Hematology

Entrustment (how much supervision did this activity need?)

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

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform a physical examination that informs the diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Propose a preliminary management plan
• □ME 2.2 Synthesize clinical information for succinct presentation to a supervisor
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements

Communicator

• □COM 2.1 Use patient-centred interviewing skills

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. ●coagulopathy
2. ●severe cytopenia
3. ●febrile neutropenia
4. ●leukostasis
5. ●MAHA
6. ●spinal cord compression
7. ●tumour lysis
8. ●other

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop and implement a plan for initial management

Collaborator

• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals

Leader

• □L 2.1 Apply knowledge of local protocols and resources

Professional

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

Observation

1. ●direct
2. ●indirect

Presentation

1. ●coagulopathy
2. ●thromboembolic disorder
3. ●lymphadenopathy
4. ●cytosis
5. ●cytopenia
6. ●monoclonal gammopathy

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department

Medical Expert

• □ME 2.2 Elicit a history relevant to the presentation
• □ME 2.2 Perform a physical examination that informs the diagnosis
• □ME 2.2 Identify the clinical significance of diagnostic findings
• □ME 2.2 Select additional investigations, as appropriate
• □ME 2.2 Develop a differential and most probable diagnosis
• □ME 2.4 Develop and implement a management plan

Communicator

• □COM 3.1 Convey information about the patient’s condition and plan for management clearly and compassionately
• □COM 5.1 Document the clinical encounter to convey the clinical assessment and rationale for decisions/recommendations

Case description

Feedback provided

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Entrustment (how much supervision did this activity need?)

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

Presentation

1. ●benign
2. ●malignant

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Synthesize patient information to determine clinical status, response to treatment and/or toxicity
• □ME 2.3 Integrate the patient’s and family’s perspective and context into the care plan
• □ME 2.4 Develop and implement a management plan
• □ME 2.4 Modify or adjust current therapy, as needed
• □ME 4.1 Determine the need and timing of referral to another physician
• □ME 4.1 Implement a plan for ongoing care, follow-up on investigations, and monitoring of response to treatment and/or disease progression

Collaborator

• □COL 3.1 Determine when care should be transferred back to a primary care provider
• □COL 3.2 Summarize the patient's issues, including plans to deal with ongoing issues

Case description

Feedback provided

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Entrustment (how much supervision did this activity need?)

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

Presentation

1. ●immune cytopenia
2. ●leukemia
3. ●lymphoproliferative disorder
4. ●myelodysplasia
5. ●myeloproliferative neoplasm
6. ●plasma cell dyscrasia
7. ●other

Medical Expert

• □ME 1.3 Apply knowledge of conventional systemic therapy, including pharmacology, expected adverse events and their prevention/management
• □ME 2.2 Assess a patient’s suitability to proceed with systemic therapy
• □ME 2.4 Select and prescribe the standard dose and regimen
• □ME 2.4 Implement appropriate monitoring strategies
• □ME 2.4 Select and prescribe supportive care to optimize patient comfort and mitigate adverse effects
• □ME 5.2 Follow standard procedures when ordering and/or administering systemic therapy

Collaborator

• □COL 1.2 Work effectively with pharmacists and nurses

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

Morphology

1. ●normal peripheral blood film
2. ●acute promyelocytic leukemia
3. ●leukemic blasts
4. ●schistocytes
5. ●severe thrombocytopenia
6. ●sickle cells
7. ●spherocytes

Medical Expert

• □ME 1.3 Apply knowledge of peripheral blood morphology
• □ME 2.2 Perform a morphologic assessment and recognize critical findings
• □ME 2.2 Formulate a differential diagnosis based on the morphologic assessment
• □ME 2.4 Provide suggestions for further testing and/or management as relevant

Communicator

• □COM 5.1 Communicate critical results urgently, 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

Medical Expert

• □ME 3.1 Determine the safety and appropriateness of the procedure
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
• □ME 3.4 Demonstrate effective procedure preparation
• □ME 3.4 Prepare to obtain and handle samples, sending for appropriate testing
• □ME 3.4 Set up and position the patient for the procedure
• □ME 3.4 Perform bone marrow aspirate and/or biopsy in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Demonstrate safe handling of instruments and biologic samples
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Document the procedure, including quality of specimen obtained and the presence/absence of complications

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Implement emergency care protocols or therapy for emergencies related to hematologic or oncologic conditions or their treatment

Communicator

• □COM 5.1 Document the clinical encounter to convey the outcome and rationale for clinical recommendations/decisions

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians

Professional

• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

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

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
• □ME 2.3 Establish goals of care with the patient and family
• □ME 2.2 Identify whether the case warrants discussion at multidisciplinary case conference
• □ME 2.4 Develop and implement a management plan
• □ME 4.1 Coordinate treatment and follow-up plans

Communicator

• □COM 3.1 Convey information about the patient’s condition and plan for management clearly and compassionately

Collaborator

• □COL 1.2 Work effectively with members of the interprofessional team to implement a management plan

Leader

• □L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options

Health Advocate

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

Scholar

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

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

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Synthesize patient information to determine treatment adherence, clinical status and/or response to therapy
• □ME 2.4 Modify or adjust current therapy, as needed
• □ME 4.1 Implement a plan for ongoing care, follow-up on investigations, and monitoring of response to treatment and/or disease progression
• □ME 4.1 Determine the need and timing of referral to another physician

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 5.1 Document the clinical encounter to convey the clinical assessment and the rationale for decisions/recommendations

Leader

• □L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options

Health Advocate

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

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Presentation

1. ●immune cytopenia
2. ●leukemia
3. ●lymphoproliferative disorder
4. ●myelodysplasia
5. ●myeloproliferative neoplasm
6. ●plasma cell dyscrasia
7. ●other

Complex or rare disorder

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply knowledge of systemic therapy, including pharmacology, expected adverse events and their prevention/management
• □ME 2.2 Assess a patient’s suitability to proceed with systemic therapy
• □ME 2.4 Select and prescribe the appropriate dose and regimen
• □ME 2.4 Implement required adjustments in systemic therapy and/or supportive care based on patient's health status, performance status or co- morbidities
• □ME 2.4 Implement appropriate monitoring strategies
• □ME 2.4 Select and prescribe supportive care to optimize patient comfort and mitigate adverse effects

Collaborator

• □COL 1.2 Work effectively with pharmacists and nurses

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Determine the safety and appropriateness of the procedure
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
• □ME 3.4 Demonstrate effective procedure preparation, including patient identification and/or safety checklist as appropriate
• □ME 3.4 Perform lumbar puncture in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Verify and administer intrathecal medication
• □ME 3.4 Demonstrate safe handling of instruments, biologic samples and/or biohazardous material
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Document the procedure, including quality of specimen obtained and the presence/absence of complications

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Allogenic transplant

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Recognize when a patient may benefit from referral for HSCT or cellular therapy
• □ME 2.2 Plan and coordinate an appropriate diagnostic workup
• □ME 3.2 Describe a proposed therapy to the patient/family, including the rationale, possible toxicities, expected outcomes and alternative treatments

Communicator

• □COM 3.1 Convey information about the treatment options clearly and accurately
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions

Collaborator

• □COL 3.2 Organize the handover of care to the most appropriate physician
• □COL 1.3 Communicate effectively with the HSCT team

Health Advocate

• □HA 1.1 Identify barriers to access and care for individual patients

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

Complication

1. ●none
2. ●GVHD
3. ●infection
4. ●other late effect

Medical Expert

• □ME 1.3 Apply knowledge of HSCT and cellular therapy, and their toxicities and complications
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Perform a physical exam to detect evidence of GVHD
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement a plan for initial management
• □ME 2.4 Incorporate consultant recommendations to develop and implement a definitive management plan

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family

Collaborator

• □COL 1.3 Communicate effectively with the HSCT 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

Case mix

1. ●apheresis
2. ●indication and selection of blood component and fractionated blood product
3. ●transfusion emergency
4. ●transfusion reaction and/or complication

Medical Expert

• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 2.2 Determine the indications for transfusion therapy /apheresis
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 1.3 Apply knowledge of the therapeutic use of blood components and transfusion therapies
• □ME 2.2 Select the most appropriate blood product
• □ME 2.4 Provide advice regarding the sequence and/or timing of transfusion therapy

Communicator

• □COM 5.1 Document the encounter to convey clinical reasoning and rationale for recommendations

Collaborator

• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan

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

Testing

1. ●ABO typing/discrepancy
2. ●antibody mediated transfusion issue
3. ●positive direct antiglobulin test
4. ●red cell antibody panel

Medical Expert

• □ME 1.3 Apply knowledge of immunohematology, including major blood group systems and the role of the human leukocyte antigen (HLA) system
• □ME 1.3 Apply knowledge of common problems of blood-banking, including incompatible cross match, and auto- and alloimmune antibodies and their differentiation
• □ME 1.3 Apply knowledge of the principles of test methodology and instrumentation in a hematology laboratory
• □ME 2.2 Interpret laboratory testing to determine the compatibility of blood products
• □ME 2.2 Select ancillary testing, as required
• □ME 2.4 Establish the probable cause of an adverse reaction to blood product therapy, as applicable

Collaborator

• □COL 1.2 Work effectively with transfusion medicine laboratory team members

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 mix

1. ●red blood cell disorder
2. ●white blood cell disorder
3. ●platelet disorder
4. ●acute lymphoid neoplasm
5. ●chronic lymphoid neoplasm
6. ●acute myeloid neoplasm
7. ●chronic myeloid neoplasm
8. ●plasma cell disorder
9. ●infectious disease (e.g. malaria)

Specimen

1. ●blood film
2. ●bone marrow aspirate

Medical Expert

• □ME 1.3 Apply knowledge of peripheral blood morphology
• □ME 1.3 Apply knowledge of bone marrow anatomy and pathology
• □ME 2.2 Assess the quality of the sample and any impact on the diagnostic interpretation
• □ME 2.2 Perform a morphologic assessment of peripheral blood and/or bone marrow
• □ME 2.2 Formulate a differential diagnosis based on the morphologic assessment
• □ME 2.2 Select ancillary testing, as required
• □ME 2.2 Establish a diagnosis that takes into account clinical correlation

Communicator

• □COM 5.1 Formulate a clear, concise and accurate report in a timely fashion
• □COM 5.1 Communicate critical results urgently, as needed

Scholar

• □S 1.1 Identify and use resources for ongoing learning applicable to blood cell morphology

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

Testing

1. ●molecular
2. ●cytogenetics
3. ●flow cytometry
4. ●specialized coagulation testing
5. ●hemoglobinopathy investigation

Case mix

1. ●myeloid
2. ●lymphoid
3. ●other

Medical Expert

• □ME 1.3 Apply knowledge of the principles of test methodology and instrumentation in a hematology laboratory
• □ME 1.3 Apply knowledge in clinical and biomedical sciences relevant to interpretation of hematology laboratory findings
• □ME 1.3 Apply knowledge of laboratory quality assurance including pre-analytic errors, and sample quality
• □ME 2.2 Identify pre-analytic errors
• □ME 2.2 Assess the quality of the sample and any impact on the diagnostic interpretation
• □ME 2.2 Interpret investigations
• □ME 2.2 Select ancillary testing, as required
• □ME 2.2 Integrate information from ancillary studies and other sources

Communicator

• □COM 5.1 Convey critical or unexpected lab results in a timely 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

Discussion topic

1. ●new diagnosis
2. ●prognosis
3. ●treatment plan
4. ●end of life

Case mix

1. ●benign
2. ●malignant

Observation

1. ●direct
2. ●indirect

Difficult conversation

1. ●yes
2. ●no

Medical Expert

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

Communicator

• □COM 1.1 Demonstrate empathy, respect and compassion
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 3.1 Verify understanding of information conveyed
• □COM 4.3 Answer questions in a respectful manner
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 2.2 Summarize and close the encounter effectively
• □COM 5.1 Document the encounter to convey the discussion and its outcome

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 2.2 Synthesize cases for discussion at multidisciplinary rounds

Collaborator

• □COL 1.3 Convey information clearly
• □COL 1.3 Encourage discussion, questions, and interaction
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 2.2 Facilitate the development of consensus when there are differences in recommendations provided by other health care professionals

Health Advocate

• □HA 1.1 Recognize and respond to the patient’s individual needs and issues

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient service
2. ●consult service

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 and implement patient-centred management plans
• □ME 4.1 Formulate and implement plans for discharge that include appropriate ongoing care and follow up

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Select investigation strategies demonstrating awareness of availability and access in the outpatient setting
• □ME 2.4 Adjust management plans based on evolving clinical status and/or response to treatment
• □ME 2.4 Formulate treatment plans that are suitable for implementation in the outpatient setting
• □ME 1.5 Triage consultation requests based on clinical acuity

Collaborator

• □COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.1 Review and act on test results in a timely manner
• □L 4.2 Manage bookings to optimize clinic scheduling

Professional

• □P 1.1 Respond punctually to requests from patients or other health care professionals

Case description

Feedback provided

Next steps