Palliative Medicine (Adult)

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. ●case review

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Elicit information about the patient’s and/or family’s understanding of the illness
• □ME 2.2 Gather information about the patient’s social circumstances and supports
• □ME 2.2 Use validated tools to assess functional status and symptoms
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Synthesize and organize clinical information for presentation to a supervisor

Communicator

• □COM 1.2 Optimize the environment for patient and family comfort, dignity, privacy, engagement, and safety
• □COM 1.1 Communicate using a patient-centred approach
• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Communicator

• □COM 1.2 Optimize the environment for patient and family comfort, dignity, privacy, engagement, and safety
• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 3.1 Provide accurate information
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 3.1 Verify and validate the patient’s and/or family’s understanding
• □COM 4.3 Answer questions from the patient and/or family
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Gather information to establish the clinical question
• □ME 2.1 Determine the urgency of the situation
• □ME 2.4 Provide recommendations for management
• □ME 2.4 Determine if an in-person assessment is required

Communicator

• □COM 5.1 Prepare documentation that accurately conveys the encounter(s) and outcome

Collaborator

• □COL 3.2 Summarize and prioritize patient issues for handover to an accepting physician

Leader

• □L 2.1 Apply knowledge of local protocols and resources

Professional

• □P 1.1 Respond punctually to requests or calls from patients or other health care professionals
• □P 1.1 Work within one’s own limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Last hour(s) of life

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Recognize risk factors for complicated grief and bereavement
• □ME 2.4 Provide supportive counselling and resources for coping with loss

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 4.1 Validate the patient’s and/or family’s experiences and/or concerns
• □COM 3.1 Provide information about the process of dying and signs of impending death
• □COM 4.1 Ask about and integrate rituals and end-of-life practices in keeping with the patient’s and family’s cultural, spiritual and religious beliefs

Professional

• □P 1.1 Work within one’s own limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Task completed

1. ●death pronouncement
2. ●death certificate
3. ●discussion re. medical examiner/coroner notification
4. ●organ donation
5. ●request for autopsy
6. ●other

Medical Expert

• □ME 2.2 Determine the time and nature of death

Professional

• □P 3.1 Prepare the death certificate in a complete and timely manner
• □P 3.1 Adhere to requirements for notification of death, including considerations for mandatory reporting to the medical examiner/coroner
• □P 3.1 Apply knowledge of procedures for autopsy and/or organ donation

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Presentation

1. ●acute bowel obstruction
2. ●agitated delirium (severe)
3. ●airway obstruction
4. ●bleeding
5. ●dyspnea crisis
6. ●pain crisis
7. ●seizures
8. ●spinal cord compression
9. ●suicidality
10. ●superior vena cava syndrome
11. ●other

Setting

1. ●inpatient
2. ●ER
3. ●clinic
4. ●community

Medical Expert

• □ME 2.1 Determine the urgency of the situation
• □ME 2.2 Perform a history and physical exam relevant to the patient presentation, in a time-effective manner
• □ME 2.3 Review goals of care and realign if needed
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Develop and implement an initial management plan
• □ME 4.1 Determine the need for and urgency of referral for definitive management
• □ME 4.1 Determine appropriate disposition and/or setting for ongoing care

Communicator

• □COM 3.1 Share information about the patient’s condition and plans for management clearly and compassionately
• □COM 5.1 Prepare documentation that accurately conveys the encounter(s) and outcome

Professional

• □P 1.1 Work within one’s own limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Category

1. ●cancer
2. ●other diagnosis

Medical Expert

• □ME 1.4 Apply a biopsychosocial approach to the clinical assessment
• □ME 2.2 Elicit a history and perform a physical exam
• □ME 2.2 Use validated tools to assess functional status and symptoms
• □ME 2.2 Assess prognosis using disease specific indicators, including clinical signs, symptoms, and investigations
• □ME 2.4 Develop a management plan

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)
• □COM 3.1 Explain the palliative care philosophy to the patient and family
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Collaborator

• □COL 1.2 Integrate the assessment and perspectives of other members of the interprofessional team
• □COL 1.3 Work effectively with the referring physician and/or service

Health Advocate

• □HA 1.1 Facilitate patient and family access to needed services and resources

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Symptom

1. ●anxiety
2. ●constipation
3. ●delirium
4. ●demoralization
5. ●depression
6. ●dyspnea
7. ●fatigue
8. ●insomnia
9. ●itch
10. ●nausea
11. ●poor appetite
12. ●other (please specify)

Setting

1. ●inpatient
2. ●clinic
3. ●community

Medical Expert

• □ME 1.4 Apply a biopsychosocial approach to the clinical assessment
• □ME 2.2 Elicit a history and perform a physical exam
• □ME 2.2 Use validated tools to assess functional status and symptoms
• □ME 2.2 Assess response to previously attempted treatments, including side effects, toxicity and efficacy
• □ME 2.4 Develop a management plan, which may include non-pharmacologic, pharmacologic and/or interventional treatment(s) as relevant
• □ME 2.4 Select and prescribe appropriate monitoring strategies

Communicator

• □COM 1.6 Integrate the patient’s beliefs, concerns, expectations and experiences relevant to the presenting problem
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Health Advocate

• □HA 1.2 Work with the patient and/or family to increase their understanding of their symptoms and health care needs

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

Pain management

1. ●cannabinoids
2. ●fentanyl
3. ●hydromorphone
4. ●gabapentinoids
5. ●morphine
6. ●oxycodone
7. ●SNRI/SSRI
8. ●TCA
9. ●antiepileptic agents
10. ●NSAIDs/steroids
11. ●physical/psychological/spiritual/existential strategies

Setting

1. ●inpatient
2. ●clinic
3. ●community

Medical Expert

• □ME 1.4 Apply a biopsychosocial approach to the clinical assessment
• □ME 2.2 Elicit a history and perform a physical exam
• □ME 2.2 Use validated tools to assess functional status and symptoms
• □ME 2.2 Assess response to previously attempted treatments, including side effects, toxicity and efficacy
• □ME 2.4 Develop a management plan, which may include non-pharmacologic, pharmacologic and/or interventional treatment(s) as relevant
• □ME 2.4 Select and prescribe the appropriate dose and regimen
• □ME 2.4 Select and prescribe appropriate monitoring strategies

Communicator

• □COM 1.6 Integrate the patient’s beliefs, concerns, expectations and experiences relevant to the presenting problem
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Health Advocate

• □HA 1.2 Work with the patient and/or family to increase their understanding of their symptoms and health care needs

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 observation

1. ●direct
2. ●case discussion

Interlocutor

1. ●patient
2. ●family
3. ●other

Medical Expert

• □ME 2.2 Assess the presence, nature, and sources of an individual’s suffering, exploring underlying depression or anxiety

Communicator

• □COM 1.1 Demonstrate empathy, respect and compassion
• □COM 2.1 Set up the conversation and ask permission to proceed
• □COM 2.1 Invite the patient and/or family member to share what they are experiencing
• □COM 2.1 Use empathic listening and appropriate non-verbal communication to demonstrate attentiveness, interest, and responsiveness
• □COM 1.4 Identify, verify and validate non-verbal cues
• □COM 4.1 Validate the patient’s and/or family member’s experience of illness and suffering
• □COM 4.1 Identify the individual’s strengths and resources in dealing with suffering
• □COM 2.2 Summarize and close the encounter effectively

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Ascertain the patient’s and/or family’s understanding of the patient’s condition

Communicator

• □COM 1.1 Demonstrate empathy, respect and compassion
• □COM 1.1 Seek permission from patient and/or their family to talk about their values and wishes for their care
• □COM 3.1 Provide information about the disease trajectory and possible complications
• □COM 2.1 Explore the patient’s and/or family’s values and wishes for their care
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 1.3 Demonstrate an understanding of the disease experience from the patient’s and family’s perspective
• □COM 3.1 Recommend goals of care based on the patient’s and/or family’s values and wishes for their care
• □COM 2.2 Summarize and close the encounter effectively
• □COM 5.1 Document the encounter to convey the discussion and its outcome

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

Focus of meeting

1. ●disposition planning
2. ●transfer between care settings
3. ●other (please specify)

Patient present

1. ●yes
2. ●no

Medical Expert

• □ME 2.1 Ascertain participants’ understanding of the situation and the reason for the encounter

Communicator

• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 4.3 Use communication skills and strategies that help the patient and family make an informed decision
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Collaborator

• □COL 1.2 Determine who is part of the meeting and their roles, both from the patient side and the health care team side

Leader

• □L 3.1 Encourage free discussion and participation from attendees
• □L 3.1 Attend to meeting flow, organization, and time management
• □L 3.1 Summarize and clarify key points and discussions

Professional

• □P 1.2 Prepare for a meeting, reviewing its purpose and background information

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

Input provided by

1. ●nurse
2. ●social worker
3. ●pharmacist
4. ●spiritual care
5. ●other

Collaborator

• □COL 1.2 Demonstrate an understanding of the scope and expertise of other health care professionals within the specialist palliative care team
• □COL 1.3 Communicate effectively with other physicians and health care professionals
• □COL 1.1 Respond appropriately to input from other health care professionals

Health Advocate

• □HA 1.1 Facilitate patient and family access to needed services and resources

Professional

• □P 1.1 Respond punctually to requests or calls from patients or other health care professionals
• □P 1.1 Behave in a professional manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Underlying condition

1. ●cancer
2. ●cardiac
3. ●gastrointestinal/hepatobiliary
4. ●immunological
5. ●multisystem organ failure
6. ●neurological/neuromuscular
7. ●renal
8. ●respiratory
9. ●other

Setting

1. ●inpatient
2. ●clinic
3. ●community

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess physical, functional, psychological, social, cultural, and spiritual domains
• □ME 2.2 Assess the patient’s and/or family’s level of distress and resiliency
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Assess prognosis using disease specific indicators, including clinical signs, symptoms, validated tools, and investigations
• □ME 2.4 Develop a management plan
• □ME 4.1 Determine the need for referral to another health care professional

Communicator

• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Collaborator

• □COL 1.2 Integrate the assessment and perspectives of other members of the interprofessional team
• □COL 1.3 Work effectively with the referring physician and/or service

Health Advocate

• □HA 1.1 Facilitate patient and family access to needed services and resources

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Underlying condition

1. ●cancer
2. ●cardiac
3. ●gastrointestinal/hepatobiliary
4. ●immunological
5. ●multisystem organ failure
6. ●neurological/neuromuscular
7. ●renal
8. ●respiratory
9. ●other

Setting

1. ●inpatient
2. ●clinic
3. ●community

Virtual visit

1. ●no
2. ●yes

Medical Expert

• □ME 2.2 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess physical, functional, psychological, social, cultural, and spiritual domains
• □ME 2.2 Assess the patient’s and/or family’s level of distress and resiliency
• □ME 2.2 Assess response to treatment as well as changes in condition or goals of care
• □ME 2.2 Anticipate transitions and future health needs
• □ME 2.4 Develop recommendations for management, which may include modification of current therapy

Communicator

• □COM 4.3 Engage the patient and family in goal setting and shared decision- making regarding recommendations for management
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Collaborator

• □COL 1.3 Work effectively with the referring physician and/or service

Health Advocate

• □HA 1.2 Work with the patient and family to increase their understanding of their condition and health care needs

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Issue addressed

1. ●death at home
2. ●potential for catastrophic event (e.g., bleed, status epilepticus, acute airway obstruction)
3. ●social or geographical complexities
4. ●other

Medical Expert

• □ME 2.2 Assess prognosis using disease specific indicators, including clinical signs, symptoms, validated tools, and investigations
• □ME 4.1 Anticipate changes in the patient’s condition and the evolving needs of the patient and their family
• □ME 2.4 Determine the patient’s current and future needs for health care resources and service
• □ME 2.4 Develop a management plan adapted to the patient’s setting of care

Communicator

• □COM 3.1 Convey information and provide anticipatory guidance to the patient and family regarding the patient’s care needs and treatment plan
• □COM 4.3 Answer questions from the patient and/or family

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.2 Summarize and document patient issues for the accepting physician providing rationale for key decisions and recommendations for management

Leader

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

Health Advocate

• □HA 1.1 Work with other health care professionals to address barriers to access resources and services

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 observation

1. ●direct
2. ●case review

Symptom

1. ●complex cluster
2. ●hiccups
3. ●intractable nausea and vomiting
4. ●intractable seizures
5. ●nutritional failure
6. ●refractory dyspnea
7. ●refractory sialorrhea
8. ●severe neurologic irritability
9. ●other

Setting

1. ●inpatient
2. ●clinic
3. ●community

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess physical, functional, psychological, social, cultural, and spiritual domains
• □ME 2.2 Use validated tools to assess functional status and symptoms
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Assess response to previously attempted treatments, including side effects, toxicity and efficacy
• □ME 2.4 Develop a management plan, which may include non-pharmacologic, pharmacologic and/or interventional treatment(s) as relevant
• □ME 2.4 Select and prescribe the appropriate dose and regimen
• □ME 2.4 Select and prescribe appropriate monitoring strategies

Communicator

• □COM 1.6 Integrate the patient’s beliefs, concerns, expectations and experiences relevant to the presenting problem
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Health Advocate

• □HA 1.2 Work with the patient and/or family to increase their understanding of their symptoms and health care needs

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

Pain management strategy

1. ●continuous intravenous opioid infusion
2. ●continuous subcutaneous opioid infusion
3. ●ketamine infusion
4. ●lidocaine infusion
5. ●methadone rotation
6. ●referral for interventional procedure
7. ●other

Medical Expert

• □ME 2.4 Determine the most appropriate pain management strategy, which may include non-pharmacologic, pharmacologic and/or interventional treatment(s) as relevant
• □ME 2.4 Select or adjust dosage based on factors such as response, tolerability, age, and pharmacokinetic considerations
• □ME 5.1 Apply strategies for safe prescribing
• □ME 2.4 Select and implement a monitoring strategy, including laboratory monitoring as relevant

Communicator

• □COM 4.2 Explore the patient’s and/or family’s beliefs and attitudes towards medications and other therapeutic options
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Assess the presence, nature, and sources of an individual’s suffering, exploring demoralization, depression, or anxiety
• □ME 2.2 Identify the overlap between physical, psychosocial, spiritual, and existential symptoms
• □ME 2.2 Identify the impact of pain and intractable symptoms on psychological well- being and quality of life
• □ME 4.1 Determine the need for referral to another health care professional

Communicator

• □COM 2.2 Gather information about what the patient and/or family member is experiencing
• □COM 2.2 Explore requests for hastened death
• □COM 4.1 Validate the patient’s and/or family member’s experience of illness and suffering
• □COM 4.1 Identify the individual’s strengths and resources in dealing with suffering
• □COM 3.1 Provide information about potential non-pharmacological and pharmacological interventions for suffering
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 4.3 Use communication skills and strategies that help the patient and family make an informed decision
• □COM 5.1 Document the encounter to convey the discussion and its outcome

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

Intervention

1. ●cancer therapy
2. ●dialysis
3. ●feeding
4. ●ICD
5. ●invasive or non-invasive ventilation
6. ●surgical or procedural intervention
7. ●transfusion support
8. ●other

Medical Expert

• □ME 2.2 Assess prognosis using disease specific indicators, including clinical signs, symptoms, validated tools, and investigations
• □ME 4.1 Anticipate changes in the patient’s condition and the evolving needs of the patient and their family
• □ME 2.1 Ascertain the patient’s and/or family’s understanding of the patient’s condition
• □ME 2.3 Discuss and clarify previously established advanced directives and goals of care
• □ME 2.4 Develop a management plan for the role of life-prolonging or disease- focused interventions in the patient’s care

Communicator

• □COM 2.1 Explore the patient’s and/or family’s values and wishes for their care
• □COM 3.1 Provide information about the disease trajectory and possible complications, symptoms, or issues that may arise
• □COM 3.1 Work with patients and their families to help them understand the relevant options for care
• □COM 4.3 Support the patient and/or family in making decisions regarding care that are consistent with the patient’s values and goals
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Assess a patient’s suitability to proceed with palliative sedation therapy
• □ME 3.2 Obtain and document informed consent
• □ME 2.4 Select and prescribe the appropriate dose and regimen
• □ME 2.4 Select and prescribe appropriate monitoring strategies
• □ME 5.2 Follow standard operating procedures
• □ME 2.4 Modify or adjust therapy as needed

Communicator

• □COM 3.1 Provide the patient and family with information about the benefits, risks and alternatives to continuous palliative sedation therapy
• □COM 5.1 Document the encounter to convey clinical reasoning and the rationale for recommendations

Collaborator

• □COL 1.2 Work effectively with pharmacists and nurses

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. ●paracentesis
2. ●thoracentesis
3. ●other procedure (please specify)

POCUS used

1. ●no
2. ●yes

Simulation

1. ●no
2. ●yes

Medical Expert

• □ME 3.2 Obtain informed consent explaining the risks, rationale, and alternatives to the proposed procedure
• □ME 3.4 Assemble/gather the appropriate equipment and materials
• □ME 3.4 Demonstrate clean technique, establish and respect the sterile field, and maintain universal precautions
• □ME 3.4 Select and provide local anaesthesia
• □ME 3.4 Perform the procedure in a skillful and safe manner
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □ME 3.4 Establish and communicate a plan for post-procedure care

Communicator

• □COM 3.1 Communicate effectively with patient and/or assistant(s) during the procedure
• □COM 5.1 Document the procedure and outcome

Professional

• □P 1.1 Work within one’s own limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Ascertain participants’ understanding of the situation and the reason for the encounter

Communicator

• □COM 1.1 Demonstrate empathy, respect and compassion
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 3.1 Verify understanding of information conveyed
• □COM 1.4 Identify, verify and validate non-verbal cues
• □COM 4.3 Answer questions in a respectful manner
• □COM 2.2 Manage the flow of the encounter
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 2.2 Summarize and close the encounter effectively
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Professional

• □P 4.3 Facilitate debriefing discussions with the interprofessional team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.5 Triage clinical activities

Collaborator

• □COL 1.2 Assign responsibilities to members of the health care team appropriate to their scope of practice and level of expertise
• □COL 1.3 Communicate effectively with other physicians and health care professionals

Leader

• □L 4.1 Manage time and prioritize tasks
• □L 3.1 Organize and coordinate the daily work of the team
• □L 4.2 Run the service efficiently, safely, and effectively

Scholar

• □S 2.4 Provide junior learners with teaching and clinical supervision

Professional

• □P 1.1 Respond punctually to requests or calls from patients or other health care professionals
• □P 4.3 Support junior learners to manage the personal stress associated with caring for patients with palliative needs and their families
• □P 1.1 Behave in a professional 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

Setting

1. ●inpatient
2. ●clinic
3. ●community

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 2.4 Manage urgent and complex clinical situations

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Scholar

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

Professional

• □P 4.3 Monitor and support well-being within the team

Case description

Feedback provided

Next steps