Pediatric General 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

Setting

1. ●ER
2. ●inpatient
3. ●PICU
4. ●clinic
5. ●simulation

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.2 Perform a history and physical exam relevant to the presentation in a timely manner
• □ME 2.1 Provide assessment and initial stabilization of ABCs
• □ME 1.4 Recognize urgent problems and seek assistance
• □ME 1.6 Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making
• □ME 2.2 Develop a differential diagnosis

Communicator

• □COM 1.4 Identify, verify, and validate a patient’s/family’s non-verbal cues
• □COM 2.3 Identify and consider parental/care-giver concerns regarding the patient’s condition

Collaborator

• □COL 1.3 Acknowledge and integrate input and/or recommendations from other health care professionals

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●ER
2. ●inpatient
3. ●PICU
4. ●clinic
5. ●simulation

Medical Expert

• □ME 2.2 Synthesize clinical information to formulate a summary of the case

Communicator

• □COM 1.1 Introduce oneself and explain one’s role in the interprofessional team
• □COM 3.1 Convey information about medical course and/or management plan clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the family and/or caregiver(s)
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●simulation

Medical Expert

• □ME 4.1 Establish plans for ongoing care, including follow-up on investigations and response to treatment
• □ME 5.2 Use structured handover tools and strategies to enhance patient safety

Collaborator

• □COL 3.1 Identify appropriate time, context and content for effective handover
• □COL 3.2 Summarize patient issues providing rationale for key decisions
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □COL 3.2 Communicate effectively with the receiving physician(s), clarifying issues 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

Case

1. ●simple
2. ●perforated

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case

1. ●elective
2. ●emergent

Complexity

1. ●first laparotomy
2. ●redo
3. ●conversion

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

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

Observation

1. ●direct
2. ●case review

Case mix

1. ●neonate with acute abdomen
2. ●neonate with congenital malformation
3. ●child with acute abdomen/bowel obstruction
4. ●child with newly diagnosed malignancy
5. ●new outpatient pediatric surgery consult
6. ●other presentation

Setting

1. ●ER
2. ●inpatient
3. ●clinic

Medical Expert

• □ME 2.2 Elicit a history, including the perinatal history as relevant
• □ME 2.2 Perform the physical exam in a manner that minimizes discomfort or distress, without excluding key elements
• □ME 2.2 Adapt the clinical assessment to the child’s age and development
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Select further investigations, considering the limitations of blood volume on laboratory testing and the challenges of medical imaging in children
• □ME 2.4 Develop a plan for management which may include observation, surgery and/or non-operative intervention

Communicator

• □COM 3.1 Share information and explanations that are clear, accurate and timely with the patient and family
• □COM 4.3 Answer questions from the patient and/or family

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●trauma
2. ●sepsis
3. ●acute abdomen
4. ●oncology
5. ●other

Observation

1. ●direct
2. ●case review

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 2.2 Focus the assessment of a critically ill patient, performing it in a time- effective manner without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Develop and implement an initial management plan
• □ME 3.3 Prioritize a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 4.1 Determine the need, timing and priority of referral to another physician

Collaborator

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □ME 1.5 Carry out professional duties in the face of multiple competing demands
• □ME 1.5 Prioritize patients on the basis of clinical presentations
• □ME 2.4 Develop and implement management plans

Collaborator

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

Leader

• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □L 4.2 Run the service efficiently, safely, and effectively

Health Advocate

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

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 2.2 Ensure a safe learning environment for all members of the team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 5.1 Recognize the occurrence of a patient safety incident
• □ME 5.1 Prioritize the initial medical response to a harmful patient safety incident to mitigate further injury
• □ME 5.1 Document harmful patient safety incidents as per institutional processes

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □COM 3.2 Apologize appropriately for a harmful patient safety incident
• □COM 3.2 Plan and document follow-up to a harmful patient safety incident

Professional

• □P 4.3 Debrief the team after a patient safety incident

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age group

1. ●neonate
2. ●infant
3. ●toddler
4. ●child
5. ●adolescent

Person providing consent/assent

1. ●patient
2. ●parent
3. ●legal guardian
4. ●substitute decision maker

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.3 Apply knowledge of the indications for, and techniques and complications of surgical procedures
• □ME 2.3 Share concerns in a constructive and respectful manner about goals of care when they are not felt to be achievable

Communicator

• □COM 3.1 Convey information about a proposed procedure or intervention clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the family and/or caregiver(s)
• □COM 5.1 Document the consent/assent discussion in an accurate and complete manner

Professional

• □P 3.1 Apply provincial laws governing practice as it pertains to consent and assent

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. ●laparotomy
2. ●MIS
3. ●pyloromyotomy
4. ●bowel resection and anastomosis
5. ●inguinal hernia repair
6. ●central venous access (not PICC)
7. ●surgical enteral access
8. ●other procedure

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

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. ●NICU
2. ●PICU
3. ●ward

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.4 Provide routine post-operative management, including intravenous fluids, diet, wound care and medications
• □ME 2.4 Provide appropriate pain management
• □ME 4.1 Recognize and manage complications
• □ME 2.4 Develop and implement plans for discharge
• □ME 4.1 Coordinate the availability of services and resources in the home, as well as follow-up care

Communicator

• □COM 3.1 Share information and explanations that are clear, accurate and timely with the patient and family

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □COL 1.2 Work effectively with other health care professionals

Health Advocate

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●outpatient

Case mix

1. ●neonate with acute abdomen
2. ●neonate with congenital malformation
3. ●child with acute abdomen/bowel obstruction
4. ●child with newly diagnosed malignancy
5. ●new outpatient pediatric surgery consult

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner without excluding key elements
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Synthesize patient information to assess indications and risk of surgery
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context
• □ME 3.2 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

Communicator

• □COM 3.1 Provide information on diagnosis and prognosis clearly and compassionately
• □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 clinical encounter to convey clinical reasoning, rationale for decisions and/or recommendations

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

Case mix

1. ●abdominal wall defect
2. ●CPAM
3. ●CDH
4. ●bowel obstruction/polyhydramnios
5. ●other presentation

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.4 Perform a clinical assessment, incorporating prenatal investigations, to address all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.3 Work with the patient’s family to establish goals of care
• □ME 2.4 Develop a management plan that aligns with the goals of care

Communicator

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

Collaborator

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

Health Advocate

• □HA 1.1 Facilitate access to bereavement support for a patient’s family, as appropriate

Professional

• □P 1.3 Recognize and respond to ethical issues

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of the natural history of conditions relevant to Pediatric Surgery
• □ME 2.2 Assess the need and timing of transition from pediatric to adult care
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 4.1 Establish plans for ongoing care that include monitoring health status and anticipate the progression of the patient’s condition

Collaborator

• □COL 3.2 Summarize the clinical case in a transfer summary, including guidance for management of ongoing issues

Health Advocate

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●trauma
2. ●oncology
3. ●sepsis
4. ●acute abdomen
5. ●other

Setting

1. ●ER
2. ●NICU
3. ●PICU
4. ●other

Includes input from

1. ●other physician
2. ●nurse
3. ●respiratory technician
4. ●social worker
5. ●other health care professional

Observation

1. ●direct
2. ●case review

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for patient care within the boundaries and expectations of the consultant role
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context
• □ME 2.4 Develop a plan for management which may include observation, surgery and/or non-operative intervention
• □ME 3.1 Integrate planned procedures and therapies into the overall plan of care

Collaborator

• □COL 1.3 Contribute to quality patient care by sharing medical expertise
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 2.2 Work effectively with other health care professionals to develop plans for clinical care when there are differences in opinion and/or recommendations

Leader

• □L 2.1 Allocate health care resources for optimal patient care

Health Advocate

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

Scholar

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

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●trauma
2. ●sepsis
3. ●acute abdomen
4. ●oncology
5. ●other

Setting

1. ●ER
2. ●PICU
3. ●NICU
4. ●simulation

Age group

1. ●neonate
2. ●infant
3. ●toddler
4. ●child
5. ●adolescent

Medical Expert

• □ME 2.4 Assess clinical status and adjust resuscitative and diagnostic efforts as appropriate
• □ME 2.4 Manage hemodynamic support and monitoring
• □ME 2.4 Manage non-invasive and/or invasive ventilation
• □ME 5.2 Demonstrate situational awareness, avoid fixation error
• □ME 3.1 Integrate planned procedures or therapies into resuscitative efforts
• □ME 4.1 Ask for additional assistance and/or other services when indicated
• □ME 1.4 Act decisively and maintain control in critical situations
• □ME 2.4 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued

Collaborator

• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.2 Use closed loop communication
• □COL 1.3 Participate and/or lead debriefing of an event with the health care team

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts

Professional

• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Condition

1. ●thyroglossal duct cyst
2. ●branchial cleft cyst
3. ●thyroid surgery
4. ●lymphadenopathy
5. ●lymphovascular malformation
6. ●other condition

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●splenic
2. ●pancreatic
3. ●biliary atresia/choledochal cyst
4. ●other condition

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●inguinal hernia <6 months of age
2. ●orchidopexy
3. ●testicular torsion
4. ●non- malignant ovarian pathology

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

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. ●tunneled line
2. ●other procedure

Technical complexity

1. ●simple
2. ●intermediate
3. ●complex

Age

1. ●≤2 yrs
2. ●>2 yrs

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●Wilms tumour
2. ●neuroblastoma

Medical Expert

• □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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 3.1 Pre-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 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □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 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Adjust plan/procedure as unexpected elements unfold, demonstrating surgical maturity and judgement
• □ME 3.4 Post-procedure plan: Appropriate complete post-procedure plan

Collaborator

• □COL 1.2 Professional and effective communication/utilization of staff

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 Carry out professional duties in the face of multiple, competing demands
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 2.4 Establish patient-centred management plans
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice

Communicator

• □COM 2.2 Manage the flow and timing of clinical encounters
• □COM 5.1 Document clinical encounters in an accurate, complete and timely manner

Leader

• □L 2.1 Consider costs when choosing options for investigation or treatment
• □L 4.2 Book operative cases with appropriate urgency, duration, and equipment and patient preparation
• □L 4.1 Manage time effectively in the ambulatory clinic
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinic

Health Advocate

• □HA 1.1 Work with patients to address the determinants of health that affect them and their access to needed health services or resources

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

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 Establish patient-centred management plans
• □ME 4.1 Formulate and implement plans for discharge that include appropriate ongoing care and follow-up

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

• □L 4.1 Set priorities and manage time to fulfil diverse responsibilities
• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Health Advocate

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

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 5.2 Lead the team in the use of the surgical safety checklist, or equivalent
• □ME 3.4 Perform surgical procedures in a skillful and safe manner
• □ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure and list of cases as appropriate
• □ME 3.4 Establish plans for post-operative care

Communicator

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

Collaborator

• □COL 3.2 Transition patient care safely to the post-operative team

Professional

• □P 1.2 Prepare for surgical procedures, reviewing the list of planned operations
• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in Pediatric Surgery

Collaborator

• □COL 1.1 Establish positive relationships with other members of the health care team
• □COL 1.3 Share expertise to develop a care plan in collaboration with other physicians
• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 2.2 Achieve consensus when there are differences in recommendations provided by other health care professionals

Leader

• □L 2.1 Allocate health care resources for optimal patient care

Scholar

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

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Synthesize patient information
• □ME 4.1 Determine the need, timing and priority of referral to another physician
• □ME 2.3 Establish goals of care in collaboration with the patient and family
• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 2.4 Establish a patient-centred management plan despite limited, non- diagnostic, or conflicting clinical data
• □ME 2.4 Develop a plan to deal with clinical uncertainty

Communicator

• □COM 3.1 Convey information related to the uncertainty in diagnosis and/or treatment in a clear, timely and transparent manner
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □COM 4.3 Use communication skills and strategies that help the patient/family make informed decisions

Collaborator

• □COL 1.2 Consult as needed with other physicians

Professional

• □P 1.1 Identify limits in one’s own expertise

Case description

Feedback provided

Next steps