Orthopedic Surgery

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform an appropriate physical exam
• □ME 2.2 Order appropriate labs, imaging, and testing
• □ME 2.2 Generate a differential diagnosis
• □ME 2.4 Develop an initial management plan for common patient presentations

Communicator

• □COM 2.3 Gather information from other sources, including family members and the health information system, that may assist in the patient’s care
• □COM 1.1 Communicate using a patient-centered 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, privacy, engagement, and safety
• □COM 5.1 Organize information in appropriate sections in an electronic or written medical record
• □COM 5.1 Maintain accurate and up-to-date problem lists and medication lists

Professional

• □P 1.1 Complete assigned responsibilities
• □P 1.1 Maintain patient confidentiality and identify situations where confidentiality is breached
• □P 1.5 Exhibit professional behaviors in the use of technology-enabled communication

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

Injury

1. ●open fracture
2. ●fracture
3. ●joint dislocation
4. ●soft tissue injury

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform an appropriate physical exam
• □ME 1.4 Apply clinical and biomedical sciences to manage common patient presentations
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.3 Work with the patient and family to understand relevant options for care
• □ME 2.4 Develop and implement an initial management plan
• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.3 Establish advance directives and goals of care with the patient/family
• □ME 4.1 Determine the need for referral to other specialists for pre-operative optimization
• □ME 4.1 Determine the need for, and coordinate availability of, enhanced post- operative monitoring/care, such as ICU or step down unit

Communicator

• □COM 3.1 Provide information about the diagnosis, prognosis and plan of care clearly and compassionately
• □COM 5.1 Document a clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Health Advocate

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

Professional

• □P 1.1 Manage specialty-specific issues of confidentiality, intervening when confidentiality is breached

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

Domain

1. ●trauma
2. ●foot and ankle
3. ●hip and knee
4. ●sports
5. ●upper extremity/hand
6. ●oncology
7. ●spine

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage common patient presentations
• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform an appropriate physical exam
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Determine diagnosis
• □ME 2.3 Assess patient’s decision-making capacity and work with the patient and family to establish goals of care
• □ME 2.4 Develop and implement an initial management plan
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources
• □ME 3.2 Obtain informed consent
• □ME 3.4 Perform a diagnostic or therapeutic injection, as relevant

Communicator

• □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 3.1 Provide information about the diagnosis, prognosis and plan of care clearly and compassionately
• □COM 5.1 Document a clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

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

Health Advocate

• □HA 1.3 Work with the patient and/or family 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

Condition

1. ●compartment syndrome
2. ●joint infection
3. ●urgent soft tissue infection
4. ●cauda equine
5. ●neurovascular compromise
6. ●other condition

Setting

1. ●emergency department
2. ●inpatient unit
3. ●simulation

Medical Expert

• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.1 Prioritize aspects of the patient’s assessment and management, responding to urgent presentations as well as ongoing changes in patient status
• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform an appropriate physical examination
• □ME 2.2 Interpret the findings of the physical exam to ascertain clinical significance
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop a plan for initial management that includes appropriate monitoring, medical management and disposition
• □ME 2.4 Identify patients that may need further surgical or radiological intervention
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources

Communicator

• □COM 5.1 Document a clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

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

Professional

• □P 4.1 Maintain professional clinical performance in stressful situations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●emergency department
2. ●outpatient
3. ●inpatient
4. ●operating room

Condition

1. ●fracture
2. ●MSK infection

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform an appropriate physical exam
• □ME 2.2 Adapt the clinical assessment to the child’s age and developmental stage
• □ME 2.2 Identify abnormalities in hemodynamic status to recognize the acutely septic patient
• □ME 2.2 Recognize risk factors for non-accidental trauma
• □ME 2.2 Recognize complications such as osteomyelitis, avascular necrosis, and premature physeal closure
• □ME 2.2 Select and interpret appropriate investigations
• □ME 1.4 Apply knowledge of Kocher’s criteria in establishing diagnosis of septic arthritis
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 3.3 Recognize situations requiring emergent or urgent surgical care
• □ME 4.1 Determine the need and timing of referral to another health care professional
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources
• □ME 3.4 Apply emergency splinting and immobilization, as relevant

Communicator

• □COM 3.1 Share information and explanations that are clear, accurate, and timely, while checking for patient/family understanding

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. ●literature review based on clinical question
2. ●paper or grant presentation
3. ●paper review at journal club

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □S 3.2 Identify, select and navigate pre-appraised resources
• □S 3.4 Identify evidence appropriate to one’s scope of practice
• □S 3.3 Interpret study findings and critique their relevance to their practice
• □S 3.3 Determine the validity and risk of bias in a source of evidence
• □S 3.4 Discuss the barriers to and facilitators of applying evidence into practice
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present the information in an organized manner

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

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. ●ward
2. ●clinic
3. ●emergency department
4. ●operating room
5. ●simulation

Procedure

1. ●closed reduction and casting
2. ●skeletal traction
3. ●skin traction
4. ●joint aspiration and fluid analysis
5. ●joint injection
6. ●other procedure

Patient demographic

1. ●adult
2. ●pediatric

Medical Expert

• □ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □ME 3.1 Interpret imaging studies to confirm diagnosis and indications for intervention
• □ME 3.2 Obtain informed consent
• □ME 3.4 Gather the required instruments and materials
• □ME 3.4 Prepare and position the patient for the procedure
• □ME 3.4 Select and provide sedation and analgesia, as appropriate
• □ME 3.4 Apply knowledge of anatomy, key landmarks and the procedure
• □ME 3.4 Demonstrate aseptic technique: skin preparation, establishing and respecting the sterile field
• □ME 3.4 Execute the steps of the procedure in a safe and efficient manner
• □ME 3.4 Order and review post-procedure imaging and/or fluid analysis, as applicable
• □ME 4.1 Provide discharge instructions and plan for follow-up
• □ME 3.4 Prevent and/or manage immediate complications of the procedure

Communicator

• □COM 5.1 Document the procedure

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●cannulated screws
2. ●sliding hip screw
3. ●IM nail
4. ●diaphyseal plating
5. ●periarticular fracture plating

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach • Safe use and interpretation of fluoroscopy • Application of internal fixation (interfragmentary screws, compression plate, intramedullary nail) • Appropriate use of AO techniques to manage fracture • Appropriate soft tissue management and closure
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●closed fracture reduction of simple fracture patterns
2. ●apply percutaneous pins
3. ●apply cast to maintain fracture reduction

Site

1. ●forearm
2. ●distal radius
3. ●tibia
4. ●ankle

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Closed reduction of fracture or fracture-dislocation • Percutaneous pinning of a fracture • Safe use and interpretation of fluoroscopy • Application of cast/splint of a fracture or fracture-dislocation
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, post-op plan and risk of long term complications (e.g. growth plate) to the parents/patient

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●operating room
2. ●simulation lab

Procedure

1. ●primary THA
2. ●primary TKA

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach • Retractor placement/protection of important structures • Safe operation of power equipment • Appropriate soft tissue management and closure
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●knee scope
2. ●shoulder scope

Simulation

1. ●yes
2. ●no

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Accurate marking of pertinent anatomic structures on patient, for surgical planning i.e. the location of the A-C joint, coracoid, biceps tendon, pes anserinus, etc. • Portal creation and safe joint entry • Appropriate selection and handling of instruments • Joint inspection • Identification of normal/pathologic structures
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Domain

1. ●trauma
2. ●foot and ankle
3. ●hip and knee
4. ●sports
5. ●upper extremity/hand
6. ●oncology
7. ●spine

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in orthopedic surgery
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purpose
• □ME 2.4 Develop a plan for management which may include observation, surgical intervention and/or non-operative intervention

Communicator

• □COM 3.1 Provide information about the diagnosis, prognosis and plan of care clearly and compassionately
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally sensitive
• □COM 5.1 Document a clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.2 Consult as needed with other physicians and/or health care professionals
• □COL 1.3 Provide timely and necessary written information to colleagues to enable effective care

Health Advocate

• □HA 1.3 Work with the patient and/or family 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

Complexity

1. ●simple
2. ●complex

Condition

1. ●foot abnormality
2. ●club foot
3. ●angular or rotational deformity
4. ●DDH
5. ●perthes
6. ●scoliosis
7. ●SCFE
8. ●syndromes
9. ●other

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.4 Apply clinical and biomedical sciences to manage core patient presentations in orthopedic surgery
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Adapt the clinical assessment to the child’s age and developmental stage
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and interpret appropriate investigations
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purpose
• □ME 2.4 Develop a plan for management which may include observation, surgical intervention and/or non-operative intervention

Communicator

• □COM 3.1 Provide information about the diagnosis, prognosis and plan of care clearly and compassionately
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally sensitive
• □COM 5.1 Document a clinical encounter to adequately convey clinical reasoning and rationale for decisions and/or recommendations

Collaborator

• □COL 1.2 Consult as needed with other physicians and/or health care professionals
• □COL 1.3 Provide timely and necessary written information to colleagues to enable effective care

Health Advocate

• □HA 1.3 Work with the patient and/or family 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

Complication

1. ●soft tissue infection/dehiscence
2. ●peripheral nerve injury
3. ●deep vein thrombosis/pulmonary embolus
4. ●vascular injury
5. ●loss of reduction or implant complication post-ORIF
6. ●mal-union
7. ●non-union
8. ●peri-prosthetic fracture
9. ●joint dislocation
10. ●other

Medical Expert

• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Recognize and respond to complications of orthopedic surgery
• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining treatment priorities
• □ME 2.4 Develop a plan for management which may include observation, surgical intervention and/or non-operative intervention
• □ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches
• □ME 3.3 Advocate for a patient’s procedure or therapy on the basis of urgency and available resources
• □ME 3.2 Obtain informed consent
• □ME 3.3 Organize and facilitate surgical management including booking the procedure, obtaining imaging, and obtaining the required instrumentation

Communicator

• □COM 3.2 Disclose adverse events and/or outcomes to the patient and family accurately and appropriately

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age group

1. ●pediatric
2. ●adult

Medical Expert

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

Communicator

• □COM 3.1 Provide information about diagnosis, prognosis, and plan of care clearly and compassionately
• □COM 4.3 Use effective communication skills and strategies, such as body posture, language at the appropriate level, and periodic checks for understanding
• □COM 2.1 Actively listen and respond to patient cues
• □COM 4.3 Answer questions from the patient and family
• □COM 5.1 Document the consent discussion in an accurate and complete manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □Part A: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □Part A: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □Part A: ME 2.4 Develop and implement plans for ongoing care, discharge and follow-up
• □Part A: ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □Part A: COM 1.5 Manage disagreements and emotionally charged conversations with patients and/or families

Collaborator

• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □Part A: L 2.1 Allocate health care resources for optimal patient care
• □Part A: L 4.1 Manage time and prioritize tasks
• □Part A: L 3.1 Plan work schedules for the service team
• □Part A: L 4.2 Run the service efficiently, safely and effectively

Health Advocate

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

Scholar

• □Part A: S 3.4 Integrate best evidence and clinical expertise into decision-making
• □Part A: S 2.3 Supervise junior learners to ensure they work within their limits
• □Part B: S 2.4 Provide formal and informal teaching for junior learners
• □Part B: S 2.5 Provide junior learners with useful timely feedback

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Communicator

• □Part A: COM 5.1 Organize information in appropriate sections
• □Part A: COM 5.1 Document all relevant findings and investigations
• □Part A: COM 5.1 Document a clinical encounter to adequately convey clinical reasoning, and rationale for decisions and/or recommendations
• □Part A: COM 5.1 Document the plan for ongoing management
• □Part A: COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □Part A: COL 3.2 Demonstrate safe written handover of care

Professional

• □Part A: P 1.5 Exhibit professional behaviours in the use of technology-enabled communication

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

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

Scholar

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

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. ●ward
2. ●OR
3. ●clinic
4. ●small group

Observer

1. ●orthopedic surgeon
2. ●fellow
3. ●TTP resident
4. ●Core resident
5. ●Foundations resident
6. ●TTD resident

Collaborator

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

Leader

• □L 1.2 Actively encourage all involved in health care to report and respond to unsafe situations

Scholar

• □S 2.4 Identify the learning needs of a junior learner
• □S 2.1 Use strategies for deliberate, positive role-modelling
• □S 2.2 Ensure a safe learning environment for all members of the team
• □S 2.3 Supervise junior learners to ensure they work within their limits
• □S 2.3 Balance clinical supervision and graduated responsibility, ensuring the safety of patients and learners
• □S 2.4 Demonstrate basic skills in teaching others, including peers
• □S 2.4 Plan learning activities appropriate to the level of the learner
• □S 2.4 Describe how to formally plan a medical education session
• □S 2.4 Describe sources of information used to assess learning needs
• □S 2.4 Define specific learning objectives for a teaching activity
• □S 2.4 Describe clinical teaching strategies relevant to orthopedics
• □S 2.5 Provide junior learners with useful timely feedback
• □S 2.6 Appropriately assess junior learners

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

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

Scholar

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

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complication

1. ●loss of reduction
2. ●implant complication
3. ●infection
4. ●mal-union
5. ●non- union
6. ●peri-prosthetic fracture
7. ●joint dislocation

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●AKA
2. ●through knee
3. ●BKA
4. ●ankle/foot

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Osseous management (use of saw, bevel bone, length of residual bone) • Vascular ligation • Nerve handling • Flap preparation • Soft tissue handling • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●upper extremity
2. ●lower extremity

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Soft-tissue fixation/repair/debridement • Implant and/or suture selection • Soft tissue handling • Closure and dressing • Splinting and/or casting
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●upper extremity
2. ●lower extremity
3. ●pelvis

Setting

1. ●ER/OR
2. ●simulation

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Fracture reduction, including use of adjuncts, as necessary • Appropriate soft tissue management including open fractures • Safe use and interpretation of fluoroscopy • Insertion of pins and application of external fixator
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●femur
2. ●tibia

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts , as necessary • Safe use and interpretation of fluoroscopy • Insertion of guide wire(s) • Reaming • Internal fixation, using nails, screws, plate and/or K-wires as applicable • Appropriate soft tissue management including open fractures
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Location

1. ●diaphyseal
2. ●meta-diaphyseal

Site

1. ●upper extremity
2. ●lower extremity

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts, as necessary • Safe use and interpretation of fluoroscopy • Internal fixation, using nails, screws, plate and/or K-wires as applicable • Appropriate use of AO techniques to manage fracture • Closure and dressing • Appropriate soft tissue management including open fractures
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●proximal humerus
2. ●distal humerus
3. ●olecranon
4. ●distal radius
5. ●distal femur
6. ●tibial plateau
7. ●pilon
8. ●ankle

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts, as necessary • Safe use and interpretation of fluoroscopy • Internal fixation, using nails, screws, plate and/or K-wires as applicable • Appropriate soft tissue management including open fractures
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, operative findings and patient status to the family in a clear, accurate and timely manner

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Fixation

1. ●plate and/or screws
2. ●proximal femoral nail

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts, as necessary • Safe use and interpretation of fluoroscopy • Insertion of guide wire(s) • Reaming • Insertion of implant(s) • Soft tissue handling
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●hemiarthroplasty
2. ●total hip arthroplasty

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Acetabulum evaluation and/or preparation • Femur preparation • Appropriate cement technique if required • Trial reduction • Insertion of implant(s) • Assessment of stability • Soft tissue handling • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Condition

1. ●hallux valgus
2. ●hammer toes
3. ●hallux rigidus
4. ●rheumatoid forefoot deformity

Procedure

1. ●metatarsophalangeal (MTP) fusion
2. ●hallux valgus correction
3. ●toe corrections
4. ●other procedure

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Deformity correction (boney and/or soft tissue release) • Joint preparation • Instrumentation • Safe use and interpretation of fluoroscopy • Soft tissue handling • Splinting and/or casting
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●ankle
2. ●hindfoot
3. ●midfoot

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Joint preparation • Deformity correction (boney and/or soft tissue release) • Position of fusion • Instrumentation • Safe use and interpretation of fluoroscopy
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●TKA
2. ●THA

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Retractor placement and protection of important structures • Safe operation of power equipment • Accurate intra-operative assessment of implant sizes and appropriate use of equipment trials • Assessment of ROM, stability, limb length and soft tissue balance • Precise implantation of true components • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●hip
2. ●knee

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Retractor placement and protection of important structures • Safe operation of power equipment • Accurate intra-operative assessment of implant sizes and appropriate use of equipment trials • Assessment of ROM, stability, limb length and soft tissue balance • Precise implantation of true components • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●shoulder
2. ●hip
3. ●knee
4. ●ankle

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Portal creation and safe joint entry • Appropriate selection and handling of instruments • Performance of the procedure without damage to healthy structures • Recognition of intra-articular pathology • Surgical treatment of intra-articular pathology • Appropriate selection of implant, as relevant • Soft tissue handling
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site

1. ●shoulder
2. ●elbow
3. ●wrist
4. ●hand

Procedure

1. ●arthroplasty
2. ●fusion
3. ●osteotomy
4. ●resection
5. ●debridement/release

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Implant utilization when applicable • Soft tissue handling • Splinting and/or casting
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●decompression of ulnar nerve
2. ●cubital tunnel release
3. ●decompression of median nerve
4. ●carpal tunnel release

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Soft tissue handling • Appropriate nerve protection • Assessment of adequate decompression • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Soft tissue handling • Hemostasis • Sampling/collaboration with pathology • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team
• □COL 1.3 Collaborate with other physicians to achieve diagnosis

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

Fixation

1. ●upper extremity
2. ●lower extremity
3. ●NA

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts, as necessary • Insertion of implant(s) • Closure and dressing • Safe use and interpretation of fluoroscopy • Soft tissue handling
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Presentation

1. ●supracondylar fracture
2. ●lateral condyle fracture
3. ●growth plate fracture
4. ●SCFE
5. ●diaphyseal bone fracture
6. ●Monteggia fracture/dislocation
7. ●infection

Arthrotomy

1. ●yes
2. ●no

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Surgical approach and exposure • Fracture reduction, including use of adjuncts, as necessary • Internal fixation, using nails, screws, plate and/or K-wires as applicable • Closure and dressing • Splinting and/or casting • Safe use and interpretation of fluoroscopy
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, post-op plan and risk of long term complications (e.g. growth plate) to the parents/patient

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Procedure

1. ●application of Pavlik harness
2. ●application of cast for clubfoot
3. ●application of hip spica

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Appropriate application of casts and harness for DDH/clubfoot
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Communicator

• □COM 3.1 Provide information about the procedure, post-op plan and risk of long term complications (e.g. growth plate) to the parents/patient

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Appropriate position of incision • Correct level localization and verification • Soft tissue handling • Identification and following of appropriate tissue planes (may be midline or paraspinal) • Hemostasis • Closure and dressing
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Correct level localization and verification • Safe opening of ligamentum flavum • Removal of compressive elements • Appropriate care of neural element(s)
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-operative plan: Assess clinical information to determine/confirm diagnosis and appropriateness of procedure
• □ME 3.4 Case preparation: Position patient correctly, understand approach and required instruments, be prepared to deal with probable complications
• □ME 1.4 Knowledge of procedure: Understand steps, potential risks, and the means to overcome them
• □ME 3.4 Technical performance: Perform steps of procedure efficiently, avoiding pitfalls and respecting soft tissues • Correct level localization and verification • Landmarking for pedicle screw start point • Insertion of pedicle screw • Completion of rod insertion • Preparation of fusion site and bone grafting • Appropriate care of neural element(s)
• □ME 3.4 Visuospatial skills: Demonstrate 3D spatial orientation, position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Establish an appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Demonstrate planned course of procedure, economy of movement and flow

Collaborator

• □COL 1.2 Professional and effective communication/utilization of assistants and OR team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.4 Apply knowledge of key anatomic relationships
• □ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □ME 3.4 Select and provide sedation and analgesia, as appropriate
• □ME 3.4 Position the patient appropriately
• □ME 3.4 Apply and tighten pins and place halo ring/tong in the appropriate position
• □ME 3.4 Assess and manage alignment, including the safe application of traction weight or vest
• □ME 3.4 Perform post procedure neurologic exam
• □ME 3.4 Order and review post procedure imaging

Communicator

• □COM 5.1 Document the procedure

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

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
• □ME 1.6 Carry out professional duties in the face of multiple, competing demands
• □ME 2.4 Establish patient-centred management plans
• □ME 1.7 Recognize and respond to the complexity, uncertainty, and ambiguity in practice
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 4.1 Determine appropriate timing of next visit based on planned investigations, clinical status and/or anticipated clinical course

Communicator

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

Leader

• □L 4.1 Manage time effectively to maintain clinic flow
• □L 4.2 Book operative cases with appropriate urgency, duration and equipment

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

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

Communicator

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

Collaborator

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

Leader

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

Scholar

• □Part A: S 2.3 Allocate appropriate time for junior learners’ educational activities while ensuring patient care, efficiency, resources, and safety are maintained
• □Part B: S 2.3 Provide junior learners with opportunities for appropriate clinical responsibility
• □Part B: S 2.5 Provide junior learners with feedback to enhance learning and performance

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 2.2 Integrate information from the clinical assessment to determine the patient’s clinical status and health care needs
• □ME 2.4 Determine whether the patient needs immediate intervention and/or admission/transfer to hospital
• □ME 2.4 Establish a plan for management and/or for care prior to and during transport to another health setting
• □ME 2.4 Provide guidance for management of changes in the patient’s clinical status

Communicator

• □COM 2.3 Request and synthesize patient information gathered by another health professional
• □COM 5.1 Document telephone advice provided

Leader

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

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps