Gynecologic Reproductive Endocrinology and Infertility

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

Context

1. ●embryo transfer
2. ●other

Medical Expert

• □ME 3.2 Verify patient identity and consent
• □ME 3.4 Adjust instrument settings to optimize image quality
• □ME 3.4 Obtain standard views
• □ME 3.4 Verify appropriate reprocessing of ultrasound equipment after use

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort and privacy
• □COM 3.1 Communicate effectively with the patient during the procedure
• □COM 5.1 Record high-quality images of ultrasound findings

Professional

• □P 1.1 Work within personal limits, asking for assistance 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 observation

1. ●direct
2. ●case review

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Interpret the findings of the history, physical examination, and prior investigations in light of the clinical question
• □ME 2.4 Propose a management plan, including selecting appropriate investigations
• □ME 2.2 Synthesize and organize clinical information for succinct presentation to a supervisor

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 3.1 Provide preconception counselling

Professional

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

Finding

1. ●normal pelvis
2. ●pelvic pathology
3. ●normal first trimester
4. ●abnormal first trimester
5. ●stimulated ovary

Medical Expert

• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 3.4 Adjust instrument settings to optimize image quality
• □ME 3.4 Use a systematic approach in performing ultrasonography
• □ME 3.4 Obtain standard views
• □ME 3.4 Adapt the examination, as needed, based on findings during the procedure
• □ME 3.4 Identify all major and minor findings

Communicator

• □COM 5.1 Record high-quality images of ultrasound findings
• □COM 3.1 Convey the findings to the patient clearly and compassionately

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

Etiology

1. ●ovulatory dysfunction
2. ●sperm factor
3. ●tubal and/or uterine
4. ●other

Medical Expert

• □ME 2.2 Elicit a history relevant to the presentation and perform a physical exam if appropriate
• □ME 2.2 Interpret previous investigations
• □ME 2.2 Integrate the clinical data to formulate a differential and most likely diagnosis
• □ME 2.4 Develop a management plan

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 3.1 Provide preconception counselling
• □COM 3.1 Provide information to the patient about the condition and options for management
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 5.1 Document the clinical encounter to convey the clinical assessment and rationale for decisions/recommendations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complexity

1. ●easy
2. ●difficult

Medical Expert

• □ME 3.4 Prepare for the procedure: review the patient’s chart; confirm patient and sample identity
• □ME 3.2 Explain the procedure to the patient and confirm verbal consent to proceed
• □ME 3.4 Perform the procedure in a skilful and safe manner, adapting to unanticipated findings or challenging/changing clinical circumstances
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the procedure and its outcome

Collaborator

• □COL 1.2 Communicate effectively with the patient and/or assistant during the procedure

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

Context

1. ●journal club
2. ●division or departmental rounds
3. ●chart review meeting
4. ●conference
5. ●scholarly project
6. ●quality assurance project
7. ●practice review

Scholar

• □S 3.2 Identify and select relevant high-quality articles pertinent to the topic or field
• □S 3.3 Assess the level of evidence quality including internal/external validity and source(s) of bias
• □S 3.1 Identify remaining gaps in knowledge and questions for further investigation
• □S 3.4 Integrate best evidence and clinical expertise
• □S 3.3 Interpret study findings and critique their relevance to clinical practice
• □S 2.4 Present information in an organized and clear manner

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

Finding

1. ●pelvic pathology
2. ●normal first trimester
3. ●abnormal first trimester

Medical Expert

• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 3.4 Assess image adequacy
• □ME 2.2 Integrate findings with the clinical information and prior imaging studies
• □ME 3.4 Provide interpretation of gynecologic and first trimester obstetric ultrasound

Communicator

• □COM 5.1 Provide a clear, concise, and accurate report
• □COM 5.1 Report critical findings in a timely manner

Collaborator

• □COL 1.2 Work effectively with sonographers and other health professionals, as relevant, to optimize the imaging examination

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

Technique

1. ●HSG
2. ●saline infusion

Medical Expert

• □ME 3.4 Prepare for the procedure: review the chart; anticipate potential findings; determine the need for premedication
• □ME 3.4 Prepare for the procedure: check equipment and patient positioning
• □ME 3.4 Perform catheter insertion, verify position, and infuse appropriate media
• □ME 3.4 Acquire high-quality images and all relevant views
• □ME 3.4 Adapt the examination, as needed, based on findings during the procedure
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Provide post-procedural counselling and instructions, including the need for antibiotic prophylaxis

Communicator

• □COM 3.2 Explain the procedure to the patient and confirm verbal consent to proceed
• □COM 5.1 Provide a clear, concise, and accurate report

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. ●endocrine conditions
2. ●fertility preservation/transgender care
3. ●heritable conditions/PGT
4. ●ovulatory dysfunction
5. ●recurrent pregnancy loss
6. ●sperm factor
7. ●third-party reproduction
8. ●tubal/uterine factor

Patient demographic

1. ●adult
2. ●pediatric

Medical Expert

• □ME 2.2 Gather all relevant information
• □ME 2.2 Interpret previous investigations
• □ME 2.2 Integrate the clinical data to establish a diagnosis
• □ME 2.3 Establish goals of care with the patient
• □ME 2.4 Develop a patient-centred plan for management, which may include additional investigations or procedures
• □ME 3.2 Obtain and document informed consent for further investigations or procedures

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 3.1 Provide information to the patient about the condition and options for management

Health Advocate

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

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●non-hospital surgical facility
2. ●other

Medical Expert

• □ME 3.4 Complete the pre-procedural anesthetic assessment
• □ME 3.1 Determine the most appropriate plan for pain management/sedation
• □ME 5.2 Select and apply monitoring strategies
• □ME 3.4 Provide procedural pain management/sedation in a skilful and safe manner
• □ME 3.4 Recognize and respond to a complication or adverse event

Communicator

• □COM 5.1 Ensure proper documentation of sedation and monitoring during the procedure

Collaborator

• □COL 1.2 Communicate effectively with the patient and team during the procedure

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

Features

1. ●good prognosis
2. ●medically indicated fertility preservation
3. ●significant comorbidities
4. ●PCOS
5. ●PGT-M/PGT-SR
6. ●poor prognosis/repeat IVF
7. ●third-party IVF

Medical Expert

• □ME 2.2 Review and integrate the clinical information about the patient’s case
• □ME 2.2 Select an ART treatment plan suitable for the patient’s health status and reproductive goals
• □ME 3.2 Describe the management options to the patient, including the rationale, risks and side effects, expected outcomes, alternative treatments, and associated costs

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient make an informed decision
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Health Advocate

• □HA 1.1 Facilitate the patient’s access to additional resources and treatment support

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. ●easy egg retrieval
2. ●difficult egg retrieval
3. ●easy embryo transfer
4. ●difficult embryo transfer

Medical Expert

• □ME 3.4 Prepare for the ART procedure: review the patient’s chart; confirm consent; confirm required equipment
• □ME 5.2 Participate in the pre-procedural time-out or safety checklist
• □ME 3.4 Perform the procedure in a skilful and safe manner, adapting to unanticipated findings or challenging/changing clinical circumstances
• □ME 3.4 Use ultrasound guidance effectively
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Recognize and respond to a complication or adverse event
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the procedure and its outcome

Collaborator

• □COL 1.2 Communicate effectively with the patient and team during the procedure

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

Context

1. ●OHSS (risk reduction, diagnosis, and/or management)
2. ●patient concern
3. ●unexpected treatment event

Medical Expert

• □ME 2.2 Recognize signs and symptoms of adverse effects of treatment
• □ME 2.2 Interpret the results of investigations performed to monitor the patient’s condition and/or treatment
• □ME 2.2 Synthesize patient information to determine clinical status, response to treatment, and/or adverse effects
• □ME 2.3 Integrate the patient’s perspective into the care plan
• □ME 2.4 Develop a plan for ongoing management, which may include modification of current therapy
• □ME 4.1 Coordinate treatment and follow-up plans

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●hysteroscopic lysis of adhesions/septum
2. ●hysteroscopic myomectomy
3. ●operative laparoscopy
4. ●other

Medical Expert

• □ME 3.4 Prepare for the surgical procedure: review relevant investigations and pre- operative assessments/consults
• □ME 5.2 Participate in the pre-procedural time-out or safety checklist
• □ME 1.3 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks, and means to avoid/overcome them
• □ME 3.4 Perform the key technical skills of the procedure
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgment, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

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

Collaborator

• □COL 1.2 Work effectively with the OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Ascertain participants’ understanding of the situation and the reason for the encounter

Communicator

• □COM 3.1 Provide information and explanations that are clear and accurate
• □COM 3.1 Verify understanding of information conveyed
• □COM 4.3 Listen effectively and reiterate patient concerns accurately
• □COM 4.1 Communicate in a manner that is empathetic, respectful, compassionate, non-judgmental, and culturally aware
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 2.2 Summarize and close the encounter effectively

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

Communicator

• □COM 5.1 Document all relevant findings and investigations
• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Provide a clear clinical impression and plan for ongoing management
• □COM 5.1 Convey clinical reasoning and the rationale for decisions
• □COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □COL 1.2 Identify the roles of the referring physician and the GREI subspecialist clearly in the ongoing management plan

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

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 that consider all relevant aspects of patient care

Communicator

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

Collaborator

• □COL 1.2 Work effectively and respectfully with the clinical team

Leader

• □L 4.1 Manage time effectively to maintain clinic flow
• □L 4.1 Review and act on results of investigations in a timely manner

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.1 Respond punctually to requests from patients or other health care professionals
• □P 1.1 Manage schedule and make arrangements for coverage by another physician when absent or unavailable
• □P 1.1 Work within personal limits, asking for assistance 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

Medical Expert

• □ME 1.5 Carry out professional duties in the face of multiple competing demands and conflicts
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.4 Develop plans for management, which may include modification of the current protocol and timing of egg retrieval and embryo transfer procedures
• □ME 4.1 Implement plans for ongoing care

Collaborator

• □COL 1.2 Work effectively with the interprofessional ART clinic team to address clinical and administrative issues

Leader

• □L 4.1 Manage time effectively to maintain clinic flow

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

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

Leader

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

Scholar

• □S 4.4 Generate a focused question for scholarly investigation
• □S 4.5 Evaluate the existing literature relevant to the scholarly project and summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.2 Apply ethical principles in research, quality improvement, or other scholarly work
• □S 4.4 Identify, consult, and collaborate with content experts and others in the conduct of scholarly work
• □S 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis and interpretation
• □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