Respirology (Adult)

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. ●undifferentiated respiratory complaint
2. ●obstructive lung disease
3. ●restrictive lung disease
4. ●sleep disordered breathing
5. ●lung cancer
6. ●respiratory infection
7. ●pleural disease

Setting

1. ●inpatient
2. ●outpatient

Observation type

1. ●direct
2. ●case presentation
3. ●review of consult letter

Medical Expert

• □ME 1.3 Apply knowledge of biomedical and clinical sciences to identify, diagnose, and address common clinical problems
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Gather a history and perform a physical exam relevant to the presentation
• □ME 2.2 Select and interpret investigations
• □ME 2.4 Develop and implement an initial management plan

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 5.1 Organize information in appropriate sections within an electronic or written medical record

Professional

• □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

Setting

1. ●ICU
2. ●inpatient ward
3. ●ER
4. ●bronchoscopy suite
5. ●ambulatory clinic
6. ●simulation

Case mix

1. ●asthma
2. ●cystic fibrosis
3. ●COPD
4. ●bronchoscopy complication
5. ●ILD
6. ●hemoptysis
7. ●pneumothorax
8. ●respiratory failure
9. ●airway obstruction
10. ●other condition

Medical Expert

• □ME 2.2 Perform an appropriately timed clinical assessment of a patient who needs airway and/or ventilation assistance
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Gather a history and perform a physical exam relevant to the presentation
• □ME 2.2 Select and interpret investigations
• □ME 2.1 Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Communicator

• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.1 Receive and appropriately respond to input from 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. ●bronchoscopy
2. ●ultrasound assisted thoracentesis
3. ●ultrasound assisted chest tubes
4. ●other procedure

Consent observed

1. ●yes
2. ●no

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.2 Explain the risks and benefits of, and the rationale, for a proposed procedure
• □ME 3.2 Obtain informed consent
• □ME 2.2 Integrate and synthesize clinical information to assess clinical status, peri-procedural risk and opportunities for risk mitigation
• □ME 2.4 Anticipate peri-procedural issues and complications, and incorporate these considerations in the management plan
• □ME 3.4 Select the appropriate location and sedation for the patient’s procedure
• □ME 3.4 Develop a plan for the appropriate disposition of the patient post procedure, as applicable

Communicator

• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

• □COL 1.3 Communicate effectively with 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 1.3 Apply pathophysiologic concepts to identify, diagnose, and address common clinical problems
• □ME 2.2 Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.4 Develop and implement a management plan
• □ME 3.2 Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines

Communicator

• □COM 2.3 Seek and synthesize relevant information from other sources, including the patient’s family
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan

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. ●ICU
2. ●inpatient ward
3. ●ER
4. ●bronchoscopy suite
5. ●ambulatory clinic

Case mix

1. ●airway disease
2. ●respiratory failure/ICU
3. ●neoplasm
4. ●infection
5. ●industrial/environmental/aspiration/lung injury
6. ●immunologic disease
7. ●restrictive disorder
8. ●sleep disorder
9. ●pulmonary circulation
10. ●other condition

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Perform focused clinical assessment without excluding key elements
• □ME 2.2 Select and interpret investigations
• □ME 2.4 Develop and implement management plans, including providing or arranging for definitive care
• □ME 5.2 Apply the principles of situational awareness to clinical practice
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs

Communicator

• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations
• □COM 3.1 Convey information about medical course and management plan clearly and compassionately

Collaborator

• □COL 3.2 Communicate with health care professionals and/or receiving physicians, clarifying issues related to transfer 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. ●flexible bronchoscopy
2. ●ultrasound assisted thoracentesis
3. ●other procedure

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.4 Demonstrate effective procedural preparation, including the use of a pre- procedure time-out or safety checklist as appropriate
• □ME 3.4 Set up and position the patient for a procedure
• □ME 3.4 Perform common procedures in a skilful, fluid, and safe manner with minimal assistance
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage immediate complications of the procedure

Communicator

• □COM 3.1 Convey the findings and/or outcomes of the procedure to the patient clearly and compassionately
• □COM 5.1 Document the encounter to accurately convey the procedure and outcome
• □COM 5.1 Complete clinical documentation in a timely manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology
• □ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 3.4 Interpret respiratory diagnostic investigations
• □ME 3.4 Summarize findings of clinical relevance, and provide suggestions for further testing and/or management as appropriate

Communicator

• □COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □COM 5.1 Communicate critical results urgently, as needed

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

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

Communicator

• □COM 5.1 Organize information in appropriate sections within an electronic or written medical record
• □COM 5.1 Document all relevant findings and investigations
• □COM 5.1 Convey clinical reasoning and the rationale for decisions
• □COM 5.1 Provide a clear plan for ongoing management
• □COM 5.1 Adapt the written consultation to the clinical context
• □COM 5.1 Complete clinical documentation in a timely manner

Collaborator

• □COL 1.3 Share expertise when acting in the consultant role, using referral as an opportunity to improve quality of care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type

1. ●direct observation
2. ●case presentation
3. ●review of consult letter

Setting

1. ●inpatient
2. ●outpatient

Case mix

1. ●interstitial lung disease
2. ●pulmonary vascular disease
3. ●cystic fibrosis
4. ●neuromuscular disease
5. ●atypical infection
6. ●pulmonary complication of systemic disease
7. ●other condition

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Select and interpret investigations in the context of the patient’s presentation
• □ME 2.2 Integrate the patient’s other medical problems and current health status into the clinical assessment
• □ME 3.3 Balance risk, effectiveness and priority of interventions in the presence of multiple co-morbidities and/or other features of case complexity
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context
• □ME 4.1 Implement a plan for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression

Communicator

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

Collaborator

• □COL 1.3 Work effectively with other health care professionals to plan and provide care for individual patients

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of observation

1. ●direct observation
2. ●case presentation
3. ●review of consult letter

Setting

1. ●inpatient
2. ●outpatient

Case mix

1. ●lymphangioleiomyomatosis
2. ●pulmonary alveolar proteinosis
3. ●Birt-Hogg- Dubé syndrome
4. ●pulmonary Langerhans cell histiocytosis
5. ●pulmonary alveolar microlithiasis
6. ●hepatopulmonary syndrome
7. ●other condition

Medical Expert

• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Recognise atypical or uncertain presentations
• □ME 2.2 Select, sequence and interpret investigations based on a differential diagnosis
• □ME 2.4 Demonstrate flexibility in clinical reasoning in the setting of clinical uncertainty
• □ME 2.4 Establish a patient-centred management plan despite limited, non- diagnostic, or conflicting clinical data
• □ME 4.1 Determine the need and timing of referral to another health care professional

Communicator

• □COM 3.1 Convey information related to the uncertainty in diagnosis and/or treatment in a clear, timely and transparent manner

Leader

• □L 2.1 Demonstrate judicious use of health care resources

Health Advocate

• □HA 1.1 Facilitate timely access to health services or resources

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●ICU
2. ●inpatient ward
3. ●ER
4. ●ambulatory clinic
5. ●sleep laboratory
6. ●pulmonary function laboratory

Case mix

1. ●sleep disordered breathing
2. ●chronic respiratory failure
3. ●other condition

Modality

1. ●CPAP
2. ●non-invasive ventilation
3. ●invasive ventilation
4. ●medication delivery system
5. ●airway clearance technique
6. ●home oxygen
7. ●tracheostomy care
8. ●other modality

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage core patient presentations
• □ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.4 Develop and implement management plans that consider all of the patient’s health problems and context
• □ME 3.1 Integrate all sources of information to develop a procedural or therapeutic plan that is safe, patient-centred, and considers the risks and benefits of all approaches

Collaborator

• □COL 1.2 Consult as needed with other health care professionals, including other physicians
• □COL 1.3 Communicate effectively with physicians and other health care professionals

Health Advocate

• □HA 1.1 Facilitate timely access to health services or resources

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology and cardiopulmonary interactions to the care of any patient receiving ventilator support
• □ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 1.4 Perform clinical assessments that address all relevant issues
• □ME 2.2 Integrate information from the clinical assessment to formulate an understanding of the patient’s condition
• □ME 2.2 Interpret medical imaging of the respiratory system
• □ME 2.4 Develop and implement management plans for patients requiring non- invasive or invasive ventilation, including weaning from prolonged and/or complicated mechanical ventilation
• □ME 3.1 Determine the need for and timing of tracheostomy

Collaborator

• □COL 1.3 Communicate effectively with other health care professionals

Scholar

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

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●ICU
2. ●inpatient ward
3. ●bronchoscopy suite
4. ●interventional clinic
5. ●ER
6. ●ambulatory clinic

Procedure

1. ●central line placement
2. ●intubation
3. ●bronchoscopy
4. ●thoracentesis
5. ●pleurodesis
6. ●chest tube

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy
• □ME 3.4 Demonstrate effective procedural preparation, including the use of a pre- procedure time-out or safety checklist as appropriate
• □ME 3.4 Set up and position the patient for a procedure
• □ME 3.4 Perform common procedures in a skilful, fluid, and safe manner with minimal assistance
• □ME 3.4 Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered
• □ME 3.4 Establish and implement a plan for post-procedure care
• □ME 3.4 Recognize and manage immediate complications of the procedure

Communicator

• □COM 3.1 Convey the findings and/or outcomes of the procedure to the patient clearly and compassionately
• □COM 5.1 Document the encounter to accurately convey the procedure and outcome
• □COM 5.1 Complete clinical documentation in a timely manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Type of assessment

1. ●direct
2. ●case review

Presentation

1. ●malignant
2. ●non-malignant

Medical Expert

• □ME 2.1 Identify patients for whom the patient perceived burden of disease modifying therapy or investigations is greater than the clinical benefits
• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease modifying approach
• □ME 2.3 Address the impact of the medical condition on the patients’ ability to pursue life goals and purposes
• □ME 2.3 Establish goals of care in collaboration with the patient and family
• □ME 2.4 Develop and implement management plans that optimize symptom management and support achievement of the patient’s goals of care

Communicator

• □COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regards to their care
• □COM 3.1 Provide information on diagnosis and prognosis clearly and compassionately
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●PFT laboratory
2. ●PSG (polysomnography) laboratory
3. ●teaching rounds
4. ●other setting

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology
• □ME 1.3 Apply knowledge of the technical components of diagnostic testing including equipment and protocols
• □ME 3.4 Assess the quality and validity of the study, and any impact on the diagnostic interpretation
• □ME 3.4 Interpret respiratory diagnostic investigations
• □ME 3.4 Summarize findings of clinical relevance, and provide suggestions for further testing and/or management as appropriate

Communicator

• □COM 5.1 Provide clear, concise and accurate reports of diagnostic testing in a timely fashion
• □COM 5.1 Communicate critical results urgently, as needed

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

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 3.3 Modify test selection and/or protocol to address the clinical question

Collaborator

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

Leader

• □L 3.1 Prioritize requests for respiratory diagnostic testing based on clinical information
• □L 3.1 Apply knowledge of quality assurance, equipment maintenance, infection control, emergency procedures and staffing requirements
• □L 1.4 Apply knowledge of the metrics and measurement systems used to track quality management and safety activities

Professional

• □P 1.1 Respond to requests from technical staff in a timely manner
• □P 3.1 Demonstrate awareness of provincial accreditation requirements for a PFT lab

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

Role of observer

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

Medical Expert

• □Part A: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician
• □Part A: ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □Part A: ME 2.1 Determine the priorities for patient care
• □Part A: ME 4.1 Determine the need and timing of referral to another health care professional
• □Part A: ME 2.4 Develop plans for patient care that anticipate clinical response and progress to other settings of care, including home
• □Part A: ME 4.1 Coordinate investigation, treatment and follow-up when multiple physicians and health care professionals are involved
• □Part A: ME 4.1 Develop and implement plans for discharge that include appropriate ongoing care, arrangements for relevant community support services and follow-up on investigations
• □Part A: ME 5.2 Use systems to track and follow-up on clinical data such as investigations and laboratory tests
• □Part B: ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician

Communicator

• □Part A: COM 5.1 Document clinical encounters in an accurate, complete, timely and accessible manner
• □Part B: COM 1.5 Manage disagreements and emotionally charged conversations with patients and/or families

Collaborator

• □Part A: COL 1.3 Use referral and consultation as opportunities to improve quality of care
• □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 1.1 Receive and appropriately respond to input from other health care professionals
• □Part B: COL 1.3 Communicate effectively with physicians and other health care professionals
• □Part B: COL 2.1 Show respect toward collaborators

Leader

• □Part A: L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □Part A: L 4.1 Manage time and prioritize tasks
• □Part A: L 2.1 Allocate health care resources for optimal patient care
• □Part A: L 2.2 Optimize practice patterns for cost-effectiveness and cost control
• □Part B: L 4.2 Run the service efficiently, safely, and effectively

Health Advocate

• □Part B: HA 1.1 Facilitate timely access to health services or resources

Scholar

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

Professional

• □Part B: P 1.1 Respond punctually to requests from patients or other health care providers
• □Part B: P 1.1 Demonstrate professional behaviours, including punctuality, integrity and compassion
• □Part B: P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting/presentation type

1. ●academic half-day session
2. ●grand rounds
3. ●journal club
4. ●formal undergraduate medical courses
5. ●other small group formal session
6. ●other large group formal session
7. ●other setting

Learner/audience

1. ●peers
2. ●faculty
3. ●other trainees
4. ●other health professionals
5. ●public
6. ●other audience

Scholar

• □S 2.2 Create a positive learning environment
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.4 Develop learning objectives for a teaching activity relevant to the audience and setting
• □S 2.4 Present information in an organized manner to facilitate understanding
• □S 2.4 Use audiovisual aids effectively, as appropriate
• □S 2.4 Provide adequate time for questions and discussion

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●inpatient
2. ●ambulatory
3. ●longitudinal clinic
4. ●specialty clinic
5. ●consult service

Medical Expert

• □ME 1.4 Perform relevant and time-effective clinical assessments
• □ME 1.5 Prioritize among patients based on the urgency of clinical presentations
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 2.4 Establish patient-centred management plans

Leader

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

Scholar

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

Case description

Feedback provided

Next steps