Obstetrics and Gynecology

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

1. ●antepartum
2. ●intrapartum

Setting

1. ●in-patient
2. ●out-patient

Medical Expert

• □ME 2.2 Elicit a history that informs the diagnosis
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select appropriate investigations based on the differential diagnosis
• □ME 2.4 Develop an initial management plan for common obstetric presentations
• □ME 3.3 Recognize and discuss the importance of the triaging and timing of a procedure or therapy
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.2 Mitigate physical barriers to communication to optimize patient comfort, dignity, privacy, engagement, and safety
• □COM 1.4 Identify, verify, and validate non-verbal cues on the part of patients and their families
• □COM 2.2 Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record

Collaborator

• □COL 1.3 Discuss with the patient and family any plan for involving other health care professionals, including other physicians, in the patient’s care
• □COL 2.1 Respond to requests and feedback in a respectful and timely manner
• □COL 2.1 Show respect for the diversity of perspectives and expertise among 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

Common gynecologic presentations

1. ●abnormal uterine bleeding
2. ●vulvovaginitis
3. ●pelvic pain
4. ●other

Medical Expert

• □ME 2.2 Elicit a history that informs the diagnosis
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select appropriate investigations based on the differential diagnosis
• □ME 2.4 Develop an initial management plan for common gynecologic presentations
• □ME 3.3 Recognize and discuss the importance of the triaging and timing of a procedure or therapy
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy, and is characterized by empathy, respect, and compassion
• □COM 1.2 Mitigate physical barriers to communication to optimize patient comfort, dignity, privacy, engagement, and safety
• □COM 1.4 Identify, verify, and validate non-verbal cues on the part of the patients and their families
• □COM 2.2 Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record

Collaborator

• □COL 1.3 Discuss with the patient and family any plan for involving other health care professionals, including other physicians, in the patient’s care
• □COL 2.1 Respond to requests and feedback in a respectful and timely manner
• □COL 2.1 Show respect for the diversity of perspectives and expertise among 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

Medical Expert

• □ME 2.2 Perform a patient assessment including history and physical exam
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Select appropriate investigations and interpret the results
• □ME 2.3 Address the patient’s ideas, fears, and concerns about pregnancy and her prenatal care
• □ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each screening and treatment option in the context of best evidence and guidelines
• □ME 4.1 Establish plans for ongoing care for the patient, taking into consideration her clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Communicator

• □COM 3.1 Communicate the plan of care clearly and accurately to the patient and their family
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

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

Leader

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

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources
• □HA 1.2 Work with the patient to increase opportunities to adopt healthy behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Investigation

1. ●non-stress test
2. ●amniotic fluid volume
3. ●Point of Care Ultrasound (POCUS)
4. ●biophysical profile
5. ●fetal heart rate tracing
6. ●other

Setting

1. ●clinic
2. ●obstetrics day unit
3. ●triage
4. ●labour & delivery

Counselling on fetal movement count

1. ●yes
2. ●no

Atypical/abnormal findings

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to assess fetal well-being
• □ME 1.5 Perform a focused clinical assessment that addresses all relevant issues
• □ME 1.5 Recognize an urgent or difficult problem that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.7 Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities for the patient encounter
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements as necessary
• □ME 3.1 Determine the most appropriate method(s) for the purpose of assessment of fetal well-being
• □ME 3.4 Perform a fetal assessment which may include fetal heart rate monitoring, biophysical profile, umbilical artery Doppler, EFW, and fetal scalp sampling
• □ME 3.4 Perform POCUS in a skilful, fluid, and safe manner without assistance

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 3.1 Share information and explanations that are clear, accurate, timely, and adapted to the patient’s and her family’s level of understanding and need
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.1 Demonstrate commitment and accountability for patients in their care
• □ME 1.7 Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making
• □ME 1.5 Recognize an urgent or difficult problem that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.6 On the basis of patient-centred priorities, prioritize multiple competing tasks that need to be addressed
• □ME 2.2 Perform a patient assessment including history and physical exam
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement an initial management plan for common problems in obstetric practice
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 3.1 Use strategies to verify and validate the patient’s understanding
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals

Health Advocate

• □HA 2.2 Identify patients or populations that are not being served optimally in their clinical practice

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 clinical and biomedical sciences to manage presentations in obstetric care
• □ME 3.4 Manage the first stage of normal childbirth in a timely, skilful, and safe manner, including fetal and maternal well-being, determination of progress of labour, fetal position, dilatation and station
• □ME 3.4 Manage the second stage of normal childbirth in a timely, skilful, and safe manner
• □ME 3.4 Manage the delivery of an infant
• □ME 3.4 Assess and manage perineal trauma
• □ME 3.4 Manage the delivery of the placenta
• □ME 3.4 Perform cervical ripening and augmentation of labour, as required
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 1.5 Recognize an urgent or difficult problem that may need the involvement of more experienced colleagues and seek their assistance

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 3.1 Share information and explanations that are clear, accurate, timely, and adapted to the patient’s and her family’s level of understanding and need
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals

Professional

• □P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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 surgical anatomy, steps of the procedure, potential intraoperative risks, and means to avoid/overcome them
• □Part A: ME 3.1 Describe the indications and complications of cesarean section
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks, benefits, alternatives and the rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Position and prep patient correctly
• □Part A: ME 3.4 Open the incision using sharp and/or energy-based instruments
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Deliver the infant using appropriate technique
• □Part A: ME 3.4 Maintain hemostasis and control bleeding using appropriate technique with attention to adjacent structures
• □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, including post- operative orders

Communicator

• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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 clinical and biomedical sciences to manage presentations in obstetric care
• □ME 1.5 Recognize an urgent or difficult problem that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.5 Perform a focused clinical assessment that addresses all relevant issues
• □ME 1.6 Maintain a duty of care and patient safety while balancing multiple responsibilities
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context in collaboration with the patient and family and, when appropriate, the interprofessional team

Communicator

• □COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
• □COM 4.3 Counsel the patient regarding potential postpartum complications including depression
• □COM 3.1 Discuss birth control methods to be adopted in the postpartum period
• □COM 3.1 Use strategies to verify and validate the patient’s understanding
• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 3.2 Communicate with a patient’s primary health care professional about the patient’s 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

• □ME 1.4 Apply clinical and biomedical sciences to manage presentations in gynecologic care
• □ME 1.5 Recognize an urgent or difficult problem that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.6 Maintain a duty of care and patient safety while balancing multiple responsibilities
• □ME 1.7 Identify clinical situations in which complexity, uncertainty, and ambiguity play a role in decision-making
• □ME 2.2 Perform a patient assessment including history and physical exam
• □ME 2.2 Select appropriate investigations and interpret the results
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement an initial management plan for urgent and emergent gynecologic presentations
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □ME 3.2 Obtain and document informed consent, explaining the risks, benefits, alternatives and the rationale for the proposed treatment options
• □ME 4.1 Ensure follow-up on results of investigation

Communicator

• □COM 1.6 Assess a patient’s decision-making capacity
• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □COM 3.1 Use strategies to verify and validate the patient’s understanding
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

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

Health Advocate

• □HA 2.2 Identify patients or populations that are not being served optimally in their clinical practice

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 issue

1. ●reversible contraception
2. ●permanent contraception
3. ●emergency contraception
4. ●medical pregnancy termination
5. ●surgical pregnancy termination

Co-morbidity

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.4 Apply clinical and biomedical sciences to manage presentations in gynecologic care
• □Part A: ME 2.2 Perform a patient assessment including history and physical exam
• □Part A: ME 2.2 Synthesize clinical information for the purpose of counselling about contraceptive options and pregnancy termination
• □Part A: ME 2.3 Work with the patient to understand relevant options for care
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □Part A: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks, benefits, alternatives and the rationale for the proposed treatment options
• □Part B: ME 3.4 Perform LARC insertion/removal in a skilful, fluid, and safe manner

Communicator

• □Part A: COM 4.1 Explore the perspectives of the patient and others when developing care plans
• □Part A: COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
• □Part A: COM 4.1 Communicate with cultural awareness and sensitivity
• □Part A: COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Leader

• □Part A: L 2.1 Consider costs when choosing care options

Health Advocate

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

Professional

• □Part A: P 1.3 Manage ethical issues encountered in the clinical and academic setting

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage presentations in gynecologic care
• □ME 2.2 Perform a patient assessment including history and physical exam
• □ME 2.2 Select appropriate investigations and interpret the results
• □ME 2.4 Develop and implement an initial management plan for common gynecologic conditions
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □ME 3.2 Obtain and document informed consent, explaining the risks, benefits, alternatives and the rationale for the proposed treatment options
• □ME 3.4 Perform common procedures in a skilful, fluid, and safe manner, including endometrial or vulvar biopsy, LARC insertion or Pap smear

Communicator

• □COM 4.3 Answer questions from the patient and family about next steps
• □COM 5.1 Document the clinical encounter to adequately convey findings, clinical reasoning and the rationale for decisions

Health Advocate

• □HA 1.3 Work with the patient to identify opportunities for disease prevention, health promotion, and health protection

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●basic laparoscopy (port placement, electrocautery, closing incisions)
2. ●diagnostic hysteroscopy
3. ●global endometrial ablation
4. ●surgical management of Bartholin’s abscess
5. ●dilatation and curettage

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 1.4 Apply knowledge of the principles of electrosurgery
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks, benefits, alternatives and the rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Assemble required equipment
• □Part A: ME 3.4 Interpret findings of examination under anesthesia
• □Part A: ME 3.4 Place laparoscopic ports
• □Part A: ME 3.4 Orient spatially without hesitation and position instruments where intended
• □Part A: ME 3.4 Perform safe 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, including post- operative orders

Communicator

• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●clinic
2. ●inpatient unit
3. ●labour and delivery
4. ●intensive care unit

Counselling

1. ●preconception
2. ●antenatal

Presentation

1. ●genetic disorder
2. ●maternal medical disorder
3. ●history of previous pregnancy complication
4. ●fetal complication
5. ●pregnancy complication

External cephalic version attempt

1. ●yes
2. ●no

Observation

1. ●direct
2. ●indirect

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 obstetrics and gynecology
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Prioritize issues to be addressed in the patient encounter
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Health Advocate

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

Professional

• □P 1.3 Manage ethical issues encountered in the clinical and academic setting

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical (ER, triage, L&D, antenatal ward, ICU)
2. ●simulation

Maternal complication

1. ●not applicable
2. ●chorioamnionitis
3. ●trial of labour after cesarean section
4. ●complicated induction
5. ●severe hypertensive disorder of pregnancy
6. ●pre-gestational diabetes
7. ●maternal comorbidities (e.g., cardiac, GI, renal, pulmonary)
8. ●1st or 2nd stage dystocia
9. ●intrapartum hemorrhage
10. ●uterine rupture
11. ●shock
12. ●eclampsia
13. ●other

Fetal complication

1. ●not applicable
2. ●preterm delivery (gestational age <32 weeks)
3. ●multiples
4. ●intrauterine fetal death
5. ●malposition
6. ●cord prolapse
7. ●atypical/abnormal fetal heart rate tracing

Manual rotation

1. ●yes
2. ●no

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 obstetrics and gynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 1.6 Carry out professional duties in the face of multiple, competing demands
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 1.7 Seek assistance in situations that are complex, novel, or involve uncertainty
• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about goals of care that are not felt to be achievable
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Leader

• □L 2.2 Apply evidence and management processes to achieve cost-appropriate 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

Complication

1. ●shoulder dystocia
2. ●vaginal breech, multiple delivery
3. ●postpartum hemorrhage (PPH)
4. ●3rd or 4th degree tear
5. ●other

Setting

1. ●clinical
2. ●simulation

Procedure

1. ●vacuum
2. ●outlet forceps (non-rotation)
3. ●low forceps (non-rotation)
4. ●rotational forceps
5. ●perineal laceration
6. ●shoulder dystocia
7. ●internal podalic version
8. ●breech extraction

Medical Expert

• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about goals of care that are not felt to be achievable
• □ME 3.2 Describe the steps of the procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Integrate required information to reach diagnosis and determine correct procedure required
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 3.4 Prepare and position the patient correctly, gather required instruments, apply knowledge of the approach and anticipate probable complications
• □ME 3.4 Perform the steps of the procedure efficiently, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Document the procedure
• □ME 3.4 Establish and implement a plan for care following delivery
• □ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
• □COM 3.1 Debrief the delivery with the patient and family in a timely, honest, and transparent manner

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Professional

• □P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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 cesarean section

1. ●classical
2. ●multiple pregnancy
3. ●2nd stage
4. ●morbidly obese patient
5. ●extensive extension
6. ●abnormal placentation (e.g., accreta, previa)
7. ●difficult repeat cesarean section
8. ●STAT cesarean section
9. ●transverse lie
10. ●other

Complication management

1. ●repair of extensive extension
2. ●surgical management of postpartum hemorrhage
3. ●uterine dehiscence/rupture repair
4. ●management of extensive intra-abdominal adhesions/ scar tissue
5. ●not applicable

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 1.5 Recognize urgent or difficult problems that may need the involvement of more experienced colleagues and seek their assistance
• □Part A: ME 3.1 Integrate required information to reach diagnosis and determine correct procedure required
• □Part A: ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □Part A: ME 3.4 Perform the steps of the procedure efficiently, avoiding pitfalls and respecting soft tissues
• □Part A: ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 3.4 Establish and implement a plan for care following delivery
• □Part A: ME 5.2 Apply the principles of situational awareness to clinical practice
• □Part A: ME 3.4 Document the procedure

Communicator

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

Collaborator

• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●delayed postpartum hemorrhage
2. ●infection
3. ●perineal complications, vaginal hematoma
4. ●mastitis
5. ●endometritis
6. ●venous thromboembolism/pulmonary embolus
7. ●septic thrombophlebitis
8. ●psychosocial comorbidities
9. ●postpartum psychiatric disorders (e.g., psychosis, depression)

Observation

1. ●direct
2. ●indirect

Setting

1. ●office setting
2. ●postpartum ward
3. ●triage/ER
4. ●simulation

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 obstetrics and gynecology
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context
• □ME 4.1 Determine the need and timing of referral to another physician or health care professional

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Health Advocate

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●ER
2. ●inpatient
3. ●gynecology clinic
4. ●diagnostic imaging
5. ●ultrasound unit
6. ●simulation

Obstetrics cases

1. ●not applicable
2. ●standard BPP
3. ●modified BPP (cord Doppler)
4. ●fetal position and number
5. ●placental location
6. ●fetal viability
7. ●basic fetal biometry (BPD, HC, AC, FL)
8. ●cervical length

Gynecology cases

1. ●not applicable
2. ●confirm intrauterine pregnancy
3. ●crown rump length (CRL)
4. ●free fluid in pelvis/abdomen
5. ●US guided curettage

Free fluid

1. ●not applicable
2. ●normal
3. ●abnormal

Observation

1. ●direct
2. ●image review

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 obstetrics and gynecology
• □ME 1.5 Perform ultrasound assessments that address the breadth of issues in each case
• □ME 3.4 Adjust instrument settings appropriately to optimize image quality
• □ME 3.4 Obtain standard views
• □ME 2.2 Recognize clinically significant findings in an US examination
• □ME 1.7 Seek assistance in situations that are complex, novel, or involve uncertainty
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 4.1 Determine the need and timing of referral to another physician or health care professional

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

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 department
2. ●inpatient ward
3. ●outpatient clinic

Patient presentation

1. ●acute intra-abdominal process
2. ●severe ovarian hyperstimulation syndrome
3. ●acute uterine bleeding
4. ●early pregnancy complications

Observation

1. ●direct
2. ●indirect

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 obstetrics and gynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Prioritize issues to be addressed in the patient encounter
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion
• □ME 2.3 Share concerns, in a constructive and respectful manner, with patients and their families about goals of care that are not felt to be achievable
• □ME 2.4 Develop and implement plans for definitive management of acute gynecologic emergencies
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Communicator

• □COM 2.1 Actively listen and respond to patient cues
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complex gynecologic condition

1. ●menstrual disorder
2. ●complex menopausal complaint
3. ●pre-invasive gynecologic condition
4. ●complex gynecologic infection
5. ●pelvic mass
6. ●vulvar dystrophy
7. ●other

Procedure

1. ●endometrial biopsy
2. ●cervical biopsy
3. ●vulvar biopsy
4. ●loop electrosurgical excision procedure (LEEP)
5. ●not applicable

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 obstetrics and gynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed during the current encounter or during future visits or with other health care practitioners
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given procedure or therapy
• □ME 3.4 Perform common procedures in a skilful, fluid, and safe manner with minimal assistance

Communicator

• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

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

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices
• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

Health Advocate

• □HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients

Scholar

• □S 3.3 Evaluate the applicability (external validity or generalizability) of evidence from 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

Patient presentation

1. ●infertility
2. ●fertility preservation
3. ●fertility pursuit (e.g., Solo/LGBTQ+)
4. ●recurrent pregnancy loss
5. ●complications following artificial reproductive technologies (ART)

Etiology

1. ●endometriosis
2. ●anovulation/amenorrhea
3. ●congenital uterine anomaly
4. ●social
5. ●tubal factor
6. ●male factor infertility
7. ●complications from treatment
8. ●ovarian hyperstimulation syndrome (OHSS)
9. ●other

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in reproductive endocrinology to manage patients with reproductive challenges
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.4 Develop a plan to address reproductive challenges, in collaboration with a patient with or without inclusion of her partner
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 4.1 Establish plans for ongoing care for the patient, taking into consideration her clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

Communicator

• □COM 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Leader

• □L 2.1 Consider costs when choosing care options

Health Advocate

• □HA 2.1 Analyze public policy that affects patients with reproductive challenges

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●outpatient
2. ●emergency department
3. ●inpatient

Patient presentation

1. ●labial agglutination
2. ●vaginal discharge
3. ●vulvovaginitis
4. ●simple straddle injuries
5. ●sexual health counselling
6. ●abnormal uterine bleeding
7. ●amenorrhea
8. ●other menstrual irregularities
9. ●adnexal masses
10. ●delayed/precocious puberty
11. ●obstructive Mullerian anomalies
12. ●other

Pre-pubertal patient

1. ●yes
2. ●no

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage pediatric patients with obstetric or gynecologic presentations
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their health
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Collaborator

• □COL 3.1 Determine when care should be transferred to another physician or health care professional
• □COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●outpatient
3. ●operating room

Patient presentation

1. ●pelvic organ prolapse (POP)
2. ●urinary incontinence (UI)- stress
3. ●urinary incontinence (UI)- urge
4. ●lower urinary tract symptoms (LUTS)
5. ●anal incontinence and defecatory dysfunction
6. ●fistulas

Management

1. ●pessary fitting
2. ●cystoscopy
3. ●urodynamic interpretation
4. ●primary surgical correction of stress incontinence
5. ●other

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 urogynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context
• □ME 3.2 Ensure that patients are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □ME 3.4 Perform cystoscopy in a skilful, fluid, and safe manner with minimal assistance
• □ME 3.4 Perform pessary fitting in a skilful, fluid, and safe manner with minimal assistance

Communicator

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

Health Advocate

• □HA 1.2 Select patient education resources related to Gynecology
• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Patient presentation

1. ●chronic pelvic pain
2. ●sexual health concern

Diagnosis

1. ●vulvodynia
2. ●levator hypertonicity
3. ●myofascial pain
4. ●female sexual dysfunction
5. ●other

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patients presenting with chronic pain or sexual concerns
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 2.1 Actively listen and respond to patient cues
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately

Collaborator

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

Health Advocate

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

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

Tumour site

1. ●ovarian/fallopian tube/primary peritoneal
2. ●endometrial/sarcoma
3. ●cervix
4. ●vulva/vagina
5. ●gestational trophoblastic disease (GTD)
6. ●other

Palliation

1. ●yes
2. ●no

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 obstetrics and gynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select appropriate investigations and interpret the results
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □COM 1.6 Tailor approaches to decision-making to patient capacity, values, and preferences
• □COM 5.1 Document clinical encounters to adequately convey findings, clinical reasoning and the rationale for decisions

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □HA 1.1 Facilitate timely patient access to 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

Procedure

1. ●endometrial resection
2. ●endometrial ablation
3. ●myomectomy
4. ●septoplasty of partial/complete septum
5. ●lysis of intrauterine adhesions
6. ●other

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 1.4 Apply knowledge of the principles of electrosurgery
• □Part A: ME 3.1 Describe the indications, risks and complications of advanced hysteroscopy
• □Part A: ME 3.2 Obtain and document informed consent, explaining to the patient the risks, benefits, alternatives and rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Assemble required equipment
• □Part A: ME 3.4 Select and manage distension media
• □Part A: ME 3.4 Interpret hysteroscopic findings
• □Part A: ME 3.4 Orient spatially without hesitation and position instruments where intended
• □Part A: ME 3.4 Perform safe 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 Identify and trouble-shoot equipment issues
• □Part A: ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care, including post- operative orders
• □Part A: ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome
• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●vaginal hysterectomy
2. ●anterior and posterior repair
3. ●simple vulvectomy
4. ●cervical conization
5. ●perineorrhaphy
6. ●colpocleisis

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 3.1 Describe the indications, risks and complications of major vaginal procedures
• □Part A: ME 3.2 Obtain and document informed consent, explaining to the patient the risks, alternatives and the rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Assemble required equipment
• □Part A: ME 3.4 Orient spatially without hesitation and position instruments where intended
• □Part A: ME 3.4 Perform safe 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 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care, including post- operative orders
• □Part A: ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome
• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●laparoscopic salpingostomy/salpingectomy
2. ●laparoscopic ovarian cystectomy
3. ●salpingo-oophorectomy
4. ●laparoscopic treatment of endometriosis
5. ●laparoscopic-assisted vaginal hysterectomy (LAVH)
6. ●total laparoscopic hysterectomy (TLH)

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 1.4 Apply knowledge of the principles of electrosurgery
• □Part A: ME 3.1 Describe the indications, risks and complications of advanced laparoscopy
• □Part A: ME 3.2 Obtain and document informed consent, explaining to the patient the risks, benefits, alternatives and the rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Assemble required equipment
• □Part A: ME 3.4 Identify laparoscopic anatomical landmarks
• □Part A: ME 3.4 Place laparoscopic ports
• □Part A: ME 3.4 Orient spatially without hesitation and position instruments where intended
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Interpret laparoscopic findings
• □Part A: ME 3.4 Demonstrate intraoperative judgment, fluidity of movement, and forward progression
• □Part A: ME 3.4 Identify and trouble-shoot equipment issues
• □Part A: ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care, including post- operative orders
• □Part A: ME 5.2 Apply the principles of situational awareness to clinical practice

Communicator

• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome
• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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. ●total abdominal hysterectomy
2. ●subtotal abdominal hysterectomy
3. ●salpingo-oophorectomy/oophorectomy
4. ●ovarian cystectomy
5. ●abdominal myomectomy
6. ●omentectomy
7. ●peritoneal biopsy
8. ●conversion from planned laparoscopy
9. ●repair of incisional dehiscence
10. ●adhesiolysis

Medical Expert

• □Part A: ME 1.4 Apply knowledge of surgical anatomy, steps of the procedure, potential intraoperative risks and means to avoid/overcome them
• □Part A: ME 3.1 Describe the indications, risks and complications of laparotomy and open gynecologic surgery
• □Part A: ME 3.2 Obtain and document informed consent, explaining to the patient the risks, benefits, alternatives and the rationale for the proposed treatment options
• □Part A: ME 3.4 Demonstrate effective procedure preparation, including the use of a pre- procedure time-out or safe surgical checklist as appropriate
• □Part A: ME 3.4 Assemble required equipment
• □Part A: ME 3.4 Interpret findings of examination under anesthesia
• □Part A: ME 3.4 Orient spatially without hesitation and position instruments where intended
• □Part A: ME 3.4 Perform safe 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 5.2 Apply the principles of situational awareness to clinical practice
• □Part A: ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care, including post- operative orders

Communicator

• □Part A: COM 5.1 Document the surgical encounter to adequately convey the procedure and outcome
• □Part A: COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Collaborator

• □Part A: COL 1.2 Communicate effectively and professionally with the OR team

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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

Complication

1. ●bowel obstruction
2. ●bowel injury
3. ●infection
4. ●perioperative bleeding
5. ●genitourinary complication
6. ●thromboembolic disease
7. ●wound complication
8. ●nerve injury
9. ●uterine perforation
10. ●vascular injury
11. ●other

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage surgical complications
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 1.7 Seek assistance in situations that are complex, novel, or involve uncertainty
• □ME 2.4 Develop and implement patient-centred management plans that consider all of the patient’s health problems and context
• □ME 5.1 Recognize and respond to harm from health care delivery, including patient safety incidents
• □ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

Communicator

• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □COM 5.1 Adapt record keeping to the clinical context

Collaborator

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

Leader

• □L 1.2 Model a just culture to promote openness and increased reporting
• □L 1.4 Use data on measures of clinical performance during team discussions and to support team decision-making
• □L 1.1 Analyze and provide feedback on processes seen in one’s own practice, team, organization, or system

Scholar

• □S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

Professional

• □P 4.1 Integrate skills that support adaptation and recovery in challenging situations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complexity of day

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in obstetrics and gynecology
• □ME 1.5 Perform clinical assessments that address all relevant issues
• □ME 1.6 Carry out professional duties in the face of multiple, competing demands
• □ME 1.6 Prioritize patients on the basis of clinical presentations

Communicator

• □COM 1.5 Manage disagreements and emotionally charged conversations
• □COM 3.2 Disclose adverse events to patients and their families accurately and appropriately

Collaborator

• □COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □COL 1.1 Respond appropriately to input from other health care professionals

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 1.2 Contribute to a culture that promotes patient safety
• □L 1.2 Model a just culture to promote openness and increased reporting
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □L 2.4 Run the service efficiently, safely and effectively

Scholar

• □S 2.1 Use strategies for deliberate, positive role-modelling

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

1. ●gynecology
2. ●obstetrics

Medical Expert

• □ME 1.1 Demonstrate a commitment to high-quality care of their patients
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in obstetrics and gynecology
• □ME 1.7 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in obstetrics and gynecology practice
• □ME 3.3 Prioritize a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 4.1 Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

Leader

• □L 1.2 Contribute to a culture that promotes patient safety
• □L 2.1 Allocate health care resources for optimal patient care

Health Advocate

• □HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients

Professional

• □P 2.1 Demonstrate accountability to patients, society, and the profession by recognizing and responding to societal expectations of the profession
• □P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice

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

Communication scenario

1. ●unexpected diagnosis (e.g., stillbirth)
2. ●mismatched expectations (i.e., patient perceives serious when diagnosis is not serious)
3. ●adverse event
4. ●new diagnosis of incurable disease/cancer
5. ●progressive disease
6. ●therapy modification
7. ●transition to palliative care
8. ●other

Simulation

1. ●yes
2. ●no

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 Share information and explanations that are clear and accurate while checking for understanding
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
• □COM 4.3 Answer questions regarding care delivery, treatment decisions and/or prognosis in a respectful manner
• □COM 2.2 Manage the flow of a challenging patient encounter, including those with angry, distressed, or excessively talkative individuals

Professional

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

Case description

Feedback provided

Next steps