Medical Microbiology

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. ●history and physical examination
2. ●case summary and management plan

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to a supervisor
• □ME 2.2 Select appropriate investigations
• □ME 2.4 Propose a management plan

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, and privacy
• □COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in the patient’s care
• □COM 5.1 Document the clinical encounter using a structured approach

Professional

• □P 1.1 Recognize one's own limits and seek 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

Precautions

1. ●airborne
2. ●contact
3. ●droplet

Medical Expert

• □ME 2.2 Identify situations requiring the application of IPAC precautions
• □ME 1.3 Apply knowledge of clinical conditions associated with contact, droplet, and airborne precautions
• □ME 5.2 Follow procedures for IPAC, including handwashing and donning and doffing PPE

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

Sample type

1. ●blood
2. ●CSF
3. ●respiratory
4. ●urine
5. ●viral
6. ●other

Issue

1. ●test orders/requisitioning issue
2. ●sample issue

Setting

1. ●lab
2. ●simulation

Medical Expert

• □ME 3.1 Assess specimen quality, adequacy, and fit for the stated indication
• □ME 3.1 Apply acceptance and rejection criteria
• □ME 5.1 Resolve issues related to specimen misidentification
• □ME 3.2 Identify specimens that require urgent processing
• □ME 5.2 Apply safe practices in the laboratory to minimize occupational risk

Leader

• □L 1.1 Apply knowledge of the principles of quality assurance pertinent to laboratory medicine

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

Organism classification

1. ●GPC chains
2. ●GPC clusters
3. ●GPB
4. ●GNB
5. ●GNCB
6. ●other

Medical Expert

• □ME 1.3 Apply knowledge of how a light microscope works
• □ME 3.3 Perform basic microscope maintenance
• □ME 1.3 Apply knowledge of the taxonomy and appearance of microorganisms and cells
• □ME 3.3 Perform a Gram stain
• □ME 3.3 Perform microscopy
• □ME 3.4 Describe microorganism shape and staining and cell type

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

Methodology

1. ●culture
2. ●molecular
3. ●serologic
4. ●microscopic

Medical Expert

• □ME 2.2 Integrate and synthesize patient information to establish the clinical question
• □ME 1.3 Apply knowledge of the procedures for specimen collection and identification

Communicator

• □COM 2.3 Gather patient information from another health professional

Collaborator

• □COL 1.3 Provide advice to clinical colleagues regarding specimen procurement and handling
• □COL 1.3 Communicate effectively with other health 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

Sample type

1. ●blood
2. ●sputum
3. ●sterile fluid
4. ●tissue
5. ●vaginal
6. ●wound
7. ●other

Organism classification

1. ●GPC chains
2. ●GPC clusters
3. ●GNB
4. ●GNCB
5. ●GPB
6. ●other

Medical Expert

• □ME 3.3 Perform a Gram stain
• □ME 3.3 Perform microscopy
• □ME 3.3 Assess the quality of the preparation and any impact on the diagnostic interpretation
• □ME 3.3 Differentiate normal flora and contaminants from organisms of significance
• □ME 3.3 Characterize microorganisms and cellular elements based on Gram stain and morphology
• □ME 3.3 Apply screening scores and protocols as applicable
• □ME 3.4 Formulate a differential diagnosis and clinical interpretation based on the morphologic assessment
• □ME 3.4 Recognize when findings require urgent communication with the treating health care professional
• □ME 3.4 Recognize when findings require notification to IPAC or public health authorities

Communicator

• □COM 5.1 Provide a report of Gram stain findings

Case description

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Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of the principles of laboratory identification and speciation of microorganisms
• □ME 3.3 Perform standard stains for organism identification for common aerobic and anaerobic bacteria and yeasts
• □ME 3.3 Select culture media and incubation conditions
• □ME 3.3 Select and use standard identification techniques
• □ME 3.4 Interpret results of microorganism identification
• □ME 3.3 Determine the clinical significance of an organism
• □ME 3.3 Determine if there is a need for antimicrobial susceptibility testing
• □ME 3.4 Recognize when findings require urgent communication with the treating health care professional
• □ME 3.4 Recognize when findings require notification to IPAC or public health authorities

Communicator

• □COM 5.1 Provide reports of microorganism identification

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

Sample type

1. ●blood
2. ●sputum
3. ●sterile fluid
4. ●tissue
5. ●vaginal
6. ●wound
7. ●other

Age group

1. ●adult
2. ●pediatric
3. ●both

Organism classification

1. ●GNB
2. ●GPB
3. ●GPC
4. ●other bacteria of clinical significance

Methodology

1. ●automated methods
2. ●gradient diffusion
3. ●Kirby-Bauer
4. ●molecular methods
5. ●phenotypic methods
6. ●reference methods
7. ●other

Significance for IPAC

1. ●no
2. ●yes

Medical Expert

• □ME 3.3 Select appropriate reference methodology
• □ME 3.3 Perform antimicrobial susceptibility testing
• □ME 3.3 Select and use appropriate confirmatory testing as needed
• □ME 1.3 Apply knowledge of common intrinsic and acquired resistance patterns
• □ME 3.4 Interpret results of antimicrobial susceptibility testing
• □ME 3.4 Recognize when findings require notification to IPAC or public health authorities

Communicator

• □COM 5.1 Provide reports that follow a standardized format and approved guidelines and/or policies

Leader

• □L 2.2 Apply the principles of antimicrobial stewardship

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

Age group

1. ●adult
2. ●pediatric

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.2 Perform a history and physical exam relevant to the patient presentation, in a time-effective manner
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Develop and implement a plan for initial management
• □ME 2.4 Determine the appropriate disposition and/or setting for ongoing care

Collaborator

• □COL 1.3 Work effectively with the other health care professionals involved in the patient’s care

Professional

• □P 1.1 Work within personal limits, seeking 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

Age group

1. ●adult
2. ●pediatric

Category

1. ●infectious
2. ●non-infectious

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical exam relevant to the presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Develop a management plan
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to a supervisor

Communicator

• □COM 2.1 Use patient-centred interviewing skills
• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)

Collaborator

• □COL 1.2 Work effectively as a member of the clinical 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

Age group

1. ●adult
2. ●pediatric

Category

1. ●infectious
2. ●non-infectious

Medical Expert

• □ME 2.2 Gather clinical information to assess health status and symptoms
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Assess response to therapy, complications, and evolution of the clinical course
• □ME 2.4 Adapt the management plan to the clinical course
• □ME 1.6 Seek assistance as needed

Communicator

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

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan

Health Advocate

• □HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs

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. ●review of case

Age group

1. ●adult
2. ●pediatric

Setting

1. ●ICU
2. ●inpatient-medical
3. ●inpatient-surgical
4. ●outpatient
5. ●emergency department

System

1. ●cardiovascular
2. ●CNS
3. ●genital
4. ●GI
5. ●ophthalmic
6. ●osteoarticular
7. ●respiratory
8. ●skin and soft tissue
9. ●urinary
10. ●other (write in)

Medical Expert

• □ME 2.2 Apply infection control practices as appropriate to the clinical syndrome
• □ME 2.2 Gather a clinical history, including the patient’s risk factors for infectious disease
• □ME 2.2 Perform a physical exam relevant to the presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 1.3 Apply knowledge of the principles of antimicrobial stewardship
• □ME 2.4 Develop and implement a plan for initial management
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to a supervisor

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)

Collaborator

• □COL 1.2 Work effectively with the medical microbiology laboratory

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. ●ICU
2. ●inpatient-medical
3. ●inpatient-surgical
4. ●outpatient
5. ●emergency department

Issue

1. ●modify therapy based on incoming data and clinical response
2. ●management of complication or toxicity of therapy
3. ●sign-off of care with follow up as appropriate

Medical Expert

• □ME 2.2 Gather clinical information to assess health status and symptoms
• □ME 2.2 Assess response to therapy, complications, and evolution of the clinical course
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Adapt the management plan based on response to therapy, adverse effects, and/or results of therapeutic drug monitoring
• □ME 4.1 Provide recommendations for discharge and/or follow-up

Communicator

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

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.2 Work effectively with the consulting service and other health professionals

Health Advocate

• □HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs
• □HA 1.1 Facilitate access to needed health services and resources, e.g., outpatient antimicrobial therapy

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

Situation

1. ●diagnosis and treatment plan
2. ●discharge planning
3. ●counselling about adverse effects
4. ●other (write in)

Communicator

• □COM 3.1 Provide accurate information about the medical condition and plans for investigation and/or management
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 4.3 Answer questions from the patient and/or family
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware

Health Advocate

• □HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into interactions with patients

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. ●oral handover
2. ●written handover

Medical Expert

• □ME 5.2 Use structured communication tools and strategies to enhance patient safety

Collaborator

• □COL 3.2 Summarize and prioritize patient issues providing rationale for key decisions
• □COL 3.2 Provide anticipatory guidance for ongoing management, such as results of outstanding investigations and/or anticipated events/outcomes
• □COL 3.2 Clarify issues with the receiving physician(s), as needed
• □COL 1.3 Integrate the patient’s perspective and context into the care plan

Professional

• □P 1.1 Complete assigned responsibilities in a timely manner

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

Setting

1. ●clinical
2. ●laboratory

Collaborator

• □COL 1.2 Demonstrate an understanding of the scope and expertise of other health care professionals
• □COL 1.3 Communicate effectively with other health care professionals
• □COL 1.1 Respond appropriately to input from other health care professionals

Professional

• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities in a timely manner
• □P 1.1 Behave in a professional manner
• □P 1.1 Respond punctually to requests from patients or 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

Category

1. ●bacteria
2. ●fungus
3. ●mycobacteria
4. ●parasite
5. ●virus
6. ●other

Issue

1. ●critical results
2. ●immunocompromised host
3. ●laboratory resource utilization
4. ●serology
5. ●other

Age group

1. ●adult
2. ●pediatric

Medical Expert

• □ME 2.2 Integrate and synthesize patient information to establish the clinical question
• □ME 2.4 Develop a plan for investigation and/or management
• □ME 1.3 Apply knowledge of the principles of antimicrobial stewardship

Communicator

• □COM 2.3 Gather patient information from another health professional

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Provide advice regarding procurement and handling of specimens, interpretation of laboratory findings, and/or appropriate use of antimicrobial therapy
• □COL 1.3 Communicate effectively with other health professionals

Leader

• □L 2.2 Apply evidence-based best practices to microbiology utilization

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

Category

1. ●bacteria
2. ●fungus
3. ●mycobacteria
4. ●parasite
5. ●virus

Medical Expert

• □ME 1.3 Apply knowledge of the principles of laboratory identification and speciation of microorganisms
• □ME 3.3 Select and/or perform standard stains for organism identification
• □ME 3.3 Select culture media and incubation conditions
• □ME 3.3 Select and use standard identification techniques
• □ME 3.3 Select ancillary techniques in a resource-effective manner
• □ME 3.3 Determine if a specimen, isolate, or microorganism requires referral to a reference laboratory
• □ME 3.3 Determine the clinical significance of an organism
• □ME 3.3 Determine if there is a need for antimicrobial susceptibility testing
• □ME 3.4 Interpret results of microorganism identification
• □ME 3.4 Recognize when findings require notification to IPAC or public health authorities
• □ME 5.2 Apply biosafety and biosecurity measures in the laboratory

Communicator

• □COM 5.1 Provide reports of microorganism identification
• □COM 5.1 Document actions taken to communicate significant or unexpected findings

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

Category

1. ●bacteria
2. ●fungus
3. ●mycobacteria
4. ●virus
5. ●other

Medical Expert

• □ME 1.3 Apply knowledge of antimicrobial resistance patterns
• □ME 3.3 Direct the selection of antimicrobials for testing
• □ME 3.3 Select phenotypic and genotypic testing in a resource-effective manner
• □ME 3.3 Determine action plan on discordant, unusual, or unexpected results
• □ME 3.3 Determine if a specimen, isolate, or microorganism requires referral to a reference laboratory
• □ME 3.4 Interpret results of antimicrobial susceptibility testing
• □ME 3.4 Recognize when findings require notification to IPAC or public health authorities

Communicator

• □COM 5.1 Provide reports that follow a standardized format and approved guidelines and/or policies

Leader

• □L 2.2 Apply the principles of antimicrobial stewardship

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 Address pre-analytical, analytical, and post-analytical issues
• □ME 3.3 Select ancillary techniques in a resource-effective manner
• □ME 3.3 Determine if a specimen, isolate, or microorganism requires referral to a reference laboratory
• □ME 3.4 Interpret results of microorganism identification
• □ME 3.4 Interpret results of antimicrobial susceptibility testing
• □ME 5.2 Apply and adhere to quality management processes throughout the pre- analytic, analytic, and post-analytic phases

Collaborator

• □COL 1.2 Provide guidance and support to laboratory staff to assess and resolve diagnostic challenges
• □COL 1.2 Work effectively with laboratory staff
• □COL 2.1 Delegate tasks and responsibilities in a respectful manner
• □COL 1.3 Convey results to the treating health care professional, IPAC, or public health authorities as appropriate to the nature of the organism and urgency of the scenario

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.3 Identify “red flags” for biosafety
• □ME 5.2 Apply biosafety and biosecurity measures in the laboratory
• □ME 3.3 Determine if a specimen, isolate, or microorganism requires referral to a reference laboratory

Collaborator

• □COL 1.2 Work effectively with laboratory staff
• □COL 1.2 Provide guidance and support to laboratory staff to assess and resolve diagnostic challenges

Professional

• □P 3.1 Adhere to regulations governing the transport, storage, and disposal of infectious agents

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

NCE type

1. ●pre-analytic
2. ●analytic
3. ●post-analytic

Detailed assessment

1. ●no
2. ●yes

Medical Expert

• □ME 5.1 Recognize an event as a laboratory error or non-conforming event
• □ME 5.1 Prioritize the initial response to mitigate the impact on patient safety
• □ME 5.1 Identify what measures should be taken after an incident to contribute to process improvement
• □ME 5.1 Report laboratory errors and non-conforming events as per institutional processes

Communicator

• □COM 3.2 Identify circumstances where patient notification is required

Leader

• □L 1.1 Recommend preventive, remedial, and/or corrective actions

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 1.3 Work effectively with laboratory personnel and relevant stakeholders

Leader

• □L 3.1 Participate in the design of a test verification/validation protocol
• □L 3.1 Coordinate the performance of test verification/validation with laboratory personnel
• □L 3.1 Analyze results and determine acceptability criteria
• □L 3.1 Recommend for or against the adoption of a new test

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

SOP

1. ●review of existing SOP
2. ●creation of new SOP

Stage

1. ●pre-analytic
2. ●analytic
3. ●post-analytic

Collaborator

• □COL 1.3 Work effectively with laboratory personnel and relevant stakeholders

Leader

• □L 1.4 Review pertinent laboratory data to assess current practice
• □L 2.2 Determine cost differences between best practice and current practice
• □L 3.1 Determine the appropriate standard operating procedure or test algorithm
• □L 3.1 Document recommendations using the appropriate format
• □L 3.1 Identify the impact of a change in test methodology or availability and the stakeholders who may be affected by the change
• □L 3.1 Develop the communication strategy for a change in laboratory practice

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

Collaborator

• □COL 1.3 Work effectively with laboratory personnel and relevant stakeholders

Leader

• □L 1.4 Apply knowledge of the metrics and measurement systems used to track quality management, utilization, and safety activities
• □L 1.1 Review and analyze data to ascertain the quality of medical microbiology services
• □L 1.1 Identify variation/gaps between actual and targeted performance
• □L 1.1 Perform an analysis of the reason(s) for the gap in desired outcomes
• □L 1.1 Apply knowledge of process improvement methodologies
• □L 1.1 Recommend preventive, remedial, and/or corrective actions

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.2 Demonstrate a commitment to continuous quality improvement

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 Gather information about the clinical presentation
• □ME 2.2 Correlate the findings of investigation with the clinical presentation
• □ME 2.2 Determine the appropriateness of the antimicrobial regimen
• □ME 2.4 Provide recommendations for antimicrobial selection, including dose, route of administration, and duration of therapy
• □ME 2.4 Provide recommendations for de-escalation and monitoring of antimicrobial treatment

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals

Leader

• □L 2.2 Identify opportunities for antimicrobial stewardship

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. ●hospital
2. ●community
3. ●simulation

Resident role

1. ●declare outbreak
2. ●lab assessment (pathogen identification and typing)
3. ●epidemiological assessment

Medical Expert

• □ME 2.2 Gather information about the situation and determine if an outbreak is occurring
• □ME 2.2 Characterize the outbreak, both quantitatively and qualitatively
• □ME 2.2 Assess causality and degree of risk associated with exposure
• □ME 2.4 Develop a plan for control and prevention measures
• □ME 2.2 Advise on and select appropriate lab methodologies to support outbreak investigation
• □ME 2.4 Develop a plan for surveillance and monitoring

Collaborator

• □COL 1.3 Convey information to other health care professionals in a manner that enhances patient care and the work of the outbreak team/committee
• □COL 1.2 Work effectively with other members of the IPAC and outbreak team and with public health

Professional

• □P 3.1 Adhere to requirements for mandatory reporting

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

Exposure

1. ●viral - respiratory
2. ●viral – GI
3. ●mycobacteria
4. ●other

Medical Expert

• □ME 2.2 Gather and/or review clinical information related to the request for IPAC consultation
• □ME 2.2 Synthesize clinical information and results of investigations to develop an understanding of the clinical question
• □ME 2.4 Provide recommendations for pharmacologic and non-pharmacologic preventive interventions
• □ME 2.4 Provide recommendations for investigations or screening tests
• □ME 2.4 Provide recommendations for surveillance procedures

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals, and other stakeholders
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan

Professional

• □P 3.1 Adhere to requirements for mandatory reporting

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

Age group

1. ●adult
2. ●pediatric

Setting

1. ●ICU
2. ●inpatient – medical
3. ●inpatient – surgical
4. ●emergency department

Immunocompromised

1. ●no
2. ●yes

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Formulate a differential and most likely diagnosis
• □ME 2.2 Integrate information about the patient’s presentation, concurrent illnesses, and other factors that may impact the diagnosis or outcome
• □ME 2.4 Develop a management plan
• □ME 4.1 Develop a plan for follow-up

Collaborator

• □COL 1.3 Work effectively with the other health care professionals involved in the patient’s care

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

Issue

1. ●modify therapy based on incoming data and clinical response
2. ●management of complication or toxicity of therapy
3. ●sign-off or transfer of care with follow up as appropriate

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 its treatment
• □ME 2.2 Synthesize patient information to determine clinical status and response to treatment
• □ME 2.4 Adapt the management plan based on response to therapy, adverse effects, and/or results of therapeutic drug monitoring
• □ME 2.4 Provide recommendations for antimicrobial selection, including dose, route of administration, and duration of therapy
• □ME 4.1 Provide recommendations for discharge and/or follow-up

Communicator

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

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.2 Work effectively with the consulting service and other health professionals

Leader

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

Health Advocate

• □HA 1.1 Facilitate access to needed health services and resources, e.g., outpatient antimicrobial therapy
• □HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs

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

Type of visit

1. ●new consult
2. ●follow-up

System

1. ●cardiovascular
2. ●CNS
3. ●ENT
4. ●GI
5. ●intra-abdominal
6. ●ophthalmic
7. ●osteoarticular
8. ●respiratory
9. ●skin and soft tissue
10. ●STI
11. ●systemic/disseminated
12. ●urinary
13. ●other

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Integrate information about the patient’s presentation, concurrent illnesses, and other factors that may impact the diagnosis or outcome
• □ME 2.4 Develop a management plan
• □ME 4.1 Develop a plan for follow-up
• □ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

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

Collaborator

• □COL 1.3 Work effectively with the other health care professionals involved in the patient’s care

Leader

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

Health Advocate

• □HA 1.1 Facilitate access to needed health services and resources, e.g., outpatient antimicrobial therapy
• □HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs

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. ●immunocompromised (e.g., pre-immunosuppression, pre-transplant, splenectomy, other)
2. ●pre-exposure prophylaxis/harm reduction
3. ●post-exposure prophylaxis
4. ●pre-surgical
5. ●vaccine-related counselling
6. ●infant of HIV+ mother
7. ●pre- travel counselling

Direct observation of counselling

1. ●no
2. ●yes

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess individualized risk for acquisition of infectious disease
• □ME 2.4 Provide recommendations for immunization, prophylaxis, and/or harm reduction

Communicator

• □COM 1.3 Elicit the patient’s and/or family’s beliefs, concerns, and expectations for the clinical encounter
• □COM 3.1 Provide information and explanations that are clear and accurate
• □COM 4.3 Solicit and answer questions from the patient and/or family
• □COM 4.1 Obtain informed consent for procedures or vaccines
• □COM 1.1 Respect patient autonomy, privacy, and confidentiality

Health Advocate

• □HA 1.2 Provide education resources and facilitate services for the patient and/or family

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

Document

1. ●inpatient consultation
2. ●outpatient consultation
3. ●inpatient progress note
4. ●outpatient progress note
5. ●sign-off, discharge, or transfer note

Communicator

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

Collaborator

• □COL 1.2 Identify the roles of the referring physician and the medical microbiology consultant in the ongoing management plan
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □COL 2.1 Convey information thoughtfully and respectfully

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 1.3 Provide teaching points to improve quality of 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

Scholar

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

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 a commitment to high-quality health care services
• □ME 5.2 Apply and adhere to quality management processes throughout the pre-analytic, analytic, and post-analytic phases
• □ME 1.5 Carry out professional duties in the face of multiple competing demands

Collaborator

• □COL 1.2 Provide guidance and support to laboratory staff to assess and resolve diagnostic challenges
• □COL 1.2 Work effectively with peers, faculty members, laboratory staff, administrative personnel, and managers of technical staff
• □COL 1.3 Provide guidance and support for questions arising from clinical colleagues, IPAC, public health, or other stakeholders

Leader

• □L 3.1 Prioritize tasks in the laboratory to provide services in a timely manner
• □L 3.1 Adapt or develop solutions to address issues in service delivery, such as equipment malfunction and reagent shortfalls

Scholar

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

Professional

• □P 1.1 Work within personal limits, seeking 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 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role
• □ME 2.1 Triage referrals on the basis of clinical acuity
• □ME 2.4 Establish management plans that consider all relevant aspects of the patient’s care

Collaborator

• □COL 1.3 Communicate effectively with the consulting service
• □COL 2.2 Work effectively with other health care professionals when there are differences in opinion and/or recommendations

Leader

• □L 4.1 Manage time and prioritize tasks
• □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

Professional

• □P 1.1 Behave in a professional manner 10 L4.2 Run the service efficiently, safely, and 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

Collaborator

• □COL 1.3 Contribute medical microbiology expertise to the discussion
• □COL 1.3 Communicate effectively with other health care professionals
• □COL 1.3 Demonstrate respect for the opinions of other meeting participants

Leader

• □L 3.1 Summarize and clarify key points, discussions, and action items

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.2 Prepare for a meeting, reviewing its purpose, and any relevant background information
• □P 1.1 Behave in a professional manner

Case description

Feedback provided

Next steps