital
5. ●collaborative geriatric specialty services

Supervisor

1. ●geriatrician
2. ●TTP resident

Medical Expert

• □ME 1.6 Provide evidence-informed, patient-centred care of a medical condition in the context of frailty and multicomplexity and its impact on the patient
• □ME 2.2 Perform a comprehensive physical examination tailored to the patient’s presentation
• □ME 1.4 Perform clinical assessments that identify and differentiate between normal aging and disease states
• □ME 2.2 Select and interpret appropriate investigations as they apply in the context of age
• □ME 1.3 Apply clinical and biomedical sciences to manage patients with typical and atypical presentations of acute and chronic geriatric syndromes
• □ME 2.4 Evaluate the applicability of clinical guidelines in the context of co- morbidities, aging and patient goals
• □ME 2.4 Develop and implement management plans in collaboration with the patient and family and the interprofessional team

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Provide timely and necessary written information to colleagues to enable effective relationship-centred care

Health Advocate

• □HA 1.3 Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection

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

Assessment tool

1. ●MMSE
2. ●MOCA
3. ●FAB
4. ●Boston
5. ●Clock Drawing test
6. ●IQCODE
7. ●ToCA
8. ●SLUMS
9. ●other

Setting

1. ●inpatient
2. ●outpatient

Supervisor

1. ●geriatrician
2. ●TTP resident
3. ●care of the elderly physician

Medical Expert

• □ME 2.2 Identify frailty, cognitive impairment, mood disorders and/or functional impairment
• □ME 2.2 Complete and score all required elements of the assessment according to guidelines
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 2.3 Seek and summarize relevant information from other sources, including the patient’s family, and medical records
• □COM 5.1 Organize the information from an assessment within a written document
• □COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional 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

Presentation

1. ●mild cognitive impairment (MCI)
2. ●Alzheimer’s
3. ●vascular dementia
4. ●mixed cause dementia
5. ●Lewy body dementia

Supervisor

1. ●geriatrician
2. ●psychiatrist
3. ●neurologist
4. ●care of the elderly physician

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □Part A: ME 1.4 Perform a focused clinical and cognitive assessment appropriate to the patient presentation
• □Part A: ME 2.2 Identify patients who require neuropsychological testing
• □Part A: ME 2.2 Select additional investigations as appropriate
• □Part A: ME 2.2 Synthesize patient information, incorporating caregiver and interprofessional team input, to determine a diagnosis
• □Part C: ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in common neurocognitive disorders with typical presentations
• □Part C: ME 1.3 Apply knowledge of clinical sciences as it pertains to non-pharmacologic treatment options
• □Part C: ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □Part C: ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s condition evolves
• □Part C: ME 2.4 Develop and implement initial management plans for common neurocognitive disorders
• □Part C: ME 4.1 Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence
• □Part C: ME 2.4 Integrate knowledge of available community resources into the development of patient-centred care plans

Communicator

• □Part B: COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part B: COM 3.1 Convey sensitive information regarding driving, cognition and other safety concerns clearly and compassionately
• □Part B: COM 1.5 Recognize when strong emotions are impacting an interaction and respond appropriately
• □Part B: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □Part B: COM 4.1 Communicate with cultural awareness and sensitivity
• □Part B: COM 4.3 Answer questions from the patient and family about next steps
• □Part B: COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions

Leader

• □Part C: L 2.1 Apply knowledge of the resources available in the care setting when developing and implementing management plans
• □Part C: L 2.1 Apply knowledge of resources or agencies that address the health needs of older patients presenting with neurocognitive disorders

Professional

• □Part B: P 3.1 Adhere to professional and ethical codes, standards of practice, and laws governing practice, especially as they relate to driving safety

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. ●hyperactive (i.e., agitated)
2. ●hypoactive
3. ●mixed

Setting

1. ●geriatric unit
2. ●inpatient consult
3. ●pre- and/or post-operative setting
4. ●emergency room
5. ●day hospital
6. ●residential care
7. ●other

Supervisor

1. ●geriatrician
2. ●care of the elderly physician

Medical Expert

• □Part A: ME 1.3 Apply clinical and biomedical sciences to the diagnosis and/or management of delirium
• □Part A: ME 1.4 Perform focused clinical assessments, including appropriate history, physical examination, medication review and investigations
• □Part A: ME 2.2 Identify patients who require delirium screening
• □Part A: ME 2.2 Select additional investigations as appropriate
• □Part A: ME 2.2 Synthesize patient information, incorporating caregiver and interprofessional team input, to determine a diagnosis
• □Part A: ME 2.2 Perform a delirium screen using validated tools
• □Part C: ME 1.3 Apply clinical and biomedical sciences to the diagnosis and/or management of delirium
• □Part C: ME 2.2 Select and interpret appropriate investigations as they apply in the context of delirium
• □Part C: ME 2.4 Develop and implement initial management plans for patients in delirium
• □Part C: ME 2.4 Integrate knowledge of available community resources into the development of patient-centred care plans

Communicator

• □Part B: COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part B: COM 3.1 Convey sensitive information regarding cognition and delirium clearly and compassionately
• □Part B: COM 1.4 Respond to patient’s non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □Part B: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner
• □Part B: COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care
• □Part C: COM 1.6 Adapt to the unique needs of patients in delirium and to their clinical condition and circumstances
• □Part C: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □Part C: COM 5.1 Document information about patients and their medical conditions in a manner that enhances interprofessional care

Leader

• □Part C: L 2.1 Apply knowledge of the resources available in the care setting when developing and implementing management plans

Health Advocate

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

Professional

• □Part B: P 3.1 Adhere to professional and ethical codes, standards of practice, and laws governing practice

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●renal dysfunction
2. ●delirium
3. ●dementia
4. ●multiple morbidity
5. ●multiple medications
6. ●falls
7. ●orthostatic hypotension
8. ●functional decline
9. ●other

Supervisor

1. ●geriatrician
2. ●geriatric pharmacist
3. ●care of elderly physician

Setting

1. ●inpatient
2. ●outpatient

Medical Expert

• □ME 2.2 Perform a full medication history assessment and reconciliation
• □ME 2.2 Identify potentially inappropriate medications (PIMs), adverse drug reactions (ADRs), prescribing cascades, and time to benefit (TTB)
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for given treatment prescriptions
• □ME 3.1 Ascertain the efficacy of prescribed treatment in the context of the patient’s presentation
• □ME 4.1 Determine the necessity and timing of referral to another health care professional
• □ME 3.1 Determine the most appropriate procedures and therapies
• □ME 2.4 Evaluate the applicability and/or limitations of the extrapolation of clinical trial data and/or clinical practice guidelines to older adults
• □ME 4.1 Establish plans for monitoring the patient and treatment efficacy
• □ME 2.4 Provide and/or adjust treatment prescriptions considering the pharmacokinetics and pharmacodynamics, adherence, and cost issues

Communicator

• □COM 4.1 Explore the perspectives of the patient and others when developing care plans in the context of prescribing and deprescribing

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians and pharmacists
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Leader

• □L 2.1 Demonstrate stewardship of health care 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

Case mix

1. ●movement disorders
2. ●MSK disorders
3. ●sensory impairment
4. ●cerebellar/ataxic
5. ●NPH
6. ●vascular (stroke/subcortical)
7. ●orthostatic hypotension
8. ●multiple medications
9. ●cognitive impairment
10. ●other

Supervisor

1. ●geriatrician
2. ●care of the elderly physician
3. ●physiatrist
4. ●neurologist

Setting

1. ●inpatient unit
2. ●day hospital
3. ●outpatient clinic
4. ●inpatient consult
5. ●rehabilitation unit
6. ●home visit
7. ●simulation

Medical Expert

• □Part A: ME 2.2 Perform an MSK examination appropriate to the patient presentation
• □Part A: ME 2.2 Perform a neurological examination appropriate to the patient presentation
• □Part A: ME 2.2 Perform gait analysis and balance assessment including a description of the patient’s gait using a systematic approach
• □Part A: ME 2.2 Interpret the results of gait and balance screening tools including gait speed, BBS, and TUG test
• □Part B: ME 1.4 Perform falls risk assessments, including a comprehensive assessment of extrinsic and intrinsic risk factors that may lead to falls in older adults
• □Part B: ME 2.2 Select and interpret appropriate investigations based on the patient’s presentation
• □Part B: ME 2.4 Develop and implement a management plan for falls
• □Part B: ME 2.4 Prescribe appropriate simple gait aids (e.g. cane, walker)

Communicator

• □Part B: COM 3.1 Convey information on diagnosis and prognosis related to falls risk clearly and compassionately to the patient and caregivers

Collaborator

• □Part A: COL 1.1 Respond appropriately to input from other health care professionals as it relates to balance and gait
• □Part A: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 1.1 Respond appropriately to input from other health care professionals as it relates to balance and gait
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 1.3 Communicate effectively with physicians and 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

Collaborator

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

Scholar

• □S 2.1 Be a positive role model
• □S 2.2 Create a positive learning environment
• □S 2.3 Provide opportunities for appropriate graded clinical responsibility
• □S 2.3 Be available and accessible to junior learners
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Develop learning objectives for a teaching activity
• □S 2.4 Present the information in an organized manner to facilitate understanding
• □S 2.4 Provide adequate time for questions and discussion
• □S 2.5 Provide feedback to enhance learning and performance
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case presentation

1. ●cognitive impairment
2. ●mood disorders
3. ●functional impairment/decline
4. ●frailty/multicomplexity
5. ●mobility/falls/gait disorders
6. ●bone health
7. ●orthostatic hypotension
8. ●dizziness
9. ●sarcopenia and deconditioning
10. ●incontinence
11. ●weight loss and optimal nutrition
12. ●optimal prescribing
13. ●pressure ulcers/injuries
14. ●driving safety awareness

Assessment of rehabilitative potential

1. ●yes
2. ●no

Setting

1. ●inpatient consult
2. ●geriatric unit
3. ●outpatient clinic
4. ●day hospital
5. ●outreach

Medical Expert

• □Part A: ME 1.3 Apply clinical and biomedical sciences to manage common syndromes and/or issues in older adults
• □Part A: ME 1.4 Perform comprehensive geriatric assessments that address all relevant issues
• □Part A: ME 2.2 Perform medication reviews
• □Part A: ME 2.1 Prioritize which issues need to be addressed during future visits
• □Part A: ME 2.2 Select and/or interpret appropriate investigations
• □Part A: ME 2.2 Synthesize patient information, incorporating caregiver and interprofessional team input, to determine a diagnosis
• □Part A: ME 2.2 Assess patients for rehabilitative potential
• □Part A: ME 2.2 Assess and project functional status trajectory for older adults with common syndromes and/or issues
• □Part A: ME 2.4 Establish a patient-centred management plan informed by comprehensive geriatric assessment
• □Part A: ME 2.4 Integrate optimal prescription practices into management plan
• □Part A: ME 4.1 Determine the necessity and timing of referral to another health care professional

Communicator

• □Part B: COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for patient and family understanding
• □Part B: COM 4.3 Answer questions from the patient and family about next steps
• □Part C: COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner that enhances interprofessional care, and is in compliance with legal and privacy requirements
• □Part C: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □Part C: COL 1.3 Engage in respectful shared decision-making with primary and/or referring physicians and other health care professionals

Health Advocate

• □Part A: HA 1.2 Incorporate disease prevention and health promotion into interactions with individual patients, as applicable

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations across the spectrum of frailty including multiple complex interacting comorbidities
• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family as the patient’s situation evolves
• □ME 2.2 Project the trajectory of illness and care needs
• □ME 2.2 Integrate new findings and changing clinical circumstances into the assessment of the patient’s clinical status
• □ME 2.2 Perform medication reviews
• □ME 2.4 Establish a patient-centred management plan informed by comprehensive geriatric assessment
• □ME 2.4 Develop, in collaboration with the patient and family, a plan to deal with clinical uncertainty
• □ME 2.4 Integrate the results of a frailty assessment to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.3 Balance risk, effectiveness and priority of interventions in the presence of multiple co-morbidities

Communicator

• □COM 3.1 Share information and explanations that are clear and accurate while checking for patient and family understanding
• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Collaborator

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

Health Advocate

• □HA 1.2 Incorporate disease prevention and health promotion into interactions with individual patients, as applicable

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case presentation

1. ●personal care decision
2. ●financial decision
3. ●other

Observation

1. ●direct
2. ●case review

Simulation

1. ●yes
2. ●no

Supervisor

1. ●geriatrician
2. ●psychiatrist

Medical Expert

• □ME 2.2 Perform a capacity assessment, screening for financial capacity, as required relevant to the patient presentation
• □ME 2.2 Demonstrate effective clinical problem solving and judgment to address patient capacity to make a decision
• □ME 2.4 Develop and implement management plans

Communicator

• □COM 1.6 Tailor approaches to patient capacity assessment taking into account culture, education, sensory impairment, language
• □COM 3.1 Provide information on diagnosis and prognosis in a clear, comprehensive, respectful, and objective manner
• □COM 5.1 Maintain clear, concise, accurate, and appropriate records of clinical encounters and plans

Collaborator

• □COL 1.3 Collaborate with the patient’s health care team in order to perform a comprehensive capacity assessment, as needed

Health Advocate

• □HA 1.1 Facilitate timely access to resources including the public guardian and/or trustee, legal advice, appeal mechanisms, family education and support

Professional

• □P 3.1 Apply provincial laws governing practice as it pertains to consent, capacity, and elder abuse and neglect

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●frontotemporal dementia (FTD)
2. ●primary progressive aphasia (PPA)
3. ●atypical Alzheimer’s dementia (AD)
4. ●rapidly progressive dementia
5. ●Jakob-Creutzfeld dementia (JCD)
6. ●Parkinson’s disease (PD) spectrum
7. ●infectious causes, including HIV
8. ●normal pressure hydrocephalus (NPH)
9. ●other

Setting

1. ●outpatient clinic
2. ●memory disorders clinic
3. ●geriatric unit
4. ●inpatient consult
5. ●day hospital
6. ●simulation
7. ●other

Supervisor

1. ●geriatrician
2. ●neurologist
3. ●psychiatrist
4. ●care of the elderly physician

Medical Expert

• □Part A: ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □Part A: ME 2.2 Perform a clinical assessment focusing on differentiating causes of complex and/or uncommon neurocognitive disorders
• □Part A: ME 2.2 Select and interpret neuroimaging and neuropsychology investigations, as appropriate
• □Part A: ME 2.4 Establish a patient-centred management plan for complex and/or uncommon neurocognitive disorders including both non-pharmacologic and pharmacologic modalities
• □Part A: ME 4.1 Establish and implement patient-centred care plans that involve available community resources

Communicator

• □Part B: COM 1.6 Adapt to the unique needs/preferences of each patient
• □Part B: COM 3.1 Convey information and provide counselling related to the patient’s diagnosis, management plan, and prognosis in a timely, honest, and transparent manner

Collaborator

• □Part A: COL 1.3 Use referral and consultation as opportunities to improve quality of care and patient safety by sharing expertise
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals

Leader

• □Part A: L 2.1 Demonstrate stewardship of health care resources

Professional

• □Part B: P 1.3 Manage ethical issues encountered in the clinical setting including genetic testing, use of enteral feeding, resuscitation and end-of-life issues

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

BPSD presentations

1. ●sexually inappropriate behaviour
2. ●physical aggression
3. ●agitation
4. ●psychotic features
5. ●pacing/wandering
6. ●apathy
7. ●depression
8. ●anxiety
9. ●other

Setting

1. ●outpatient clinic
2. ●specialized (memory disorders) clinic
3. ●geriatric unit
4. ●inpatient consult
5. ●geriatric psychiatry
6. ●behavioural neurology
7. ●long-term care
8. ●day hospital
9. ●other

Supervisor role

1. ●geriatrician
2. ●neurologist
3. ●psychiatrist
4. ●care of the elderly physician

Medical Expert

• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family as the patient’s situation evolves
• □ME 2.2 Perform medication reviews
• □ME 2.2 Identify potential medication-related contributors to BPSD
• □ME 2.2 Synthesize patient information to determine underlying causes/precipitating factors of BPSD
• □ME 2.4 Develop and implement non-pharmacologic interventions in collaboration with the patient and family, and the interprofessional team
• □ME 2.4 Integrate optimal prescription practices into management plan
• □ME 4.1 Determine the necessity and timing of referral to another health care professional
• □ME 4.1 Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Communicator

• □COM 1.4 Respond to patient’s non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 2.2 Manage the flow of challenging patient or caregiver encounters, including those with angry or distressed individuals
• □COM 3.1 Share information and explanations that are clear and accurate while checking for patient and family understanding

Collaborator

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

Health Advocate

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

Scholar

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

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and best practices around physical and chemical restraints

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient consult
2. ●geriatric unit
3. ●outpatient clinic
4. ●geriatric oncology
5. ●Transcatheter Heart Valve Program (TAVI) clinic
6. ●residential care
7. ●emergency department
8. ●other

Medical Expert

• □Part A: ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the identification, prevention and/or management of delirium
• □Part A: ME 2.2 Identify patients with atypical presentations and/or course of delirium
• □Part A: ME 2.4 Develop and implement multi-component prevention strategies for delirium
• □Part A: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management of delirium
• □Part A: ME 2.4 Integrate non-pharmacologic therapies into delirium prevention
• □Part A: ME 5.1 Optimize the safety of patients in delirium, ensuring the avoidance of chemical and physical restraints whenever possible and using them skilfully and appropriately when necessary
• □Part A: ME 4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation
• □Part B: ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the identification, prevention and/or management of delirium
• □Part B: ME 2.2 Identify patients with atypical presentations and/or course of delirium
• □Part B: ME 2.4 Develop and implement management plans
• □Part B: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management of delirium
• □Part B: ME 2.4 Integrate non-pharmacologic therapies into management plans for delirium
• □Part B: ME 5.1 Optimize the safety of patients in delirium, ensuring the avoidance of chemical and physical restraints whenever possible and using them skilfully and appropriately when necessary
• □Part B: ME 4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

Communicator

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

Leader

• □Part A: L 1.4 Engage others in the adoption and refinement of health information technology or systems for improved delirium prevention
• □Part B: L 1.4 Engage others in the adoption and refinement of health information technology or systems for improved management of delirium

Health Advocate

• □Part A: HA 1.3 Work with the patient and family to identify opportunities for delirium prevention
• □Part A: HA 2.3 Contribute to a process to improve prevention, recognition, and management of delirium within a community or population

Scholar

• □Part A: S 4.1 Contribute to a scholarly investigation or the dissemination of research findings on the prevention and management of delirium

Professional

• □Part A: P 3.1 Adhere to professional and ethical codes, standards of practice, and laws governing practice
• □Part B: P 3.1 Adhere to professional and ethical codes, standards of practice, and laws governing practice

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

Mental health condition

1. ●depression
2. ●anxiety
3. ●sleep disorder
4. ●delusional disorder
5. ●other

Setting

1. ●geriatric psychiatry
2. ●outpatient clinic
3. ●geriatric unit
4. ●inpatient consult
5. ●day hospital
6. ●other

Supervisor role

1. ●geriatrician
2. ●psychiatrist
3. ●care of the elderly physician

Medical Expert

• □Part A: ME 1.4 Perform clinical assessments that identify suicidal and homicidal risk
• □Part A: ME 2.2 Elicit a history, and interpret the results for the purpose of diagnosis and management of uncomplicated mental health conditions
• □Part A: ME 2.2 Synthesize patient information to recognize potential organic conditions contributing to the disorder
• □Part A: ME 3.1 Describe indications, contraindications, risks, and alternatives of pharmacological and non-pharmacological therapy
• □Part A: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional
• □Part B: ME 1.3 Apply clinical and biomedical sciences to the assessment and management of common uncomplicated mental health conditions in older adults
• □Part B: ME 2.4 Provide evidence-informed, patient-centred care of uncomplicated mental health conditions in the presence of medical co-morbidities
• □Part B: ME 4.1 Determine the need, timing and priority of referral to another physician and/or health care professional

Communicator

• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for patient and family understanding

Collaborator

• □Part B: COL 1.3 Use co-management and consultation as opportunities to improve quality of care and patient safety by sharing expertise
• □Part B: COL 1.3 Engage in respectful shared decision-making with other physicians and/or 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

Patient diagnosis

1. ●non-cancer diagnosis
2. ●major neurocognitive disorder
3. ●other

Supervisor

1. ●geriatrician
2. ●palliative care physician
3. ●care of the elderly physician
4. ●internist

Medical Expert

• □Part A: ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □Part A: ME 2.1 Identify patients whose condition has progressed to end stage
• □Part A: ME 2.1 Identify patients for whom the patient-perceived burden of disease- modifying therapy or investigations is greater than the clinical benefit
• □Part A: ME 2.2 Project the trajectory of illness and care needs
• □Part A: ME 2.2 Perform medication reviews
• □Part A: ME 2.2 Demonstrate optimal prescribing and deprescribing practices
• □Part A: ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease-modifying approach
• □Part A: ME 2.3 Establish goals of care in collaboration with the patient and family
• □Part A: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part A: ME 2.4 Establish a patient-centred management plan focused on implementing patient choices
• □Part A: ME 2.4 Develop and implement management plans that optimize symptom management and support achievement of the patient’s goals of care
• □Part A: ME 3.1 Determine the most appropriate pharmacological and non- pharmacological approaches to symptom control
• □Part A: ME 2.2 Select investigations and therapies appropriate to the patient’s goals of care

Communicator

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

Professional

• □Part A: P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice
• □Part A: P 3.1 Demonstrate knowledge and appropriate use of provincial laws governing practice as it pertains to medical assistance in dying (MAiD)
• □Part A: P 3.1 Demonstrate knowledge and appropriate use of provincial laws governing practice as it pertains to planning for future end-of-life care such as substitute decision makers, advanced directives, and preferred setting for end-of-life care, as applicable
• □Part B: P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice
• □Part B: P 3.1 Demonstrate knowledge and appropriate use of provincial laws governing practice as it pertains to medical assistance in dying (MAiD)
• □Part B: P 3.1 Demonstrate knowledge and appropriate use of provincial laws governing practice as it pertains to planning for future end-of-life care such as substitute decision makers, advanced directives, and preferred setting for end-of-life care, as applicable

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 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □Part A: ME 2.2 Identify patients with complex psychosocial issues
• □Part A: ME 1.4 Recognize urgent situations that may need the involvement of more experienced colleagues, team members and community resources
• □Part A: ME 2.2 Recognize patients at risk of elder abuse/neglect or safety issues, or legal and ethical issues in care planning, and report if appropriate
• □Part A: ME 2.4 Establish patient-centred management plans that demonstrate cultural competence, incorporating all of the patient’s health problems and needs, values and preferences

Communicator

• □Part A: COM 5.1 Document clinical encounters to adequately convey identified risks of elder abuse/neglect, safety issues and/or legal and ethical issues
• □Part A: COM 1.3 Reflect on how personal bias and cultural competence impacts care delivery
• □Part A: COM 1.3 Recognize when strong emotions such as anger, fear, anxiety, or sadness are impacting on interactions and respond appropriately with suggestions for future encounters

Health Advocate

• □Part A: HA 1.1 Identify the risk factors, consequences and potential interventions for social isolation and elder abuse/neglect
• □Part A: HA 1.1 Reflect on the determinants of health that affect access to health care and resources for older adult patients

Professional

• □Part A: P 3.1 Apply provincial laws governing practice as it pertains to consent, capacity, and elder abuse and neglect

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 meeting

1. ●family
2. ●team

Observer

1. ●geriatrician
2. ●care of the elderly physician
3. ●other supervising physician
4. ●other health professional

Family Meeting STACER

1. ●yes
2. ●no

Team Meeting STACER

1. ●yes
2. ●no

Simulation

1. ●yes
2. ●no

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 2.4 Establish management plans in patient encounters when there are significant disagreements about what is achievable

Communicator

• □COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care and modify the approach to the patient accordingly
• □COM 1.4 Manage own non-verbal communication skills in difficult situations
• □COM 1.5 Manage disagreements and emotionally charged conversations
• □COM 3.1 Communicate clearly with patients and others in the setting of ethical dilemmas
• □COM 3.2 Disclose patient safety incidents to the patient and family accurately and appropriately
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

Collaborator

• □COL 1.1 Establish and maintain healthy relationships with physicians and other colleagues in the health care professions to support relationship- centred collaborative care
• □COL 1.2 Negotiate overlapping and shared care responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □COL 2.1 Show respect toward collaborators
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture

Leader

• □L 3.1 Demonstrate leadership skills to enhance health care
• □L 4.1 Set priorities and manage time

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment
• □P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice
• □P 1.1 Lead initiatives that promote respectful work environments

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

Supervisor role

1. ●geriatrician
2. ●care of the elderly physician
3. ●psychiatrist
4. ●physiatrist
5. ●other

Scholar

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

Professional

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

Medical Expert

• □ME 1.5 Prioritize patients based on the urgency of clinical presentation
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands

Collaborator

• □COL 3.2 Demonstrate safe handover of care during patient transition out of the hospital setting

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities including clinical, administrative, supervisory, and teaching responsibilities
• □L 4.2 Describe remuneration models as they pertain to Geriatric Medicine

Scholar

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

Professional

• □P 1.1 Respond appropriately to feedback from patients, families and health care professionals
• □P 1.1 Exhibit appropriate professional behaviours
• □P 2.1 Demonstrate accountability to patients, society and profession by participating in ethical billing practices
• □P 4.1 Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Activity

1. ●case report
2. ●health promotion project
3. ●QI project
4. ●committee participation
5. ●policy review
6. ●advocacy activity
7. ●morbidity and mortality rounds
8. ●community teaching
9. ●other

Leader

• □L 1.1 Gather information for the purposes of quality assurance or improvement
• □L 1.1 Integrate existing standards for health care delivery with findings of data collection
• □L 1.1 Identify potential improvement opportunities
• □L 1.1 Identify the impact of human and system factors on health care delivery
• □L 3.1 Contribute to a health care change initiative
• □L 3.1 Demonstrate leadership skills to enhance health care

Health Advocate

• □HA 2.2 Improve clinical practice by applying a process of continuous quality improvement
• □HA 2.3 Contribute to a process to improve health in the community or older adult population

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 4.4 Perform data analysis

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice 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 4.2 Adjust educational experiences to gain competencies necessary for future practice

Health Advocate

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

Scholar

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

Case description

Feedback provided

Next steps