Neurosurgery

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 Elicit an accurate history
• □ME 2.2 Perform a general physical exam
• □ME 2.2 Perform a neurological exam
• □ME 2.2 Synthesize patient information from the clinical assessment for the purpose of written or verbal summary to a supervisor
• □ME 1.4 Demonstrate knowledge of basic neuroanatomy

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, privacy, engagement, and safety
• □COM 1.1 Establish rapport and explain the purpose of the visit
• □COM 2.1 Conduct the interview in a patient-centered manner
• □COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in a given patient’s care

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. ●emergency room
2. ●inpatient
3. ●outpatient clinic

Location

1. ●central
2. ●spine
3. ●peripheral

Etiology

1. ●trauma
2. ●tumour
3. ●hemorrhage
4. ●other

Medical Expert

• □ME 2.2 Perform the history and physical exam in a timely manner, without excluding key elements
• □ME 2.2 Perform a relevant, focused neurological exam
• □ME 2.2 Interpret the findings of the history and physical exam to localize the clinical problem
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Order investigations as appropriate, including laboratory, imaging, and electrodiagnostic investigations
• □ME 2.2 Interpret investigations, including but not limited to CT scans, for neurosurgical presentations
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □ME 2.2 Synthesize patient information from the clinical assessment for the purpose of written or verbal summary to a supervisor
• □ME 4.1 Determine the need and timing of follow-up

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately
• □COM 4.3 Answer questions from the patient and/or family

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●subarachnoid hemorrhage
2. ●severe traumatic brain injury
3. ●spontaneous intracranial hemorrhage
4. ●acute hydrocephalus
5. ●mass lesion with acute deterioration
6. ●other

Medical Expert

• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Perform a relevant, focused neurological exam
• □ME 2.2 Interpret the findings of the physical exam to ascertain clinical significance
• □ME 2.2 Interpret investigations, including but not limited to CT scans, for neurosurgical presentations
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop plans for initial management of patients with cranial emergencies that include appropriate monitoring, medical management, and disposition
• □ME 2.4 Implement plans for blood pressure control and/or medical management of increased intracranial pressure/hydrocephalus
• □ME 2.4 Identify patients that may need further surgical or radiological intervention

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions
• □COM 3.1 Provide timely updates to the patient’s family regarding changes in medical condition or patient transfer to an acute unit

Collaborator

• □COL 1.2 Work effectively with other physicians and health care professionals engaged in the mutual care of a patient

Leader

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

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

Level

1. ●cervical
2. ●thoracic and/or lumbar

Etiology

1. ●trauma
2. ●tumour
3. ●degenerative
4. ●infection
5. ●other

Medical Expert

• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 1.4 Apply knowledge of complex anatomy of spine and nervous structures including anatomic/congenital variants
• □ME 1.4 Apply principles of spine biomechanics and spinal stability
• □ME 2.2 Perform a relevant, focused neurological exam
• □ME 2.2 Order investigations as appropriate, including laboratory, imaging, and electrodiagnostic investigations
• □ME 2.2 Interpret clinical findings and diagnostic studies with the appropriate emphasis on spinal balance and biomechanics
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop plans for initial management of patients with spinal emergencies that include appropriate monitoring, medical management, and disposition
• □ME 2.4 Identify patients that may need further surgical or radiological intervention

Communicator

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

Collaborator

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

Etiology

1. ●acute stroke
2. ●other common neurologic condition (write in)

Medical Expert

• □ME 2.2 Perform a relevant, focused neurological exam
• □ME 2.2 Interpret the findings of the history and physical exam to localize the clinical problem
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Order investigations as appropriate, including laboratory, imaging, and electrodiagnostic investigations
• □ME 2.2 Interpret investigations for neurological presentations
• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.4 Develop and implement initial management plans
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 2.2 Conduct a focused patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 3.1 Provide information to the patient and family clearly and compassionately
• □COM 4.1 Answer questions from the patient and/or family
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.1 Identify patients requiring handover to other physicians or 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 drain

1. ●lumbar drain
2. ●intracranial pressure monitor
3. ●external ventricular drain

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □Part A: ME 3.4 Identify anatomical landmarks and select an appropriate operative site
• □Part A: ME 3.4 Select and provide sedation and local analgesia, as appropriate
• □Part A: ME 3.4 Demonstrate aseptic technique: skin preparation, draping, establishing and respecting the sterile field
• □Part A: ME 3.4 Position the patient appropriately
• □Part A: ME 3.4 Execute the steps of the procedure in a safe and efficient manner
• □Part A: ME 3.4 Set up the drainage system or monitor, and ensure it is functioning well

Communicator

• □Part A: COM 5.1 Document the procedure

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

Scenario

1. ●clinical
2. ●simulation

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □Part A: ME 3.4 Select and provide sedation and local analgesia, as appropriate
• □Part A: ME 3.4 Position the patient appropriately
• □Part A: ME 3.4 Place the halo ring or tongs in the appropriate position
• □Part A: ME 3.4 Assess and manage alignment, including the safe application of traction weight or vest
• □Part A: ME 3.4 Order and review post procedure imaging

Communicator

• □Part A: COM 5.1 Document the procedure

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

Supervisor role

1. ●staff
2. ●senior resident

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 2.2 Interpret imaging studies to determine diagnosis and indications for surgical intervention
• □Part A: ME 3.4 Identify anatomical landmarks and select an appropriate operative site
• □Part A: ME 3.2 Obtain informed consent
• □Part A: ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □Part A: ME 3.4 Position the patient appropriately
• □Part A: ME 3.4 Demonstrate aseptic technique: skin preparation, establishing and respecting the sterile field
• □Part A: ME 3.4 Create burr hole
• □Part A: ME 3.4 Perform durotomy and drainage of hematoma
• □Part A: ME 3.4 Safely insert drain, if required
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care
• □Part A: ME 5.2 Use cognitive aids such as surgical checklists, structured communication tools, or care paths, to enhance patient safety

Communicator

• □Part A: COM 5.1 Document the procedure

Collaborator

• □Part A: COL 1.2 Work effectively with the interprofessional 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

Supervisor

1. ●staff
2. ●senior resident

Medical Expert

• □ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □ME 3.4 Demonstrate aseptic technique: skin preparation, establishing and respecting the sterile field
• □ME 3.4 Open and close the incision
• □ME 3.4 Set up the drill and its attachments
• □ME 3.4 Provide adequate exposure of target cranial surface
• □ME 3.4 Place burr holes and safely complete craniotomy
• □ME 3.4 Manage epidural hemostasis
• □ME 3.4 Perform safe dural opening
• □ME 3.4 Perform effective dural closing

Collaborator

• □COL 1.2 Work effectively with the interprofessional 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

Supervisor

1. ●staff
2. ●senior resident

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Demonstrate aseptic technique: skin preparation, establishing and respecting the sterile field
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform midline exposure of the posterior elements
• □Part A: ME 3.4 Separate fascia from spinous processes or appropriate levels
• □Part A: ME 3.4 Expose the spinous processes and lamina cleanly, without disruption of the facet joints

Collaborator

• □Part A: COL 1.2 Work effectively with the interprofessional 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

Role of observer

1. ●attending staff
2. ●other services (ICU) nurse
3. ●clinical assistant
4. ●other health professional
5. ●other trainee (e.g., fellow, resident, medical student)

Medical Expert

• □ME 2.4 Establish and adjust management plans for patients admitted to the Neurosurgery ward

Collaborator

• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with other physicians and colleagues

Leader

• □L 4.2 Organize formal educational activities, such as M and M rounds
• □L 4.2 Plan relevant work schedules (e.g., call schedules)
• □L 4.2 Run the service efficiently, safely and effectively
• □L 2.1 Allocate health care resources for optimal patient care

Scholar

• □S 2.3 Supervise learners to ensure they work within their limits
• □S 2.4 Provide bedside and other informal clinical teaching
• □S 2.5 Provide ongoing feedback to enhance learning and performance

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

Case mix

1. ●subarachnoid hemorrhage
2. ●severe traumatic brain injury
3. ●spontaneous intracranial hemorrhage
4. ●acute hydrocephalus
5. ●mass lesion with acute deterioration

Herniation syndrome

1. ●yes
2. ●no

Medical Expert

• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 2.2 Identify indications for surgical intervention
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 2.4 Institute appropriate medical and monitoring parameters
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Leader

• □L 2.1 Triage interventions for the patient in the context of the urgent care needs of other 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

Type of issue

1. ●CSF leak
2. ●wound infection
3. ●vasospasm
4. ●new postoperative neurologic deficit
5. ●post-operative hemorrhage

Medical Expert

• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 2.2 Identify indications for surgical intervention
• □ME 2.3 Recognize and respond to changes in patient status that indicate a need to reassess goals of care
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 2.4 Institute appropriate medical and monitoring parameters
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □ME 5.1 Identify adverse events as cues to adapt practice and adopt strategies to avoid complications

Communicator

• □COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate manner
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and/or patient safety incidents to patients and families

Leader

• □L 2.1 Triage interventions for the patient in the context of the urgent care needs of other 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

Scenario

1. ●bad news
2. ●adverse event
3. ●other

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.4 Respond to patients’ non-verbal communication and use appropriate non- verbal behaviours to enhance communication
• □COM 3.1 Provide information to the patient and family clearly and compassionately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □COM 4.3 Avoid the use of medical jargon and technical terminology; use language that the patient can understand
• □COM 4.3 Answer questions regarding care delivery, treatment decisions and/or prognosis in a respectful manner

Collaborator

• □COL 2.2 Listen for the purposes of understanding and finding common ground
• □COL 2.2 Manage differences and resolve conflicts

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

Location

1. ●intracranial infection
2. ●spinal epidural abscess
3. ●other

Medical Expert

• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.1 Determine the acuity of the issue and establish priorities for patient care
• □ME 2.1 Treat the patient’s urgent issues: provide relief from acute pain and/or initiate antibiotics as appropriate
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 2.4 Develop a plan for determining the source and nature of the infection
• □ME 2.4 Initiate appropriate empiric antibiotic therapy
• □ME 2.4 Determine the need for, plan for, and timing of surgical intervention
• □ME 4.1 Determine the plan for medical management and monitoring in collaboration with other health care professionals (e.g., infectious disease, pharmacy)

Collaborator

• □COL 1.2 Work effectively with other physicians or surgeons to provide all needed aspects 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

Case mix

1. ●obstructive hydrocephalus
2. ●normal pressure hydrocephalus
3. ●communicating hydrocephalus
4. ●Chiari/syrinx
5. ●arachnoid cyst

Medical Expert

• □ME 1.4 Apply knowledge of basic CSF physiology
• □ME 1.4 Apply knowledge of normal CSF-related anatomy
• □ME 1.4 Apply knowledge of pathophysiology of CSF-related disorders, and their clinical presentations and differential diagnosis
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Interpret imaging studies
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Determine the need for, plan for, and timing of surgical intervention

Communicator

• □COM 4.3 Use communication skills and strategies that help patients make informed decisions about their health

Health Advocate

• □HA 1.2 Select and provide relevant patient education resources

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 1.4 Apply knowledge of the indications and techniques for surgical procedures
• □ME 3.2 Explain the risks and benefits of, and the alternatives for a proposed procedure
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable

Communicator

• □COM 1.6 Identify patients who lack decision-making capacity and seek out their substitute decision maker
• □COM 3.1 Provide information to the patient and family clearly and compassionately
• □COM 4.3 Avoid the use of medical jargon and technical terminology; use language that the patient can understand
• □COM 2.1 Actively listen and respond to patient cues and questions
• □COM 5.1 Document the consent discussion in an accurate and complete 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

Type of craniotomy

1. ●infratentorial
2. ●pterional
3. ●supratentorial

Medical Expert

• □Part A: ME 3.4 Apply the surgical safety checklist
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Provide adequate exposure of target cranial surface
• □Part A: ME 3.4 Place burr holes and safely complete craniotomy
• □Part A: ME 3.4 Manage epidural hemostasis
• □Part A: ME 3.4 Perform safe dural opening
• □Part A: ME 3.4 Perform effective dural closing
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Type of procedure

1. ●craniotomy for traumatic brain injury
2. ●repair of a skull fracture

Location

1. ●epidural
2. ●subdural
3. ●intraaxial

Medical Expert

• □Part A: ME 3.4 Apply the surgical safety checklist
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Evacuate hematoma, as required
• □Part A: ME 3.4 Manage the associated fracture, as required
• □Part A: ME 3.4 Manage intraoperative complications as required, including brain edema and/ active bleeding

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Procedure

1. ●shunt insertion
2. ●shunt revision
3. ●Chiari
4. ●Cyst
5. ●ETV
6. ●Syrinx to SAH/P shunt

Location

1. ●not applicable
2. ●ventriculoperitonal
3. ●ventriculopleural
4. ●ventriculoatrial
5. ●lumboperitoenal

Medical Expert

• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Perform intraventicular navigation of a neuroendoscope, in relevant procedures
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Demonstrate intraoperative judgment, fluidity of movement, and forward progression
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Communicator

• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Describe the encounter to convey the procedure and outcome
• □COM 5.1 Convey surgical reasoning and the rationale for decisions
• □COM 5.1 Document all relevant findings
• □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

Scholar

• □S 4.4 Generate focused questions for scholarly investigation
• □S 4.4 Identify, consult, and collaborate with content experts and others in the conduct of scholarly work
• □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 4.3 Actively participate as a research team member, balancing the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician
• □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
• □S 4.5 Disseminate findings via manuscript or presentation

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

• □Part A: L 1.1 Review a case, or series of cases, to assess outcomes of health care delivery
• □Part A: L 1.1 Compare outcomes to established best practices to identify opportunities for quality improvement
• □Part A: L 1.1 Identify factors that may contribute to improvements in quality of care
• □Part A: L 3.1 Propose changes to improve clinical outcomes and/or quality of health care delivery
• □Part A: L 3.2 Develop a strategy for implementing change in health care delivery

Scholar

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

Professional

• □Part A: 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

Patient presentation

1. ●epilepsy
2. ●movement disorder
3. ●pain and/or spasticity, other

Medical Expert

• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Elicit information regarding the impact of the disorder on the patient’s functional ability
• □ME 2.2 Select and/or interpret investigations
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.2 Determine if the patient would benefit from surgical intervention
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 4.1 Provide referral for advanced neurosurgical procedures, as appropriate

Communicator

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

Collaborator

• □COL 1.2 Work effectively with other physicians or surgeons to provide all needed aspects of care

Health Advocate

• □HA 1.1 Facilitate timely patient access to health 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

Trigeminal neuralgia

1. ●yes
2. ●no

Decision

1. ●no surgery
2. ●percutaneous technique
3. ●open technique

Medical Expert

• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Elicit information regarding the impact of the disorder on the patient’s functional ability
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Determine if the patient would benefit from surgical intervention
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention

Communicator

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

Collaborator

• □COL 1.2 Work effectively with other physicians or surgeons to provide all needed aspects of care

Health Advocate

• □HA 1.1 Facilitate timely patient access to health 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

Indication

1. ●biopsy
2. ●movement disorder
3. ●radiosurgery
4. ●other

Use of stereotactic frame

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Select and apply local anesthesia, as appropriate
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select an appropriate procedure plan, including targeting
• □Part A: ME 3.4 Apply the frame and/or register the frameless system
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and 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

Surgical technique

1. ●percutaneous rhizotomy
2. ●microvascular decompression

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents as appropriate
• □Part A: ME 3.4 Perform arachnoid dissection
• □Part A: ME 3.4 Identify and decompress the target nerve Relevant for “percutaneous rhizotomy” context only:
• □Part A: ME 3.4 Achieve successful targeting of needle
• □Part A: ME 3.4 Achieve adequate nerve lesioning
• □Part A: ME 3.4 Use intraoperative imaging appropriately (e.g., fluoroscopy)

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room team Relevant for “microvascular decompression” context only:

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●carpal
2. ●ulnar
3. ●brachial plexus
4. ●other

Medical Expert

• □ME 1.4 Apply knowledge of peripheral nerve anatomy and physiology
• □ME 1.4 Apply knowledge of brachial and lumbosacral plexus anatomy
• □ME 1.4 Apply knowledge of traumatic nerve injuries
• □ME 1.4 Apply knowledge of nerve compression syndromes
• □ME 2.2 Elicit information regarding the impact of the disorder on the patient’s functional ability
• □ME 2.2 Perform sensory and motor examination relevant to peripheral nerve, and brachial and lumbosacral plexus
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Interpret electrodiagnostic evaluations
• □ME 2.2 Distinguish between peripheral neuropathy and other etiologies
• □ME 2.4 Recognize indications for treatment
• □ME 2.4 Determine the need for, plan for, and timing of surgical intervention
• □ME 2.4 Provide non-operative management options for common entrapment neuropathies (e.g., carpal tunnel syndrome; ulnar neuropathy; meralgia paresthetica)

Communicator

• □COM 4.3 Use communication skills and strategies that help patients make informed decisions about their health

Health Advocate

• □HA 1.2 Select and provide relevant patient education 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 procedure

1. ●carpal tunnel decompression
2. ●ulnar nerve decompression/ transposition

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Select and apply local anesthesia, as appropriate
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 4.1 Provide discharge instructions and plan for follow-up

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Type of procedure

1. ●sural nerve biopsy
2. ●muscle biopsy

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Select and apply local anesthesia, as appropriate
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 4.1 Provide discharge instructions and plan for follow-up

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Integrate neuropathology into intraoperative surgical decision-making
• □Part A: ME 3.4 Utilize intraoperative neurophysiologic monitoring effectively, as appropriate
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents as appropriate

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Type of spinal condition

1. ●degenerative
2. ●neoplastic
3. ●congenital
4. ●deformity
5. ●syrinx
6. ●other

Neurologic deficit

1. ●yes
2. ●no

Mechanically unstable

1. ●yes
2. ●no

Level

1. ●cervical
2. ●thoracic and/or lumbar

Medical Expert

• □ME 1.4 Apply knowledge of the natural history and outcomes of patients with spinal conditions
• □ME 1.4 Apply knowledge of operative and non-operative management of spine conditions and their complications
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.2 Recognize the indications for instrumented fusion
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Communicator

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

Health Advocate

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

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

Level

1. ●cervical
2. ●thoracic and/or lumbar

Neurologic deficit

1. ●yes
2. ●no

Mechanically unstable

1. ●yes
2. ●no

Etiology

1. ●trauma
2. ●malignancy
3. ●other

Medical Expert

• □ME 1.4 Apply knowledge of the natural history and outcomes of patients with spinal conditions
• □ME 1.4 Apply knowledge of operative and non-operative management of spine conditions and their complications
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Recognize the indications for instrumented fusion
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate 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

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Expose and close for the procedure
• □Part A: ME 3.4 Perform intraoperative verification of surgical level
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform adequate decompression
• □Part A: ME 3.4 Consider spinal stability

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Etiology

1. ●trauma
2. ●other

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Perform intraoperative verification of surgical level
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Place and position retractor system
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Etiology

1. ●cauda equina syndrome
2. ●other

Revision

1. ●no
2. ●yes

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Expose and close for the procedure
• □Part A: ME 3.4 Perform intraoperative verification of surgical level
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform adequate decompression
• □Part A: ME 3.4 Consider spinal stability
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Expose and close for the procedure
• □Part A: ME 3.4 Perform intraoperative verification of surgical level
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform adequate decompression
• □Part A: ME 3.4 Consider spinal stability
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Expose the appropriate spinal level
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform adequate decompression
• □Part A: ME 3.4 Consider spinal stability
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Approach

1. ●anterior
2. ●posterior

Level

1. ●occipito-cervical
2. ●cervical
3. ●thoracic
4. ●lumbar

Interbody fusion

1. ●no
2. ●yes

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Expose and close for the procedure
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Design a fusion construct that optimizes stability and alignment
• □Part A: ME 3.4 Ensure adequate bony substrate for fusion
• □Part A: ME 3.4 Perform safe and effective instrumentation
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Level

1. ●cervical
2. ●thoracic
3. ●lumbar

Location

1. ●intramedullary
2. ●extramedullary

Medical Expert

• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Plan the incision
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Select and use intraoperative monitoring effectively, as indicated
• □Part A: ME 3.4 Perform intraoperative verification of surgical level
• □Part A: ME 3.4 Open and close spinal dura
• □Part A: ME 3.4 Perform safe intradural tissue dissection of relevant structures with gentle tissue handling
• □Part A: ME 3.4 Consider spinal stability
• □Part A: ME 3.4 Integrate neuropathology into intraoperative surgical decision-making

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Location

1. ●cranial
2. ●spinal
3. ●other

Condition

1. ●aneurysm
2. ●vascular malformation
3. ●carotid stenosis

Medical Expert

• □ME 1.4 Apply knowledge of indications for endovascular and surgical aneurysm repair
• □ME 1.4 Apply knowledge of available endovascular techniques for intracranial aneurysm repair
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Interpret imaging studies
• □ME 2.2 Determine natural history of the vascular lesion, with reference to risk factors
• □ME 3.1 Identify all relevant treatment options and discuss relative risk and benefits of endovascular versus surgical treatment as appropriate
• □ME 3.1 Determine if the condition warrants surgical intervention and if the patient is a candidate for interventional procedures
• □ME 2.4 Develop an appropriate management plan including but not limited to observation, surgery and/or endovascular intervention
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional
• □ME 2.4 Provide peri-procedural management for patient undergoing endovascular intervention
• □ME 4.1 Establish plans for ongoing care

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with other physicians and colleagues

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

Location

1. ●cranial
2. ●spinal
3. ●other

Condition

1. ●aneurysm
2. ●vascular malformation
3. ●carotid stenosis

Medical Expert

• □ME 1.4 Apply knowledge of indications for endovascular and surgical aneurysm repair
• □ME 1.4 Apply knowledge of available endovascular techniques for intracranial aneurysm repair
• □ME 2.1 Identify patients at risk of clinical deterioration
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 3.1 Identify all relevant treatment options and discuss relative risk and benefits of endovascular versus surgical treatment as appropriate
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 2.4 Develop an appropriate management plan including but not limited to observation, surgery and/or endovascular intervention
• □ME 3.1 Determine if the condition warrants surgical intervention and if the patient is a candidate for interventional procedures
• □ME 2.4 Provide peri-procedural management for patient undergoing endovascular intervention
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Collaborator

• □COL 1.2 Work effectively with other physicians or surgeons to provide all needed aspects 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

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Manage intraoperative anticoagulation
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Ensure adequate proximal and distal vessel exposure
• □Part A: ME 3.4 Perform arteriotomy, plaque dissection, and vessel arteriotomy closure safely and effectively
• □Part A: ME 3.4 Monitor for and address inadequate cerebral perfusion
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Use the operating microscope effectively
• □Part A: ME 3.4 Perform craniotomy for exposure
• □Part A: ME 3.4 Perform arachnoid dissection safely
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 1.4 Apply knowledge of neuroprotective adjuncts
• □Part A: ME 3.4 Determine indications for and use temporary clipping, as relevant
• □Part A: ME 3.4 Select and apply aneurysm clip
• □Part A: ME 3.4 Confirm aneurysm exclusion and patency of parent vessel
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Perform craniotomy for exposure
• □Part A: ME 3.4 Open dura for exposure
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Recognize and manage any associated pathology (e.g., AVM, tumour)
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Location

1. ●extra-axial
2. ●intra-axial
3. ●pituitary adenoma

Tumour

1. ●primary
2. ●metastatic
3. ●other

Medical Expert

• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop management plans including observation, biopsy, resection, radiotherapy, radiosurgery, and/or chemotherapy
• □ME 2.4 Determine the need for, plan for, and timing of surgical intervention
• □ME 3.2 Obtain and document informed consent
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Collaborator

• □COL 1.3 Communicate effectively with other physicians and colleagues

Health Advocate

• □HA 1.2 Select and provide relevant patient education 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

Case mix

1. ●skull base
2. ●eloquent brain primary
3. ●ventricular
4. ●pineal region
5. ●posterior fossa
6. ●acoustic neuroma

Medical Expert

• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop management plans including observation, biopsy, resection, radiotherapy, radiosurgery, chemotherapy and/or preoperative embolization
• □ME 2.4 Determine the need for, plan for, and timing of surgical intervention
• □ME 3.2 Obtain and document informed consent
• □ME 4.1 Determine the necessity and appropriate timing of referral to another health care professional

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Collaborator

• □COL 1.3 Communicate effectively with other physicians and colleagues

Health Advocate

• □HA 1.2 Select and provide relevant patient education resources

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

Location

1. ●extra-axial
2. ●intra-axial
3. ●posterior fossa

Tumour type

1. ●primary
2. ●metastatic

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Use optical magnification appropriately
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Debulk the tumour and dissect the brain tumour interface
• □Part A: ME 2.4 Assess and determine plan for extent of resection
• □Part A: ME 3.4 Integrate neuropathology into intraoperative surgical decision- making
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●complex meningioma
2. ●skull base tumour
3. ●primary posterior fossa tumour
4. ●eloquent intraaxial brain tumour

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Select and use intraoperative monitoring and mapping effectively as indicated
• □Part A: ME 3.4 Debulk the tumour and dissect the brain tumour interface, nerve, or vessel
• □Part A: ME 3.4 Use optical magnification appropriately
• □Part A: ME 2.4 Assess and determine plan for extent of resection
• □Part A: ME 3.4 Integrate neuropathology into intraoperative surgical decision-making
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Set up and use endoscope for intraoperative visualization
• □Part A: ME 2.4 Assess and determine plan for extent of resection
• □Part A: ME 3.4 Debulk the tumour and protect critical adjacent structures: optic apparatus, internal carotid, normal pituitary gland
• □Part A: ME 3.4 Ensure appropriate reconstruction of skull base
• □Part A: ME 3.4 Manage intraoperative hemostasis, including effective use of adjunctive agents
• □Part A: ME 3.4 Anticipate and/or manage intraoperative complications

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 1.4 Apply knowledge of physiology and anatomy of the pediatric spine
• □ME 1.4 Demonstrate knowledge of the management (operative and non-operative) of pediatric head and spine injury
• □ME 1.4 Demonstrate knowledge of birth trauma relating to nerve, brain, and spine
• □ME 2.2 Perform an age appropriate history and physical examination
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select, prioritize, and interpret investigations
• □ME 2.4 Develop and implement initial management plans
• □ME 1.4 Apply knowledge of pediatric physiology, including blood volumes, blood pressure, heart rate, and fluid resuscitation

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family
• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions

Collaborator

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

Health Advocate

• □HA 1.2 Counsel patients regarding preventive strategies for trauma and head injury prevention

Professional

• □P 3.1 Apply the laws governing consent/assent in the pediatric age group
• □P 3.1 Adhere to requirements for mandatory reporting, such as suspicious injury

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. ●hydrocephalus
2. ●craniosynostosis
3. ●tethered cord
4. ●epilepsy
5. ●brain tumour
6. ●posterior fossa brain tumour

Medical Expert

• □ME 1.4 Apply knowledge of embryological development as it relates to congenital malformations
• □ME 2.2 Elicit a history, including the prenatal history as relevant
• □ME 2.2 Perform the physical exam in a manner that minimizes discomfort or distress, without excluding key elements
• □ME 2.2 Adapt the clinical assessment to the child’s age and development
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select investigations, including imaging with consideration of the need for sedation, and radiation exposure
• □ME 2.2 Interpret imaging studies
• □ME 2.4 Develop a management plan which may include observation, surgical intervention and/or non-operative intervention
• □ME 3.1 Demonstrate knowledge of surgical options and indications

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately
• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions

Professional

• □P 3.1 Apply the laws governing consent/assent in the pediatric age group

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 Perform clinical assessments that address all relevant issues
• □ME 2.4 Provide routine post-operative management, including intravenous fluids, diet, wound care, and medications
• □ME 2.4 Provide appropriate pain management
• □ME 2.4 Adjust medication dosing for patient age, size, and/or renal function

Communicator

• □COM 3.1 Provide information to the patient and family clearly and compassionately

Collaborator

• □COL 1.2 Work effectively with other physicians and health care professionals engaged in the mutual care of a patient

Health Advocate

• □HA 1.3 Incorporate health promotion into interactions with the patient and 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

Age

1. ●infant
2. ●toddler
3. ●older child
4. ●adolescent

Medical Expert

• □Part A: ME 2.2 Interpret preoperative imaging related to the nature of the condition and surgical planning
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 3.4 Demonstrate intraoperative judgment, fluidity of movement, and forward progression
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care
• □Part A: ME 4.1 Provide post-operative orders for patient and device management

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □Part A: ME 3.4 Apply the surgical safety checklist
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Provide adequate exposure of target cranial surface
• □Part A: ME 3.4 Place burr holes and safely complete craniotomy
• □Part A: ME 3.4 Perform safe dural opening
• □Part A: ME 3.4 Perform effective dural closing
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Ensure meticulous control of blood loss
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 4.1 Provide post-operative orders

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Diagnosis

1. ●tethered cord
2. ●other

Medical Expert

• □Part A: ME 3.4 Position, prep, and drape the patient
• □Part A: ME 1.4 Apply knowledge of key anatomic relationships to the specific or proposed surgical procedure
• □Part A: ME 3.4 Select appropriate instruments, implants, sutures and/or equipment
• □Part A: ME 3.4 Plan the incision, with or without the use of navigation
• □Part A: ME 3.4 Open and close the incision
• □Part A: ME 3.4 Use optical magnification appropriately
• □Part A: ME 3.4 Perform safe tissue dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Recognize and address anatomical variants, and modify the surgical procedure as appropriate
• □Part A: ME 4.1 Provide post-operative orders

Communicator

• □Part A: COM 5.1 Document surgical clinical encounters in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Work effectively with the operating room 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

Medical Expert

• □ME 1.5 Prioritize patients based on the urgency of clinical presentations
• □ME 2.4 Establish patient-centered management plans

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete and timely manner

Leader

• □L 4.2 Manage bookings to optimize clinic scheduling
• □L 4.2 Book operative cases with appropriate urgency, duration, and equipment
• □L 4.1 Manage time effectively in the ambulatory clinic
• □L 4.1 Review and act on test results in a timely manner
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Scholar

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

Professional

• □P 1.1 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

Type of procedures

1. ●general
2. ●functional
3. ●peripheral
4. ●spinal
5. ●vascular
6. ●oncology
7. ●pediatric
8. ●other

Medical Expert

• □Part A: ME 3.4 Select appropriate materials and equipment for the procedure
• □Part A: ME 5.2 Lead the team in the use of the surgical safety checklist
• □Part A: ME 3.4 Perform procedures in a skillful and safe manner
• □Part A: ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure as appropriate
• □Part A: ME 4.1 Establish plans for post-operative care

Communicator

• □Part A: COM 3.1 Convey information about the procedure, operative findings and patient status to the family clearly and compassionately
• □Part A: COM 5.1 Document surgical procedures in an accurate, complete, timely and accessible manner

Collaborator

• □Part A: COL 3.2 Transition patient care safely to the post-operative team
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 1.3 Communicate effectively with the operating room team

Leader

• □Part B: L 4.2 Demonstrate leadership skills in the operating room

Scholar

• □Part B: S 2.3 Provide junior learners with opportunities for appropriate clinical responsibility
• □Part B: S 2.5 Provide junior learners with feedback to enhance learning and performance

Professional

• □Part A: P 1.2 Prepare for surgical procedures, reviewing the list of planned operations
• □Part A: P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings
• □Part B: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment
• □Part B: P 4.1 Maintain professional clinical performance in demanding or stressful clinical 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

Role of observer

1. ●neurosurgeon
2. ●other physician or health care professional

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Neurosurgery
• □ME 2.4 Establish patient-centered management plans
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Communicate effectively with other physicians and colleagues
• □COL 1.3 Contribute to quality patient care by sharing surgical expertise
• □COL 2.1 Actively listen to and engage in interactions with collaborators
• □COL 2.2 Achieve consensus when there are differences in recommendations provided by other health care professionals

Leader

• □L 2.1 Allocate health care resources for optimal patient care

Scholar

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

Professional

• □P 1.1 Exhibit professional behaviours

Case description

Feedback provided

Next steps