Nuclear Medicine

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Identify relevant findings of a physical examination
• □Part A: ME 2.2 Interpret the findings of the history, physical examination and investigations in light of the clinical question
• □Part A: ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
• □Part B: ME 3.5 Use the digital system to retrieve images
• □Part B: ME 3.5 Manipulate images to review a study

Communicator

• □Part A: COM 2.3 Seek and integrate information from other sources
• □Part B: COM 5.1 Apply a systematic method of reporting nuclear medicine studies
• □Part B: COM 5.1 Use the radiology information system to issue a report

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. ●cancer
2. ●cardiac
3. ●other medical
4. ●surgical

Pediatrics

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Formulate a basic differential diagnosis
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
• □ME 2.4 Identify and/or monitor key clinical features in the implementation of a management plan

Communicator

• □COM 2.1 Use patient-centred interviewing skills
• □COM 3.1 Convey information to the patient and/or family clearly and compassionately
• □COM 5.1 Document the essential elements of a clinical encounter using a structured approach

Collaborator

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

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

Presentation

1. ●acute respiratory distress
2. ●allergic reactions
3. ●altered level of consciousness
4. ●chest pain
5. ●hemodynamic instability
6. ●hypoglycemia
7. ●other presentation

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.2 Perform a history and physical exam relevant to the patient presentation, in a time-effective manner
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Develop and implement initial management plans
• □ME 4.1 Determine the appropriate disposition and/or setting for ongoing care

Communicator

• □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

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●emergency
2. ●inpatient
3. ●ambulatory

Case mix

1. ●oncology
2. ●infectious
3. ●renal
4. ●endocrine
5. ●cardiac
6. ●other condition

Test requested

1. ●bone scan
2. ●V/Q scan
3. ●HIDA scan
4. ●renal scan
5. ●MIBI
6. ●thyroid scan
7. ●scan for GI bleed
8. ●PET scan
9. ●other test

Test selection modified

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □ME 2.2 Integrate and synthesize patient information to establish the clinical question
• □ME 2.4 Apply diagnostic algorithms for the investigation of conditions examined by nuclear medicine techniques
• □ME 2.4 Advise referring physicians on the most appropriate selection, sequence and/or timing of further investigation(s)

Communicator

• □COM 2.3 Gather patient information from another health professional

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 1.4 Work with technical and other staff to address patient issues and ensure appropriate medical care

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient 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. ●oncology
2. ●infectious
3. ●renal
4. ●endocrine
5. ●cardiac
6. ●MSK
7. ●pulmonary
8. ●GI
9. ●neuro
10. ●other condition

Test requested

1. ●bone scan
2. ●V/Q scan
3. ●HIDA scan
4. ●renal scan
5. ●MIBI
6. ●thyroid scan
7. ●scan for GI bleed
8. ●PET scan
9. ●non-imaging
10. ●other test

Pharmacologic intervention

1. ●yes
2. ●no

Additional views

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Gather clinical data from the patient and other sources
• □ME 2.2 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □ME 2.2 Integrate and synthesize patient information to establish the clinical question
• □ME 2.2 Formulate a basic differential diagnosis
• □ME 3.5 Select the protocol for common nuclear medicine examinations
• □ME 3.5 Review images to assess adequacy to answer the clinical question
• □ME 3.5 Modify or optimize the exam, as needed
• □ME 3.5 Determine that the examination is complete

Communicator

• □COM 1.2 Optimize patient comfort

Collaborator

• □COL 1.4 Work with technical and other staff to address patient needs and the clinical question

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care
• □HA 1.3 Adapt the examination as needed to limit radiation exposure

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 1.3 Apply knowledge of cross-sectional anatomy
• □ME 3.5 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □ME 3.5 Demonstrate a methodological approach to the interpretation of diagnostic testing
• □ME 3.5 Recognize normal variants, artefacts and imaging pitfalls
• □ME 3.5 Identify key findings and common significant incidental findings
• □ME 2.2 Formulate a basic differential diagnosis
• □ME 3.5 Correlate findings with clinical information and other imaging modalities
• □ME 2.4 Provide suggestions for further testing and/or patient disposition as relevant
• □ME 3.5 Interpret findings of cross-sectional imaging in the context of the clinical question
• □ME 4.1 Recognize and respond to situations or results that warrant verbal reporting to the referring physician

Communicator

• □COM 5.1 Prepare a report for presentation to a supervisor

Collaborator

• □COL 1.4 Work with technical staff to optimize the study and/or request additional reconstructions

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Integrate and synthesize patient information to establish the clinical question
• □ME 3.5 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □ME 1.3 Apply knowledge of the principles of the use of in vivo and in vitro radionuclides and radiopharmaceuticals for imaging and non-imaging studies
• □ME 3.5 Demonstrate a methodological approach to the interpretation of diagnostic testing
• □ME 3.5 Identify key findings and common significant incidental findings
• □ME 3.5 Recognize normal variants, artefacts and imaging pitfalls
• □ME 2.2 Formulate a basic differential diagnosis
• □ME 3.5 Correlate findings with clinical information and other imaging modalities
• □ME 3.5 Interpret findings of cross-sectional imaging, in the context of the clinical question
• □ME 2.4 Provide suggestions for further testing and/or patient disposition as relevant
• □ME 4.1 Recognize and respond to situations or results that warrant verbal reporting to the referring physician

Communicator

• □COM 5.1 Generate a clear, concise report that enhances patient management

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 4.1 Recognize and respond to situations or results that warrant verbal reporting to the referring physician
• □ME 3.5 Summarize findings, and provide suggestions for further testing and /or patient disposition as relevant
• □ME 1.6 Demonstrate insight into their own limits of expertise

Communicator

• □COM 5.1 Document in the imaging report actions taken to communicate significant or unexpected findings

Collaborator

• □COL 1.3 Convey information to clinicians in a manner that enhances patient management

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

Event

1. ●on-site
2. ●off-site
3. ●simulated

Medical Expert

• □ME 1.3 Apply knowledge of radiation safety, protection and associated regulations as applied to the safe use and transportation of radioisotopes and radiopharmaceuticals
• □ME 5.1 Recognize and respond to a safety event in a timely manner
• □ME 5.1 Initiate procedures to contain or mitigate risk to person, patient and/or staff
• □ME 1.6 Seek assistance, as needed
• □ME 5.1 Identify the nature of the radiation safety event

Collaborator

• □COL 1.2 Apply knowledge of the role of the radiation safety officer
• □COL 1.4 Work with staff to ensure patient, technologist and personal safety

Leader

• □L 3.1 Demonstrate responsibility for radiation safety

Professional

• □P 1.1 Adhere to procedures for the management of the nature of the specific radiation incident

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

Observer role

1. ●NM physician
2. ●NM physicist
3. ●nurse
4. ●technologist
5. ●other physician/surgeon
6. ●other residents or students
7. ●other

Collaborator

• □COL 1.2 Demonstrate an understanding of the scope and expertise of other health care professionals
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.4 Provide guidance to resolve clinical or imaging challenges

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 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

Medical Expert

• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 2.2 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □ME 2.1 Recognize and respond to circumstances that require direct communication with the referring physician
• □ME 1.3 Apply knowledge of diagnostic algorithms for investigation and the role of nuclear medicine imaging
• □ME 2.2 Identify patient factors that may affect the choice of examination or study protocol
• □ME 2.4 Modify and/or customize the request as needed
• □ME 2.4 Determine the priority of the request, and triage the examination
• □ME 2.4 Use pharmacologic agents or techniques to intentionally modify radiopharmaceutical distribution or excretion
• □ME 2.4 Modify and/or customize nuclear medicine studies, with consideration of the patient’s specific needs

Collaborator

• □COL 1.4 Communicate effectively with technical staff about the urgency and/or customization of nuclear medicine studies

Leader

• □L 2.1 Consult with technical staff to judiciously allocate radiopharmaceutical and imaging 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 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 3.5 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □ME 2.2 Perform a focused history and/or examination to gather additional clinical information
• □ME 1.3 Apply knowledge of the principles of the use of in vivo and in vitro radionuclides and radiopharmaceuticals for imaging and non-imaging studies
• □ME 3.5 Use computer applications to optimize the images and/or views needed in order to answer the clinical question
• □ME 3.5 Recognize normal variants, artefacts and imaging pitfalls
• □ME 3.5 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 5.1 Recognize and manage adverse events and emergency conditions requiring urgent medical attention
• □ME 3.5 Identify all relevant findings

Communicator

• □COM 5.1 Provide clear, concise, accurate and grammatically correct reports of diagnostic testing in a timely fashion

Collaborator

• □COL 1.4 Work with technical staff to solve imaging challenges and optimize the quality of examinations

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Gather and synthesize patient information to establish the clinical question
• □ME 3.5 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □ME 2.2 Perform a focused history and/or examination to gather additional clinical information
• □ME 1.3 Apply knowledge of the pitfalls and artefacts unique to hybrid imaging, including registration and attenuation correction
• □ME 1.3 Apply knowledge of the principles of the use of PET radionuclides and radiopharmaceuticals for imaging studies
• □ME 2.4 Use pharmacologic agents or techniques to intentionally modify radiopharmaceutical distribution or excretion
• □ME 3.5 Use computer applications to optimize the images and/or views needed in order to answer the clinical question
• □ME 3.5 Recognize normal variants, artefacts and imaging pitfalls
• □ME 3.5 Identify all relevant findings
• □ME 3.5 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 5.1 Recognize and manage adverse events and emergency conditions requiring urgent medical attention

Communicator

• □COM 5.1 Provide clear, concise, accurate and grammatically correct reports of diagnostic testing in a timely fashion

Collaborator

• □COL 1.4 Work with technical staff to solve imaging challenges and optimize the quality of examinations

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.5 Summarize findings of clinical relevance
• □ME 3.5 Generate an appropriate differential and most likely diagnosis
• □ME 2.4 Provide suggestions for further testing and/or patient disposition as relevant

Communicator

• □COM 5.1 Use a systematic method of reporting, integrating clinical and imaging information
• □COM 5.1 Provide clear, concise, accurate and grammatically correct reports of diagnostic testing in a timely fashion
• □COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □COL 1.3 Convey information to clinicians in a manner that enhances patient management
• □COL 1.3 Convey diagnostic uncertainty, as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.5 Demonstrate a methodological approach to the interpretation of diagnostic testing
• □ME 3.5 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □ME 1.3 Apply knowledge of cross-sectional anatomy
• □ME 3.5 Recognize normal variants, artefacts and imaging pitfalls
• □ME 3.5 Identify all relevant findings
• □ME 3.5 Generate an appropriate differential and most likely diagnosis
• □ME 2.4 Provide suggestions for further testing and/or patient disposition as relevant

Communicator

• □COM 5.1 Use a systematic method of reporting, integrating clinical and imaging information
• □COM 5.1 Provide clear, concise, accurate and grammatically correct reports of diagnostic testing in a timely fashion
• □COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □COL 1.4 Work with technical staff to optimize the study and/or request additional reconstructions
• □COL 1.3 Convey information to clinicians in a manner that enhances patient management
• □COL 1.3 Convey diagnostic uncertainty, as needed

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Condition

1. ●benign
2. ●malignant

Pediatric patient

1. ●no
2. ●yes

Complex case

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Perform a physical exam that informs the diagnosis
• □Part A: ME 2.2 Correlate prior investigations, including the results of relevant laboratory investigations and imaging
• □Part A: ME 2.2 Select and/or interpret additional investigations, as needed
• □Part A: ME 2.2 Synthesize patient information to assess eligibility for therapeutic nuclear medicine intervention
• □Part A: ME 3.3 Triage therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part A: ME 2.2 Gather information about the patient’s home, mobility and access to care
• □Part A: ME 2.4 Develop plans for radiation protection and radiation safety following therapeutic intervention
• □Part B: ME 1.3 Apply knowledge of the natural history, clinical manifestations and management of conditions treatment by nuclear medicine techniques
• □Part B: ME 3.2 Explain the risks, benefits and adverse effects of, and alternatives and rationale for a proposed therapy
• □Part C: ME 2.4 Integrate nuclear medicine therapy into the overall plan of the patient’s care
• □Part C: ME 1.3 Apply knowledge of radiation biology pertinent to therapeutic uses of radionuclides
• □Part C: ME 1.3 Apply knowledge of radiation dosimetry
• □Part C: ME 3.6 Determine the radiopharmaceutical choice and efficacy
• □Part C: ME 3.6 Calculate the administered dose, integrating knowledge of internal dosimetry, radiation protection and radiation safety
• □Part C: ME 2.2 Identify patient factors that may affect the dose and/or distribution of the radioactive agent
• □Part C: ME 3.3 Triage therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part C: ME 2.4 Develop a plan for therapeutic intervention using a radionuclide and/or radiopharmaceutical, taking into account the patient’s specific needs
• □Part C: ME 4.1 Develop plans for the ongoing care of a patient who has received therapy with a radionuclide or radiopharmaceutical
• □Part C: ME 4.1 Determine the need and timing of referral to another physician, including radiologists and/or oncologists as relevant

Communicator

• □Part A: COM 3.1 Convey information about diagnosis and prognosis to the patient and/or family clearly and compassionately
• □Part B: COM 3.1 Convey information about diagnosis and prognosis to the patient and/or family clearly and compassionately
• □Part B: COM 3.1 Convey the concept of relative risk, as it applies to radiation exposure, in discussion of treatment
• □Part B: COM 4.3 Use effective communication skills and strategies, such as body posture, language at the appropriate level, and periodic checks for understanding
• □Part B: COM 2.1 Actively listen and respond to patient cues
• □Part B: COM 4.3 Answer questions from a patient and family
• □Part B: COM 5.1 Document the consent discussion in an accurate and complete manner

Health Advocate

• □Part A: HA 1.1 Facilitate timely patient access to services and resources
• □Part B: HA 1.3 Counsel the patient and family about post therapy restrictions

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

Route of administration

1. ●oral
2. ●parenteral

Medical Expert

• □Part A: ME 2.2 Perform a focused clinical assessment
• □Part A: ME 2.2 Assess the patient’s suitability to proceed with unsealed source therapy
• □Part A: ME 1.3 Apply knowledge of radiation safety, protection and associated regulations as applied to the safe use and transportation of radioisotopes and radiopharmaceuticals
• □Part A: ME 5.2 Use appropriate personal protective measures
• □Part A: ME 3.5 Demonstrate safe handling of radionuclides and radiopharmaceuticals
• □Part A: ME 3.6 Verify patient identity and treatment dose
• □Part A: ME 5.2 Limit unnecessary radiation exposure to patient and staff
• □Part A: ME 3.6 Manage immediate complications, as relevant
• □Part B: ME 2.2 Perform a focused clinical assessment
• □Part B: ME 2.2 Assess the patient’s suitability to proceed with unsealed source therapy
• □Part B: ME 3.6 Supervise the administration of unsealed source therapy
• □Part B: ME 3.5 Monitor patient comfort and safety, and adjust the procedure as needed
• □Part B: ME 3.6 Manage immediate complications, as relevant
• □Part B: ME 4.1 Establish a plan for discharge and/or decommissioning
• □Part B: ME 4.1 Establish a plan for ongoing care, monitoring response to treatment, further investigations and/or further intervention

Communicator

• □Part B: COM 4.3 Answer questions from a patient and family

Collaborator

• □Part A: COL 1.2 Work effectively with the team providing unsealed source therapy

Health Advocate

• □Part B: HA 1.3 Counsel the patient and family about post therapy restrictions

Professional

• □Part A: P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Perform a focused clinical assessment
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Identify adverse effects of unsealed source therapy
• □ME 2.2 Synthesize patient information to determine response to treatment and/or toxicity of therapy
• □ME 4.1 Establish a plan for ongoing care, monitoring response to treatment, further investigations and/or further intervention
• □ME 4.1 Determine the need and timing of referral to another physician, including radiologists and/or oncologists as relevant

Communicator

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

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●sentinel node injections
2. ●lymphoscintigraphy
3. ●VP shunt injections
4. ●venipuncture
5. ●bladder catheterization
6. ●other procedure

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 1.3 Apply knowledge of key anatomic relationships
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Select and provide sedation and local analgesia, as appropriate
• □ME 3.4 Position the patient appropriately
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, gown and glove
• □ME 3.4 Perform procedures in a skillful and safe manner
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Recognize and manage immediate complications

Communicator

• □COM 5.1 Document the procedure

Collaborator

• □COL 1.2 Communicate effectively with nurses, technical staff and/or assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Category

1. ●exercise
2. ●persantine
3. ●dobutamine

Study stopped/altered due to patient factors

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Assess a patient’s suitability to proceed with cardiac stress testing
• □ME 3.1 Select the protocol relevant to the clinical question and patient condition
• □ME 3.2 Obtain and document informed consent, explaining the risks and the rationale for the procedure
• □ME 3.5 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.5 Modify or adjust the procedure to optimize study quality, as needed
• □ME 3.4 Recognize and manage immediate complications

Communicator

• □COM 5.1 Communicate critical results urgently, as needed

Collaborator

• □COL 1.2 Communicate effectively with nurses, technical staff and/or assistants during the procedure

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.5 Use computer applications to optimize the images and/or views needed in order to answer the clinical question
• □ME 3.5 Assess the quality and validity of the study and any impact on the diagnostic interpretation
• □ME 3.5 Recognize artefacts and imaging pitfalls
• □ME 3.5 Provide interpretation of nuclear cardiology studies
• □ME 2.4 Provide suggestions for further testing and/or management as relevant
• □ME 3.5 Recognize critical findings

Communicator

• □COM 5.1 Provide clear, concise, accurate and grammatically correct reports of diagnostic testing in a timely fashion

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

Complexity of day

1. ●low
2. ●medium
3. ●high

Medical Expert

• □Part A: ME 2.1 Prioritize requests for nuclear medicine examinations
• □Part A: ME 3.5 Supervise, analyze and interpret nuclear medicine studies
• □Part A: ME 5.1 Recognize and manage adverse events and emergency conditions requiring urgent medical attention
• □Part A: ME 2.4 Advise referring physicians on the most appropriate investigation and/or sequence of investigations

Communicator

• □Part A: COM 5.1 Convey urgent or unexpected results to the referring physician in a timely manner
• □Part A: COM 4.3 Answer questions from a patient and family

Collaborator

• □Part A: COL 1.4 Coordinate scheduling of cases with technical and other staff
• □Part A: COL 1.4 Work with technical staff to solve imaging challenges and optimize the quality of examinations
• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals
• □Part B: COL 1.4 Provide guidance to resolve clinical or imaging challenges

Leader

• □Part A: L 2.1 Allocate resources for optimal delivery of services

Scholar

• □Part B: S 2.2 Help to create a positive learning environment
• □Part B: S 2.3 Provide learners with opportunities for appropriate clinical responsibility

Professional

• □Part A: P 1.1 Work within personal limitations, seeking assistance as needed
• □Part B: P 1.1 Respond to requests from technical staff in a timely manner
• □Part B: P 1.1 Demonstrate professional behaviours, including punctuality, integrity and compassion
• □Part B: P 1.1 Recognize when behaviours toward colleagues and/or learners undermine a respectful environment and report the behaviour to the appropriate individual

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

Event

1. ●clinical
2. ●simulated

Medical Expert

• □ME 5.1 Recognize and respond to a safety event in a timely manner
• □ME 5.1 Contain the spill and mitigate risk to person, patient and/or staff
• □ME 1.6 Seek assistance, as needed
• □ME 5.1 Identify potential improvement opportunities arising from radiation safety incidents and near misses

Communicator

• □COM 3.2 Communicate issues arising from a breach in radiation safety to the patient and/or family

Collaborator

• □COL 1.4 Work with staff to ensure patient, technologist and personal safety

Leader

• □L 3.1 Demonstrate responsibility for radiation safety
• □L 3.1 Manage the specific nature of the radiation safety incident, following appropriate procedures
• □L 3.1 Follow procedures for reporting radiation safety incidents

Professional

• □P 3.1 Apply knowledge of the regulatory requirements related to radiation safety and safety incidents

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Synthesize cases for discussion at interdisciplinary rounds
• □ME 1.3 Apply knowledge of the natural history, clinical manifestations and management of conditions examined or treated by nuclear medicine techniques
• □ME 1.3 Apply knowledge of diagnostic algorithms for investigation and the role of nuclear medicine imaging

Collaborator

• □COL 1.3 Convey information to clinicians in a manner that enhances patient management
• □COL 1.3 Encourage discussion, questions, and interaction relevant to the case
• □COL 2.1 Actively listen to and engage in interactions with members of the interdisciplinary team
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 1.3 Participate effectively at interdisciplinary rounds

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Scholar

• □S 3.3 Critically evaluate health literature
• □S 3.4 Integrate best evidence and clinical expertise

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

Leader

• □L 1.1 Identify issues related to the quality of the delivery of nuclear medicine services
• □L 1.1 Perform an analysis of human and system factors related to the quality concern
• □L 1.1 Identify opportunities for improvement
• □L 1.1 Formulate a plan for ongoing quality improvement

Scholar

• □S 4.4 Collect data to characterize the issue
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.5 Summarize and communicate the findings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of activity

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

Audience

1. ●junior learners
2. ●peers
3. ●NM physicians
4. ●other audience

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 health 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

Level of learner

1. ●medical student
2. ●junior resident
3. ●technologists

Medical Expert

• □Part A: ME 1.5 Carry out professional duties in the face of multiple competing demands

Collaborator

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

Scholar

• □Part A: S 2.1 Apply strategies for deliberate, positive role-modelling
• □Part A: S 2.2 Help to create a positive learning environment
• □Part A: S 2.3 Supervise learners to ensure they work within their limits
• □Part A: S 2.3 Balance clinical supervision and graduated responsibility, ensuring the safety of patients and learners
• □Part A: S 2.4 Provide clinical teaching and/or other informal learning activities
• □Part A: S 2.5 Provide feedback to enhance learning and performance
• □Part B: S 2.2 Help to create a positive learning environment
• □Part B: S 2.3 Provide learners with opportunities for appropriate clinical responsibility
• □Part B: S 2.3 Available and accessible to junior learners
• □Part B: S 2.4 Provide clinical teaching and/or other informal learning activities
• □Part B: S 2.5 Provide feedback to enhance learning and performance
• □Part B: S 2.1 Apply strategies for deliberate, positive role-modelling

Professional

• □Part A: P 1.1 Recognize when behaviours towards colleagues and/or learners undermine a respectful environment and report the behaviour to the appropriate individual
• □Part A: P 3.3 Participate in the assessment of junior learners
• □Part A: P 4.3 Support others in their professional transitions

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

Complexity of day

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 2.1 Prioritize requests for nuclear medicine examinations
• □ME 3.5 Supervise, analyze and interpret nuclear medicine studies
• □ME 3.5 Interpret and report the caseload of nuclear medicine studies in a timely fashion
• □ME 2.4 Advise referring physicians on the most appropriate investigation and/or sequence of investigations

Collaborator

• □COL 1.4 Coordinate scheduling of cases with technical and other staff
• □COL 1.4 Guide technical staff to resolve clinical or imaging challenges

Leader

• □L 2.1 Allocate resources for optimal delivery of services
• □L 3.1 Adapt or develop imaging schedules to address a change in resources, including equipment malfunction and radiopharmaceutical shortfalls
• □L 3.1 Work with staff to address personnel, management and patient care issues

Scholar

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

Professional

• □P 1.1 Work within personal limitations, seeking assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of case

1. ●diagnostic
2. ●therapeutic

Patient age

1. ●child
2. ●adult

Medical Expert

• □ME 2.2 Synthesize cases for discussion at interdisciplinary rounds
• □ME 1.3 Apply knowledge of the natural history, clinical manifestations and management of conditions examined or treated by nuclear medicine techniques
• □ME 2.4 Demonstrate flexibility in clinical reasoning, in the setting of clinical uncertainty
• □ME 2.4 Establish a patient-centred management plan despite limited, non- diagnostic, or conflicting clinical data
• □ME 4.1 Determine the need and timing of referral to another physician, including radiologists and/or oncologists as relevant

Communicator

• □COM 3.1 Convey information to the patient and/or family clearly and compassionately
• □COM 4.3 Use communication strategies and skills that help the patient and family make decision despite uncertainty in diagnosis or treatment

Collaborator

• □COL 2.1 Actively listen to and engage in interactions with members of the interdisciplinary team
• □COL 1.3 Incorporate the opinions and perspectives of other physicians into the formulation of the management plan
• □COL 2.2 Facilitate the development of consensus when there are differences in recommendations provided by other 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

Medical Expert

• □ME 1.4 Present and discuss cases effectively at clinical rounds, in the role of a consultant in nuclear medicine
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Collaborator

• □COL 1.3 Contribute to quality patient care by sharing expertise
• □COL 1.3 Convey information to clinicians in a manner that enhances patient management
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Support clinical colleagues in the development and implementation of a management plan
• □COL 2.2 Facilitate the development of 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

Health Advocate

• □HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care

Scholar

• □S 3.3 Critically evaluate health literature
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

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

Collaborator

• □COL 1.1 Receive and respond appropriately to input from others
• □COL 1.3 Work effectively with physicians and other colleagues

Leader

• □L 3.1 Demonstrate an understanding of the administrative operations of a nuclear medicine department, clinic and/or service
• □L 3.1 Contribute to improvements in nuclear medicine professional practice

Scholar

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

Professional

• □P 2.1 Demonstrate a commitment to active participation in the activities of the profession
• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps