Pediatric Neurology

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 type

1. ●direct
2. ●indirect

Event observed

1. ●history
2. ●physical exam
3. ●neurological exam

Presentation type

1. ●medical
2. ●neurological
3. ●psychiatric

Medical Expert

• □ME 2.2 Elicit an accurate relevant history
• □ME 2.2 Perform a physical examination relevant to the presentation

Communicator

• □COM 2.1 Conduct the interview in a patient-centred manner
• □COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in a given patient’s care

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

Presentation

1. ●acute abdomen
2. ●confusion
3. ●chest pain
4. ●decreased level of consciousness
5. ●deterioration of neurological status (i.e., weakness, impending herniation)
6. ●psychosis/mania
7. ●respiratory distress
8. ●seizure
9. ●shock
10. ●unstable vital signs
11. ●other presentation (write in)

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □ME 2.4 Apply emergency care protocols for patient emergencies
• □ME 5.2 Use cognitive aids, such as pre-printed orders or care paths

Communicator

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

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals

Leader

• □L 2.1 Apply knowledge of local resources for optimal patient care

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 and organize clinical information for clear and succinct presentation to supervisor

Communicator

• □COM 2.1 Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial 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

Type of documentation

1. ●consult note
2. ●admission note
3. ●progress note

Communicator

• □COM 5.1 Document all relevant findings
• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Prepare documentation that accurately conveys the encounter and outcome
• □COM 5.1 Complete clinical documentation in a timely manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 5.2 Use structured communication tools and strategies to enhance patient safety

Collaborator

• □COL 3.2 Summarize and prioritize patient issues providing rationale for key decisions
• □COL 3.2 Communicate plans for ongoing management of patients, such as outstanding investigations and anticipated events / outcomes
• □COL 3.2 Communicate with the receiving physician(s) or health care professional(s) during transitions in care, clarifying issues as needed
• □COL 1.3 Integrate the patient’s perspective and context into the care plan

Professional

• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities

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 stroke
2. ●status epilepticus
3. ●neuromuscular respiratory failure
4. ●suspected spinal cord compression
5. ●meningitis/encephalitis
6. ●impending herniation
7. ●reduced level of consciousness/coma
8. ●thunderclap headache
9. ●other

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 patient presentation, in a time-effective manner
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Administer relevant scales (e.g., GCS, NIHSS)
• □ME 2.4 Develop and implement a plan for initial management

Collaborator

• □COL 2.1 Show respect towards other members of the health care team

Professional

• □P 1.1 Work within personal limitations, 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

Event observed

1. ●history
2. ●physical

Presentation

1. ●abnormal movements
2. ●altered mental status
3. ●dizziness/balance problems
4. ●headache/pain
5. ●paroxysmal event
6. ●sensory disturbance
7. ●visual disturbance
8. ●weakness
9. ●other

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Synthesize clinical information to localize the neurological problem

Communicator

• □COM 2.1 Conduct the interview in a patient-centred 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

Presentation

1. ●abnormal movements
2. ●altered mental status
3. ●dizziness/balance problems
4. ●headache/pain
5. ●paroxysmal event
6. ●sensory disturbance
7. ●visual disturbance
8. ●weakness
9. ●other

Medical Expert

• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Synthesize clinical information to localize a neurological problem
• □ME 2.2 Develop a differential diagnosis
• □ME 2.4 Develop and implement a plan for initial management
• □ME 4.1 Determine the need and urgency of referral to other health care professionals
• □ME 2.4 Determine the appropriate disposition and/or setting for ongoing care
• □ME 1.6 Seek assistance in situations that are complex or new

Communicator

• □COM 2.3 Identify other sources of information (e.g. family, medical record) that may assist in the given patient’s care

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

Domain

1. ●cardiology
2. ●critical care
3. ●dermatology
4. ●endocrinology
5. ●gastrointestinal
6. ●genetics/metabolics
7. ●hematology
8. ●infectious disease
9. ●neonatology
10. ●neurosurgery
11. ●oncology
12. ●psychiatry
13. ●respirology
14. ●rheumatology
15. ●other

Medical Expert

• □ME 2.2 Perform a focused clinical assessment
• □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 4.1 Ensure follow-up on results of investigation and response to treatment

Communicator

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

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 2.1 Show respect towards other members of the health care team

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Complexity

1. ●simple
2. ●complex

Age

1. ●neonate
2. ●child
3. ●adolescent/adult

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
• □ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □ME 3.4 Set up and position the patient for a lumbar puncture
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Prepare and cleanse the procedural site
• □ME 3.4 Perform lumbar puncture in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage complications

Communicator

• □COM 5.1 Document the encounter to convey the procedure and 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

Context

1. ●patient-directed
2. ●substitute decision maker

Medical Expert

• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease modifying approach
• □ME 3.2 Determine the capacity of the patient to give consent and where appropriate establish the appropriate substitute decision maker
• □ME 2.3 Establish goals of care in collaboration with the patient and/or family

Communicator

• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately
• □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 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regards to their care
• □COM 1.5 Recognize when strong emotions (e.g. fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
• □COM 5.1 Document the encounter to reflect the discussion and decision(s)

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. ●acute stroke
2. ●seizures
3. ●acute neuromuscular weakness
4. ●myelitis
5. ●increased intracranial pressure
6. ●CNS infection
7. ●acute demyelination
8. ●encephalopathy/coma
9. ●other

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Synthesize clinical information to localize the neurological problem
• □ME 2.2 Develop a differential diagnosis
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 3.3 Balance risk, effectiveness and priority of interventions in the presence of multiple co-morbidities and/or other features of case complexity
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and needs
• □ME 4.1 Determine the need and urgency of referral to other health care professionals

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.3 Work effectively with other health care professionals to plan and provide care for individual patients

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

Age

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

Case mix

1. ●cognitive/neurodegenerative
2. ●demyelinating / inflammatory
3. ●developmental
4. ●epilepsy
5. ●functional
6. ●headache
7. ●inborn errors of metabolism
8. ●movement disorder
9. ●neuromuscular
10. ●neuro-ophthalmology
11. ●neuro- oncology
12. ●vascular
13. ●traumatic brain injury
14. ●neuro-otology
15. ●neuro-infectious disease
16. ●neurologic complications of pregnancy / delivery
17. ●sleep
18. ●systemic disease
19. ●other

Medical Expert

• □ME 2.2 Gather clinical information to assess health status and symptoms
• □ME 2.2 Assess the patient’s clinical course and anticipate future health needs
• □ME 2.4 Apply strategies for disease prevention and health promotion
• □ME 4.1 Prevent and/or manage complications of neurological disease
• □ME 2.4 Manage common medical co-morbidities in patients with chronic neurological disease
• □ME 2.4 Manage common issues (physical symptoms and psycho-social) in patients with chronic neurological disease
• □ME 1.3 Apply knowledge of clinical pharmacology as it pertains to drug prescribing in neurological disease

Collaborator

• □COL 1.3 Integrate the patient’s perspective and context into the care plan
• □COL 1.3 Engage in respectful shared decision-making with other physicians and/or health care professionals

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
• □HA 1.2 Work with the patient to increase their understanding of their illness 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

Presentations

1. ●acute stroke
2. ●impending herniation
3. ●reduced level of consciousness/coma
4. ●neuromuscular respiratory distress
5. ●suspected meningitis/encephalitis
6. ●suspected spinal cord compression
7. ●suspected status epilepticus
8. ●thunderclap headache
9. ●other

Medical Expert

• □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 appropriate investigations
• □ME 3.3 Prioritize a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and needs
• □ME 3.2 Obtain informed consent
• □ME 4.1 Determine the appropriate disposition and/or setting for ongoing care

Communicator

• □COM 3.1 Convey information about diagnosis and prognosis clearly and compassionately

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians

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. ●simulation
4. ●ED
5. ●LTC

Exam technique

1. ●movement disorder exam
2. ●neuro-muscular exam
3. ●neuro- ophthalmological exam
4. ●cognitive/developmental exam
5. ●functional exam
6. ●examination of the comatose patient
7. ●Epley maneuver
8. ●Dix-Hallpike test
9. ●HINTS
10. ●neonatal exam
11. ●other (enter text)

Complex

1. ●yes
2. ●no

Age

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

Medical Expert

• □ME 3.2 Explain the risks and benefits of, and the rationale for a proposed examination, procedure or therapy
• □ME 2.2 Perform specialized examination techniques in a skilful manner
• □ME 3.4 Perform examination in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances
• □ME 2.2 Recognize and correctly interpret the findings of special clinical maneuvers and procedures

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 document

1. ●new assessment consultation note
2. ●follow-up consultation note
3. ●discharge summary
4. ●letter to referring physician

Setting

1. ●outpatient
2. ●inpatient
3. ●ED

Complex

1. ●yes
2. ●no

Communicator

• □COM 5.1 Organize information in appropriate sections
• □COM 5.1 Document all relevant findings and investigations
• □COM 5.1 Convey clinical reasoning and the rationale for decisions
• □COM 5.1 Provide a clear plan for ongoing management
• □COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □COL 1.2 Identify the roles of the referring physician and the neurology consultant in the ongoing management plan
• □COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management
• □COL 2.1 Convey information thoughtfully and respectfully

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making
• □S 1.3 Provide teaching points to improve quality of care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Site of observation

1. ●interprofessional team meeting
2. ●family meeting
3. ●teaching session
4. ●rounds session
5. ●other

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician

Collaborator

• □COL 1.2 Work effectively with the interprofessional team

Leader

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

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

Complex

1. ●yes
2. ●no

Transition to adult care

1. ●yes
2. ●no

Medical Expert

• □ME 2.2 Assess patient/caregiver health literacy and developmental readiness for the demands of the adult care setting
• □ME 2.2 Assess psychosocial issues that may affect health and/or access to services
• □ME 2.2 Assess adherence to treatment and monitoring plans
• □ME 2.4 Anticipate, prevent and manage changes in health status at the time of transition
• □ME 4.1 Establish plans for ongoing care that include monitoring health status and managing adherence

Communicator

• □COM 1.6 Tailor approaches to decision-making to patient capacity, values and preferences
• □COM 3.1 Provide information to patients and families clearly and compassionately
• □COM 4.3 Address questions from the patient and family about next steps

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.2 Convey relevant information to the most appropriate physician

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

Issue

1. ●acute neurological emergency
2. ●breaking bad news
3. ●goals of care
4. ●end of life
5. ●managing conflict
6. ●non-adherence
7. ●abuse
8. ●other

Medical Expert

• □ME 2.3 Establish goals of care in collaboration with the patient and/or family

Communicator

• □COM 1.1 Develop trusting and supportive relationships with patients and families
• □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 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 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 4.3 Answer questions regarding care delivery, treatment decisions and/or prognosis
• □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

Complexity and volume of case load

1. ●low
2. ●high

Medical Expert

• □Part A: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part A: ME 1.4 Perform relevant and time-effective clinical assessments
• □Part A: ME 1.5 Prioritize patients based on the urgency of clinical presentations
• □Part A: ME 2.4 Develop plans for patient care that anticipate clinical response and progress to other settings of care, including home
• □Part A: ME 4.1 Coordinate treatment and follow-up across care settings

Collaborator

• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 1.2 Assign tasks and responsibilities to other team members, commensurate with their skills and patient complexity
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals
• □Part B: COL 1.1 Respond appropriately to input from other health care professionals

Leader

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

Health Advocate

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

Scholar

• □Part A: S 3.4 Integrate best evidence and clinical expertise into decision-making
• □Part B: S 2.1 Use strategies for deliberate, positive role-modelling
• □Part B: S 2.2 Create a positive learning environment
• □Part B: S 2.5 Provide feedback to enhance learning and performance

Professional

• □Part A: P 4.1 Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings
• □Part B: P 1.1 Respond punctually to requests from patients or other health care professionals
• □Part B: P 1.1 Exhibit appropriate professional behaviors
• □Part B: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 5.2 Use systems to track and follow-up on clinical data, such as studies and laboratory tests

Collaborator

• □COL 1.3 Address the questions and concerns of the referring/primary care physician when acting in the consultant role
• □COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.1 Review and act on test results in a timely manner
• □L 4.2 Manage a practice effectively including activities such as billing and communicating with third-party providers

Professional

• □P 1.1 Respond punctually to requests from patients or other health care providers
• □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

Medical Expert

• □ME 2.2 Interpret clinical information gathered by another health professional, along with the results of investigations, for the purposes of diagnosis and management
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Establish a plan for ongoing care in the local setting and/or for care prior to and during transfer

Communicator

• □COM 2.3 Request and synthesize patient information gathered by another health professional
• □COM 5.1 Document advice provided to off-site 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 1.2 Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions

Leader

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

Case description

Feedback provided

Next steps