Neonatal-Perinatal Medicine

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 1.4 Recognize one’s own limits and seek assistance as needed
• □ME 2.2 Provide assessment and initial stabilization as per established protocols
• □ME 1.3 Apply knowledge of established protocols for neonatal resuscitation
• □ME 3.4 Perform the sequence of neonatal resuscitation as per established protocols
• □ME 3.1 Integrate planned procedures or therapies into resuscitative efforts
• □ME 3.4 Perform bag/mask ventilation effectively when indicated

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals

Professional

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

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

Observation

1. ●assessment and management plan
2. ●admission note and orders

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history including pertinent antenatal, perinatal, and/or postnatal information
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 1.3 Apply knowledge of the indications, function, and limitation of biomedical devices used in the care of the infant
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Develop a management plan for common neonatal presentations
• □ME 2.2 Synthesize clinical information to formulate a summary of the case

Communicator

• □COM 3.1 Convey information to the family clearly and compassionately
• □COM 5.1 Document all relevant findings and investigations
• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Convey clinical reasoning and the rationale for decisions
• □COM 5.1 Document relevant patient care orders
• □COM 5.1 Complete clinical documentation 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

Medical Expert

• □ME 2.2 Synthesize clinical information to formulate a summary of the case
• □ME 1.4 Recognize one’s own limits and seek assistance as needed

Communicator

• □COM 1.1 Introduce oneself and explain one’s role in the interprofessional team
• □COM 1.1 Communicate using a patient-centered and family-integrated approach that facilitates trust and that is characterized by empathy, respect, and compassion
• □COM 3.1 Convey information about medical course and management plan clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 1.4 Identify, verify, and validate non-verbal cues on the part of the family and/or caregiver(s)
• □COM 3.1 Use strategies to verify and validate the understanding of the family and/or caregiver(s)

Professional

• □P 1.2 Ensure that family and/or caregiver(s) are informed about the diagnosis and plan 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

Setting

1. ●delivery room
2. ●NICU
3. ●other clinical setting
4. ●simulation

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 3.4 Perform the sequence of neonatal resuscitation as per established protocols
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess clinical status and re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 2.4 Manage non-invasive and/or invasive ventilation
• □ME 1.4 Recognize one’s own limits and seek assistance as needed

Collaborator

• □COL 1.3 Communicate with the health care team using clear language
• □COL 1.2 Use closed loop communication
• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.2 Seek and respond to input from other health care professionals
• □COL 1.2 Integrate the skills of other health care professionals in the resuscitation

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts, assuming the leadership role as appropriate

Professional

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

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 consult

1. ●antenatal
2. ●postnatal

Issue

1. ●prematurity > 27 weeks
2. ●maternal
3. ●neonate

Medical Expert

• □ME 2.2 Perform the history and physical exam in a timely manner, without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 1.3 Apply knowledge of normal and aberrant fetal physiology, growth, and development
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Develop and implement a management plan
• □ME 4.1 Determine the need and timing of follow-up

Communicator

• □COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information
• □COM 2.3 Identify other sources of information (e.g. family, medical record) that may assist in a patient’s care
• □COM 3.1 Convey information to the family clearly and compassionately
• □COM 4.3 Answer questions from the 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

Decision to transfer

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Assess the need and timing of transfer to another level of care
• □ME 2.4 Establish a plan for ongoing care in the local setting and/or for care prior to and during transfer
• □ME 2.4 Plan the logistics of transfer including stabilization and procedures to be done prior to transfer, equipment and personnel requirements, methods of monitoring and assessment during transport
• □ME 1.3 Apply knowledge of the indications, function, and limitation of biomedical devices used in the care of the infant
• □ME 2.4 Provide anticipatory guidance for management of changes in the patient’s clinical status during medical transport

Communicator

• □COM 2.3 Request and synthesize patient information gathered by another health professional
• □COM 5.1 Document telephone advice provided, and the care provided during transport

Collaborator

• □COL 1.3 Communicate with the health care team using clear language

Leader

• □L 2.1 Apply knowledge of the resources and/or services available in various care settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●delivery room
2. ●NICU
3. ●other clinical setting
4. ●simulation

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Position the patient appropriately
• □ME 3.4 Demonstrate aseptic technique: hand cleanse, gown and glove; skin preparation; draping; establishing and respecting the sterile field
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Handle sharps safely
• □ME 3.4 Perform procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the encounter to convey the procedure and 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

Presentation

1. ●cyanosis
2. ●extreme prematurity
3. ●cardiovascular instability
4. ●respiratory distress
5. ●abdominal wall defect
6. ●concerning abdominal conditions
7. ●neurocritical conditions
8. ●congenital anomalies
9. ●congenital diaphragmatic hernia

Medical Expert

• □ME 1.3 Apply knowledge of the indications, function, and limitation of biomedical devices used in the care of the infant
• □ME 2.1 Prioritize issues to address in the patient’s assessment and management
• □ME 2.2 Elicit an accurate, relevant history including pertinent antenatal, perinatal, and/or postnatal information
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 2.4 Develop and implement a management plan
• □ME 1.4 Recognize one’s own limits and seek assistance as needed
• □ME 4.1 Determine the need and timing of referral to other health care professionals

Communicator

• □COM 5.1 Document relevant information 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

Condition

1. ●respiratory distress
2. ●severe or persistent hypoglycemia
3. ●neonatal sepsis
4. ●severe hyperbilirubinemia
5. ●hypoxic-ischemic encephalopathy without multiorgan injury
6. ●seizures
7. ●common surgical disorder

Decision

1. ●escalation of care
2. ●de-escalation of care
3. ●no change to treatment plan
4. ●ready for transition to home or lower level of care

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage common patient presentations in Neonatal-Perinatal Medicine
• □ME 2.1 Iteratively establish priorities as the patient’s situation evolves
• □ME 1.4 Perform appropriate clinical assessments throughout the course of a patient’s illness
• □ME 2.2 Ascertain the patient’s clinical status and response to treatment
• □ME 2.4 Adapt management plans, as needed, in response to new findings or changing clinical circumstances
• □ME 2.4 Provide supportive care, including fluid management, pain and symptom management, and nutritional support as relevant
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Assess the need and timing of transfer to another level of care

Communicator

• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Health Advocate

• □HA 1.2 Promote positive neurodevelopmental care practices

Scholar

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

Professional

• □P 1.1 Respond punctually to requests from families or other health care providers

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

Participants at discussion

1. ●family
2. ●other health care professionals
3. ●others

Medical Expert

• □ME 2.3 Work with the patient’s family to establish goals of care

Communicator

• □COM 3.1 Convey information about medical course and management plan clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the family and/or caregiver(s)
• □COM 4.3 Use communication skills and strategies that help the family make informed decisions
• □COM 1.5 Recognize when emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 4.3 Answer questions regarding care delivery, treatment decisions, and/or prognosis in a respectful manner
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware

Collaborator

• □COL 1.2 Respect the roles and responsibilities of 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

Type of handover

1. ●morning handover
2. ●evening handover
3. ●transfer within hospital
4. ●transfer to other hospital
5. ●discharge home

Type of observation

1. ●direct
2. ●review of documentation

Medical Expert

• □ME 4.1 Establish plans for ongoing care, including follow-up on investigations and response to treatment
• □ME 5.2 Use structured communication tools and strategies to enhance patient safety

Collaborator

• □COL 3.2 Summarize patient issues providing rationale for key decisions
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □COL 3.2 Communicate with the receiving physician(s) or health care professional during transitions in care, clarifying issues 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

Teaching activity

1. ●clinical teaching and supervision
2. ●formal teaching presentation

Collaborator

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

Scholar

• □S 2.3 Provide opportunities for appropriate clinical responsibility
• □S 2.3 Supervise learners to ensure they work within their limits
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Present information in an organized manner to facilitate understanding
• □S 2.5 Provide feedback to enhance learning and performance
• □S 2.5 Provide specific suggestions for improvement of performance
• □S 2.4 Provide adequate time for questions and/or discussion

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Document

1. ●consultation
2. ●discharge summary
3. ●resuscitation/deterioration
4. ●difficult conversations
5. ●developmental or complex care follow-up

Medical Expert

• □ME 2.2 Synthesize clinical information to formulate a summary

Communicator

• □COM 5.1 Document all relevant findings and investigations
• □COM 5.1 Document resuscitative/stabilization efforts and the sequence of events, as applicable
• □COM 5.1 Provide a clear plan for ongoing management
• □COM 5.1 Convey clinical reasoning and the rationale for decisions
• □COM 5.1 Document relevant discussions with families and/or other health care providers, as applicable
• □COM 5.1 Organize information in a logical manner
• □COM 5.1 Complete clinical documentation 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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.4 Reassess clinical status and re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 2.4 Manage hemodynamic support and monitoring
• □ME 4.1 Ask for additional assistance and/or other services when indicated
• □ME 1.4 Act decisively and maintain control in critical situations
• □ME 2.2 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued
• □ME 5.2 Demonstrate situational awareness and cognitive flexibility

Collaborator

• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.2 Seek and respond to input from other health care professionals
• □COL 1.3 Convey the purpose of debriefing an event to the health care team
• □COL 1.3 Facilitate discussions within the health care team, ensuring everyone has the opportunity to participate

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts, assuming the leadership role as appropriate
• □L 1.2 Establish a safe environment for debriefing critical events
• □L 1.2 Encourage all members of the team to identify opportunities to improve patient care
• □L 1.1 Summarize debriefing discussions, identifying potential improvements in health care delivery

Scholar

• □S 2.5 Role model self-assessment and feedback seeking behaviour

Professional

• □P 4.3 Recognize, support, and respond effectively to colleagues in need 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

Issue

1. ●uncertain viability/diagnosis
2. ●complex surgical issue
3. ●complex medical issue
4. ●multidisciplinary antenatal consult
5. ●life limiting condition

Medical Expert

• □ME 1.3 Apply knowledge of normal and aberrant fetal physiology, growth, and development
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 3.1 Describe the indications, contraindications, risks and alternatives for a given procedure or therapy
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □ME 2.3 Address with the family their ideas about the nature and cause of the health problem, and their fears and concerns
• □ME 2.3 Work with the patient’s family to establish goals of care
• □ME 2.4 Develop and implement a management plan that aligns with the family’s goals of care

Communicator

• □COM 1.1 Develop trusting and supportive relationships with families in distress
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 1.5 Recognize when emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately

Health Advocate

• □HA 1.1 Assess a patient’s need for additional health services or resources

Scholar

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

Professional

• □P 1.3 Recognize and respond to ethical issues
• □P 4.1 Exhibit self-awareness, recognizing and managing the impact of end-of-life care on personal well-being and professional performance

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 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 1.3 Apply knowledge of the physiological implications of ground and air transport
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Establish a plan for ongoing care in the local setting and/or for care prior to and during transfer
• □ME 2.4 Plan the logistics of transfer including stabilization and procedures to be done prior to transfer, equipment and personnel requirements, methods of monitoring and assessment during transport
• □ME 2.4 Provide anticipatory guidance for management of changes in the patient’s clinical status during medical transport

Communicator

• □COM 5.1 Document telephone advice and the care provided during transport

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate with the health care team using clear language

Leader

• □L 2.1 Apply knowledge of the resources and/or services available in various care settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●delivery room
2. ●NICU
3. ●other clinical setting
4. ●simulation

Medical Expert

• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Position the patient appropriately
• □ME 3.4 Demonstrate aseptic technique: hand cleanse, gown and glove; skin preparation; draping; establishing and respecting the sterile field
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Handle sharps safely
• □ME 3.4 Perform procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the encounter to convey the procedure and 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

Category

1. ●respiratory
2. ●cardiac
3. ●extreme preterm
4. ●surgical
5. ●technology-dependent
6. ●multisystem
7. ●other category

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage patient presentations in Neonatal- Perinatal Medicine
• □ME 2.1 Iteratively establish priorities as the patient’s situation evolves
• □ME 1.4 Perform appropriate clinical assessments throughout the course of a patient’s illness
• □ME 2.2 Ascertain the patient’s clinical status and response to treatment
• □ME 2.4 Provide supportive care, including fluid management, pain and symptom management, and nutritional support as relevant
• □ME 2.3 Work with the patient’s family to establish goals of care
• □ME 2.4 Develop plans to monitor the evolution of the clinical course and/or the patient’s response to treatment
• □ME 2.4 Adapt management plans, as needed, in response to new findings or changing clinical circumstances
• □ME 3.1 Integrate planned procedures and/or therapies into the overall plan of care
• □ME 2.4 Manage issues related to a gastrostomy, ostomy, and/or tracheostomy
• □ME 2.4 Troubleshoot biomedical devices used for monitoring and/or treatment
• □ME 4.1 Coordinate investigation, treatment, and follow-up when multiple physicians and health care professionals are involved
• □ME 4.1 Determine the need and timing of referral to other health care professionals
• □ME 2.4 Assess the need and timing of transfer to another level of care

Communicator

• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions
• □COM 3.1 Convey information to the family clearly and compassionately

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with physicians and colleagues in other health care professions

Leader

• □L 2.1 Consider costs when choosing diagnostic and/or treatment options

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 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 2.4 Anticipate, prevent, and manage changes in health status at the time of transition
• □ME 4.1 Establish plans for ongoing care, including follow-up on investigations and response to treatment

Communicator

• □COM 3.1 Convey information to the family regarding the patient’s care needs, discharge plan, and anticipatory guidance
• □COM 4.3 Answer questions from the family

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.2 Organize handover to the accepting physician
• □COL 3.2 Summarize patient issues providing rationale for key decisions
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management

Leader

• □L 2.1 Apply knowledge of the resources and/or services available in various care settings

Health Advocate

• □HA 1.1 Work with other health care professionals to address barriers to access to resources and services
• □HA 1.2 Select family education resources related to neonatal-perinatal care

Professional

• □P 1.1 Keep the family informed of changes in health status, treatment plan, and/or setting 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

Type of discussion

1. ●end of life
2. ●complex decision
3. ●other

Source of information

1. ●direct observation
2. ●family feedback
3. ●other physician
4. ●other health care professional
5. ●other source

Medical Expert

• □ME 2.3 Work with the patient’s family to establish goals of care
• □ME 2.4 Develop and implement a management plan that aligns with the family’s goals of care

Communicator

• □COM 1.1 Develop trusting and supportive relationships with families in distress
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the family and/or caregiver(s)
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 1.5 Recognize when emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions

Health Advocate

• □HA 1.1 Facilitate access to bereavement support for a patient’s family, as appropriate

Professional

• □P 1.3 Recognize and respond to ethical issues
• □P 4.1 Exhibit self-awareness, recognizing and managing the impact of end-of-life care on personal well-being and professional performance

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 3.1 Integrate planned procedures and/or therapies into the overall plan of care
• □ME 5.2 Track and follow-up on clinical data such as investigations and laboratory tests

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations

Collaborator

• □COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □COL 1.3 Communicate effectively with other health care professionals
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care 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
• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.2 Run the service efficiently, safely, and effectively

Scholar

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

Professional

• □P 1.1 Demonstrate professional behaviours, including punctuality, integrity, and compassion

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 5.1 Identify a patient safety incident in a timely manner
• □ME 5.1 Incorporate, as appropriate, into a differential diagnosis, harm from health care delivery
• □ME 2.2 Select and/or interpret investigations
• □ME 5.1 Mitigate further injury from adverse events, as appropriate
• □ME 2.4 Develop and implement a management plan
• □ME 5.1 Document harmful patient safety incidents as per institutional processes
• □ME 5.1 Identify potential improvement opportunities arising from harmful safety incidents and near misses

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and disclose patient safety incidents
• □COM 4.3 Answer questions from the 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

Medical Expert

• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 4.1 Coordinate the involvement of consulting services in patient care

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware

Collaborator

• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care when there are differences in opinion and/or recommendations

Leader

• □L 4.1 Manage time and prioritize tasks
• □L 2.1 Allocate health care resources for optimal patient care
• □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 4.1 Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps