Radiation Oncology

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●indirect

Portion observed

1. ●history
2. ●physical exam
3. ●case presentation
4. ●documentation

Patient with acute needs

1. ●yes
2. ●no

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Elicit a thorough history relevant to the presentation
• □ME 2.2 Perform a physical exam relevant to the presentation, including breast and/or pelvi-rectal assessment, as appropriate

Communicator

• □COM 1.1 Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion
• □COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □COM 2.2 Conduct a patient encounter using an organized framework
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record
• □COM 5.1 Document a clinical encounter to include all relevant information

Professional

• □P 1.5 Follow relevant policies regarding the appropriate use of electronic medical records

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 2.4 Identify patients who require a transfer of care

Communicator

• □COM 5.1 Summarize the patient’s issues in the transfer summary, including plans to deal with ongoing issues
• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record
• □COM 5.1 Maintain accurate and up-to-date problem and medication lists

Collaborator

• □COL 2.1 Respond to requests in a respectful and timely manner
• □COL 3.2 Communicate with the receiving physician(s) or health care professional during transitions in care, clarifying issues as needed
• □COL 3.2 Describe specific information required for safe and effective handover during transitions in care

Professional

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct
2. ●indirect

Setting

1. ●inpatient
2. ●emergency department
3. ●clinic
4. ●operating room

Clinical conditions

1. ●acute abdomen
2. ●acute cardiovascular event
3. ●acute respiratory illness
4. ●hemodynamic instability
5. ●metabolic abnormalities
6. ●delirium or confusion
7. ●sepsis or serious infection/abscess
8. ●uncontrolled pain
9. ●other

Medical Expert

• □Part A: ME 2.2 Gather a history and perform a physical exam relevant to the presentation
• □Part A: ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □Part A: ME 2.2 Select and interpret imaging relevant to the clinical situation
• □Part A: ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □Part A: ME 2.4 Develop and implement an initial management plan for common medical problems, considering the perspective of the patient and family
• □Part A: ME 2.4 Manage patients in the acute post-operative period with regards to analgesia, fluid and nutritional requirements and antibiotic therapy
• □Part A: ME 2.4 Utilize pain management algorithms in the administration and monitoring of analgesia, including opiates, and anticipate side effects related to analgesic use
• □Part A: ME 3.3 Consider urgency, and potential for deterioration, in advocating for the timely execution of a procedure or therapy
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part B: ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves
• □Part B: ME 2.3 Address with the patient and their family their ideas about the nature and cause of the health problem, fears and concerns, and expectations of health care professionals
• □Part B: ME 2.3 Share concerns with the patient and family about goals of care that are not felt to be achievable
• □Part C: ME 1.3 Apply knowledge of the indications and techniques for surgical procedures
• □Part C: ME 3.1 Describe the indications, contraindications, risks, benefits, and alternatives for a given procedure or therapy

Communicator

• □Part A: COM 2.1 Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation
• □Part A: COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions
• □Part B: COM 3.1 Convey information about medical course and management plan
• □Part B: COM 2.1 Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial information
• □Part B: COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □Part B: COM 3.1 Provide information on the results of clinical assessments and diagnostic testing, and treatment plans
• □Part B: COM 4.3 Use communication skills and strategies that help the patient and/or family make an informed decision
• □Part C: COM 3.1 Convey information about medical course and management plan
• □Part C: COM 3.1 Use plain language and avoid medical jargon
• □Part C: COM 4.3 Use communication skills and strategies that help the patient and/or family make an informed decision
• □Part C: COM 2.1 Actively listen and respond to patient cues
• □Part C: COM 5.1 Document the consent discussion in an accurate and complete manner
• □Part C: COM 1.3 Demonstrate sensitivity for different religious and cultural expectations of care

Collaborator

• □Part A: COL 1.1 Receive and appropriately respond to input from other health care professionals
• □Part D: COL 3.1 Identify patients requiring handover to other physicians or health care professionals
• □Part D: COL 3.2 Summarize patient issues, including plans to deal with ongoing issues
• □Part D: COL 3.2 Communicate with the receiving physician(s) or health care professional during transitions in care, clarifying issues as needed
• □Part D: COL 3.2 Provide anticipatory guidance for results of outstanding investigations and/or next steps for management

Scholar

• □Part A: S 2.4 Demonstrate basic skills in teaching others, including peers

Professional

• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures
• □Part C: P 3.1 Identify patients who lack decision-making capacity and seek out their substitute decision maker

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

Focus of PLP

1. ●clinical question
2. ●performance gap
3. ●Medical Expert CanMEDS role
4. ●other CanMEDS role
5. ●other (write in)

Scholar

• □S 1.2 Identify and record learning needs
• □S 3.1 Develop a search strategy
• □S 3.3 Collect, extract and synthesize evidence
• □S 3.3 Interpret evidence

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Issue

1. ●febrile neutropenia
2. ●oncological emergency
3. ●uncontrolled symptom and/or pain

Medical Expert

• □Part A: ME 2.2 Perform preoperative assessment of patients prior to oncologic surgery, including the risks associated with co-morbidities and medications
• □Part A: ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □Part A: ME 2.2 Gather a relevant clinical history
• □Part A: ME 2.2 Perform a physical exam relevant to the presentation
• □Part A: ME 2.2 Select and/or interpret investigations
• □Part A: ME 2.2 Gather various types of laboratory and pathology reports (including special stains, molecular tests, and flow cytometry) and integrate the information into patient assessment
• □Part A: ME 2.2 Select and interpret multimodality medical imaging in the management of cancer patients
• □Part A: ME 1.3 Apply knowledge of the potential risks of systemic agents related to timing of radiation and surgical treatments
• □Part A: ME 2.4 Anticipate, identify and manage side effects of systemic therapy (e.g., anaphylactic reactions, neutropenic sepsis)
• □Part A: ME 2.4 Utilize pain management algorithms in the administration and monitoring of analgesia, including opiates, and anticipate side effects related to analgesic use
• □Part A: ME 2.4 Develop a management plan
• □Part A: ME 2.2 Plan and coordinate a diagnostic workup
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part B: ME 2.3 Discuss and clarify previously established advance directives and goals of care
• □Part B: ME 2.4 Discuss with the patient and family the degree of uncertainty inherent in all clinical situations
• □Part B: ME 2.3 Work with the patient and their family to understand relevant options for care

Communicator

• □Part A: COM 2.1 Use patient-centred interviewing skills
• □Part A: COM 2.1 Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial information
• □Part B: COM 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
• □Part B: COM 1.4 Identify, verify and validate non-verbal cues
• □Part B: COM 4.1 Engage in discussions with patient and family regarding expectations of care and specific wishes and options related to end-of-life decision making
• □Part B: COM 5.1 Document the encounter to adequately convey the discussion and its outcome

Collaborator

• □Part A: COL 1.2 Work effectively with other members of the interprofessional team

Leader

• □Part A: L 2.2 Apply evidence and guidelines with respect to resource utilization, specific to diagnostic imaging and laboratory investigations

Health Advocate

• □Part A: HA 1.1 Facilitate the patient’s timely access to the health services and resources they need

Professional

• □Part A: P 4.1 Demonstrate an ability to regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks
• □Part B: P 3.1 Identify patients who lack decision-making capacity and seek out their substitute decision maker
• □Part B: P 3.1 Adhere to institutional policies and procedures relevant to advance directives and goals of care
• □Part B: P 3.1 Apply the laws governing substitute 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

Type of observation

1. ●direct
2. ●indirect

Setting

1. ●clinic
2. ●inpatient
3. ●emergency department
4. ●other

Case mix

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck, and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign condition

Radiation oncology emergency

1. ●yes
2. ●no

Medical Expert

• □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 Gather various types of laboratory and pathology reports (including special stains, molecular tests, and flow cytometry) and integrate the information into patient assessment
• □Part A: ME 2.2 Gather various types of medical imaging reports and integrate report information into patient assessment
• □Part B: ME 2.2 Perform the physical exam skills relevant to the patient’s diagnosis
• □Part B: ME 2.2 Respectfully acknowledge patient’s cultural values and preferences as relevant to the physical exam
• □Part C: ME 3.4 Gather and assess required information prior to the procedure
• □Part C: ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □Part C: ME 3.4 Prepare and position the patient for the procedure
• □Part C: ME 5.2 Apply precautions to minimize exposure to infectious agents
• □Part C: ME 3.4 Perform the procedure skillfully, positioning the instrument accurately and as required
• □Part C: ME 3.4 Identify normal and abnormal findings

Communicator

• □Part A: COM 1.4 Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □Part A: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part A: COM 2.1 Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview
• □Part A: COM 2.2 Manage the flow of the encounter
• □Part A: COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
• □Part C: COM 5.1 Document all relevant findings

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. ●indirect

Case mix

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign condition

Goal of management

1. ●curative
2. ●palliative
3. ●adjuvant
4. ●neo-adjuvant
5. ●no radiotherapy

Radiation oncology emergency

1. ●yes
2. ●no

Complexity

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 1.3 Apply clinical and biomedical evidence and sciences to manage core presentations in Radiation Oncology
• □Part A: ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context, tumour factors and relevant treatment options, in collaboration with the patient and family
• □Part A: ME 2.2 Select and appropriately prioritize additional investigations required prior to treatment
• □Part A: ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed radiation therapy, respecting patient capacity, values, and preferences
• □Part A: ME 2.4 Complete the radiotherapy treatment requisition accurately and completely, including selection of the appropriate type of external beam radiation equipment, intracavitary or interstitial radiation techniques or radioisotopes for therapeutic use
• □Part A: ME 2.4 Consider and recommend appropriate and available clinical trials

Communicator

• □Part A: COM 3.1 Provide information on diagnosis, prognosis, and plan of care in a clear, compassionate manner
• □Part A: COM 3.1 Provide information about the radiation treatment plan, planning process, and management through treatment clearly and in language that the patient understands
• □Part A: COM 3.1 Use strategies to verify and validate the understanding of the patient and family to facilitate learning
• □Part A: COM 4.2 Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health
• □Part B: COM 5.1 Organize information in appropriate sections
• □Part B: COM 5.1 Document all relevant findings and investigations
• □Part B: COM 5.1 Convey clinical reasoning and the rationale for decisions
• □Part B: COM 5.1 Document the plan for ongoing management
• □Part B: COM 5.1 Complete clinical documentation in a timely manner

Leader

• □Part A: L 2.1 Use clinical judgment to minimize wasteful practices

Health Advocate

• □Part A: HA 1.1 Facilitate timely patient access to radiation therapy treatment

Scholar

• □Part A: S 4.2 Identify ethical principles for research and incorporate them into obtaining informed consent, considering harm and benefits, and considering vulnerable populations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign condition

Retreatment

1. ●no
2. ●yes

Technique

1. ●cervix brachytherapy
2. ●prostate brachytherapy
3. ●IMRT
4. ●SRS
5. ●SBRT
6. ●IGRT
7. ●other

Medical Expert

• □Part A: ME 3.5 Select the radiation prescription, providing rationale for dose/fractionation
• □Part A: ME 3.5 Use treatment simulation equipment effectively (including defining appropriate immobilization, patient preparation and techniques to minimize/account for organ motion)
• □Part A: ME 3.5 Integrate information from relevant clinical examinations and imaging (CT, PET, MR and Ultrasound), and pathology reports
• □Part A: ME 3.5 Perform contouring, applying the rationale for definition of GTV (+/- GTV2)
• □Part A: ME 3.5 Perform contouring, applying the rationale for definition of CTV (+/- CTV2)
• □Part A: ME 3.5 Perform contouring, applying the rationale for definition of PTV (+/- PTV2)
• □Part A: ME 3.5 Perform contouring of normal structures relevant to the case and prioritizing relative to targets
• □Part B: ME 3.5 Evaluate the radiation plan for target coverage
• □Part B: ME 3.5 Evaluate normal tissue constraints/dose to organs at risk
• □Part B: ME 3.5 Provide rationale for beam energy and dose modifiers
• □Part B: ME 3.5 Suggest modification or approve plan, as required
• □Part B: ME 3.5 Order appropriate verification imaging for treatment
• □Part C: ME 2.2 Interpret imaging studies to determine procedural plan
• □Part C: ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
• □Part C: ME 3.4 Prepare and position the patient for the procedure
• □Part C: ME 3.4 Determine a plan for sedation and monitoring appropriate to the patient’s condition and the clinical setting
• □Part C: ME 3.4 Apply knowledge of anatomy, key landmarks and the procedure
• □Part C: ME 3.4 Demonstrate aseptic technique where applicable: skin preparation, establishing and respecting the sterile field
• □Part C: ME 3.4 Participate in the procedure, including positioning the instrument accurately and as required
• □Part C: ME 3.4 Use image guidance where applicable including planning, registration, and navigation
• □Part C: ME 3.4 Determine that the procedure is complete
• □Part C: ME 3.4 Monitor patient comfort and safety, and modify the procedure as needed
• □Part C: ME 3.4 Identify and respond to immediate complications of the procedure
• □Part C: ME 4.1 Provide discharge instructions and plan for follow-up

Communicator

• □Part B: COM 5.1 Document radiation prescription plans in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements
• □Part C: COM 5.1 Document the procedure

Collaborator

• □Part C: COL 1.2 Communicate effectively with nurses and assistants during the procedure

Leader

• □Part B: L 1.1 Identify appropriate cases for oncology-related peer review and quality assurance activities

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Case mix

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign condition

Acute issue

1. ●yes
2. ●no

Complexity

1. ●yes
2. ●no

Type of complexity

1. ●compliance with therapy
2. ●psychosocial distress
3. ●end of treatment anxiety
4. ●financial stress
5. ●complications from radiotherapy +/- concurrent therapies
6. ●progression of disease
7. ●complications of cancer

Medical Expert

• □Part A: ME 1.1 Demonstrate commitment and accountability for patients in their care
• □Part A: ME 1.4 Perform clinical assessments for patients undergoing radiation treatment
• □Part A: ME 1.6 Adapt care as the patient’s clinical situation evolves
• □Part A: ME 2.2 Recognize emergencies arising during treatment (e.g., febrile neutropenia, pulmonary emboli) and need for admission as applicable
• □Part A: ME 3.4 Recognize and manage acute radiation reactions
• □Part A: ME 3.4 Establish and implement a plan for post-radiation care
• □Part B: ME 3.5 Adapt radiation plans as needed during treatment
• □Part B: ME 5.1 Recognize near-misses in real time and respond to correct them, preventing them from reaching the patient
• □Part C: ME 1.1 Demonstrate commitment and accountability for patients in their care

Communicator

• □Part A: COM 3.2 Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents
• □Part A: COM 5.1 Document clinical encounters in an accurate, complete, timely, and accessible manner, and in compliance with legal and privacy requirements

Collaborator

• □Part A: COL 1.2 Consult as needed with other health care professionals, including other physicians, to manage a patient through radiation therapy
• □Part B: COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a team
• □Part C: COL 1.1 Work effectively with physicians and other health care professionals within the interprofessional team during radiation planning
• □Part C: COL 1.2 Consult as needed with other health care professionals, including other physicians to manage a patient through radiation therapy
• □Part C: COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner
• □Part C: COL 2.2 Demonstrate awareness of team dynamics and analyze strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture

Professional

• □Part C: 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

Type of observation

1. ●direct
2. ●indirect

Case mix

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign condition

Setting

1. ●clinic
2. ●inpatient

Medical Expert

• □Part A: ME 4.1 Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence
• □Part A: ME 1.6 Adapt care as the patient’s clinical situation evolves
• □Part A: ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of ongoing follow- up in a time efficient and focused manner
• □Part A: ME 4.1 Identify and manage subacute and chronic sequelae of treatments of radiation therapy
• □Part C: ME 2.1 Ascertain participants’ understanding of the situation and the reason for the encounter
• □Part C: ME 2.3 Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes
• □Part C: ME 2.3 Share concerns with the patient and family about goals of care that are not felt to be achievable

Communicator

• □Part A: COM 4.1 Explore the perspectives of the patient and others when developing plans for ongoing care
• □Part C: COM 1.1 Demonstrate empathy, respect and compassion
• □Part C: COM 3.1 Share information and explanations that are clear and accurate
• □Part C: COM 3.1 Verify understanding of information conveyed
• □Part C: COM 1.4 Identify, verify and validate non-verbal cues
• □Part C: COM 4.3 Answer questions in a respectful manner
• □Part C: COM 2.2 Manage the flow of the encounter
• □Part C: COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □Part C: COM 1.5 Establish boundaries as needed in emotional situations
• □Part C: COM 2.2 Summarize and close the encounter effectively

Collaborator

• □Part A: COL 1.2 Determine the need for involving other health care professionals, and incorporate their perspectives as appropriate
• □Part B: COL 1.3 Provide timely pertinent information to the other health care professionals
• □Part B: COL 3.2 Summarize and document patient issues for other health care professionals providing rationale for key decisions and recommendations for management
• □Part B: COL 1.2 Consult as needed with other health care professionals, including other physicians, for coordination of ongoing care and survivorship
• □Part B: COL 1.2 Negotiate overlapping and shared care responsibilities with physicians and other colleagues in the health care professions to coordinate ongoing care

Leader

• □Part A: L 2.1 Use clinical judgment to minimize wasteful practices
• □Part B: L 2.1 Apply knowledge of health care resources available in other care settings

Health Advocate

• □Part A: HA 1.1 Facilitate timely patient access to health services and resources related to follow-up, surveillance, and survivorship
• □Part A: HA 1.3 Incorporate disease prevention, health promotion, and health surveillance activities into interactions with individual patients

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

Topic

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone
11. ●pediatric oncology
12. ●benign conditions
13. ●radiation oncology emergencies
14. ●medical physics
15. ●radiobiology
16. ●treatment planning
17. ●other

Audience

1. ●patients and families
2. ●health professionals and learners
3. ●public

Teaching activity

1. ●patient education
2. ●academic half day teaching
3. ●journal club presentations
4. ●divisional/departmental rounds
5. ●other

Scholar

• □S 1.3 Collaborate with other members of the health care team to facilitate learning
• □S 1.3 Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice
• □S 2.4 Identify the learning needs and desired learning outcomes of the audience
• □S 2.4 Develop learning objectives for a teaching activity
• □S 3.3 Critically evaluate the integrity, reliability and applicability of health- related research and literature
• □S 2.4 Present the information in an organized manner to facilitate understanding
• □S 2.4 Deliver the information effectively, adapting to the needs of the audience and their health literacy
• □S 2.4 Provide adequate time for questions and discussion
• □S 2.5 Provide written or verbal feedback to other learners, and other members of the team to enhance learning and performance

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Visit

1. ●consult
2. ●on-treatment
3. ●follow-up post radiation

Tumour site

1. ●breast
2. ●central nervous system (CNS) and eye
3. ●gastrointestinal (GI)
4. ●genitourinary (GU)
5. ●gynecologic
6. ●head, neck and thyroid
7. ●lung/mediastinum
8. ●lymphoma/hematologic
9. ●skin
10. ●soft tissue/bone

Medical Expert

• □Part A: ME 1.1 Assume primary responsibility for the longitudinal management of a patient from presentation through treatment and follow-up
• □Part A: ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in their discipline
• □Part A: ME 1.4 Perform appropriately timed clinical assessments addressing the breadth of the discipline with recommendations that are well organized and properly documented in written and/or oral form
• □Part A: ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □Part A: ME 3.5 Develop and sign off plans and take responsibility to have attending co-sign
• □Part B: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part B: ME 1.5 Prioritize clinical tasks, e.g., radiotherapy planning, returning patient phone calls, following up on investigations, completing paperwork
• □Part B: ME 2.1 Prioritize which issues need to be addressed during future visits or with other health care providers

Communicator

• □Part A: COM 3.2 Disclose patient safety incidents to the patient and family accurately and appropriately
• □Part A: COM 5.1 Document clinical encounters in an accurate, complete, timely, and accessible manner, and in compliance with legal and privacy requirements

Collaborator

• □Part A: COL 3.1 Determine when care should be transferred to another physician or health care professional
• □Part B: COL 1.3 Engage in respectful shared decision making with physicians and other health care professionals
• □Part B: COL 1.2 Negotiate overlapping and shared care responsibilities with physicians and other health care professionals
• □Part B: COL 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
• □Part B: COL 3.2 Demonstrate safe handover of care, both verbal and written, during patient transitions to a different health care professional, setting, or stage of care

Leader

• □Part A: L 4.2 Apply appropriate strategies and processes to track pending patient care issues
• □Part A: L 4.2 Manage online approvals/completing forms in a time effective manner
• □Part B: L 4.2 Apply appropriate strategies for organizing and scheduling of clinic flow, including timely start and finish of clinics

Health Advocate

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

Scholar

• □Part A: S 3.4 Integrate best evidence and clinical expertise into decision making in practice

Professional

• □Part A: P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice
• □Part B: P 1.1 Exhibit appropriate professional behaviours
• □Part B: P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice
• □Part B: P 3.2 Recognize and respond in an appropriate and constructive manner to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions
• □Part B: P 4.3 Promote a culture that recognizes, supports, and responds effectively to colleagues in need

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. ●indirect

Medical Expert

• □Part A: ME 5.1 Identify a patient safety incident in a timely manner
• □Part A: ME 5.1 Prioritize the initial medical response to the event to mitigate further injury
• □Part A: ME 5.1 Report the event as per institutional processes
• □Part B: ME 5.1 Consider harm from health care delivery in a differential diagnosis, when appropriate
• □Part B: ME 5.1 Identify safety issues that may arise, including systemic therapy, surgical oncology, and palliative care
• □Part B: ME 5.1 Describe an approach to analyzing an adverse medical event
• □Part B: ME 5.1 Identify what measures should be taken after an incident to contribute to process improvement
• □Part B: ME 5.2 Describe strategies to address the effects of human and system factors on clinical practice

Communicator

• □Part A: COM 3.2 Disclose the medical error or adverse event to the patient and family
• □Part A: COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □Part A: COL 2.2 Communicate clearly and directly with team/colleagues to promote understanding, debrief and resolve issues related to the incident

Scholar

• □Part B: S 2.1 Identify behaviours associated with positive and negative role-modeling by learners and teachers

Professional

• □Part B: P 4.1 Manage the impact of physical and environmental factors on health professionals’ performance
• □Part B: P 4.1 Demonstrate an awareness of the importance of personal health and emotional well-being while delivering care to patients

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 Triage new referrals considering tumour site-specific clinical indications and urgency, patient condition and competing new referrals

Collaborator

• □COL 1.3 Work effectively with physicians and other colleagues

Leader

• □L 1.1 Apply the science of quality improvement to contribute to improving systems of patient care
• □L 1.3 Analyze harmful patient safety incidents and near-misses to enhance systems of care
• □L 2.2 Apply evidence and management processes to achieve cost-appropriate care
• □L 3.1 Participate in leadership opportunities and development

Scholar

• □S 1.1 Develop, implement, monitor and revise a personal learning plan to enhance professional practice

Professional

• □P 2.1 Contribute through active participation in the activities of the profession (e.g., tumour board)
• □P 4.2 Apply strategies to mitigate against the emotional and physical impact of chronic stress on physicians

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Leader

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

Scholar

• □S 4.4 Generate focused questions for scholarly investigation
• □S 3.3 Critically evaluate the literature
• □S 4.2 Apply required standards of research ethics, as appropriate to the scholarly project
• □S 4.4 Select appropriate methods of addressing a given scholarly question
• □S 4.4 Collect data for a scholarly project
• □S 4.3 Actively participate as a project team member, balancing the roles and responsibilities of a project leader with the clinical roles and responsibilities of a physician
• □S 4.4 Perform data analysis
• □S 4.5 Complete and disseminate a work of scholarship
• □S 4.5 Summarize and communicate the findings of applicable research and scholarly inquiry

Professional

• □P 1.2 Demonstrate a commitment to excellence in all aspects of scholarly activity

Case description

Feedback provided

Next steps