Pediatrics

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. ●preschool
4. ●school age
5. ●adolescent

Activity observed

1. ●history
2. ●physical
3. ●presentation

Clinical setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community

Medical Expert

• □ME 2.2 Elicit an accurate, relevant history
• □ME 2.2 Perform a physical exam that informs the diagnosis
• □ME 2.2 Synthesize patient information from the clinical assessment for the purpose of written or oral summary to a supervisor

Communicator

• □COM 1.2 Optimize the physical environment for patient and family comfort, dignity, privacy, engagement and safety
• □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 the 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

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Clinical setting

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

Type of orders

1. ●medication/prescription
2. ●intravenous fluids
3. ●diet/nutrition
4. ●diagnostic tests
5. ●other (please specify)

Medical Expert

• □ME 2.4 Adjust medication dosing for patient age, size and/or other relevant factors
• □ME 2.1 Recognize situations requiring direct communication of orders to the appropriate team member

Communicator

• □COM 5.1 Document patient care orders
• □COM 5.1 Organize information in appropriate sections

Professional

• □P 1.1 Complete assigned responsibilities in a timely fashion

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Clinical presentation

1. ●decreased level of consciousness
2. ●fever
3. ●hypo/hypertension
4. ●hypoxemia
5. ●pain
6. ●seizure
7. ●tachy/bradycardia
8. ●tachy/bradypnea
9. ●other presentation (please specify)

Setting

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

Medical Expert

• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 3.4 Perform the sequence of resuscitation as per established protocols
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Reassess clinical status and re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 1.4 Recognize urgent problems that need the involvement of more experienced colleagues and seek their assistance

Collaborator

• □COL 1.3 Work effectively with 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

Setting

1. ●delivery room
2. ●simulation

Type of encounter

1. ●standard newborn care (stimulation and drying)
2. ●initiation of resuscitation

Medical Expert

• □ME 1.4 Perform a focused clinical assessment, without excluding any key elements
• □ME 1.3 Apply knowledge of the physiology of neonatal adaptation to extrauterine life
• □ME 3.4 Perform basic neonatal resuscitation, if needed
• □ME 2.1 Recognize when a neonate needs additional resuscitation
• □ME 1.4 Recognize urgent problems that need the involvement of more experienced colleagues and seek their assistance

Communicator

• □COM 3.1 Communicate effectively with the parent(s)

Collaborator

• □COL 1.3 Work effectively with 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

Setting

1. ●delivery room
2. ●postpartum unit/mother-baby unit
3. ●special care nursery
4. ●NICU
5. ●community practice
6. ●inpatient pediatric unit

Medical Expert

• □Part A: ME 2.2 Elicit an accurate, relevant history including pertinent antenatal, perinatal and/or postnatal information
• □Part A: ME 2.2 Perform all elements of the newborn physical examination
• □Part A: ME 2.2 Recognize normal variants and abnormal findings on the neonatal physical examination
• □Part B: ME 2.2 Perform a focused clinical assessment to assess readiness for discharge
• □Part B: ME 4.1 Establish plans for ongoing care
• □Part B: ME 1.3 Apply knowledge of newborn screening protocols

Communicator

• □Part A: COM 3.1 Share information and explanations that are clear and accurate
• □Part A: COM 3.1 Use plain language and avoid medical jargon
• □Part B: COM 3.1 Provide the parent (s) with information about newborn screenings, and associated processes for results and follow-up
• □Part B: COM 3.1 Convey information to the family clearly and compassionately
• □Part B: COM 3.1 Use plain language and avoid medical jargon
• □Part B: COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
• □Part B: COM 4.3 Answer questions from the family

Health Advocate

• □Part B: HA 1.3 Provide counselling and anticipatory guidance for common neonatal issues, including breastfeeding, safe sleeping, car seat safety, and postpartum depression

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. ●hyperbilirubinemia
2. ●hypoglycemia
3. ●neonatal abstinence syndrome
4. ●poor weight gain
5. ●respiratory distress
6. ●risk for sepsis
7. ●other (please specify)

Medical Expert

• □ME 2.2 Elicit a history, including the perinatal history as relevant
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 1.3 Apply knowledge of the limitations of blood volume on laboratory testing and the challenges of medical imaging in children
• □ME 2.2 Interpret the results of investigations in the context of the patient’s presentation
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize and interpret information from the clinical assessment
• □ME 2.4 Develop a plan for initial management

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)
• □COM 3.1 Convey information to the family clearly and compassionately

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Event observed

1. ●history
2. ●physical
3. ●diagnosis
4. ●management plan

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●on call/after hours

Type of condition

1. ●respiratory
2. ●gastrointestinal
3. ●ID
4. ●cardiac
5. ●rheumatic/musculoskeletal
6. ●hematology/oncology
7. ●endocrine
8. ●neurology
9. ●renal/genitourinary
10. ●otolaryngology/ophthalmology
11. ●dermatology
12. ●genetic
13. ●mental health
14. ●developmental/behavioural/psychosocial
15. ●allergy/immunology

Presentation

1. ●dehydration
2. ●fever
3. ●respiratory distress
4. ●other (please specify)

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 Perform a physical examination relevant to the presentation
• □ME 2.2 Adapt the clinical assessment to the child’s age and development
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 1.3 Apply knowledge of the limitations of blood volume on laboratory testing and the challenges of medical imaging in children
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize and interpret information from the clinical assessment
• □ME 2.4 Develop a plan for initial management

Communicator

• □COM 2.1 Conduct the interview in a patient-centred manner
• □COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)

Leader

• □L 2.1 Consider costs when choosing care options

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Assess a child’s growth and development
• □ME 2.2 Use screening tools and validated questionnaires, as applicable
• □ME 1.3 Apply knowledge of variations from typical growth, development and behavioural patterns
• □ME 2.2 Determine the patient’s status with respect to the immunization schedule
• □ME 2.2 Assess a patient’s and family’s health habits, access to health care, food and other resources, and other social determinants of health
• □ME 2.4 Provide counselling and anticipatory guidance, appropriate for age and developmental stage for healthy growth and development
• □ME 2.4 Develop a plan for primary and secondary prevention strategies as part of the child’s overall care

Communicator

• □COM 4.1 Incorporate the patient’s/family’s beliefs, values, preferences, context and expectations
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health and/or social system(s)
• □HA 1.2 Work with the patient and/or family to increase their understanding of their illness and health care needs
• □HA 1.2 Provide advice about appropriate educational resources
• □HA 1.3 Work with the patient and/or family to increase opportunities to adopt healthy 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

Procedure

1. ●bag valve mask ventilation
2. ●cardiopulmonary resuscitation (ventilation and massage)
3. ●changing tracheostomy tubes for obstruction or decannulation
4. ●intraosseous injection
5. ●lumbar puncture
6. ●needle thoracostomy

Setting

1. ●clinical
2. ●simulation

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

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 Position the patient appropriately
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, mask, gown and glove
• □ME 3.4 Select and provide sedation and local analgesia, as appropriate
• □ME 3.4 Handle sharps safely
• □ME 3.4 Perform the procedure in a skilful and safe manner
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed

Communicator

• □COM 5.1 Document the procedure and outcome

Collaborator

• □COL 1.2 Communicate effectively with patient and/or assistant(s) during the procedure

Professional

• □P 1.1 Work within personal limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●on call/after hours

Communicator

• □COM 1.1 Establish rapport with the patient and family
• □COM 1.6 Tailor the approach to communication to the needs of the patient and/or family
• □COM 1.1 Engage the patient in the discussion as appropriate for their developmental stage
• □COM 3.1 Convey information about medical course and management plan
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 4.3 Solicit and 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

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●on call/after hours
6. ●simulation

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Complexity

1. ●low
2. ●moderate
3. ●high

Format

1. ●admission note
2. ●consult letter
3. ●discharge summary
4. ●progress note
5. ●other (please specify)

Medical Expert

• □ME 2.2 Synthesize and interpret information from the clinical assessment

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

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. ●level I and/or II NICU

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 Provide anticipatory guidance for ongoing management, such as results of outstanding investigations and/or anticipated events/outcomes
• □COL 3.2 Clarify issues with the receiving physician(s), as needed, and confirm with closed loop communication
• □COL 1.3 Integrate the patient’s and family’s perspective and context into the care plan

Professional

• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities in a timely fashion

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 Integrate clinical information to determine the patient’s clinical status and health care needs
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression
• □ME 2.4 Anticipate changes in health status at the time of transition

Communicator

• □COM 3.1 Convey information to the patient and/or family regarding the patient’s care needs and treatment plan
• □COM 4.3 Solicit and answer questions from the patient and/or family

Collaborator

• □COL 3.2 Communicate with the accepting physician(s) or health care professional, clarifying issues as needed
• □COL 3.2 Summarize and prioritize patient issues providing rationale for key decisions
• □COL 3.2 Provide anticipatory guidance for ongoing management, such as results of outstanding investigations and/or anticipated events/outcomes

Leader

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

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health and/or social system(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

Medical Expert

• □ME 1.4 Recognize one’s own limits and seek assistance as needed
• □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 1.3 Apply knowledge of established protocols for neonatal resuscitation
• □ME 3.4 Perform the sequence of neonatal resuscitation as per established protocols
• □ME 3.1 Integrate planned procedures or therapies into resuscitative efforts

Collaborator

• □COL 1.2 Integrate the skills of other health care professionals in the resuscitation

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

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●on call/after hours
6. ●simulation

Presentation (check all that apply)

1. ●respiratory
2. ●hemodynamic
3. ●fluid and electrolyte/metabolic
4. ●neurologic
5. ●other presentation (please specify)

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 2.2 Focus the assessment, performing in a time-effective manner without excluding key elements
• □ME 3.4 Perform the sequence of resuscitation as per established protocols
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Synthesize patient information to determine differential diagnosis
• □ME 2.4 Develop and implement focused treatment strategies
• □ME 4.1 Determine the need for and timing of referral to another health care professional

Collaborator

• □COL 1.2 Work effectively as the leader of a resuscitation team
• □COL 1.3 Apply closed loop communication in urgent or crisis situations to work effectively with physicians and other colleagues in the health care professions

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

Observation

1. ●direct
2. ●case review

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●on call/after hours
6. ●NICU
7. ●PICU

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Type of condition (check all that apply)

1. ●respiratory
2. ●gastrointestinal
3. ●ID
4. ●cardiac
5. ●rheumatic/musculoskeletal
6. ●hematology/oncology
7. ●endocrine
8. ●neurology
9. ●renal/genitourinary
10. ●otolaryngology/ophthalmology
11. ●dermatology
12. ●genetic
13. ●mental health
14. ●developmental/behavioural/psychosocial
15. ●allergy/immunology

Complexity

1. ●low
2. ●medium
3. ●high

Acuity

1. ●emergent
2. ●urgent
3. ●non-urgent

Medical Expert

• □ME 2.2 Gather a history, including all pertinent medical and psychosocial issues
• □ME 2.2 Perform the physical exam in a manner that minimizes discomfort or distress, without excluding key elements
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.2 Adapt the clinical assessment to the child’s age and development

Communicator

• □COM 2.2 Manage the flow of complex patient encounters
• □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

Ages

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●NICU
6. ●PICU

Type of condition (check all that apply)

1. ●respiratory
2. ●gastrointestinal
3. ●ID
4. ●cardiac
5. ●rheumatic/musculoskeletal
6. ●hematology/oncology
7. ●endocrine
8. ●neurology
9. ●renal/genitourinary
10. ●otolaryngology/ophthalmology
11. ●dermatology
12. ●genetic
13. ●allergy/immunology

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 1.3 Apply clinical and biomedical sciences to manage complex patient presentations
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context
• □ME 4.1 Determine the need for and timing of referral to another health care professional
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and/or family understand the diagnosis and plan

Collaborator

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

Health Advocate

• □HA 1.1 Identify barriers to access and 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

Observation

1. ●direct
2. ●case review

Type of condition

1. ●respiratory
2. ●gastrointestinal
3. ●ID
4. ●cardiac
5. ●rheumatic/musculoskeletal
6. ●hematology/oncology
7. ●endocrine
8. ●neurology
9. ●renal/genitourinary
10. ●otolaryngology/ophthalmology
11. ●dermatology
12. ●genetic
13. ●allergy/immunology

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●NICU
6. ●PICU
7. ●home

Medical Expert

• □ME 1.4 Perform a clinical assessment that address all relevant issues
• □ME 2.1 Consider comorbidities and clinical urgency in determining priorities to be addressed
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.2 Integrate and summarize information obtained through the clinical assessment and investigations
• □ME 2.4 Identify and address interactions between different diseases and different treatments
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context
• □ME 2.4 Adapt guideline-based recommendations for care to the context of the patient’s specific needs and priorities
• □ME 4.1 Determine the need for and timing of referral to another health care professional
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression

Communicator

• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.2 Work effectively with other health care professionals, including other physicians

Leader

• □L 2.1 Demonstrate resource stewardship in clinical care

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health or social system(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

Type of observation

1. ●direct
2. ●case review

Condition

1. ●ADHD
2. ●anxiety disorder
3. ●conversion disorder
4. ●early psychosis
5. ●eating disorder
6. ●mood disorder
7. ●obsessive compulsive disorder
8. ●oppositional/disruptive and/or conduct disorder
9. ●substance abuse
10. ●suicidal ideation, intent, and attempts

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●longitudinal clinic

Medical Expert

• □ME 1.3 Apply knowledge of normal and abnormal physical, cognitive, emotional, social and behavioural development
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Use screening tools and validated questionnaires, as applicable
• □ME 2.2 Synthesize biological, psychological, and social information to determine a diagnosis
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context
• □ME 2.4 Prescribe first-line psychotropic medicines as applicable
• □ME 4.1 Develop a plan for ongoing management and follow-up
• □ME 4.1 Determine the need for and timing of referral to another health care professional

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health and/or social system(s)

Professional

• □P 1.1 Apply the principles and limits of confidentiality as defined by professional practice standards and the law
• □P 3.1 Apply relevant aspects of mental health law and child welfare legislation

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●case review

Condition

1. ●autism spectrum disorder
2. ●common behaviour problem(s)
3. ●learning difficulty
4. ●developmental disorder
5. ●sleep hygiene issue and/or sleep disorder

Setting

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●longitudinal clinic

Medical Expert

• □ME 1.3 Apply knowledge of normal and abnormal physical, cognitive, emotional, social and behavioural development
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Use screening tools and validated questionnaires, as applicable
• □ME 2.2 Adapt the clinical assessment to the child’s age and developmental stage
• □ME 2.2 Synthesize biological, psychological, and social information to determine a diagnosis
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context
• □ME 4.1 Determine the need for and timing of referral to another health care professional
• □ME 4.1 Develop a plan for ongoing management and follow-up

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 5.1 Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.3 Support and educate professionals in other sectors, including daycare and school teachers, in their interactions with the patient and family

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health and/or social system(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

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Type of maltreatment

1. ●physical
2. ●emotional
3. ●sexual
4. ●neglect
5. ●Munchausen by proxy

Medical Expert

• □ME 2.2 Recognize and respond to factors that raise the suspicion of child maltreatment and/or neglect
• □ME 2.2 Recognize sentinel clinical findings suggesting child maltreatment and/or neglect, including injuries, behavioural and emotional changes and other clinical signs
• □ME 1.6 Work within professional boundaries, delegating forensic interviewing to other professionals as indicated
• □ME 2.2 Assess a child for signs and symptoms of child maltreatment and/or neglect
• □ME 3.4 Collect specimens for assessment of sexually transmitted infections and/or child maltreatment
• □ME 2.2 Select and/or interpret appropriate investigations
• □ME 2.4 Develop and implement a management plan that considers all of the patient’s health problems and context
• □ME 4.1 Develop a plan for ongoing management and follow-up
• □ME 4.1 Determine the need to involve specialized care professionals, child protective services, or law enforcement

Communicator

• □COM 5.1 Document evidence of child maltreatment, including the use of diagrams and photographs as appropriate
• □COM 1.1 Communicate using a patient-centred approach that facilitates trust and autonomy and that is characterized by empathy, respect, and compassion

Health Advocate

• □HA 1.1 Facilitate timely access to services and resources in the health and/or social system(s)

Professional

• □P 3.1 Adhere to requirements for mandatory reporting
• □P 3.1 Apply relevant aspects of child welfare legislation
• □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

Procedure

1. ●access port-a-cath
2. ●cardiopulmonary resuscitation (defibrillation)
3. ●chest tube
4. ●ear curettage
5. ●G-tube reinsertion
6. ●immunization (intramuscular)
7. ●immunization (subcutaneous)
8. ●intubation
9. ●IV insertion
10. ●lumbar puncture with/without injection
11. ●manage occlusion in long-term access line
12. ●nasogastric tube
13. ●nasopharyngeal swab
14. ●obtain EKG
15. ●phlebotomy
16. ●surfactant administration
17. ●throat swab
18. ●umbilical arterial line
19. ●umbilical venous line
20. ●urinary catheterization

Setting

1. ●clinical
2. ●simulation

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Gender

1. ●female
2. ●male

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 Position the patient appropriately
• □ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, mask, gown and glove
• □ME 3.4 Select and provide sedation and local analgesia, as appropriate
• □ME 3.4 Handle sharps safely
• □ME 3.4 Perform the procedure in a skilful and safe manner
• □ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
• □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 procedure and outcome

Collaborator

• □COL 1.2 Communicate effectively with patient and/or assistant(s) during the procedure

Professional

• □P 1.1 Work within personal limits, asking for assistance as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of communication

1. ●addressing non-adherence with treatment plan
2. ●breaking bad news
3. ●disclosing unexpected complication and medical errors
4. ●managing conflict

Setting

1. ●inpatient
2. ●outpatient
3. ●ICU
4. ●simulation

Adolescent

1. ●yes
2. ●no

Interpreter

1. ●yes
2. ●no

Communicator

• □COM 1.2 Ensure the physical environment is suitable for the nature of the situation (e.g., privacy, safety)
• □COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 3.1 Share information and explanations that are clear and accurate
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
• □COM 4.3 Answer questions from the patient and/or family
• □COM 5.1 Document the clinical encounter to reflect discussion and decisions

Collaborator

• □COL 2.2 Listen to understand and acknowledge other perspectives

Professional

• □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

Case complexity

1. ●medical
2. ●multisystem
3. ●social
4. ●other complexity

Transition type

1. ●transfer of care
2. ●discharge

Settings

1. ●inpatient
2. ●outpatient
3. ●emergency department
4. ●community
5. ●PICU
6. ●NICU

Age

1. ●neonate
2. ●infant
3. ●preschool
4. ●school age
5. ●adolescent

Medical Expert

• □ME 2.2 Integrate clinical information to determine the patient’s clinical status and health care needs
• □ME 2.4 Anticipate changes in health status at the time of transition
• □ME 4.1 Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression

Communicator

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

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 3.2 Communicate effectively with the accepting physician, providing a summary of patient issues and ongoing guidance for care

Leader

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

Health Advocate

• □HA 1.1 Work with other health care professionals to address barriers to access to resources and services
• □HA 1.2 Select and/or provide access to family education 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 1.3 Apply a broad base and depth of knowledge to manage the breadth of pediatric patient presentations
• □ME 4.1 Determine the need for and timing of referral to another health care professional
• □ME 4.1 Coordinate investigation, treatment and follow-up when multiple physicians and health care professionals are involved

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 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 access to services and resources in the health and/or social system(s)

Professional

• □P 1.1 Respond punctually to requests from patients or other health care professionals
• □P 1.1 Exhibit appropriate professional behaviours
• □P 2.2 Demonstrate a commitment to patient safety and quality improvement

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

• □L 4.1 Organize work to manage clinical, scholarly, and other responsibilities

Scholar

• □S 4.4 Pose questions that are appropriately constructed and amenable to scholarly inquiry
• □S 4.4 Identify, consult, and collaborate with content experts and others in the conduct of scholarly work
• □S 4.4 Collect data for a scholarly project
• □S 4.4 Perform data analysis
• □S 4.4 Integrate existing literature and findings of data collection
• □S 4.4 Identify areas for further investigation
• □S 4.5 Summarize and communicate the findings of research and scholarly inquiry

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

Teaching event

1. ●academic half day session
2. ●bedside teaching
3. ●community presentations
4. ●conference presentation
5. ●grand rounds
6. ●large group formal session
7. ●informal/impromptu teaching
8. ●physical examination skill teaching
9. ●prepared teaching sessions with staff
10. ●procedural skills teaching
11. ●small group formal session
12. ●undergraduate medical course
13. ●other teaching event

Medical Expert

• □Part A: ME 1.3 Apply knowledge of the biomedical and clinical sciences relevant to Pediatrics

Scholar

• □Part A: S 2.4 Identify the learning needs and desired learning outcomes of others
• □Part A: S 2.4 Develop learning objectives for a teaching activity adapting to the audience and setting
• □Part A: S 2.4 Present information in an organized manner to facilitate understanding
• □Part A: S 2.4 Provide adequate time for questions and discussion
• □Part B: S 2.2 Create a safe space for feedback to be given and received
• □Part B: S 2.5 Identify behaviours to continue as well as those for improvement
• □Part B: S 2.5 Provide examples of learner performance to support the overall assessment
• □Part B: S 2.5 Provide specific actionable suggestions for improvement of performance

Professional

• □Part B: P 1.1 Complete learner assessments in a timely fashion

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 access to services and resources in the health and/or social system(s)

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 behaviours
• □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 2.2 Select investigation strategies demonstrating awareness of availability and access in the outpatient setting
• □ME 2.4 Formulate treatment plans that are suitable for implementation in the outpatient setting

Collaborator

• □COL 1.3 Provide accurate, timely and relevant written information to the referring/primary care physician
• □COL 1.2 Work effectively with outpatient clinic staff and managers

Leader

• □L 4.1 Manage time effectively to maintain clinic flow
• □L 4.2 Manage clinic booking and scheduling
• □L 4.1 Review and act on incoming test results in a timely manner
• □L 4.2 Describe remuneration models relevant to Pediatrics

Scholar

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

Professional

• □P 1.1 Respond punctually to requests from patients or 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. ●clinical
2. ●simulation

Medical Expert

• □ME 2.1 Identify patients with life-limiting conditions, including those for whom the burden of disease-modifying treatment or investigations may be greater than the clinical benefit.
• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease- modifying approach
• □ME 2.3 Address the impact of the medical condition on the patient’s future quality of life
• □ME 2.3 Establish goals of care in collaboration with the patient and/or family
• □ME 2.4 Develop a plan to optimize symptom management in support of the patient’s goals of care
• □ME 2.4 Develop management plans that accurately reflect the patient and/or family’s goals of care

Communicator

• □COM 3.1 Share information about diagnosis and prognosis clearly and compassionately
• □COM 3.1 Use strategies to verify the understanding of the patient and/or family
• □COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regard 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 clinical encounter to accurately reflect the discussion and decisions

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 management plans in patient encounters when there are significant disagreements about what is achievable

Communicator

• □COM 5.3 Share information with patients, families and other health care providers in a manner that respects patient privacy and confidentiality, and enhances understanding
• □COM 4.1 Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe
• □COM 1.4 Manage one’s own non-verbal communication skills in difficult situations

Collaborator

• □COL 1.3 Communicate effectively with physicians and other health care professionals
• □COL 1.3 Engage in respectful shared decision-making with other health care professionals
• □COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a collaborative manner

Leader

• □L 4.2 Facilitate interprofessional meetings, ensuring engagement and participation of attendees and appropriate time management

Professional

• □P 1.1 Intervene when behaviours among colleagues and/or learners undermine a respectful environment
• □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 5.1 Identify the circumstances contributing to an adverse event

Leader

• □L 1.1 Identify the impact of human and system factors on health care delivery
• □L 1.1 Integrate existing standards for health care delivery with findings of data collection
• □L 1.1 Identify changes in practice/clinical care to prevent adverse events
• □L 3.1 Demonstrate an understanding of the operations of pediatric health care delivery

Scholar

• □S 4.4 Perform data analysis
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment

Case description

Feedback provided

Next steps