Otolaryngology - Head and Neck 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

Type of observation

1. ●direct
2. ●indirect

Consult type

1. ●emergency
2. ●non-emergency

Domain

1. ●facial plastics and reconstructive surgery
2. ●head and neck surgery
3. ●laryngology
4. ●neurotology
5. ●otology
6. ●pediatric OHNS
7. ●sinonasal

Medical Expert

• □ME 2.1 Identify the concerns and goals of the patient and family during the encounter
• □ME 2.2 Elicit a basic head and neck history
• □ME 2.2 Perform a head and neck physical exam • Use of microscope for otoscopy; • Pneumatic otoscopy; • Tuning fork tests (Weber and Rinne); • Use of headlight for anterior rhinoscopy and examination of oral cavity; • Basic rhinolaryngoscopy; OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022) • Palpation of neck, including thyroid; • Examination of cranial nerves.
• □ME 2.2 Synthesize patient information including symptoms, differential diagnosis, and treatment plan clearly and concisely
• □ME 2.4 Propose initial management plans for common problems in Oto-HNS

Communicator

• □COM 3.1 Recognize when to seek help in providing clear explanations to the patient and family
• □COM 4.1 Conduct an interview, demonstrating cultural awareness
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record

Collaborator

• □COL 2.1 Show respect towards collaborators

Professional

• □P 1.1 Consistently prioritize the needs of patients and others to ensure a patient’s legitimate needs are met
• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 scenario

1. ●emergent
2. ●elective

Medical Expert

• □Part A: ME 1.4 Apply knowledge of clinical and biomedical sciences as relevant to Oto-HNS
• □Part A: ME 1.4 Apply the principles of diagnostic imaging
• □Part A: ME 1.5 Recognize urgent issues that may need the involvement of more senior colleagues and engage them immediately
• □Part A: ME 2.1 Identify and recognize life threatening or emergent issues
• □Part A: ME 2.2 Identify and differentiate normal and abnormal findings in history and physical exam OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation, for common Oto-HNS presentations
• □Part A: ME 2.2 Select and interpret laboratory and imaging investigations
• □Part A: ME 3.3 Consider urgency and potential for deterioration in advocating for the timely execution of a procedure or therapy
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care of the listed procedures
• □Part A: ME 3.4 Seek advice or supervision as needed when unanticipated findings or changing clinical circumstances are encountered
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part A: ME 4.1 Recognize need for consultation of other healthcare professionals
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □Part A: COM 1.6 Assess patients’ decision-making capacity
• □Part A: COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation
• □Part A: 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
• □Part A: COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □Part A: COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan
• □Part A: COM 4.3 Answer questions from the patient and family about next steps
• □Part A: COM 5.1 Document information about patients and their medical conditions in a manner that enhances intra-and interprofessional care
• □Part A: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □Part A: COL 1.2 Describe the roles and scopes of practice of other health care providers related to Oto-HNS
• □Part A: COL 1.3 Identify referral and consultation as opportunities to improve quality of care and patient safety by sharing expertise
• □Part A: COL 2.1 Actively listen to and engage in interactions with collaborators
• □Part A: COL 2.2 Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts
• □Part A: COL 2.2 Listen to understand and find common ground with collaborators
• □Part A: COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.3 Work with the patient and 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

Medical Expert

• □ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 performed

1. ●rigid sino-nasal endoscopy
2. ●anterior nasal packing
3. ●cauterization of anterior septum
4. ●nasal septal hematoma evacuation

Medical Expert

• □Part A: ME 1.4 Apply knowledge of clinical and biomedical sciences as relevant to Oto-HNS
• □Part A: ME 1.4 Apply clinical and biomedical sciences to manage patient presentations in Oto-HNS
• □Part A: ME 1.5 Recognize urgent issues that may need the involvement of more senior colleagues and engage them immediately
• □Part A: ME 2.1 Identify and recognize life threatening or emergent issues
• □Part A: ME 2.2 Identify and differentiate normal and abnormal findings in history and physical exam
• □Part A: ME 2.2 Perform and interpret findings of office-based exams • Flexible and/or rigid nasopharyngolaryngoscopy with or without OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022) topical anesthesia
• □Part A: ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation, for common Oto-HNS presentations
• □Part A: ME 2.2 Select and interpret appropriate investigations for common Otolaryngology- Head and Neck Surgery presentations, based on a differential diagnosis
• □Part A: ME 2.4 Develop, implement and document initial management plans for common problems in Oto-HNS
• □Part A: ME 2.4 Recognize and suggest an initial management plan for emergent issues
• □Part A: ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □Part A: ME 2.4 Discuss with the patient and family the degree of uncertainty inherent in all clinical situations
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part A: ME 4.1 Recognize need for consultation of other healthcare professionals
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □Part A: COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation
• □Part A: 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
• □Part A: COM 5.1 Document information about patients and their medical conditions in a manner that enhances intra-and interprofessional care
• □Part A: COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □Part A: COL 1.3 Identify referral and consultation as opportunities to improve quality of care and patient safety by sharing expertise
• □Part A: COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □Part A: COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □Part A: COL 3.2 Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.3 Work with the patient and 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

Age group

1. ●child
2. ●adolescent
3. ●adult

Etiology

1. ●obstructive sleep apnea
2. ●malignancy
3. ●inflammation/infection

Medical Expert

• □Part A: ME 1.4 Apply knowledge of medication dosing in pediatric patients
• □Part A: ME 1.4 Apply clinical and biomedical sciences to manage patient presentations in Oto-HNS
• □Part A: ME 1.5 Recognize urgent issues that may need the involvement of more senior colleagues and engage them immediately
• □Part A: ME 2.2 Identify and differentiate normal and abnormal findings in history and physical exam
• □Part A: ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation, for common Oto-HNS presentations OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: ME 2.3 Work with patients and their families to understand relevant options for care
• □Part A: ME 2.4 Develop, implement and document initial management plans for common problems in Oto-HNS
• □Part A: ME 2.4 Recognize and suggest an initial management plan for emergent issues
• □Part A: ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and/or alternatives for a given procedure or therapy
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 2.1 Demonstrate knowledge of techniques for eliciting health information from children and their families
• □Part A: COM 2.1 Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial information

Collaborator

• □Part A: COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Leader

• □Part A: L 2.2 Apply evidence and guidelines with respect to resource utilization relevant to common clinical scenarios

Health Advocate

• □Part A: HA 1.2 Select patient education resources related to Oto-HNS

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 clinical and biomedical sciences as relevant to Oto-HNS
• □Part A: ME 1.4 Apply knowledge of neurophysiology and neuropsychology of hearing perception
• □Part A: ME 1.4 Apply knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Oto-HNS • Conventional audiometry (including but not limited to tympanometry and stapedial reflex testing) and otoacoustic emission testing, and their applications • Audiological assessment in different age groups • Tuning forks
• □Part A: ME 1.4 Apply clinical and biomedical sciences to manage patient presentations in Oto-HNS
• □Part A: ME 1.5 Recognize urgent issues that may need the involvement of more senior colleagues and engage them immediately
• □Part A: ME 2.2 Identify and differentiate normal and abnormal findings in history and physical exam
• □Part A: ME 2.2 Perform and interpret findings of office-based exams OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022) • Perform otomicroscopy • Interpret basic puretone audiogram/tympanogram
• □Part A: ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation, for common Oto-HNS presentations
• □Part A: ME 2.2 Select and interpret appropriate investigations for common Oto-HNS presentations, based on a differential diagnosis
• □Part A: ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and/or alternatives for a given procedure or therapy
• □Part A: ME 3.1 Describe to patients common procedures or therapies for common conditions in their discipline
• □Part A: ME 3.2 Obtain informed consent for commonly performed medical and surgical procedures and therapies, under supervision
• □Part A: ME 3.2 Document the consent discussion accurately
• □Part A: ME 3.4 Establish and implement a plan for post-procedure care
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part A: ME 4.1 Recognize need for consultations of other healthcare professionals
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.6 Assess patients’ decision-making capacity
• □Part A: COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation
• □Part A: COM 2.1 Demonstrate knowledge of techniques for eliciting health information from children and their families
• □Part A: COM 2.1 Recognize the psychological, occupational, and social consequences of sensory or communication disorders

Collaborator

• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Leader

• □Part A: L 2.1 Consider costs when choosing care options
• □Part A: L 2.2 Apply evidence and guidelines with respect to resource utilization relevant to common clinical scenarios

Health Advocate

• □Part A: HA 1.3 Work with the patient and 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

Location

1. ●operating room
2. ●emergency room
3. ●other

Wound closure technique

1. ●primary wound closure
2. ●simple advancement
3. ●rotation or transposition

Case complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.1 Demonstrate compassion and a commitment to high-quality care and for patients
• □ME 1.4 Apply knowledge of cutaneous anatomy, aesthetic subunits, relaxed skin tension lines and non-distortable landmarks of the face
• □ME 2.2 Describe the size, components, and specific characteristics of a wound including special functional and aesthetic considerations
• □ME 2.4 Select the most appropriate wound closure option for the wound and patient
• □ME 3.2 Obtain informed consent for commonly performed medical and surgical procedures and therapies, under supervision
• □ME 3.4 Administer local anesthesia
• □ME 3.4 Perform common Oto - HNS procedures in a skilful, fluid, and safe manner with minimal assistance
• □ME 3.4 Apply dressings for post-procedure care
• □ME 4.1 Implement appropriate wound care and follow-up at the end of each procedure

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 5.1 Document soft tissue defects and closure providing a good description, including diagnosis, progression of healing or deterioration and management plan, including follow up

Collaborator

• □COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with ongoing issues OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of procedure

1. ●nasal
2. ●other

Medical Expert

• □Part A: ME 1.4 Apply knowledge of clinical and biomedical sciences as relevant to Oto-HNS
• □Part A: ME 1.4 Apply knowledge of common fracture patterns of the facial skeleton and their mechanisms of injury
• □Part A: ME 1.5 Recognize urgent issues that may need the involvement of more senior colleagues and engage them immediately
• □Part A: ME 2.2 Elicit a complete history for injury or trauma to the head and neck
• □Part A: ME 2.2 Perform a physical exam with attention to risk of cervical spine injury
• □Part A: ME 2.2 Select and interpret appropriate investigations for common Oto-HNS presentations, based on a differential diagnosis
• □Part A: ME 2.4 Recognize and suggest an initial management plan for emergent issues
• □Part A: ME 4.1 Recognize need for consultation of other healthcare professionals
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Collaborator

• □Part A: COL 1.2 Contribute individual expertise to interprofessional teams OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: COL 3.2 Demonstrate safe handover care, both written and oral during patient transitions
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.3 Work with the patient and 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

Type of procedure

1. ●basic airway positioning
2. ●oral airway insertion with bag mask ventilation
3. ●direct laryngoscopy with endotracheal intubation, ventilation and extubation
4. ●insertion of, and ventilation through supraglottic airway (laryngeal mask)

Age group

1. ●pediatric
2. ●adult

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.4 Apply knowledge of clinical and biomedical sciences as relevant to Oto-HNS
• □ME 2.2 Elicit a focused history and perform a physical exam to identify patients with potential for a difficult airway
• □ME 3.1 Describe indications for use of adjuncts to bag mask ventilation
• □ME 3.1 Describe indications and contra-indications for tracheal intubation and for use of supraglottic airway devices
• □ME 3.4 Prepare the equipment required to be immediately available for basic airway management
• □ME 3.4 Apply a stepwise approach to sedation/intubation in an uncomplicated patient
• □ME 3.4 Set up and position the patient for intubation
• □ME 3.4 Perform common Oto - HNS procedures in a skilful, fluid, and safe manner with minimal assistance
• □ME 5.2 Use cognitive aids such as procedural checklists, surgical timeouts, debriefing, structured communication tools, or care paths to enhance patient safety

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 5.1 Document the airway/intubation information accurately and comprehensively within an electronic or written medical record OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Collaborator

• □COL 1.1 Establish and maintain positive relationships with physicians and other colleagues
• □COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons
• □COL 2.1 Respond to requests and feedback in a respectful and timely manner
• □COL 3.2 Demonstrate safe handover care, both written and oral during patient transitions

Leader

• □L 1.2 Demonstrate knowledge of and adherence to the standard safety procedures in place at the resident’s centre OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 1.7 Recognize and respond to the complexity and uncertainty with managing an anticipated difficult airway by seeking proper assistance
• □ME 2.1 Recognize patients at risk of aspiration of gastric contents into the airway
• □ME 2.2 Elicit a focused history and perform a physical exam to identify patients with potential for a difficult airway
• □ME 2.2 Identify predictors of a difficult airway on physical examination such as a large overbite, large tongue, narrow mouth opening, short chin and/or Mallampati score
• □ME 2.4 Recognize and suggest an initial management plan for emergent issues
• □ME 3.1 Understand the indications and risks of rapid sequence induction and intubation and their steps of execution

Communicator

• □COM 5.1 Document the airway/intubation information accurately and comprehensively within an electronic or written medical record

Collaborator

• □COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □COL 2.1 Actively listen to and engage in interactions with collaborators
• □COL 2.1 Show respect towards collaborators

Leader

• □L 2.2 Apply American Society of Anesthesiology (ASA) Guidelines for Management of the Difficult Airway

Scholar

• □S 1.1 Demonstrate a structured approach to monitoring progress of learning in the clinical setting
• □S 1.2 Identify opportunities for learning and improvement by reflecting on and assessing performance and preparation
• □S 3.1 Recognize uncertainty and knowledge gaps in clinical and other professional encounters relevant to Oto-HNS OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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. ●rhinology
2. ●otology
3. ●laryngology
4. ●head and neck surgery
5. ●facial and plastic surgery

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis
• □ME 2.4 Develop, implement, and document a management plan
• □ME 2.4 Provide timely and adequate responses to complications and undesired side effects of treatment
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □ME 4.1 Establish plans for ongoing care
• □ME 4.1 Accurately identify situations that necessitate consultation of other health professionals to assist in the management of disorders encountered in Oto - HNS

Communicator

• □COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □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 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their health OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □COL 3.2 Organize the handover of care to the most appropriate physician or health care professional

Professional

• □P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, reflecting honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality
• □P 1.2 Demonstrate a commitment to excellence in all aspects of practice OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 1.6 Maintain a duty of care and patient safety while balancing multiple responsibilities
• □ME 1.6 Prioritize patients on the basis of clinical presentations
• □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

Collaborator

• □COL 1.2 Recognize, value, and utilize the expertise of interprofessional team members
• □COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons
• □COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Leader

• □L 2.1 Use clinical judgment to minimize wasteful practices
• □L 3.1 Assume the role of chief resident and lead junior residents in a hospital patient care team

Scholar

• □S 2.1 Use strategies for deliberate, positive role-modelling
• □S 2.2 Identify and respond to threats to the safe learning environment as they occur
• □S 2.2 Provide a safe environment for junior learners
• □S 2.3 Supervise learners to ensure they work within limitations, seeking guidance and supervision when needed
• □S 2.3 Balance clinical supervision and graduated responsibility, ensuring the safety of patients and learners
• □S 2.4 Describe clinical teaching strategies relevant to their discipline OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □S 2.6 Appropriately assess junior learners in various learning situations

Professional

• □P 1.1 Intervene when behaviours toward colleagues and learners undermine a respectful environment
• □P 1.2 Demonstrate a commitment to excellence in all aspects of practice
• □P 2.1 Demonstrate a commitment to the promotion of the public good in health care, including stewardship of resources
• □P 3.3 Participate in the assessment of junior learners
• □P 4.1 Exhibit strategies for managing stress and maintaining physical and mental well-being during residency
• □P 4.3 Support others in their professional transitions OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 the impact of human and system factors on health care delivery
• □L 1.1 Identify potential improvement opportunities

Scholar

• □S 4.4 Perform data analysis
• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 3.3 Evaluate the applicability (external validity or generalizability) of evidence from a resource

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment
• □P 3.3 Prepare a morbidity and mortality report or chart review OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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

Trans-oral drainage of retro/para-pharyngeal abscess

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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

Cause

1. ●neurological
2. ●obstructive
3. ●neuromuscular (functional)
4. ●inflammatory

Age group

1. ●pediatric
2. ●adult

Plan for management

1. ●surgical
2. ●medical

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in the basic and clinical sciences relevant to Oto - HNS • Anatomy and physiology of upper aerodigestive system related to swallowing, including phases of normal swallowing
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Otolaryngology – Head and Neck Surgery
• □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 2.2 Perform a focused history and physical exam to classify phase of dysphagia: oral; oro-pharyngeal; esophageal
• □ME 2.2 Identify patients experiencing or at risk for aspiration
• □ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis • Diagnostic imaging (barium swallow, modified barium swallow, CT, MRI) • Laboratory testing (manometry, pH monitor)
• □ME 3.4 Perform flexible nasopharyngolaryngoscopy and/or FEES, as relevant, and interpret the results
• □ME 2.3 Establish goals of care, which may include achieving cure, improving function, slowing disease progression, treating symptoms, and palliation, in OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022) collaboration with patients and their families

Communicator

• □COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Collaborator

• □COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons

Health Advocate

• □HA 1.2 Apply the principles of behaviour change during conversations with patients about adopting healthy behaviours
• □HA 1.3 Work with families to implement foreign body aspiration prevention
• □HA 1.3 Promote choking prevention in children OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □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, implement, and document a management plan
• □ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □ME 4.1 Establish plans for ongoing care

Communicator

• □COM 2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
• □COM 3.1 Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their health OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 Age

1. ●<3 mos
2. ●>3 mos

Procedure

1. ●suspension microlaryngoscopy
2. ●direct rigid laryngoscopy
3. ●direct rigid bronchoscopy

Airway foreign body removal

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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

Options

1. ●medical management
2. ●interventional radiology
3. ●surgical intervention

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part A: ME 1.5 Perform clinical assessments that address the breadth and depth of issues in each case OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: 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
• □Part A: ME 2.4 Recognize and establish a management plan for life threatening or emergent issues
• □Part A: 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
• □Part A: ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □Part A: ME 4.1 Accurately identify situations that necessitate consultation of other health professionals to assist in the management of disorders encountered in Oto - HNS
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part A: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner
• □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 Consult as needed with other health care professionals, including other physicians or surgeons
• □Part A: COL 1.2 Recognize, value, and utilize the expertise of interprofessional team members
• □Part A: COL 1.2 Liaise with intersecting health professionals
• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part A: COL 2.1 Maintain positive relationships in all professional contexts
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Leader

• □Part A: L 3.1 Assume the role of chief resident and lead junior residents in a hospital patient care team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Conditions

1. ●primary
2. ●recurrent
3. ●polyposis

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS • Bacteriology and bacterial resistance as related to sinusitis • Pathophysiology of chronic sinusitis with and without nasal polyposis • Principles of therapeutic agents for allergic disorders of the nose and Chronic Rhinosinusitis with nose polyps (CRSwNP) and Chronic Rhinosinusitis without nasal polyps (CRSsNP), including topical and systemic therapies
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Oto - HNS • Tests of nasal function and olfactory disorders
• □Part A: 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
• □Part A: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □Part A: ME 2.2 Develop a differential diagnosis, evaluation plan and treatment plan based on findings of appropriate investigations
• □Part A: ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis
• □Part A: ME 2.4 Develop, implement, and document a management plan
• □Part A: ME 3.2 Obtain informed consent for complex medical and surgical procedures and therapies
• □Part A: ME 4.1 Establish plans for ongoing care
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □Part C: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part C: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part C: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part C: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part C: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part C: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part C: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □Part D: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part D: ME 1.5 Assess and document the extent of the disease including rating scores where appropriate
• □Part D: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □Part D: ME 2.2 Identify risk factors for recurrent disease
• □Part D: ME 2.2 Perform and interpret findings of office- and /or clinic-based exams
• □Part D: ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis
• □Part D: ME 2.4 Develop, implement, and document a management plan OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part D: ME 2.4 Provide timely and adequate responses to complications and undesired side effects of treatment
• □Part D: ME 3.4 Perform post-sinus surgery debridement
• □Part D: ME 4.1 Establish plans for ongoing care
• □Part D: ME 4.1 Accurately identify situations that necessitate consultation of other health professionals to assist in the management of disorders encountered in Oto - HNS
• □Part D: ME 4.1 Provide long-term management of a patient after medical and/or surgical treatment

Communicator

• □Part A: COM 2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
• □Part A: COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □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 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology
• □Part D: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □Part B: COL 1.3 Professional and effective communication/utilization of staff
• □Part C: COL 1.3 Professional and effective communication/utilization of staff

Professional

• □Part A: P 1.2 Demonstrate a commitment to excellence in all aspects of practice OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part D: P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, reflecting honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality
• □Part D: P 1.2 Demonstrate a commitment to excellence in all aspects of practice OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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. ●septoplasty
2. ●turbinoplasty

Medical Expert

• □ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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

Type

1. ●vocal cord paralysis
2. ●vocal cord lesion
3. ●functional voice disorder
4. ●other

Medical Expert

• □Part A: ME 1.4 Apply knowledge of the physics of sound, voice, and speech production
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS • Infectious and inflammatory conditions • Trauma • Benign and malignant tumours • Neurologic voice disorders • The professional voice
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Oto - HNS • Principles of diagnostic endoscopy as relevant to adult and pediatric patients OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022) • Objective voice testing, and electrophysiological techniques • Aerodynamic testing • Assessment methods used specifically in children
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto - HNS • Principles of therapeutic procedures related to both endoscopic and open approaches • Principles of laser therapy of the larynx
• □Part A: ME 2.2 Perform and interpret findings of office- and/or clinic-based exams • Voice and airway analysis
• □Part A: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part A: ME 2.3 Share concerns (in a constructive and respectful manner) with patients and their families about their goals of care when they are not felt to be achievable
• □Part A: 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
• □Part A: ME 3.2 Obtain informed consent for complex medical and surgical procedures and therapies
• □Part A: ME 4.1 Establish plans for ongoing care
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part A: COM 2.2 Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

Collaborator

• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.3 Promote risk reduction through smoking cessation, responsible alcohol use, UVA/UVB protection, and/or promotion of HPV vaccination for girls and boys

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. ●nasopharynx
2. ●oral cavity
3. ●oropharynx
4. ●larynx
5. ●hypopharynx

Advanced disease

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.4 Apply knowledge of tumorigenesis of benign neoplasms and cancers of the head and neck
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto - HNS • Principles of different oncologic treatment modalities, including surgery, radiation therapy, chemotherapy and immunotherapy • Principles of laser microsurgical resection, cryotherapy, robotic surgery and/or electrosurgery
• □Part A: ME 2.2 Identify risk factors pertaining to individual cases of head and neck neoplasia
• □Part A: ME 3.4 Competently perform core Oto - HNS procedures in a timely manner • Upper aerodigestive flexible endoscopies with or without biopsy as it relates to tumour staging and treatment planning
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.4 Respond to patients’ non-verbal communication and use appropriate non- verbal behaviours to enhance communication with patients
• □Part A: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part A: COM 1.5 Manage conversations that are emotionally charged
• □Part A: COM 2.2 Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals
• □Part A: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner
• □Part A: COM 5.1 Adapt record keeping to specific guidelines of Otolaryngology – Head and Neck Surgery and the clinical context

Collaborator

• □Part A: COL 1.2 Recognize, value, and utilize the expertise of interprofessional team members
• □Part A: COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons
• □Part A: COL 1.2 Liaise with intersecting health professionals
• □Part A: COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 problem

1. ●thyroid nodule
2. ●thyroid malignancy
3. ●primary hyperparathyroidism
4. ●secondary hyperparathyroidism
5. ●other

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in the basic and clinical sciences relevant to Oto-HNS • Endocrinologic and metabolic pathophysiology • Pharmacology pertaining to management of head and neck neoplasia and endocrinologic/metabolic disorders
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part A: ME 1.4 Apply the principles of diagnostic imaging OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: ME 1.5 Perform clinical assessments that address the breadth and depth of issues in each case
• □Part A: ME 1.7 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □Part A: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □Part A: ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis
• □Part A: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part A: 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
• □Part A: ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □Part A: ME 3.2 Obtain informed consent for complex medical and surgical procedures and therapies
• □Part A: ME 3.2 Use shared decision-making in the consent process, taking risk and uncertainty into consideration
• □Part A: ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
• □Part A: COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □Part A: COM 2.1 Actively listen and respond to patient cues
• □Part A: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner
• □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 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □Part A: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their health
• □Part A: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □Part A: COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, reflecting honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality
• □Part A: P 1.2 Demonstrate a commitment to excellence in all aspects of 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 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 cancer

1. ●melanoma
2. ●squamous cell
3. ●other

Advanced disease

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in the basic and clinical sciences relevant to Oto-HNS • Principles of restoration and enhancement of form and function including but not limited to: o Principles of cervicofacial surgery o Biomechanical characteristics of skin and bone in the facial region as they relate to techniques used in facial plastic and reconstructive surgery including tissue expansion and plating maxillofacial fractures o Principles and techniques of facial reconstruction, including local and regional flaps and grafts
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto - HNS • principles of laser microsurgical resection, cryotherapy, robotic surgery and/or electro surgery • principles governing use of local and systemic chemo- and immunotherapeutic agents • principles of oncologic management of cutaneous malignancies of the face, head and neck • principles of therapeutic radiation • principles and techniques of frozen section diagnosis and Mohs micrographic surgery
• □Part A: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □Part A: ME 2.2 Select and interpret appropriate investigations for any Oto-HNS presentation based on a differential diagnosis
• □Part A: ME 2.3 Establish goals of care, which may include achieving cure, improving function, slowing disease progression, treating symptoms, and palliation, in collaboration with patients and their families
• □Part A: ME 2.4 Develop, implement, and document a management plan
• □Part A: 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
• □Part A: ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □Part A: ME 3.2 Obtain informed consent for complex medical and surgical procedures and therapies
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information
• □Part A: COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □Part A: COM 2.1 Actively listen and respond to patient cues
• □Part A: COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □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 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □Part A: COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions regarding their health
• □Part A: COM 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology

Collaborator

• □Part A: COL 1.2 Consult as needed with other health care professionals, including other physicians or surgeons
• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.3 Evaluate with the patient the potential benefits and harms of health screening
• □Part A: HA 1.3 Promote risk reduction through smoking cessation, responsible alcohol use, UVA/UVB protection, and/or promotion of HPV vaccination for girls and boys

Professional

• □Part A: P 1.1 Exhibit appropriate professional behaviours and relationships in all aspects of practice, reflecting honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality
• □Part A: P 1.2 Demonstrate a commitment to excellence in all aspects of 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

Type of fracture

1. ●mandible
2. ●complex nasal
3. ●iatrogenic

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 presentation

1. ●external nasal deformity
2. ●other

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in the basic and clinical sciences relevant to Oto-HNS
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS • effects of aging in the cervicofacial region including skin, soft tissue, and bone • wound healing abnormalities, including the keloid scar • aesthetic anomalies of the cervicofacial region OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto- HNS • principles of laser microsurgical resection, cryotherapy, robotic surgery and/or electro surgery
• □Part A: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □Part A: ME 2.3 Share concerns (in a constructive and respectful manner) with patients and their families about their goals of care when they are not felt to be achievable
• □Part A: 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
• □Part A: ME 3.1 Integrate planned procedures or therapies into global assessment and management plans
• □Part A: ME 3.2 Obtain informed consent for complex medical and surgical procedures and therapies
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □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 patient care
• □Part A: COM 2.2 Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

Collaborator

• □Part B: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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. ●adult
2. ●pediatric

Category

1. ●sudden sensorineural hearing loss
2. ●congenital
3. ●chronic otitis media
4. ●otosclerosis
5. ●other

Rapidly progressive

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Oto-HNS • hearing assessment, including but not limited to otoacoustic emissions, electrocochleography, auditory brainstem response, cortical auditory evoked response, impedance/tympanometry
• □Part A: ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto-HNS • principles of use of surgical and non-surgical assistive devices for hearing loss, including but not limited to hearing aids, bone conduction hearing devices cochlear and middle ear implants • principles underlying the effect of topical and systemic medications and their therapeutic and ototoxic effects • principles underlying the use of intratympanic injections
• □Part A: ME 2.2 Perform and interpret findings of office- and /or clinic-based exams • Neuro-otological examination
• □Part A: ME 2.2 Select and interpret vestibular and/or audiological investigations
• □Part A: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part A: ME 2.3 Share concerns (in a constructive and respectful manner) with patients and their families about their goals of care when they are not felt to be achievable
• □Part A: ME 2.4 Establish a patient-centred management plan
• □Part A: ME 2.4 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines, including procedures for which the patient is referred to other surgeons
• □Part B: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part B: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part B: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part B: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part B: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □Part B: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part B: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □Part C: ME 1.4 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □Part C: ME 3.1 Pre-procedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required
• □Part C: ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □Part C: ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □Part C: ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □Part C: ME 3.4 Post-procedure plan: Appropriate complete post procedure plan
• □Part C: ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

Communicator

• □Part A: COM 1.6 Recognize the communication requirements relevant to patients who are deaf, hard of hearing or who have speech and/or voice disorders

Collaborator

• □Part B: COL 1.3 Professional and effective communication/utilization of staff
• □Part C: COL 1.3 Professional and effective communication/utilization of staff OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Health Advocate

• □Part A: HA 1.1 Facilitate access to the local and national services and resources that are available for patients, including those who are deaf and hard of hearing
• □Part A: HA 1.3 Recognize importance and understand principles of newborn/universal hearing screening

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

Cause

1. ●peripheral
2. ●central
3. ●neurological
4. ●non-peripheral

Medical Expert

• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences to the medical and surgical management of the breadth of patient presentations in Oto - HNS
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the diagnostic techniques/procedures relevant to Oto - HNS • Vestibular assessment, including but not limited to principles of performance and interpretation of electro/videonystagmography, computerized dynamic posturography, Gans sensory organization protocol, rotatonal chair assessment, head impulse testing and vestibular evoked myogenic potentials
• □ME 1.4 Apply the principles of diagnostic imaging
• □ME 1.4 Apply a broad base and depth of knowledge in clinical and biomedical sciences as they apply to the therapeutic techniques/procedures relevant to Oto - HNS • Principles underlying the effect of topical and systemic medications and their therapeutic and ototoxic effects
• □ME 2.2 Perform and interpret findings of office- and/or clinic-based exams • Neuro-vestibular history and physical examination
• □ME 3.4 Competently perform core Oto - HNS procedures in a timely manner • Particle repositioning maneuvers, including Epley maneuver and log roll maneuver OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Collaborator

• □COL 1.2 Recognize, value, and utilize the expertise of interprofessional team members
• □COL 1.3 Provide timely and necessary information to colleagues to enable effective relationship-centered care OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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

Communicator

• □COM 3.1 Convey information about the procedure, operative findings, and patient status to the family clearly and compassionately
• □COM 5.1 Document surgical procedures in an accurate, complete, and timely manner OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Collaborator

• □COL 1.3 Communicate effectively with the operating room team
• □COL 3.2 Transition patient care safely to the post-operative team

Scholar

• □S 2.3 Provide junior learners with opportunities for appropriate clinical responsibility

Professional

• □P 1.2 Prepare for surgical procedures, reviewing the list of planned operations

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. ●low
2. ●medium
3. ●high

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 Oto - HNS
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 2.4 Establish management plans that consider all relevant aspects of the patient’s care
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 5.2 Use systems to track and follow-up on clinical data such as studies and laboratory tests
• □ME 4.1 Determine appropriate timing of future visits 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 OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Collaborator

• □COL 3.1 Determine when care should be transferred to another physician or health care professional
• □COL 1.2 Work effectively with outpatient clinic staff

Leader

• □L 4.1 Review and act on test results in a timely manner
• □L 4.1 Manage time effectively to maintain clinic flow OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.6 Carry out professional duties in the face of multiple, competing demands

Collaborator

• □COL 1.3 Lead interprofessional team meetings, including but not limited to tumour boards

Leader

• □L 1.3 Actively participate in audit rounds, identifying safety issues that need to be addressed, and generating solutions
• □L 1.3 Analyze harmful patient safety incidents and near misses to enhance systems of care
• □L 1.4 Use health informatics to improve the quality of patient care and optimize patient safety
• □L 3.1 Demonstrate leadership skills to enhance health care
• □L 3.2 Facilitate change in health care to enhance services and outcomes

Health Advocate

• □HA 2.2 Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities
• □HA 2.3 Contribute to a process to improve health in the communities or populations they serve

Scholar

• □S 1.3 Lead collaborative learning projects

Professional

• □P 1.2 Demonstrate excellence in all aspects of practice and mentor junior colleagues OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □P 2.1 Demonstrate accountability to patients, society, and the profession by recognizing and responding to societal expectations of the profession OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)

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 Apply the science of quality assurance and improvement (practice-based learning and system-based learning and improvement) to contribute to improving systems of patient care
• □L 1.1 Incorporate evidence-based medicine for quality assurance and improvement in Oto - HNS practice
• □L 1.1 Perform audits/self-audits of clinical practice and their implication for quality and improvement
• □L 1.2 Contribute to a culture that promotes patient safety
• □L 4.3 Implement processes to ensure personal practice improvement

Scholar

• □S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance
• □S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2022)
• □P 4.2 Develop a strategy to manage personal and professional demands for a sustainable independent practice

Case description

Feedback provided

Next steps