Nephrology (Adult)

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

Type of patient

1. ●CKD
2. ●ESKD
3. ●Transplant

Medical Expert

• □ME 2.2 Elicit a history and perform a relevant physical exam
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Focus the clinical encounter performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Develop and implement initial management plans
• □ME 5.2 Use cognitive aids, such as pre-printed orders or care paths

Communicator

• □COM 2.1 Use patient-centred interviewing skills to effectively gather all relevant information
• □COM 2.3 Seek and synthesize relevant information from other sources

Professional

• □P 1.1 Complete assigned responsibilities

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 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Apply emergency care protocols for Nephrology-specific patient emergencies
• □ME 5.2 Use cognitive aids, such as pre-printed orders or care paths

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals

Leader

• □L 2.1 Apply knowledge of local resources for optimal patient care

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of patient

1. ●pre-transplant kidneys
2. ●transplant

Likely etiology

1. ●pre-renal
2. ●post-renal
3. ●ATN
4. ●nephrotoxicity
5. ●GN
6. ●other

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Ascertain volume status
• □ME 2.2 Ascertain indications for urgent dialysis
• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Select additional investigations, as appropriate
• □ME 2.2 Identify patients who require renal biopsy
• □ME 2.3 Establish goals of care
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in renal disease
• □ME 2.4 Order fluids to optimize volume status and/or renal recovery
• □ME 4.1 Prevent and/or manage complications of kidney disease
• □ME 3.1 Identify indications, timing and suitable modality for initiation of renal replacement therapy

Communicator

• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●clinic

Presumptive diagnosis

1. ●hypertension
2. ●diabetes
3. ●glomerulonephritis
4. ●structural
5. ●hereditary
6. ●other

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Select additional investigations, as appropriate
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.2 Determine the severity and/or stage of the patient’s renal status and risk of progression
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in renal disease
• □ME 4.1 Prevent and/or manage complications of chronic kidney disease
• □ME 2.4 Prescribe strategies for renal protection
• □ME 3.1 Identify indications, timing and suitable modality for initiation of renal replacement therapy

Communicator

• □COM 3.1 Provide information to patients and families clearly and compassionately
• □COM 4.3 Answer questions from the patient and family about next steps

Health Advocate

• □HA 1.1 Work with patients to identify and implement strategies for health promotion and/or future options for vascular access, dialysis or transplantation

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. ●isolated proteinuria
2. ●hematuria or both

Urine microscopy done

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Interpret urine microscopy
• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Select additional investigations, as appropriate
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Identify patients who require renal biopsy
• □ME 3.2 Obtain informed consent for a renal biopsy, as indicated
• □ME 3.3 Triage procedures or therapy taking into account clinical urgency and potential for deterioration

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

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

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

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

Modality

1. ●hemodialysis
2. ●CAPD
3. ●CCPD

Type of orders

1. ●new chronic start
2. ●adjust chronic orders

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Ascertain volume status and determine dry weight/target weight for dialysis
• □ME 2.2 Synthesize patient information to determine dialysis adequacy
• □ME 1.3 Apply knowledge of mechanisms of fluid delivery, machine mechanics and membrane physiology as they relate to dialysis modalities
• □ME 3.4 Write dialysis orders for uncomplicated patients with ESKD, including all relevant components

Communicator

• □COM 5.1 Document dialysis prescriptions as per local standards and health records

Collaborator

• □COL 1.3 Communicate effectively with the dialysis team
• □COL 2.1 Show respect towards other members of the health care team

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

Stage of renal disease

1. ●chronic kidney disease
2. ●transplant
3. ●dialysis patient

Medical Expert

• □ME 1.4 Adapt the clinical assessment to the expectations and boundaries of the consultant role
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Ascertain indications for urgent dialysis
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in patients with renal disease
• □ME 3.4 Adjust dialysis prescriptions as appropriate for changing clinical circumstances

Communicator

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

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 2.2 Collaborate with colleagues in resolving conflicts

Professional

• □P 1.1 Exhibit appropriate professional behaviors

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 complications

1. ●infectious
2. ●non-infectious

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in renal disease
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

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

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 complication

1. ●infectious
2. ●non-infectious

Type of access

1. ●line
2. ●fistula
3. ●graft

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in renal disease
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □ME 5.2 Use cognitive aids, such as pre-printed orders or care paths

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.3 Communicate effectively with the dialysis team
• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 2.1 Show respect towards other members of the health care 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

Donor type

1. ●living donor
2. ●deceased donor

Medical Expert

• □ME 2.2 Focus the clinical encounter performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Ascertain indications for urgent dialysis
• □ME 2.2 Review and verify tissue typing and virtual or real time cross match results are available
• □ME 2.2 Determine a patient’s fitness for renal transplant surgery and immunosuppression
• □ME 2.4 Prescribe induction immunosuppression, as appropriate

Communicator

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

Collaborator

• □COL 1.3 Communicate effectively with physicians and 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

Resident case involvement

1. ●first 24 hours
2. ●post-op care
3. ●discharge

Medical Expert

• □ME 2.2 Assess post-operative status and progress
• □ME 2.2 Ascertain indications for urgent dialysis
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to transplantation and immunosuppression
• □ME 2.4 Prescribe induction immunosuppression, as appropriate
• □ME 2.4 Order fluids to optimize volume status and/or renal recovery
• □ME 4.1 Coordinate investigation, treatment and follow-up plans

Communicator

• □COM 3.1 Provide timely, accurate information and explanation to the patient and/or family
• □COM 3.1 Verify and validate the understanding of the patient and family with regards to the management and discharge plan

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 3.2 Summarize the patient’s issues in the discharge summary

Health Advocate

• □HA 1.2 Select patient education resources related to Nephrology

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

Timing post-transplant

1. ●first 3 months
2. ●after first 3 months

Medical Expert

• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.2 Identify patients who require a renal biopsy
• □ME 1.3 Apply knowledge of microbiology as it pertains to infectious complications of renal transplantation
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

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

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 3.1 Determine the appropriate site for line insertion
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Set up and position the patient for the procedure
• □ME 3.4 Prepare and cleanse the procedural site
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Perform the insertion of a central venous line, using ultrasound guidance as appropriate

Communicator

• □COM 5.1 Document the encounter to convey the procedure and outcome(s)

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 patient

1. ●pre-transplant kidneys
2. ●transplant

Biopsy

1. ●yes
2. ●no

RRT

1. ●yes
2. ●no

Immune-modulating therapy

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.2 Assess the indications for renal replacement therapy and modality
• □Part A: ME 2.2 Select additional investigations, including serology and renal biopsy if indicated
• □Part A: ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □Part A: ME 2.2 Synthesize clinical information to determine diagnosis and prognosis
• □Part A: ME 2.4 Establish a patient-centred management plan
• □Part A: ME 4.1 Implement a plan for ongoing care and response to treatment
• □Part B: ME 2.3 Establish goals of care which may include dialysis, immune- modulating therapy, supportive care and/or palliative care
• □Part B: ME 4.1 Establish plans for ongoing care, which may include monitoring, active treatment, renal replacement therapy and/or end of life care

Communicator

• □Part B: COM 1.6 Adapt communication to the unique needs and preferences of the patient
• □Part B: COM 2.2 Manage the flow of challenging patient encounters
• □Part B: COM 3.1 Provide information to patients and families clearly and compassionately
• □Part B: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Collaborator

• □Part A: COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Health Advocate

• □Part A: HA 1.1 Facilitate timely patient access to services and resources
• □Part B: HA 1.2 Recognize potential barriers such as illness, health literacy, cultural practice/belief and language skills

Scholar

• □Part A: 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

Indication

1. ●AKI
2. ●poisoning
3. ●metabolic disorder
4. ●other

Modality

1. ●Acute hemodialysis
2. ●SLED
3. ●CRRT
4. ●other

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Assess the indications for extracorporeal treatment
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 3.1 Ascertain the efficacy of extracorporeal treatment in the context of the patient’s presentation
• □ME 2.4 Provide and/or adjust extracorporeal treatment prescriptions
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □ME 4.1 Establish plans for monitoring the patient and treatment efficacy

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Leader

• □L 2.1 Demonstrate stewardship of acute dialysis resources

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. ●consult
2. ●follow-up

Medical Expert

• □Part A: ME 1.4 Perform clinical assessments that address all relevant issues
• □Part A: ME 2.1 Identify indications to investigate for secondary hypertension
• □Part A: ME 2.2 Interpret measures of blood pressure, including automated blood pressure monitoring
• □Part A: ME 2.2 Select and/or interpret appropriate investigations
• □Part A: ME 2.4 Establish a patient centered management plan
• □Part A: ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □Part A: ME 4.1 Implement a plan for ongoing care and response to treatment

Communicator

• □Part A: COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions
• □Part B: COM 2.1 Use patient-centered interviewing skills to effectively gather all relevant information
• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □Part B: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Collaborator

• □Part A: COL 3.2 Communicate with the patient’s primary care provider about the patient’s care

Health Advocate

• □Part B: HA 1.1 Identify barriers to access in the health care and social service system for individual patients
• □Part B: HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours
• □Part B: HA 1.2 Work with the patient to increase opportunities to adopt healthy behaviours

Scholar

• □Part A: 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. ●sodium abnormality
2. ●potassium abnormality
3. ●metabolic acid-base disorder
4. ●calcium abnormality
5. ●magnesium abnormality

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.1 Identify clinical emergencies and prioritize response
• □ME 1.3 Apply knowledge of the physiology and pathophysiology of regulation of acid-base, electrolyte and/or water homeostasis
• □ME 2.2 Perform focused clinical assessments
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Establish plans for monitoring the patient and treatment efficacy

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources
• □COM 4.3 Answer questions from the patient and family about next steps

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

Suitable to donate

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Interpret measures of renal function
• □ME 2.2 Assess the risk of transmissible disease
• □ME 2.2 Synthesize donor information to determine suitability for transplantation
• □ME 3.2 Obtain informed consent for living kidney donation

Communicator

• □COM 1.6 Assess a patient’s decision making capacity
• □COM 3.1 Share information and explanations that are clear and accurate, checking for patient understanding

Leader

• □L 2.2 Apply evidence and guidelines with respect to organ transplantation

Professional

• □P 1.3 Recognize and respond to ethical issues encountered in the clinical setting

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 donor

1. ●DNC
2. ●DCC
3. ●ECD
4. ●exceptional distribution

Decision

1. ●accept
2. ●decline

Medical Expert

• □ME 2.2 Gather relevant clinical information about the potential donor
• □ME 2.2 Interpret measures of renal function
• □ME 2.2 Request additional history or investigations, as appropriate
• □ME 2.2 Assess the risk of transmissible disease
• □ME 2.2 Synthesize donor information to determine suitability for transplantation

Leader

• □L 2.1 Use clinical judgment to make optimal use of finite resources, such as donor organs
• □L 2.2 Apply evidence and guidelines with respect to organ transplantation

Professional

• □P 1.3 Recognize and respond to ethical issues encountered in the clinical setting

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

Eligible for transplant

1. ●yes
2. ●not now
3. ●not at all

Medical Expert

• □ME 1.3 Apply knowledge of the risks and benefits of renal replacement therapy options
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Synthesize patient information to assess peri-operative risk
• □ME 2.2 Synthesize patient information to assess risk of immunosuppression
• □ME 2.2 Identify patient-specific clinical features that influence transplant eligibility and/or outcomes
• □ME 2.4 Develop management plans for transplantation and/or the waiting list
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 2.1 Use patient-centred interviewing skills to effectively gather all relevant information
• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □COM 5.1 Document clinical encounters to convey clinical reasoning and the rationale for decisions

Leader

• □L 2.2 Apply evidence and guidelines with respect to organ transplantation

Health Advocate

• □HA 2.3 Promote organ donation and access to renal transplantation

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 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.2 Identify patients who require a renal biopsy
• □ME 2.4 Establish a patient-centred management plan
• □ME 2.4 Prescribe and monitor immune modulating therapies
• □ME 4.1 Prevent and manage complications of immune modulating therapies
• □ME 4.1 Determine the necessity and timing of referral to another health care professional

Communicator

• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding

Collaborator

• □COL 1.3 Engage in respectful shared decision –making with other physicians and/or health care professionals

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 patient

1. ●pre-transplant kidneys
2. ●transplant

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and interpret the results of investigations performed to monitor treatment
• □ME 2.2 Synthesize patient information to determine response to treatment and/or toxicity
• □ME 2.2 Differentiate signs and symptoms of disease and/or disease progression from adverse effects of treatment
• □ME 2.4 Adjust management plans based on clinical status and/or response to treatment
• □ME 4.1 Prevent and manage complications of immune modulating therapies
• □ME 4.1 Determine the necessity and timing of referral to another health care professional
• □ME 4.1 Coordinate treatment and follow-up plans

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources
• □HA 1.3 Incorporate disease prevention, health promotion and health surveillance into patient interactions

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

Diagnosis

1. ●hypertension
2. ●diabetes
3. ●glomerulonephritis
4. ●PCKD, other structural
5. ●hereditary
6. ●other

Stage of CKD

1. ●2
2. ●3
3. ●4
4. ●5

Medical Expert

• □Part A: ME 1.4 Perform clinical assessments that address all relevant issues
• □Part A: ME 1.3 Apply knowledge of physiology and pathophysiology of renal dysfunction and its complications
• □Part A: ME 2.1 Prioritize which issues need to be addressed
• □Part A: ME 2.3 Establish goals of care, which may include slowing disease progression, improving function and palliation
• □Part A: ME 2.4 Prescribe strategies for renal protection, including but not limited to control of blood pressure, minimization of proteinuria and prevention of renal injury
• □Part A: ME 2.4 Apply strategies for cardiovascular disease prevention
• □Part A: ME 4.1 Implement a plan for ongoing care, follow-up on investigations, response to treatment and monitoring for disease progression

Communicator

• □Part A: COM 5.1 Document clinical information in a manner that supports intra- and inter-professional care
• □Part B: COM 5.1 Organize information in appropriate sections
• □Part B: COM 5.1 Document all relevant findings and investigations
• □Part B: COM 5.1 Convey clinical reasoning and the rationale for decisions
• □Part B: COM 5.1 Provide a clear plan for ongoing management
• □Part B: COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □Part A: COL 3.1 Determine when care should be transferred back to the primary health care provider
• □Part A: COL 3.2 Communicate with the patient’s primary care provider about the patient’s care

Health Advocate

• □Part A: HA 1.2 Work with the patient to increase opportunities to adopt healthy behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Progression to ESKD

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.4 Perform clinical assessments that address all relevant issues
• □Part A: ME 1.3 Apply knowledge of physiology and pathophysiology of renal dysfunction and its complications
• □Part A: ME 2.1 Prioritize which issues need to be addressed
• □Part A: ME 2.2 Assess the indications for renal replacement therapy and modality
• □Part A: ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □Part A: ME 4.1 Prevent and/or manage complications of kidney disease
• □Part A: ME 3.1 Integrate all sources of information to develop a plan for renal replacement therapy or end-of-life care
• □Part A: ME 4.1 Determine the necessity and timing for referral to another health care professional
• □Part B: ME 2.3 Establish goals of care, which may include slowing disease progression, improving function, and palliation

Communicator

• □Part B: COM 1.6 Adapt communication to the unique needs and preferences of the patient
• □Part B: COM 3.1 Provide information to patients and families clearly and compassionately
• □Part B: COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □Part B: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Health Advocate

• □Part A: HA 1.1 Identify barriers to access in the health care and social services systems
• □Part B: HA 1.2 Recognize potential barriers to learning such as illness, literacy and language skills
• □Part B: HA 1.2 Select patient education resources related to Nephrology
• □Part B: HA 2.3 Promote organ donation and access to renal transplantation

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 transition

1. ●CKD to ESKD
2. ●ESKD modality to another
3. ●Transplant to ESKD modality
4. ●AKI to ESKD
5. ●to end of life care

Medical Expert

• □ME 4.1 Establish plans for ongoing care

Communicator

• □COM 1.6 Tailor approaches to decision-making to patient capacity, values and preferences
• □COM 3.1 Provide information to patients and families clearly and compassionately
• □COM 1.5 Recognize when strong emotions are impacting an interaction and respond appropriately
• □COM 2.2 Manage the flow of challenging patient encounters
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.2 Organize the handover of care to the most appropriate physician

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

Professional

• □P 4.1 Recognize the personal impact of caring for patients with organ failure and at the end of life

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

Modality

1. ●in-center hemodialysis
2. ●home hemodialysis
3. ●peritoneal dialysis

Medical Expert

• □ME 2.2 Gather clinical information to assess current health status and symptoms
• □ME 2.2 Assess the patient’s clinical course and anticipate future health needs
• □ME 2.2 Examine and assess the dialysis access, and monitor access function
• □ME 2.2 Interpret the results of investigations assessing dialysis adequacy and complications of CKD
• □ME 2.4 Prescribe and adjust dialysis orders to optimize patient outcomes and/or quality of life
• □ME 2.4 Apply strategies for disease prevention and health promotion
• □ME 4.1 Prevent and/or manage complications of kidney disease
• □ME 2.4 Manage common medical co-morbidities in patients with end stage kidney disease
• □ME 2.4 Manage common symptoms in patients with end stage kidney disease
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in renal disease
• □ME 4.1 Develop long term plans for access, transplantation and/or independent dialysis

Collaborator

• □COL 1.3 Integrate the patient’s perspective into the care plan
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Health Advocate

• □HA 1.2 Work with the patient to increase opportunities to adopt heathy behaviours
• □HA 1.2 Work with patients to increase opportunities for self-care
• □HA 2.3 Promote organ donation and access to renal transplantation

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

Modality

1. ●hemodialysis
2. ●peritoneal dialysis

Type of complication

1. ●infectious
2. ●non-infectious

Recommendation

1. ●preserve existing access
2. ●change access
3. ●change modality

Medical Expert

• □ME 2.2 Examine and assess the dialysis access, and monitor access function
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Determine if the patient requires transition to another dialysis access or modality
• □ME 2.4 Develop and implement management plans
• □ME 3.3 Prioritize a procedure or therapy taking into account clinical urgency and available resources
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding

Collaborator

• □COL 1.3 Integrate the patient’s perspective into the care plan
• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Modality

1. ●hemodialysis
2. ●peritoneal dialysis

Patient disclosure

1. ●yes
2. ●no

Issue

1. ●hydrothorax
2. ●leak
3. ●perforation
4. ●air embolus
5. ●hemolysis
6. ●disequilibrium
7. ●dialyzer reaction
8. ●other

Medical Expert

• □ME 2.1 Identify clinical emergencies and prioritize response
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 5.1 Incorporate, as appropriate, into a differential diagnosis, harm from health care delivery
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 5.1 Mitigate further injury from adverse events
• □ME 2.4 Develop and implement initial management plans

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and disclose patient safety incidents
• □COM 3.2 Document harmful patient safety incidents as per institutional processes
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

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

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 Assess the patient’s health literacy
• □ME 2.2 Assess psychosocial issues that may affect health and/or access to services
• □ME 2.2 Assess adherence to treatment and monitoring plans

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Collaborator

• □COL 1.2 Make effective use of the scope and expertise of other health care professionals

Health Advocate

• □HA 1.2 Work with the patient to increase their understanding of their illness and health care needs
• □HA 1.2 Work with the patient to increase opportunities for self-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

Issue

1. ●pre-pregnancy counselling
2. ●patient with CKD
3. ●patient with transplant

Medical Expert

• □ME 1.3 Apply knowledge of the effects of kidney disease on fertility, pregnancy and fetal outcomes
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Interpret clinical information and investigations in the context of the physiology of pregnancy
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □ME 4.1 Implement a plan for ongoing care and response to treatment

Communicator

• □COM 3.1 Provide information to patients and families clearly and compassionately
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Collaborator

• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

Professional

• □P 1.3 Recognize and respond to ethical issues encountered in the clinical setting

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Select investigation strategies demonstrating awareness of availability and access in the outpatient setting
• □ME 2.4 Formulate treatment plans that are suitable for implementation in the outpatient setting
• □ME 5.2 Use systems to track and follow-up on clinical data, such as studies and laboratory tests

Collaborator

• □COL 1.3 Address the questions and concerns of the referring/primary care physician when acting in the consultant role
• □COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician

Leader

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

Scholar

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

Professional

• □P 1.1 Respond punctually to requests from patients 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

Medical Expert

• □ME 4.1 Coordinate treatment and follow-up across care settings

Collaborator

• □COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □COL 1.1 Respond appropriately to input from other health care professionals
• □COL 1.3 Communicate effectively with physicians and other health care professionals

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

Professional

• □P 1.1 Respond punctually to requests from patients or other health care professionals
• □P 1.1 Exhibit appropriate professional behaviors

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

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

Scholar

• □S 4.4 Identify, consult and collaborate with content experts and others in the conduct of scholarly work
• □S 4.4 Generate focused questions for scholarly investigation
• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health- related research and literature
• □S 4.5 Summarize the findings of a literature review
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.2 Identify ethical principles in research
• □S 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.4 Identify areas for further investigation

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 activity

1. ●journal club
2. ●grand rounds
3. ●case presentation
4. ●other

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 health related research 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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

• □L 1.1 Gather information for the purposes of quality assurance or improvement
• □L 1.1 Integrate existing standards for health care delivery with findings of data collection
• □L 1.1 Identify potential improvement opportunities
• □L 1.1 Identify the impact of human and system factors on health care delivery
• □L 3.1 Demonstrate an understanding of the operations of renal programs

Scholar

• □S 4.4 Perform data analysis
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice 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

Case complexity

1. ●medium
2. ●high

Type of disposition

1. ●manage at existing site
2. ●transfer to acute care setting with high resource intensity
3. ●transfer to acute care setting with low resource intensity
4. ●schedule into outpatient nephrology clinic

Setting

1. ●clinical
2. ●simulation

Consulting physician

1. ●community-based
2. ●hospital-based acute care
3. ●hospital-based chronic care

Medical Expert

• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 2.1 Identify clinical emergencies and prioritize response
• □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, as relevant
• □ME 2.4 Provide anticipatory guidance for management of changes in the patient’s clinical status while awaiting nephrology assessment

Communicator

• □COM 2.3 Request and synthesize patient information gathered by another health professional

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □L 2.1 Apply knowledge of health care resources in different settings to provide optimal patient care

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

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 1.4 Perform relevant and time-effective clinical assessments
• □ME 1.5 Prioritize patients based on the urgency of clinical presentations
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 2.4 Establish a patient-centered management plan

Leader

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

Scholar

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

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