Medical Oncology

Entrustment (how much supervision did this activity need?)

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

Type of interaction

1. ●consultation
2. ●follow-up visit

Type of observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 1.4 Perform a clinical assessment for a patient with cancer, including relevant psychosocial factors
• □ME 2.1 Recognize when an outpatient needs more urgent care
• □ME 1.6 Identify and seek assistance in situations that are complex, uncertain, ambiguous or new
• □ME 2.2 Assemble data pertinent to the patient’s visit, including but not limited to available laboratory, pathology, and medical imaging reports

Communicator

• □COM 5.1 Convey the clinical encounter to a supervisor

Collaborator

• □COL 2.1 Interact professionally with other health care professionals and staff in the outpatient clinic

Professional

• □P 1.1 Demonstrate punctuality

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 2.1 Ascertain the patient’s understanding of the reason for the consultation
• □Part A: ME 2.2 Perform a comprehensive clinical assessment (including performance status and goals of care)
• □Part A: ME 2.2 Interpret available investigations and ascertain which additional investigations/diagnostic tests are required to complete the assessment and allow formulation of a management plan
• □Part A: ME 2.2 Synthesize and interpret information from the clinical assessment and investigations to provide an impression
• □Part A: ME 2.2 Stage breast, colorectal, lung, and prostate cancers using the tumour, node, metastasis (TNM) system or other relevant classification system
• □Part A: ME 2.4 Develop an initial evidence-based management plan that is aligned with the patient’s goals of care
• □Part A: ME 2.4 Identify comorbidities and other factors that may impact management plan
• □Part A: ME 4.1 Identify and perform the steps required to initiate the management plan
• □Part A: ME 4.1 Provide recommendations for additional investigations and next steps in management and treatment
• □Part A: ME 1.3 Apply a broad base and depth of knowledge of the clinical and biomedical sciences as they apply to the development, diagnosis, and management of common cancers
• □Part B: ME 3.2 Demonstrate the hallmarks of informed consent

Communicator

• □Part A: COM 3.1 Provide effective explanations of the proposed goals of treatment and/or management
• □Part A: COM 3.1 Verify understanding of the information conveyed
• □Part A: COM 1.4 Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication with patients
• □Part A: COM 2.1 Use patient centred interviewing skills to elicit and address the patient’s understanding of their diagnosis and prognosis (including fears, concerns and expectations of health care professionals) 15 F COM 2.1Integrate and synthesize and present information about the patient’s beliefs, values, context, and expectations with biomedical and psychosocial information
• □Part A: COM 2.1 Explore the impact of the cancer diagnosis on the patient’s ability to achieve their own personal goals
• □Part B: COM 5.1 Document clinical encounters in an accurate, timely, and complete manner
• □Part B: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for evidence-based decisions and plans to deal with the ongoing issues

Collaborator

• □Part A: COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □Part B: COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care
• □Part B: COL 3.2 Summarize the patient’s issues in the dictated consultation note, including plans to deal with the ongoing issues

Leader

• □Part A: L 2.1 Recognize financial impact of diagnostic tests and treatments

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 2.2 Perform a focused, context-specific clinical assessment, including reassessing the patient’s performance status
• □Part A: ME 2.2 Select and interpret investigations to assess for tolerance of treatment and response to therapy
• □Part A: ME 2.2 Synthesize and interpret information from the clinical assessment and investigations and implement a management plan
• □Part A: ME 2.1 Ascertain and address the patient’s and/or the family’s understanding of the medical situation and reason for the encounter
• □Part A: ME 4.1 Identify acute, subacute, long-term and/or late effects from cancer diagnosis and/or therapeutic interventions, and initiate basic management plan
• □Part A: ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and health care professionals are involved
• □Part B: ME 3.2 Demonstrate the hallmarks of informed consent

Communicator

• □Part A: COM 2.1 Use patient-centred interviewing skills to effectively gather all relevant biomedical and psychosocial information
• □Part A: COM 2.2 Manage the flow of challenging patient encounters, including but not limited to those with angry and distressed individuals who are dealing with serious and difficult news
• □Part B: COM 5.1 Document clinical encounters in an accurate, timely, and complete manner
• □Part B: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning, the rationale for evidence-based decisions and plans to deal with the ongoing issues

Collaborator

• □Part A: COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □Part A: COL 1.1 Receive and appropriately respond to questions and input from other health care professionals
• □Part A: COL 1.2 Recognize when situations of shared or overlapping responsibility arise over the cancer care continuum
• □Part B: COL 3.2 Summarize the patient’s issues in the dictated discharge or transfer note, as applicable

Health Advocate

• □Part A: HA 1.3 Work with patients and families to identify opportunities for cancer 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

Cancer site

1. ●breast
2. ●lung
3. ●colorectal
4. ●prostate
5. ●other

Goal of management

1. ●adjuvant/curative
2. ●neoadjuvant
3. ●palliative

Type of order

1. ●new order
2. ●repeat order
3. ●modification for toxicity

Type of therapy (choose all that apply)

1. ●oral
2. ●IV
3. ●cytotoxic
4. ●hormonal
5. ●targeted
6. ●immunotherapy

Direct observation of consent process

1. ●yes
2. ●no

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge of the clinical and biomedical sciences as they apply to the development, diagnosis, and management of common cancers
• □ME 3.1 Describe the risks and benefits of the proposed systemic therapies (including acute, subacute, long-term and late toxicities from the selected agents)
• □ME 3.2 Obtain informed consent for the selected regimen
• □ME 3.5 Describe institutional standards for prescribing systemic therapies
• □ME 3.5 Direct delivery of systemic therapies
• □ME 4.1 Implement required adjustments in systemic therapy and/or supportive care
• □ME 5.1 Recognize the occurrence of patient safety incidents, including but not limited to prescription errors (such as wrong drug or dose)
• □ME 5.2 Regularly and systematically use strategies to enhance safe prescription of systemic therapies such as reference protocols from a provincial cancer agency, computerized order entry, or pre-printed orders
• □ME 3.5 Ensure accurate regimen and dose selection during prescribing process
• □ME 2.2 Ensure bloodwork and other appropriate diagnostic tests are adequate to proceed with selected regimen
• □ME 4.1 Arrange appropriate follow-up including but not limited to pre-therapy bloodwork, clinic visit, and systemic therapy appointment

Collaborator

• □COL 1.2 Respond to questions from pharmacists and nurses about systemic therapy and supportive care orders

Health Advocate

• □HA 1.1 Demonstrate an approach to working with patients to advocate for the health services or resources they need

Scholar

• □S 3.2 Select, navigate, and recognize limitations of pre-appraised resources, including but not limited to provincial drug formulary and regimen information, evidence-based guidelines, risk stratification tools, and nomograms

Professional

• □P 2.2 Adhere to institutional policies and procedures related to prescribing systemic 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

Disease context

1. ●unexpected adjuvant treatment recommendation
2. ●new diagnosis of incurable disease
3. ●progressive disease
4. ●therapy modification
5. ●other

Medical Expert

• □Part A: ME 2.1 Ascertain the patient’s and/or the family’s understanding of the medical situation and reason for the encounter
• □Part A: ME 2.4 Discuss the degree of uncertainty inherent to the clinical situation

Communicator

• □Part A: COM 1.6 Ascertain the patient’s desire for amount and detail of information
• □Part A: COM 3.1 Share information in a compassionate, patient-centred and accurate manner
• □Part A: COM 1.4 Identify, verify, and validate cues and respond with appropriate communication techniques to establish rapport
• □Part A: COM 1.1 Provide empathic responses, as appropriate
• □Part A: COM 3.1 Provide effective explanations for the proposed goals of treatment and/or management
• □Part A: COM 3.1 Verify understanding of information conveyed
• □Part A: COM 4.3 Engage the patient in shared decision-making regarding investigations and treatment options
• □Part A: COM 1.6 Assess how each patient’s personal story impacts their unique needs and preferences
• □Part A: COM 2.2 Manage the flow of the encounter
• □Part A: COM 2.2 Summarize and close the encounter effectively
• □Part B: COM 1.1 Listen to patient concerns
• □Part B: COM 3.1 Share information in a way that helps patients understand the medical situation
• □Part B: COM 4.3 Answer questions in a way that helps patient understand their options
• □Part B: COM 1.1 Help patients feel respected and safe
• □Part B: COM 3.1 Check that patients understand the next steps in their 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

Direct observation

1. ●yes
2. ●no

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.1 Recognize an urgent or emergent oncology situation and respond in a timely manner
• □ME 1.5 Prioritize multiple competing tasks
• □ME 2.4 Develop and implement a management plan aligned with the patient’s preferences and goals of care
• □ME 3.5 Manage the serious adverse events resulting from systemic therapy or complications of cancer

Collaborator

• □COL 1.3 Communicate with other healthcare professionals to advocate for the timely management of the patient with an urgent/emergent oncology problem
• □COL 3.1 Provide appropriate handover to other physicians or healthcare professionals, 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

Healthcare professional role

1. ●nurse
2. ●pharmacist
3. ●other

Medical Expert

• □Part A: ME 4.1 Coordinate investigation, treatment, and follow-up when multiple services are involved
• □Part B: ME 4.1 Coordinate investigation, treatment, and follow-up when multiple services are involved

Communicator

• □Part A: COM 5.1 Communicate and document orders and management plan effectively
• □Part B: COM 5.1 Communicate and document orders and management plan effectively

Collaborator

• □Part A: COL 1.2 Delegate or take primary responsibility when situations of shared or overlapping responsibility arise
• □Part A: COL 2.1 Recognize and respect the diversity of expertise among health care professionals
• □Part B: COL 1.1 Receive and appropriately respond to questions and input from other health care professionals
• □Part B: COL 1.2 Delegate or take primary responsibility when situations of shared or overlapping responsibility arise
• □Part B: COL 2.2 Manage differences, and resolve conflicts respectfully

Health Advocate

• □Part A: HA 1.1 Work with other health care providers to overcome barriers the patient may encounter in the health care system
• □Part B: HA 1.1 Work with other health care providers to overcome barriers the patient may encounter in the health care system

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

Goal of management

1. ●adjuvant
2. ●palliative
3. ●curative

Complexity

1. ●special population
2. ●lack of evidence or uncertainty
3. ●other

Type of observation

1. ●direct
2. ●indirect

Medical Expert

• □Part A: ME 1.3 Apply knowledge of the clinical and biomedical sciences to the diagnosis and management of the clinical problem
• □Part A: ME 1.3 Apply knowledge of clinical and biomedical sciences as they relate to the management of cancers that arise in special populations, including but not limited to immune suppressed, pregnant, and geriatric populations
• □Part A: ME 1.3 Apply knowledge of the natural history of cancers, including risk factors, incidence and prevalence, genetic predisposition, growth and dissemination patterns, and prognostic variables across the full range of cancer presentations
• □Part A: ME 1.4 Perform comprehensive clinical assessments of patients presenting with the full range of presentations in Medical Oncology
• □Part A: ME 1.6 Develop a plan that considers the complexity, uncertainty, and ambiguity inherent in the practice of Medical Oncology
• □Part A: ME 2.2 Synthesize and interpret investigations, and order additional investigations required to complete staging and provide additional information needed to make treatment decisions
• □Part A: ME 2.4 Develop and implement evidence-based and patient-centred management plans aligned with the goals of care
• □Part A: ME 3.3 Consider appropriate alternatives for therapies or diagnostic or therapeutic procedures based on available resources
• □Part A: ME 2.2 Identify patients that may be eligible for clinical trials
• □Part B: ME 3.2 Obtain and document informed consent for therapies and procedures, explaining the risks, benefits and rationale while acknowledging uncertainty

Communicator

• □Part A: COM 2.1 Explore the impact of the cancer diagnosis on the patient’s ability to achieve their own personal goals
• □Part A: COM 3.1 Convey information regarding diagnosis, prognosis, plan of care, change in clinical status, or uncertainty in a clear, compassionate, respectful, and accurate manner to the patient and family
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for evidence-based decisions
• □Part B: COM 5.1 Identify and correct vague or ambiguous documentation
• □Part B: COM 5.1 Document multidisciplinary case conference discussions in a summary report when appropriate
• □Part B: COM 5.1 Document and share information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy within the multi-disciplinary team

Collaborator

• □Part A: COL 1.2 Negotiate and clearly ascertain primary, overlapping, and shared responsibilities with physicians and other colleagues in the health care professions
• □Part B: COL 1.3 Provide timely and necessary written information to colleagues to enable effective relationship-centred care

Leader

• □Part A: L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Health Advocate

• □Part A: HA 1.1 Advocate effectively for individual patients to help them overcome barriers to accessing the most effective evidence-based therapies, and receive the health services they need to effectively treat their cancer
• □Part A: HA 1.3 Identify opportunities for fertility preservation
• □Part A: HA 1.3 Identify opportunities for testing for familial or hereditary disposition to cancer

Scholar

• □Part A: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □Part A: S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature
• □Part A: S 3.4 Recognize when the best available evidence is limited or of poor quality and develop a strategy to deal with it, including but not limited to determining optimal treatments for rare tumors or under-represented populations

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 1.4 Make recommendations that are evidence based, organized and aligned with existing or revised goals of care
• □Part A: ME 3.2 Obtain and document informed consent for therapies and procedures, explaining the risks, benefits, and rationale while acknowledging uncertainty
• □Part A: ME 4.1 Perform clinical assessment including addressing toxicities from therapeutic interventions (acute, subacute, long-term and/or late), symptoms related to cancer and response to therapy
• □Part A: ME 4.1 Identify and anticipate a patient’s upcoming care needs
• □Part A: ME 1.3 Apply knowledge of the clinical and biomedical sciences relevant to Medical Oncology
• □Part A: ME 2.1 Prioritize issues to be addressed in a patient encounter, including the patient’s context and preferences
• □Part A: ME 2.3 Establish goals of care in collaboration with patients and their families
• □Part A: ME 4.1 Implement a patient-centred, evidence-based management plan based on clinical assessment
• □Part A: ME 2.4 Consider and recommend appropriate and available clinical trials when assessing patients for change of therapy
• □Part B: ME 3.2 Obtain and document informed consent for therapies and procedures, explaining the risks, benefits, and rationale while acknowledging uncertainty

Communicator

• □Part A: 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
• □Part A: COM 1.5 Communicate using a patient-centred approach during challenging patient encounters, including when the proposed goals of care articulated by the patient or their family cannot be achieved
• □Part A: COM 3.1 Convey information regarding diagnosis, prognosis, plan of care, change in clinical status or uncertainty in a clear, compassionate, respectful and accurate manner to the patient and family
• □Part A: COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □Part A: COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non- judgmental, and culturally safe
• □Part B: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for evidence-based decisions
• □Part B: COM 5.1 Identify and correct vague or ambiguous documentation
• □Part B: COM 5.1 Document multidisciplinary case conference discussions in a summary report when appropriate
• □Part B: COM 5.1 Document and share information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality and privacy within the multi- disciplinary team

Collaborator

• □Part A: COL 1.2 Negotiate and clearly ascertain primary, overlapping, and shared responsibilities with physicians and their colleagues in the health care professions
• □Part A: COL 3.2 Demonstrate safe handover of care, both verbal and written, during patient transitions to a different health care professional, setting or stage of care
• □Part B: COL 1.3 Provide timely and necessary written information to colleagues to enable effective relationship-centred care
• □Part B: COL 3.2 Demonstrate safe handover of care, both verbal and written, during patient transitions to and from other members of the multi-disciplinary team

Health Advocate

• □Part A: HA 1.2 Work with the patient and family to increase opportunities to adopt healthy behaviours
• □Part A: HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients

Scholar

• □Part A: S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □Part A: S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature
• □Part A: S 4.1 Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health 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

• □Part A: ME 1.3 Apply a broad base and depth of knowledge of the clinical and biomedical sciences as they apply to the development, diagnosis, and management of all cancers
• □Part A: ME 3.1 Describe the risks and benefits of the systemic therapies, individually and collectively, in the selected regimen (including acute, subacute, long-term and late toxicities from the selected agents)
• □Part A: ME 3.2 Obtain informed consent for the selected regimen
• □Part A: ME 3.5 Describe institutional standards for prescribing systemic therapies
• □Part A: ME 3.5 Direct the delivery of systemic therapies
• □Part A: ME 4.1 Implement required initial adjustments in systemic therapy and/or supportive care based on patient's health status, performance status or co- morbidities
• □Part A: ME 4.1 Implement required adjustments in systemic therapy and/or supportive care based on evaluation of patient’s tolerance of treatment
• □Part A: ME 5.1 Recognize the occurrence of patient safety incidents, including but not limited to prescription errors (such as wrong drug or dose)
• □Part A: ME 5.2 Regularly and systematically use strategies to enhance safe prescription of systemic therapies such as reference protocols from a provincial cancer agency, computerized order entry, or pre-printed orders
• □Part A: ME 3.5 Ensure accurate regimen and dose selection during prescribing process
• □Part A: ME 2.2 Ensure bloodwork and other appropriate diagnostic tests are adequate to proceed with selected regimen
• □Part A: ME 4.1 Arrange appropriate follow-up including but not limited to pre-therapy bloodwork, clinic visit, and systemic therapy appointment

Communicator

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

Collaborator

• □Part B: COL 1.2 Respond to questions from pharmacists and nurses about systemic therapy and supportive care orders
• □Part B: COL 1.2 Collaborate with healthcare professionals to access prescribed medications
• □Part B: COL 1.3 Communicate management plan and level of urgency to other specialties appropriately
• □Part B: COL 2.1 Show respect towards other team members

Health Advocate

• □Part A: HA 1.1 Initiate a plan for the patient to access prescribed medications, if necessary
• □Part B: HA 1.1 Initiate a plan for the patient to access prescribed medications, if necessary

Scholar

• □Part A: S 3.2 Select, navigate, and recognize limitations of pre-appraised resources, including but not limited to provincial drug formulary and regimen information, evidence-based guidelines, risk stratification tools, and nomograms

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. ●outpatient
2. ●hospital
3. ●scheduled family meeting

Medical Expert

• □ME 2.1 Reassess patient’s priorities, information preferences and goals of care as the patient’s clinical situation evolves
• □ME 2.3 Share concerns about patient’s goals that may not be achievable and initiate discussion about addressing these concerns
• □ME 4.1 Establish and implement ongoing plans for care which include but are not limited to referral to: a family physician; pain and symptom management/palliative care; home care/community services ; psychological and spiritual support services

Communicator

• □COM 1.6 Explore and confirm the patient’s wishes regarding advanced care planning
• □COM 1.5 Respectfully discuss differences of opinion regarding discontinuation of direct anti-cancer therapy
• □COM 1.5 Convey complex or sensitive information regarding prognosis, plan of care, change in clinical status or uncertainty in a clear, compassionate, respectful, and accurate manner
• □COM 2.2 Manage the flow of challenging and emotionally charged patient encounters

Collaborator

• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

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

Goal of management

1. ●adjuvant
2. ●neoadjuvant
3. ●curative
4. ●palliative

Direct observation

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 4.1 Implement a patient-centred care, evidence-based management plan based on clinical assessment
• □Part A: ME 4.1 Refer patients to appropriate supportive care services
• □Part A: ME 3.3 Advocate for the timely implementation of a patient’s therapies and procedures based on urgency and available resources

Collaborator

• □Part A: COL 3.1 Ensure continuity of care when away or unavailable
• □Part B: COL 1.2 Respond to the concerns of other health care professionals regarding the patient’s management in a timely manner

Leader

• □Part B: L 4.1 Effectively manage clinical duties including clinic flow, prioritization of cases, and delegation of duties when appropriate

Health Advocate

• □Part A: HA 1.1 Advocate effectively for individual patients to help them overcome barriers to accessing the most effective evidence-based therapies, and receive the health services or resources they need to effectively treat their cancer

Professional

• □Part B: P 1.1 Behave in a professional and respectful manner towards staff and 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

Clinical problem

1. ●brain metastases
2. ●pain
3. ●other

Specialists involved

1. ●(choose all that apply): radiation oncologist
2. ●surgical oncologist
3. ●PSMPC (pain and symptom management palliative care) physician
4. ●interventional radiologist
5. ●other

Observation

1. ●direct observation of presentation at multidisciplinary rounds
2. ●indirect observation

Medical Expert

• □Part A: ME 2.2 Identify patients who should be discussed at multidisciplinary case conferences, prepare cases for presentation, and contribute medical expertise to the decision making process
• □Part A: ME 3.1 Describe the indications, contraindications, risks, benefits and alternatives for systemic therapies
• □Part A: ME 2.2 Evaluate a patient with suspected toxicity from combined modality treatment
• □Part A: ME 4.1 Implement an adjustment in systemic therapy and/or supportive care when necessary
• □Part A: ME 4.1 Assess a patient’s functional status after a local procedure/therapy and determine the appropriate time to start or resume systemic therapy
• □Part A: ME 5.1 Recognize and respond to patient safety incidents caused by errors in handover and transitions of care between oncology specialists

Communicator

• □Part A: COM 5.1 Document or summarize multidisciplinary case conference discussions
• □Part B: COM 5.1 Document and share information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy within the multi- disciplinary team

Collaborator

• □Part A: COL 1.3 Contribute to, and engage in respectful shared decision making at a multidisciplinary case conference meetings to establish a care plan
• □Part B: COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □Part B: COL 1.1 Solicit and respond to input from other members of the multidisciplinary team
• □Part B: COL 1.2 Negotiate, and clearly ascertain primary, overlapping, and shared responsibilities with other physicians and other colleagues in the health care professions
• □Part B: COL 1.3 Engage in respectful shared decision-making with the members of the multidisciplinary cancer care team
• □Part B: COL 2.2 Identify and manage communication barriers between members of the multi- disciplinary team
• □Part B: COL 2.2 Implement strategies to promote understanding, manage differences and resolve conflicts among collaborators
• □Part B: COL 3.2 Demonstrate safe handover of care both verbal and written, during patient transitions to and from other members of the multi-disciplinary team

Leader

• □Part A: L 1.1 Contribute to the improvement of health care delivery in teams 10 C HA 1.1Work with patients and their families to identify and facilitate their access to needed health services or resources required to complete the multidisciplinary treatment plan
• □Part B: L 4.2 Take on a leadership role of the multi-disciplinary team at the appropriate junctures

Scholar

• □Part A: S 3.4 Integrate best available evidence into the multi-disciplinary management plan

Professional

• □Part A: P 2.2 Identify situations when systemic issues compromise the safety of patients undergoing multi-disciplinary care
• □Part B: P 1.1 Exhibit appropriate professional behaviours and relationships as part of a multi- disciplinary team

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

Goal of management

1. ●curative
2. ●palliative

Advanced case of cancer

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.4 Develop and implement evidence-based and patient-centred management plans aligned with the goals of care
• □Part A: ME 4.1 Determine the necessity and appropriate timing of further investigations and/or consultations

Communicator

• □Part A: COM 4.3 Use appropriate communication skills and strategies that help patients and their families make informed decisions regarding their health
• □Part B: COM 4.3 Receive and respond to patient and family member concerns

Collaborator

• □Part A: COL 1.2 Communicate and collaborate with other health care services to facilitate patient care
• □Part A: COL 1.3 Effectively lead a multidisciplinary family meeting to establish a care plan
• □Part A: COL 3.2 Demonstrate safe handover of care, both verbal and written, during patient transitions to a different health care professional, setting or stage of care
• □Part B: COL 1.2 Respond to the concerns of other health care professionals regarding the patient’s management in a timely manner

Health Advocate

• □Part A: HA 1.1 Advocate for resources and services to facilitate patient care and discharge planning

Professional

• □Part B: P 1.1 Behave in a professional and respectful manner towards staff and 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

Medical Expert

• □ME 1.5 Triage patients referred to Medical Oncology
• □ME 1.5 Prioritize activities in the face of competing demands
• □ME 1.4 Provide on call services at staff/supervisory/consultant level

Leader

• □L 4.2 Apply knowledge of remuneration models to bill for services provided
• □L 4.2 Manage clinically related administrative duties including but not limited to lab work, insurance forms, follow up calls to patients, and calls or emails to consultants
• □L 4.2 Manage non-clinical administrative duties (including but not limited to committee work)

Case description

Feedback provided

Next steps