Plastic Surgery

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical examination and interpret the clinical significance
• □ME 2.2 Select appropriate labs, imaging and testing
• □ME 1.4 Apply knowledge of anatomy
• □ME 2.1 Determine the acuity of the condition and the priorities for patient care
• □ME 2.2 Synthesize information from the clinical assessment for the purpose of written or verbal summary to a supervisor
• □ME 2.4 Develop and implement a plan for initial management
• □ME 3.3 Recognize situations requiring emergent or urgent surgical intervention

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort and privacy
• □COM 1.1 Establish rapport and explain the purpose of the visit
• □COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in a patient’s care
• □COM 3.1 Share information and explanations with the patient/family

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. ●complex laceration
2. ●infection
3. ●wound care

Procedure

1. ●incision and drainage of abscess
2. ●debridement of wound
3. ●multilayer closure

Medical Expert

• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.4 Develop and implement a plan for initial management
• □ME 3.2 Obtain informed consent for minor procedures
• □ME 3.4 Gather appropriate instruments and materials, including choice of suture
• □ME 3.4 Select and provide local analgesia
• □ME 3.4 Demonstrate aseptic technique: skin preparation, draping, establishing and respecting the sterile field
• □ME 3.4 Perform the procedure in a skilful, fluid and safe manner
• □ME 2.4 Provide wound care, including appropriate dressings, anti-bacterials and/or wound care systems as needed
• □ME 4.1 Establish a plan for ongoing care and/or follow-up of results of investigations

Communicator

• □COM 3.1 Communicate effectively with the patient during the procedure

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. ●local anaesthesia
2. ●splinting
3. ●reduction
4. ●finger amputation/fingertip repair
5. ●extensor tendon repair

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Perform a physical examination and interpret the clinical significance
• □Part A: ME 2.2 Select and interpret imaging
• □Part A: ME 2.4 Develop and implement a plan for initial management
• □Part A: ME 1.5 Recognize urgent problems and seek assistance
• □Part B: ME 3.2 Demonstrate knowledge of the indications and contraindications for the procedure
• □Part B: ME 3.2 Obtain informed consent for minor procedures
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Select and provide local analgesia
• □Part B: ME 3.4 Demonstrate aseptic technique: skin preparation, draping, establishing and respecting the sterile field
• □Part B: ME 3.4 Develop and implement a plan for post-procedure care

Communicator

• □Part A: COM 3.1 Share information and explanations with the patient/family
• □Part B: COM 5.1 Document the procedure

Collaborator

• □Part B: COL 1.2 Work effectively with nurses and/or other assistants

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.5 Recognize urgent problems and seek assistance
• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical examination and interpret the clinical significance
• □ME 2.2 Select and interpret appropriate labs, imaging and testing
• □ME 4.1 Determine the need and timing of referral to another service

Communicator

• □COM 3.1 Share information and explanations with the patient/family

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

Burn

1. ●major
2. ●minor

Medical Expert

• □ME 2.2 Assess burn wound extent and depth
• □ME 2.1 Determine the acuity of the condition and the priorities for patient care
• □ME 2.4 Provide resuscitation, including fluid and electrolyte management
• □ME 3.4 Provide airway management and/or respiratory support
• □ME 2.4 Provide non-surgical management using topical antibacterials and all available techniques for topical wound care
• □ME 2.4 Assess the need and timing of transfer to another level of care
• □ME 2.4 Develop a plan for ongoing care and/or for care prior to and during transfer

Communicator

• □COM 3.1 Share information and explanations with the patient/family

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. ●journal club
2. ●divisional rounds
3. ●quality assurance rounds

Scholar

• □S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
• □S 3.2 Identify, select, and navigate pre-appraised resources
• □S 3.3 Identify relevant material via a search of the medical literature
• □S 3.3 Interpret study findings, including a critique of their relevance to practice
• □S 3.3 Determine the validity and risk of bias in a source of evidence
• □S 3.4 Integrate best evidence and clinical expertise
• □S 2.4 Present information in an organized manner to facilitate understanding

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

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 5.1 Organize information in appropriate sections
• □COM 5.1 Convey clinical reasoning
• □COM 5.1 Document all relevant findings
• □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. ●clinical
2. ●simulation

Medical Expert

• □ME 1.4 Apply knowledge of anatomy, key landmarks and the surgical procedure
• □ME 3.4 Close the layered abdominal incision
• □ME 3.4 Respect tissue vitality when handling tissue and instruments

Collaborator

• □COL 1.2 Work effectively with the OR team

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical examination and interpret the clinical significance
• □ME 1.4 Apply knowledge of the indications for breast cancer treatment options, including surgical interventions and adjuvant therapy
• □ME 1.4 Apply knowledge of the surgical techniques used in the management of breast cancer
• □ME 2.2 Interpret a pathology report
• □ME 2.4 Identify indications for adjuvant therapy
• □ME 3.1 Describe the indications, contraindications, risks, and alternatives for a proposed procedure

Communicator

• □COM 1.1 Recognize and respect the patient’s psychological and emotional 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

Medical Expert

• □Part A: ME 2.1 Prioritize patients based on the acuity of the clinical presentation
• □Part A: ME 2.2 Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements
• □Part A: ME 2.2 Select and interpret investigations
• □Part A: ME 2.4 Develop a plan for definitive management which may include observation, surgical intervention and/or non-operative intervention
• □Part A: ME 3.3 Book cases with appropriate urgency
• □Part A: ME 4.1 Determine the need and timing of referral to another service
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part B: ME 3.4 Establish and implement a plan for post-procedure care

Communicator

• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 3.2 Provide safe handover of care
• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

• □Part A: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □Part A: ME 3.1 Determine the most appropriate procedures or therapies for the purpose of assessment and/or management
• □Part A: ME 2.4 Develop and implement plans for ongoing care, discharge and follow-up
• □Part A: ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □Part A: COM 1.5 Manage disagreements and emotionally charged conversations with patients and/or families

Collaborator

• □Part B: COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □Part B: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals

Leader

• □Part A: L 2.1 Allocate health care resources for optimal patient care
• □Part A: L 4.1 Manage time and prioritize tasks
• □Part A: L 3.1 Plan work schedules for the service team
• □Part A: L 4.2 Run the service efficiently, safely and effectively

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 A: S 2.3 Supervise junior learners to ensure they work within their limits
• □Part B: S 2.4 Provide formal and informal teaching for junior learners
• □Part B: S 2.5 Provide junior learners with useful timely feedback

Professional

• □Part B: P 1.1 Exhibit appropriate professional behaviours
• □Part B: 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

Medical Expert

• □ME 1.5 Recognize an adverse event arising from patient care and develop a plan for appropriate follow-up and care

Communicator

• □COM 5.1 Document a clinical encounter to adequately convey a procedure, its outcome and the rationale for decisions
• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and disclose adverse events
• □COM 4.3 Answer questions from the patient and/or family

Professional

• □P 3.1 Describe how to respond to, cope with, and constructively learn from a complaint or legal action
• □P 3.1 Access support for a medico-legal issue, such as via a medical protective association
• □P 4.3 Use strategies to mitigate the personal impact of a patient adverse event

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. ●advancement
2. ●rotation
3. ●transposition
4. ●Z-plasty

Observation

1. ●direct
2. ●indirect

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

• □Part A: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part A: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform key technical skill(s): raise portion of flap while protecting pedicle/perforators, dissect portions of pedicle/perforators with assistance
• □Part A: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part A: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): expose and dissect recipient vessels
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part C: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part C: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part C: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part C: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part C: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part C: ME 3.4 Perform key technical skill(s): prepare and use microscope, prepare vessels, perform microvascular anastomosis, verify patency
• □Part C: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part C: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part A: COM 5.1 Document the surgical procedure in a complete and timely manner
• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner
• □Part C: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Make effective use of operative assistants
• □Part A: COL 1.2 Work effectively with the OR team
• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team
• □Part C: COL 1.2 Make effective use of operative assistants
• □Part C: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 1.1 Work within personal limits, asking for help as needed
• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help as needed
• □Part C: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part C: P 1.1 Work within personal limits, asking for help 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 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): prepare donor site, harvest autogenous tissue, fix graft
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Anatomical region

1. ●nose
2. ●eyelid
3. ●cheek
4. ●lip
5. ●ear
6. ●scalp

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): prepare recipient site, elevate and inset flap, close donor site
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Anatomic region

1. ●skull/scalp
2. ●orbit
3. ●midface
4. ●lower face
5. ●aerodigestive tract
6. ●nose

Medical Expert

• □Part A: ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □Part A: ME 2.2 Select and interpret imaging
• □Part A: ME 4.1 Determine the need and timing of referral to other physicians
• □Part A: ME 2.2 Assess the defect, including extent and tissue type
• □Part A: ME 3.1 Describe options for each component of the reconstruction
• □Part A: ME 3.1 Develop a plan for reconstruction, including preferred flap(s) and specifics of harvesting

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

1. ●abdomen
2. ●chest wall/trunk
3. ●pelvis/perineum
4. ●decubitus ulcer

Medical Expert

• □ME 2.1 Determine the acuity of the condition and the priorities for patient care
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess tissue perfusion and viability, including use of bedside ultrasound as appropriate
• □ME 2.2 Select and interpret investigations
• □ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □ME 3.2 Obtain informed consent, explaining the risks and benefits of, rationale for, and alternatives to a proposed procedure or therapy

Communicator

• □COM 3.1 Convey the treatment options to the patient/family clearly and compassionately
• □COM 5.1 Document a clinical encounter to convey the clinical assessment and rationale for decisions/recommendations

Collaborator

• □COL 1.2 Consult, as needed, with the wound 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

Anatomic site

1. ●pressure sore
2. ●perineal defect
3. ●thoracic defect
4. ●abdominal wall defect
5. ●other complex wound

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): pre-operative marking, debridement, obliteration of dead-space, flap elevation
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedure care

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●gastrocnemius
2. ●reverse sural
3. ●free flap
4. ●sartorious flap
5. ●soleus flap
6. ●other major reconstructive flap

Medical Expert

• □Part A: ME 2.2 Assess the defect, including extent and tissue type
• □Part A: ME 2.2 Assess tissue perfusion and viability, including use of bedside ultrasound as appropriate
• □Part A: ME 2.2 Select and interpret imaging
• □Part A: ME 2.4 Determine suitability for surgical management
• □Part A: ME 3.1 Develop a plan for reconstruction, including preferred flap(s) and specifics of harvesting
• □Part A: ME 2.3 Ascertain and manage patient expectations
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): prepare recipient site, elevate and inset flap, close donor site
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part A: COM 3.1 Provide information about the diagnosis and plan of care to the patient/family
• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.3 Consult with other physicians, as needed
• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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 fracture

1. ●zygoma
2. ●orbital floor
3. ●nasal bones
4. ●mandible

Medical Expert

• □Part A: ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □Part A: ME 2.2 Select and interpret imaging
• □Part A: ME 2.4 Develop a management plan including surgical intervention and/or non- operative intervention, as appropriate
• □Part A: ME 3.1 Integrate the clinical information to determine the surgical approach
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): use intra-operative imaging, expose and reduce fracture, apply fixation
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part A: COM 3.1 Provide information about the diagnosis and plan of care to the patient/family
• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.3 Consult with other physicians, as needed
• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●CRPP
2. ●ORIF

Setting

1. ●OR
2. ●minor procedure room

Medical Expert

• □Part A: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part A: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform key technical skill(s): use intra-operative imaging, reduce fracture, apply fixation device, ensure alignment
• □Part A: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part A: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part A: ME 3.4 Establish and implement a plan for post-operative rehabilitation

Communicator

• □Part A: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Make effective use of operative assistants
• □Part A: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 1.1 Work within personal limits, asking for help as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Determine the acuity of the condition and the priorities for patient care
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and interpret investigations
• □ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □ME 3.2 Obtain informed consent, explaining the risks and benefits of, rationale for, and alternatives to a proposed procedure or therapy

Communicator

• □COM 3.1 Provide information about the diagnosis and plan of care to the patient/family
• □COM 5.1 Document a clinical encounter to convey the clinical assessment and rationale for decisions/recommendations

Collaborator

• □COL 1.3 Communicate effectively with physicians and 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

Procedure

1. ●surgical management of basal thumb joint osteoarthritis
2. ●surgical management of Dupuytren’s disease
3. ●surgical management of stenosing tenosynovitis
4. ●arthrodesis
5. ●arthroplasty
6. ●common ligament repair
7. ●needle fasciotomy for Dupuytren’s disease
8. ●operative joint reduction
9. ●ganglion excision
10. ●excision of benign soft tissue tumor

Medical Expert

• □Part A: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part A: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform key technical skill(s): repair or reconstruct joint/ ligament/ fascia/ soft tissue, use implants appropriately
• □Part A: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part A: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part A: ME 3.4 Establish and implement a plan for post-operative rehabilitation

Communicator

• □Part A: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Make effective use of operative assistants
• □Part A: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●flexor tendon repair
2. ●extensor tendon repair
3. ●delayed tendon reconstruction (single or two stage)
4. ●tenolysis
5. ●tendon grafting
6. ●tendon transfer

Setting

1. ●ER
2. ●OR
3. ●minor surgery

Medical Expert

• □Part A: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part A: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part A: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part A: ME 3.4 Establish and implement a plan for post-operative rehabilitation

Communicator

• □Part A: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Make effective use of operative assistants
• □Part A: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●primary repair of a major nerve
2. ●carpal tunnel release surgery
3. ●ulnar nerve decompression +/- transposition
4. ●brachial plexus exposure
5. ●radial nerve decompression
6. ●nerve grafting
7. ●neuroma management
8. ●nerve transfer
9. ●benign nerve tumor extirpation

Medical Expert

• □Part A: ME 2.2 Elicit information regarding the impact of the disorder on the patient’s functional ability
• □Part A: ME 2.2 Perform sensory and motor examination relevant to peripheral nerve injury
• □Part A: ME 2.2 Select and interpret investigations
• □Part A: ME 2.2 Interpret electrodiagnostic evaluations
• □Part A: ME 2.4 Determine the need for, plan for, and timing of surgical intervention
• □Part A: ME 2.4 Provide non-operative management options, when relevant
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): repair or reconstruct nerve, use nerve graft or transfer as necessary
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part B: ME 3.4 Establish and implement a plan for post-operative rehabilitation

Communicator

• □Part A: COM 3.1 Convey the treatment options to the patient/family clearly and compassionately
• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Referral from outside centre

1. ●yes
2. ●no

Potential replantation or revascularization

1. ●yes
2. ●no

Medical Expert

• □ME 2.4 Establish a plan for care prior to and during transfer Comment [KJ1]: These two are context specific milestones; only appear if answer to “referral to outside center” is yes
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Determine extent of injury
• □ME 2.4 Develop and implement a plan for resuscitation, management of other injuries and/or pre-operative optimization
• □ME 2.4 Formulate a plan for peri-operative management, including surgical approach, timing and need for coordination with other specialists

Communicator

• □COM 2.3 Gather and synthesize pertinent patient information from a referring physician
• □COM 3.1 Convey the treatment options to the patient/family clearly and compassionately

Collaborator

• □COL 1.3 Consult and work effectively with other physicians to provide all needed aspects 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

Medical Expert

• □Part A: ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □Part A: ME 2.2 Interpret a synoptic pathology report
• □Part A: ME 2.2 Select investigations to complete staging evaluation
• □Part A: ME 2.4 Formulate a plan for peri-operative management, including surgical approach, timing and need for coordination with other specialists
• □Part A: ME 3.1 Formulate a plan for sentinel lymph node biopsy
• □Part A: ME 3.1 Determine appropriate margins for excision
• □Part A: ME 2.4 Identify indications for adjuvant therapy
• □Part A: ME 4.1 Determine the need and timing of referral to other physicians
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): excise lesion with appropriate margins, close defect with local flap or skin graft

Communicator

• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults

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. ●wide local excision with appropriate margins and advancement flap closure
2. ●elevation and inset of local flap
3. ●skin graft (full or split thickness)

Medical Expert

• □Part A: ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □Part A: ME 2.2 Develop a differential diagnosis as well as most likely diagnosis
• □Part A: ME 3.1 Select the most appropriate biopsy technique
• □Part A: ME 3.4 Perform incisional or excisional biopsy as appropriate
• □Part A: ME 3.1 Describe alternative therapies to patients, such as Moh’s, radiotherapy and medical therapies
• □Part B: ME 2.2 Interpret a pathology report
• □Part B: ME 3.1 Determine appropriate margins for excision
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): excise lesion with appropriate margins, close defect with local flap or skin graft

Health Advocate

• □Part A: HA 1.3 Counsel patients regarding the adverse effects of sun exposure

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Age group

1. ●adult
2. ●pediatric

Medical Expert

• □Part A: ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □Part A: ME 2.2 Assess social factors contributing to the risk of burn injury
• □Part A: ME 2.2 Recognize findings suggestive of non-accidental injury
• □Part A: ME 2.2 Assess burn wound extent and depth
• □Part A: ME 2.2 Determine area of burn using age appropriate clinical tools
• □Part A: ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □Part A: ME 2.4 Provide non-surgical management using topical antibacterials and all available techniques for topical wound care
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): use blood loss mitigation techniques, debride to viable wound bed, harvest and apply skin graft
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □Part B: ME 3.4 Develop and implement a plan for post-operative care

Communicator

• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Health Advocate

• □Part A: HA 1.2 Counsel patients regarding strategies for injury prevention

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Setting

1. ●ER
2. ●ICU
3. ●Burn Unit

Age group

1. ●adult
2. ●pediatric

Medical Expert

• □ME 2.2 Perform a primary and secondary survey, including estimate of TBSA and assessment of inhalation injury
• □ME 2.4 Estimate fluid requirements and provide resuscitation
• □ME 2.2 Recognize risk factors for compartment syndrome
• □ME 2.1 Recognize the need to escalate care, including airway compromise, c- spine injury and/or compartment syndrome
• □ME 3.4 Provide airway management and/or respiratory support
• □ME 3.4 Perform escharotomy/fasciotomy, when necessary
• □ME 2.3 Establish goals of care
• □ME 2.4 Develop and implement a plan for wound management including dressings, and timing and technique for debridement and grafting
• □ME 4.1 Develop plans for ongoing management, including titration of fluid management and changes in the patient’s clinical status

Communicator

• □COM 3.1 Convey information about diagnosis/prognosis clearly and compassionately
• □COM 1.5 Support patients/families in discussions and decision-making regarding poor prognosis

Collaborator

• □COL 1.3 Consult and work effectively with other physicians to provide all needed aspects 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

Anatomic location

1. ●lid ectropion
2. ●lip ectropion
3. ●cicatricial alopecia
4. ●neck contracture
5. ●joint contracture

Method

1. ●full thickness skin graft
2. ●tissue expansion
3. ●local flap
4. ●regional flap
5. ●free flap

Setting

1. ●office
2. ●outpatient
3. ●OR
4. ●simulation

Medical Expert

• □Part A: ME 2.2 Gather information about the injury and any past treatments
• □Part A: ME 2.2 Assess functional and aesthetic concerns
• □Part A: ME 2.2 Perform a physical examination to define extent of injury/wound and potential donor sites
• □Part A: ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □Part A: ME 4.1 Coordinate involvement of the multidisciplinary team in the patient’s care
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): anticipate wound size/contours post- release, release contractures, harvest skin graft or flap, set graft or flap, apply appropriate dressing/immobilization
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Health Advocate

• □Part A: HA 1.1 Assess and facilitate the patient’s access to health services, financial resources and psychological support

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Procedure discussed

1. ●laser facial resurfacing
2. ●dermabrasion
3. ●chemical peel
4. ●neurotoxin
5. ●filler

Medical Expert

• □Part A: ME 2.2 Perform an assessment of facial aging, including soft tissue and bony deformities
• □Part A: ME 2.2 Assess the psychological and social factors contributing to a request for aesthetic/cosmetic surgery
• □Part A: ME 2.3 Ascertain and manage patient expectations
• □Part A: ME 3.1 Determine the appropriate non-surgical facial rejuvenation technique
• □Part A: ME 3.1 Describe the indications, contraindications, risks, and alternatives for a proposed procedure
• □Part B: ME 1.4 Apply knowledge of facial anatomy with respect to safety and injection danger zones
• □Part B: ME 3.1 Select the appropriate dosing and volume for correction of the patient’s deformities
• □Part B: ME 3.4 Demonstrate proper injection technique including sterile technique, plane of injection and filler position

Communicator

• □Part A: COM 1.1 Recognize and respect the patient’s psychological and emotional needs
• □Part A: COM 5.1 Document discussions regarding informed consent in an accurate and complete 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

Assessment

1. ●facial
2. ●breast
3. ●trunk/extremity

Proposed procedure

1. ●blepharoplasty
2. ●facelift
3. ●brow lift
4. ●rhinoplasty
5. ●otoplasty
6. ●breast augmentation
7. ●augmentation mastopexy
8. ●mastopexy
9. ●liposuction
10. ●abdominoplasty
11. ●body lift
12. ●brachioplasty/thigh lift
13. ●labiaplasty

Setting

1. ●resident aesthetic clinic
2. ●outpatient clinic
3. ●private cosmetic facility

Medical Expert

• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Assess the psychological and social factors contributing to a request for aesthetic/cosmetic surgery
• □ME 2.2 Select and interpret investigations
• □ME 2.3 Ascertain and manage patient expectations
• □ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □ME 4.1 Identify indications for pre-operative psychological assessment
• □ME 3.2 Provide pre-operative counselling, including discussion of the risks and benefits of, and alternatives to, surgical intervention

Communicator

• □COM 1.1 Recognize and respect the patient’s psychological and emotional needs
• □COM 3.1 Use appropriate language and terminology to optimize patient understanding
• □COM 4.1 Facilitate the discussion in a way that is respectful and non- judgmental
• □COM 5.1 Document discussions regarding informed consent in an accurate and complete 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

Procedure

1. ●blepharoplasty
2. ●facelift
3. ●brow lift
4. ●rhinoplasty, otoplasty
5. ●other procedure

Setting

1. ●outpatient clinic
2. ●private cosmetic clinic

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): pre-operative marking, protection of adjacent structures
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●liposuction
2. ●abdominoplasty
3. ●body lift
4. ●brachioplasty/thigh lift
5. ●labiaplasty
6. ●other procedure

Setting

1. ●outpatient clinic
2. ●private cosmetic facility

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): pre-operative marking, flap elevation, tension free closure
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): pre-operative marking, handle implants safely, ensure symmetry
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help as needed

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.1 Determine the acuity of the condition and the priorities for patient care
• □ME 1.5 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and interpret investigations
• □ME 2.2 Synthesize patient information to assess perioperative risk and/or determine suitability for surgical management
• □ME 2.4 Develop a management plan, including non-operative and surgical intervention as appropriate
• □ME 3.2 Obtain informed consent, explaining the risks and benefits of, rationale for, and alternatives to a proposed procedure or therapy
• □ME 2.4 Formulate a plan for peri-operative management, including surgical approach, timing and need for coordination with other specialists

Communicator

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

Procedure

1. ●direct to implant reconstruction
2. ●insertion of breast tissue expander
3. ●latissimus dorsi reconstruction
4. ●autologous reconstruction

Medical Expert

• □ME 3.4 Set-up, position, and drape the patient for the procedure
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □ME 3.4 Perform key technical skill(s): pre-operative marking, develop subpectoral pocket, handle implants/ADM safely, inset autologous graft, shape reconstruction
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression
• □ME 3.4 Establish and implement a plan for post-procedural care

Communicator

• □COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □P 1.1 Work within personal limits, asking for help 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

• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Mark: incisions, design of pedicle, extent of skin resection, new nipple- areolar positioning
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Perform key technical skill(s): design and develop pedicle, de- epithelialization, final breast shaping
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Setting

1. ●ER
2. ●OR
3. ●clinic

Observation

1. ●direct
2. ●case review

Portion observed

1. ●assessment
2. ●closed reduction
3. ●application of Comment [KJ2]: Triger for context splint or cast driven milestones # 1-7 Comment [KJ3]: Trigger for context Collect 3 observations of achievement driven milestones 8-12

Medical Expert

• □ME 2.2 Gather a relevant clinical history
• □ME 2.2 Perform a physical examination and interpret the clinical significance
• □ME 2.2 Recognize findings suggestive of non-accidental injury
• □ME 2.2 Select and interpret imaging
• □ME 2.2 Adapt the clinical assessment to the child’s age and development stage
• □ME 2.4 Develop a management plan, including non-operative management or surgical intervention as appropriate
• □ME 3.4 Select and provide analgesia and/or sedation
• □ME 3.4 Perform closed reduction
• □ME 3.4 Apply a cast or splint
• □ME 3.4 Assess and manage alignment
• □ME 4.1 Develop a plan for ongoing care and timing of follow-up

Communicator

• □COM 3.1 Share information and explanations with the patient/family

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

Medical Expert

• □Part A: ME 2.2 Adapt the clinical assessment to the child’s age and development stage
• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Perform a physical examination and interpret the clinical significance
• □Part A: ME 2.2 Assess the impact of the condition on the child and family
• □Part A: ME 2.2 Select and interpret imaging
• □Part A: ME 2.4 Develop a management plan, including non-operative management or surgical intervention as appropriate
• □Part B: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part B: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part B: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part B: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part B: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part B: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part B: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part A: COM 3.1 Share information and explanations with the patient/family
• □Part B: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Professional

• □Part B: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part B: P 1.1 Work within personal limits, asking for help 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

Procedure

1. ●lip
2. ●palate

Skills

1. ●marking
2. ●complex layered closure and anatomical correction
3. ●intra-oral suturing.

Medical Expert

• □Part A: ME 3.4 Set-up, position, and drape the patient for the procedure
• □Part A: ME 5.2 Participate in the surgical safety checklist or equivalent
• □Part A: ME 1.4 Apply knowledge of anatomy, key landmarks, and the surgical procedure
• □Part A: ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □Part A: ME 3.4 Perform safe dissection of relevant structures and tissue layers with gentle tissue handling
• □Part A: ME 3.4 Perform key technical skill(s): marking, intra-oral suturing, complex layered closure and anatomical correction
• □Part A: ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □Part A: ME 3.4 Demonstrate intraoperative judgement, fluidity of movement, and forward progression

Communicator

• □Part A: COM 5.1 Document the surgical procedure in a complete and timely manner

Collaborator

• □Part A: COL 1.2 Make effective use of operative assistants
• □Part A: COL 1.2 Work effectively with the OR team

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 1.1 Work within personal limits, asking for help 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

Demographic

1. ●pediatric
2. ●elderly
3. ●physically challenged
4. ●developmental disability
5. ●translation
6. ●other issue

Communicator

• □COM 1.1 Demonstrate empathy, respect, and compassion
• □COM 1.4 Use appropriate non-verbal communication to demonstrate attentiveness, interest, and responsiveness
• □COM 3.1 Use clear and concise language; avoid or adequately explain medical jargon
• □COM 2.1 Actively listen and respond to patient cues
• □COM 4.3 Answer questions from the patient and/or family
• □COM 1.6 Adapt to the unique needs and preferences of each patient/family

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Scholar

• □S 3.3 Identify sources of information relevant to a question arising in practice

Professional

• □P 1.3 Recognize and respond to ethical issues encountered in practice
• □P 1.3 Apply the principles of ethics to address clinical issues

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.6 Carry out professional duties in the face of multiple completing demands

Scholar

• □S 2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners
• □S 2.3 Provide appropriate supervision of the learner, balancing patient safety, dignity, confidentiality and care with educational needs
• □S 2.4 Choose appropriate content, teaching format, and strategies tailored to both the learner and Plastic Surgery setting
• □S 2.4 Provide bedside teaching, including teaching procedural skills
• □S 2.5 Provide junior learners with useful timely feedback
• □S 3.4 Teach learners to effectively find, appraise and integrate evidence into decision making in their 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

Scholar

• □S 4.4 Generate focused questions for scholarly investigation
• □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
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.4 Design and execute a research plan including securing ethics approval where required
• □S 4.4 Collect and analyze data using appropriate statistical methods
• □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

Leader

• □L 1.1 Gather information for the purposes of quality assurance or improvement
• □L 1.1 Integrate existing standards for health care delivery with findings of data collection
• □L 1.1 Identify potential improvement opportunities
• □L 1.1 Identify the impact of human and system factors on 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

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 most appropriate procedures or therapies for the purpose of assessment and/or management

Communicator

• □COM 5.1 Document clinical encounters in an accurate, complete and timely manner

Collaborator

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

Leader

• □L 4.2 Manage bookings to optimize clinic scheduling
• □L 4.2 Book operative cases with appropriate urgency, duration, and including requesting specialized equipment
• □L 4.1 Manage time effectively in the ambulatory clinic
• □L 4.1 Review and act on test results (including imaging) in a timely manner
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the outpatient clinic

Professional

• □P 1.1 Communicate in an efficient and respectful manner with patients and other health care providers

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 procedure

1. ●general
2. ●hand
3. ●lower extremity
4. ●skin
5. ●breast
6. ●aesthetic
7. ●head and neck
8. ●abdomen/trunk/pelvis
9. ●pediatric
10. ●other procedure

Medical Expert

• □Part A: ME 5.2 Lead the team in the use of the surgical safety checklist
• □Part A: ME 3.4 Perform procedures in a skilful and safe manner, including effective use of surgical assistants
• □Part A: ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure as appropriate
• □Part A: ME 4.1 Establish plans for post-operative care

Communicator

• □Part A: COM 5.1 Document surgical procedures in an accurate, complete and timely manner

Collaborator

• □Part B: COL 1.2 Make effective use of operative assistants
• □Part B: COL 1.2 Work effectively with the OR team

Leader

• □Part A: L 4.1 Manage required time for entire surgical list in efficient and effective manner 7 COM 3.1Convey information about the procedure, operative findings and patient status to the family clearly and compassionately
• □Part B: L 4.2 Demonstrate leadership skills in the operating room

Scholar

• □Part B: S 2.3 Provide junior learners with opportunities for appropriate clinical responsibility
• □Part B: S 2.5 Provide feedback to learners to enhance learning and performance

Professional

• □Part A: P 1.2 Prepare for the procedure, reviewing relevant investigations and pre- operative assessments/consults
• □Part A: P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings
• □Part B: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment
• □Part B: 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 Assess the suitability of requests for consultation
• □ME 2.1 Prioritize referrals on the basis of clinical acuity
• □ME 1.5 Manage the on-call duties of Plastic Surgery

Leader

• □L 4.2 Apply knowledge of billing practices

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 an awareness of what is required to practice safely and effectively in the setting of future practice

Leader

• □L 4.2 Examine personal interests and career goals
• □L 4.2 Adjust educational experiences to gain competencies necessary for future practice

Scholar

• □S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
• □S 1.1 Define learning needs related to personal practice and/or career goals
• □S 3.1 Generate focused questions that address knowledge gaps
• □S 1.1 Create a learning plan that is feasible, includes clear deliverables and a plan for monitoring ongoing achievement
• □S 1.1 Identify resources required to implement a personal learning plan

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

Case description

Feedback provided

Next steps