Pediatric Hematology-Oncology

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

Segment observed

1. ●relevant history
2. ●physical exam
3. ●case presentation

Case

1. ●new patient
2. ●known patient

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform a physical examination that informs the diagnosis
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to a supervisor

Communicator

• □COM 2.1 Use patient-centred interviewing skills
• □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 1.1 Develop trusting and supportive relationships with patients and families
• □COM 3.1 Provide accurate information about the medical condition and plans for investigation and/or management
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □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

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

Segment observed

1. ●consent
2. ●patient preparation

Procedure

1. ●transfusion
2. ●lumbar puncture with intrathecal chemotherapy
3. ●bone marrow aspirate/biopsy

Medical Expert

• □ME 1.3 Apply knowledge of the indications for and techniques and complications of common PHO therapies and procedures
• □ME 3.2 Explain the risks and benefits of and the rationale and alternatives for a proposed treatment or procedure
• □ME 2.2 Assess clinical status, peri-procedural risk and opportunities for risk mitigation
• □ME 3.4 Make arrangements for the treatment or procedure, applying knowledge of local policies and protocols
• □ME 3.4 Develop a plan for the appropriate disposition of the patient post procedure

Communicator

• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 4.3 Answer questions from the patient and/or family
• □COM 5.1 Complete required documentation of a consent discussion

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

Category

1. ●hematologic
2. ●oncologic

Medical Expert

• □ME 2.2 Elicit a history relevant to the presentation
• □ME 2.2 Perform a physical examination that informs the diagnosis
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Identify the clinical significance of diagnostic findings
• □ME 2.2 Develop a differential and most probable diagnosis
• □ME 2.2 Plan and coordinate a diagnostic workup

Communicator

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

Complexity

1. ●low
2. ●medium
3. ●high

Adolescent

1. ●yes
2. ●no

Medical Expert

• □ME 3.2 Describe a proposed therapy to the patient/family, including the rationale, possible toxicities, expected outcomes and alternative treatments

Communicator

• □COM 1.1 Demonstrate empathy, respect and compassion
• □COM 3.1 Convey information about the diagnosis and plan for management clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the patient’s and/or family’s understanding
• □COM 1.5 Recognize when strong emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.3 Answer questions from the patient and/or family
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □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

Category

1. ●hematologic
2. ●oncologic

Medical Expert

• □ME 2.2 Interpret the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
• □ME 2.4 Identify the role and availability of clinical trial participation as a therapeutic option
• □ME 2.4 Develop a management plan
• □ME 4.1 Establish a plan for follow-up on investigations and response to treatment

Communicator

• □COM 5.1 Document the encounter to convey the discussion and its outcome

Health Advocate

• □HA 1.1 Identify barriers to access and care for individual patients

Professional

• □P 1.2 Demonstrate awareness of the limits of one’s expertise, and seek 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 1.3 Apply knowledge of conventional cytotoxic chemotherapy, including pharmacology, expected adverse events and their prevention/management
• □ME 2.2 Assess a patient’s suitability to proceed with systemic therapy
• □ME 2.4 Select and prescribe the appropriate dose and regimen
• □ME 2.4 Modify or adjust the dose and/or timing of therapy as needed
• □ME 2.4 Select and prescribe appropriate monitoring strategies
• □ME 2.4 Select and prescribe supportive care to optimize patient comfort and mitigate adverse effects
• □ME 5.2 Follow standard operating procedures when ordering and/or administering systemic therapy

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

Medical Expert

• □ME 3.1 Determine the safety and appropriateness of the procedure
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
• □ME 3.4 Demonstrate effective procedure preparation, including patient identification and/or safety checklist as appropriate
• □ME 3.4 Prepare to obtain and handle samples, sending for appropriate testing
• □ME 3.4 Set up and position the patient for the procedure
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Prepare and cleanse the procedural site
• □ME 3.4 Perform a procedure in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Verify and administer intrathecal medication
• □ME 3.4 Demonstrate safe handling of instruments, biologic samples and/or biohazardous material
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Document the procedure, including adequacy of specimen obtained and the presence/absence of complications

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. ●laboratory
2. ●clinical service

Classification

1. ●benign
2. ●malignant
3. ●other laboratory finding (please specify)

Medical Expert

• □ME 1.3 Apply knowledge of peripheral blood morphology
• □ME 1.3 Apply knowledge of cerebrospinal fluid assessment
• □ME 2.2 Perform a morphologic assessment and recognize critical findings
• □ME 2.2 Establish a diagnosis that takes into account clinical correlation
• □ME 2.4 Provide suggestions for further testing and/or management as relevant

Communicator

• □COM 5.1 Communicate critical results urgently, 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

Complexity

1. ●low
2. ●medium
3. ●high

Category

1. ●hematologic
2. ●oncologic

Medical Expert

• □ME 1.3 Apply knowledge of the clinical and biomedical sciences relevant to Pediatric Hematology/ Oncology
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
• □ME 2.3 Establish goals of care in collaboration with patients and their families
• □ME 2.4 Identify the role and availability of clinical trials participation as a therapeutic option
• □ME 2.2 Identify whether the case warrants discussion at multidisciplinary case conference
• □ME 2.4 Develop a management plan
• □ME 4.1 Determine the need and timing of referral to another physician
• □ME 4.1 Coordinate treatment and follow-up plans

Communicator

• □COM 3.1 Share information about the patient’s condition and plans for management clearly and compassionately

Collaborator

• □COL 1.2 Work effectively with members of the interprofessional team to implement a management plan

Leader

• □L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options

Scholar

• □S 3.4 Perform a scholarly review of available treatment options
• □S 3.4 Apply an evidence-based approach to clinical management

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 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 the information conveyed
• □COM 1.4 Identify, verify and validate non-verbal cues
• □COM 4.3 Answer questions in a respectful manner
• □COM 1.6 Assess how each patient’s personal story impacts their unique needs and preferences
• □COM 2.2 Manage the flow of the encounter
• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting 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

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

Diagnosis

1. ●sickle cell disease
2. ●other hemoglobinopathy
3. ●hemophilia
4. ●thalassemia
5. ●chronic ITP
6. ●thrombosis
7. ●marrow failure syndrome
8. ●immune dysregulation
9. ●other diagnosis

Issue

1. ●stable condition
2. ●progressive condition
3. ●initiate and/or change therapy
4. ●manage complications
5. ●arrange/review surveillance
6. ●supportive/preventive care
7. ●counsel/educate
8. ●other issue

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess the impact of the medical condition on the patient’s growth, development and ability to pursue life goals
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Synthesize patient information to determine clinical status, response to treatment and/or toxicity
• □ME 2.3 Integrate the patient’s and family’s perspective and context into the care plan
• □ME 2.4 Develop a plan for management, which may include modification of current therapy
• □ME 4.1 Determine the need and timing of referral to another physician
• □ME 4.1 Determine the frequency and timing of future investigations and visits

Communicator

• □COM 4.2 Facilitate self-care and chronic disease management
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 5.1 Document a clinical encounter to convey the clinical assessment and the rationale for decisions and/or recommendations

Collaborator

• □COL 3.1 Determine when care should be transferred back to a primary care provider

Leader

• □L 2.1 Consider costs and resource availability when selecting diagnostic or treatment options

Health Advocate

• □HA 1.3 Incorporate prevention, health promotion and health surveillance into patient interactions

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 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or treatment
• □ME 2.2 Differentiate signs and symptoms of disease and/or disease progression from adverse effects of treatment
• □ME 2.2 Synthesize patient information to determine clinical status, response to treatment and/or toxicity
• □ME 2.3 Integrate the patient’s and family’s perspective and context into the care plan
• □ME 2.4 Develop a plan for management, which may include modification of current therapy
• □ME 4.1 Determine the need and timing of referral to another physician
• □ME 4.1 Coordinate treatment and follow-up plans

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 5.1 Document a clinical encounter to convey the clinical assessment and the 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

Observed physical exam

1. ●yes
2. ●no

Complication

1. ●none
2. ●acute GVHD
3. ●chronic GVHD
4. ●SOS
5. ●transplant associated microangiopathy
6. ●graft failure/mixed chimerism
7. ●cytokine release syndrome
8. ●other complication

Medical Expert

• □ME 1.3 Apply knowledge of HSCT and cellular therapy, and their toxicities and complications
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Perform a physical exam to detect evidence of GVHD
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine diagnosis
• □ME 2.4 Develop and implement a plan for initial management
• □ME 2.4 Incorporate consultant recommendations to develop and implement a definitive management plan
• □ME 4.1 Establish a plan for follow-up on investigations and response to treatment

Communicator

• □COM 3.1 Provide timely, accurate information and explanations to the patient and/or family

Collaborator

• □COL 1.3 Communicate effectively with the HSCT 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

Type of referral

1. ●HSCT – allogeneic
2. ●HSCT – autologous
3. ●cellular therapy

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Recognize when a patient may benefit from referral for HSCT or cellular therapy
• □ME 2.2 Identify whether the case warrants discussion at multidisciplinary case conference
• □ME 4.1 Determine the need and timing of referral to another physician
• □ME 3.2 Describe a proposed therapy to the patient/family, including the rationale, possible toxicities, expected outcomes and alternative treatments
• □ME 2.2 Plan and coordinate an appropriate diagnostic workup
• □ME 4.1 Formulate clear and complete requests for consultation

Communicator

• □COM 3.1 Convey information about the treatment options clearly and accurately
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions

Collaborator

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

Health Advocate

• □HA 1.1 Identify barriers to access and care for individual patients
• □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

Medical Expert

• □ME 2.4 Identify the role and availability of clinical trial participation as a therapeutic option
• □ME 3.2 Describe a proposed therapy to the patient/family, including the rationale, possible toxicities, expected outcomes and alternative treatments
• □ME 2.4 Discuss the degree of uncertainty inherent to the clinical situation

Communicator

• □COM 3.1 Convey information about the treatment options clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Verify understanding of the information conveyed
• □COM 5.1 Document the consent discussion in a manner compliant with GCP standards

Scholar

• □S 4.2 Incorporate ethical principles of research in discussions regarding enrollment for a clinical trial
• □S 4.2 Advise regarding the right not to participate
• □S 4.3 Balance the roles and responsibilities of a researcher with the clinical roles and responsibilities of a physician

Professional

• □P 3.1 Adhere to professional and ethical codes 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

Caller

1. ●patient/family
2. ●physician

Decision

1. ●nil to do
2. ●manage at home
3. ●admit/ER
4. ●refer not urgent
5. ●other decision

Medical Expert

• □ME 2.2 Interpret the clinical data to establish the diagnosis and, if relevant, stage and/or severity of the condition
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 4.1 Provide recommendations for additional investigations and/or next steps in management and treatment

Communicator

• □COM 2.3 Gather patient information from a family member or health care professional
• □COM 5.1 Document advice provided by telephone to patients or other health care providers

Collaborator

• □COL 3.1 Determine when a patient should be transferred to ensure optimal patient care
• □COL 3.2 Recognize and act on patient safety issues in the transfer of care
• □COL 1.3 Work effectively with other physicians and health care professionals

Leader

• □L 2.1 Apply knowledge of the health care resources available in other care 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

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●simulation
5. ●other setting

Medical Expert

• □ME 2.1 Recognize instability and medical acuity in a clinical presentation
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Perform a history and physical exam relevant to the patient presentation, in a time- effective manner
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Apply emergency care protocols for emergencies related to hematologic or oncologic conditions or their treatment
• □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 Document the encounter to convey the outcome and rationale for clinical decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other members of the team

Professional

• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of the natural history of cancer
• □ME 1.3 Apply knowledge of the late effects of therapy
• □ME 2.2 Assess a patient’s risk of cancer relapse/recurrence and potential late effects of therapy
• □ME 2.2 Assess the impact of the medical condition on the patient’s growth, development and ability to pursue life goals
• □ME 2.2 Interpret the results of investigations performed to monitor the condition and/or its treatment
• □ME 4.1 Determine the frequency and timing of future investigations and visits

Collaborator

• □COL 3.1 Determine when care should be transferred back to a primary care provider
• □COL 1.3 Provide timely pertinent information to other health care providers

Health Advocate

• □HA 1.3 Counsel patients regarding relevant preventive health care
• □HA 1.2 Work with patients to increase opportunities for self-care and independence
• □HA 1.2 Work with patients to facilitate reintegration into school and/or work

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 2.3 Work with the patient and family to establish goals of care
• □ME 2.2 Identify symptoms influencing patient comfort at the end of life
• □ME 2.2 Determine symptom management priorities
• □ME 2.4 Develop palliative care management plans that align with patient and family goals of care
• □ME 2.3 Share concerns about goals that may not be achievable and initiate discussion about addressing these concerns

Communicator

• □COM 1.1 Develop trusting and supportive relationships with families in distress
• □COM 3.1 Provide information related to progression of illness and evolution of care
• □COM 3.1 Educate patients and families about end of life care options
• □COM 5.1 Document the encounter to convey the discussion and its outcome

Collaborator

• □COL 1.3 Consult with other health care professionals as is appropriate for optimal patient care

Health Advocate

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

Professional

• □P 1.3 Recognize and respond to the moral and ethical challenges in end of life care
• □P 4.1 Exhibit self-awareness, recognizing and managing the impact of end of life care on personal well-being and professional performance

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 complexity

1. ●medium
2. ●high

Setting

1. ●longitudinal clinic (continuity of care)
2. ●transitional clinic (from pediatrics to adult care)
3. ●patient moving jurisdiction
4. ●referral back to primary care
5. ●transfer to survivorship care

Medical Expert

• □ME 1.3 Apply knowledge of the natural history of conditions relevant to Pediatric Hematology/Oncology
• □ME 2.2 Assess the indications and timing of transition to another setting and/or stage of 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 1.3 Incorporate information and the perspectives of other members of the health care team when developing a plan for transition
• □COL 3.2 Summarize all relevant issues of the clinical case in a transfer summary
• □COL 3.2 Provide guidance for management of ongoing issues as well as anticipated changes in the clinical course

Leader

• □L 2.1 Apply knowledge of the health care resources available in other care settings

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

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 Develop and implement management plans that anticipate progress in/changes through the clinical course

Collaborator

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

Leader

• □L 4.1 Review and act on test results in a timely manner
• □L 4.1 Manage time effectively in the outpatient clinic

Scholar

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

Professional

• □P 1.2 Demonstrate awareness of the limits of one’s expertise, and seek assistance as needed
• □P 1.1 Respond punctually to requests from patients or other health care professionals
• □P 1.1 Make arrangements for coverage by another physician when absent or unavailable

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/volume of case load

1. ●low
2. ●average
3. ●high

Input collected from

1. ●nurse
2. ●other health care professional
3. ●junior resident/student

Medical Expert

• □ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □ME 2.4 Develop and implement plans for ongoing care, discharge, and follow-up

Communicator

• □COM 3.1 Share information about the medical course and plans with patients and families

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 Work effectively with other physicians and health care professionals

Leader

• □L 4.1 Manage time and prioritize tasks
• □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 Apply an evidence-based approach to clinical management
• □S 2.4 Provide teaching for junior learners
• □S 2.5 Provide junior learners with feedback to enhance learning and performance

Professional

• □P 1.1 Exhibit appropriate professional behaviors

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 activity

1. ●journal club
2. ●grand or divisional rounds
3. ●academic half day
4. ●other activity

Scholar

• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Develop learning objectives for a teaching activity
• □S 3.3 Critically evaluate the integrity, reliability and applicability of health-related research and literature
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present the information in an organized manner to facilitate understanding
• □S 2.4 Use audiovisual aids effectively
• □S 2.4 Provide adequate time for questions and discussion

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●outpatient
3. ●hematology
4. ●oncology

Includes input from

1. ●clinical associate
2. ●nurse practitioner
3. ●physician assistant
4. ●charge nurse
5. ●other nurse
6. ●social worker
7. ●other resident
8. ●medical student(s)
9. ●clerical staff
10. ●other health care professional

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □ME 1.5 Prioritize patients based on the urgency of clinical presentations
• □ME 2.4 Establish patient- and family-centred management plans

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

Scholar

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

Professional

• □P 4.1 Manage the mental and physical challenges that impact physician wellness and/or 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

Request type

1. ●special authorization for meds
2. ●special authorization for testing
3. ●disability/insurance
4. ●other

Communicator

• □COM 5.1 Complete third party clinical documentation in a thorough, responsible and timely manner

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources
• □HA 1.1 Apply the criteria for authorization of treatments, testing or other special interventions

Scholar

• □S 3.3 Perform a literature search to address a clinical question
• □S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature
• □S 4.5 Summarize the findings of a literature review

Case description

Feedback provided

Next steps