Surgical Foundations

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 Elicit an accurate relevant history
• □ME 2.2 Perform a physical examination relevant to the presentation
• □ME 2.4 Develop an initial management plan for common patient presentations in surgical practice

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort and privacy
• □COM 2.1 Conduct the interview in a patient-centred manner
• □COM 2.3 Identify other sources of information (e.g., family, medical record) that may assist in a given patient’s care
• □COM 5.1 Organize information in appropriate sections within the medical record
• □COM 5.1 Document accurate and up-to-date problem lists and medication lists

Professional

• □P 1.1 Complete assigned responsibilities in a timely fashion

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulated

Medical Expert

• □ME 1.6 Recognize own limits and seek assistance when necessary
• □ME 2.1 Perform initial resuscitation
• □ME 2.2 Elicit a history and perform a physical exam that informs the diagnosis
• □ME 2.2 Develop a differential diagnosis and adjust as new information is obtained
• □ME 2.2 Select necessary initial investigations to assist in diagnosis and management
• □ME 4.1 Identify the potential need for consultation

Communicator

• □COM 1.2 Mitigate physical barriers to communication to optimize patient comfort, privacy, engagement, and safety
• □COM 2.3 Seek and synthesize relevant information from other sources, which may include the patient’s family, hospital records and other health care professionals

Collaborator

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

Scholar

• □S 1.1 Recognize the duality of being a learner as well as a practitioner

Professional

• □P 1.1 Consistently prioritize the needs of patients and others to ensure a patient’s legitimate needs are met

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 the 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 Document accurate and up-to-date problem lists and medication lists

Professional

• □P 1.1 Complete assigned responsibilities in a timely fashion

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 5.2 Use structured handover tools and strategies to enhance patient safety
• □ME 2.1 Identify patients at risk for sudden deterioration in clinical status

Collaborator

• □COL 3.2 Summarize and prioritize patient issues providing rationale for key decisions
• □COL 3.2 Communicate plans for ongoing management of patients, such as outstanding investigations and anticipated events or outcomes
• □COL 3.2 Answer questions from the receiving physician(s) during transitions in care, clarifying issues as needed

Leader

• □L 4.3 Use information technology in a manner that improves patient safety, recognizing its limitations and risks to privacy and confidentiality

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 3.4 Demonstrate effective procedure preparation, including the use of a pre-procedure time-out or surgical safety checklist as appropriate
• □ME 3.4 Hand-cleanse, gown and glove
• □ME 3.4 Establish and maintain a sterile field
• □ME 3.4 Maintain universal precautions

Collaborator

• □COL 1.2 Demonstrate knowledge of the roles and responsibilities of all participants in the operating room

Professional

• □P 4.1 Demonstrate an understanding of occupational risks and their management

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

Wound size

1. ●< 5 cm
2. ●>5 cm

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.4 Maintain sterile technique
• □ME 3.4 Obtain appropriate assistance
• □ME 3.4 Select and use suture materials
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Assess the quality of the closure

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

Drain type

1. ●nasogastric
2. ●Jackson-Pratt or similar
3. ●chest tubes
4. ●feeding tubes
5. ●Foley catheter
6. ●central venous catheter
7. ●other

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.3 Apply knowledge of the different tubes, drains and lines used in the care of the surgical patient, the indications for their use and the risks associated with them
• □ME 2.4 Develop a management plan for common presentations related to tubes, drains and lines
• □ME 3.3 Determine the urgency with which various problems with in-situ tubes, drains and lines require intervention
• □ME 3.4 Troubleshoot tubes and drains including insertion, unblocking, repositioning, removal or replacement

Communicator

• □COM 3.1 Communicate the plan of care in a clear, compassionate, respectful, and accurate manner to the patient and family

Collaborator

• □COL 2.1 Respond to nursing requests and concerns in a respectful and timely manner

Professional

• □P 1.1 Consistently prioritize the needs of patients and others to ensure a patient’s legitimate needs are met

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 presentation

1. ●hemodynamic
2. ●airway/respiratory
3. ●decreased level of consciousness/acute change in mental status
4. ●sepsis

Setting

1. ●ward
2. ●emergency department
3. ●intensive care unit
4. ●simulation

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage core patient presentations in surgical practice
• □ME 1.4 Perform the clinical assessment in a time-effective manner
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 1.5 On the basis of patient-centred priorities, seek assistance to prioritize multiple competing tasks that need to be addressed
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations and/or imaging with sufficient attention to clinical details
• □ME 2.2 Interpret common and simple investigational modalities
• □ME 2.4 Develop and implement initial management plans for common problems in surgical practice
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □ME 4.1 Identify the need for and timing of consultation with another physician or health care professional

Communicator

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

Collaborator

• □COL 3.2 Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Leader

• □L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical settings including use of blood products, investigations, inpatient versus outpatient treatment and appropriate utilization of critical care unit resources

Professional

• □P 1.3 Provide care to the critically ill patient commensurate to expressed advanced directives
• □P 4.1 Regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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 3.1 Determine the appropriate site for line insertion
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Set up, position and drape the patient for the procedure
• □ME 3.4 Prepare and cleanse the procedural site
• □ME 3.4 Maintain universal precautions
• □ME 3.4 Perform the insertion of a central venous line, using ultrasound guidance as appropriate

Communicator

• □COM 5.1 Document the encounter to convey the procedure and outcome(s)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Role of resident

1. ●primary survey
2. ●secondary survey

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.4 Perform the clinical assessment in a timely manner
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.1 Iteratively establish priorities as the patient’s situation evolves
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy
• □ME 3.4 Perform pre-procedural tasks in a timely, skillful, and safe manner
• □ME 3.4 Perform surgical techniques in a timely, skillful, and safe manner • Vascular control in elective and critical situations • Application of a splint for bony injury or soft tissue injury • Securing arterial and venous vascular access in critical and non-critical situations
• □ME 4.1 Establish plans for ongoing care, taking into account the patient’s clinical state as well as available resources
• □ME 4.1 Implement management to stabilize the patient prior to additional testing or transfer

Communicator

• □COM 1.2 Optimize the physical environment for patient comfort and privacy

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals
• □COL 2.2 Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts
• □COL 3.1 Determine when care should be transferred to another physician or health professional
• □COL 3.2 Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

Professional

• □P 4.1 Manage the mental, physical and environmental challenges that impact behaviour and/or performance in the clinical setting

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

Surgical priority

1. ●elective
2. ●emergent

Patient risk category

1. ●low
2. ●high
3. ●critically ill

Medical Expert

• □ME 1.4 Perform a focused clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret appropriate investigations and/or imaging with sufficient attention to clinical details
• □ME 2.4 Develop and implement plans for preoperative optimization of patients
• □ME 5.2 Use preoperative care pathways, as appropriate
• □ME 2.4 Use appropriate prophylaxis
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy

Communicator

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

Collaborator

• □COL 1.2 Collaborate with other health care providers and all involved parties in booking the case including ICU, step down unit, or OR
• □COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan

Health Advocate

• □HA 1.3 Identify modifiable risk factors and promote health and wellness
• □HA 1.3 Anticipate and advocate for the perioperative needs of patients belonging to vulnerable and marginalized 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

Type of procedure

1. ●emergency
2. ●elective

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 3.2 Describe a proposed surgical care plan to the patient/family, including its risks, expected outcomes and alternative treatments

Communicator

• □COM 3.1 Convey information about the post-operative care and issues, immediate and long-term, clearly and accurately
• □COM 3.1 Use plain language and avoid medical jargon
• □COM 3.1 Verify and validate the patient’s and/or family’s understanding
• □COM 4.3 Answer questions from the patient and/or family
• □COM 4.3 Use communication skills and strategies that help the patient and/or family make informed decisions
• □COM 5.1 Document the consent discussion and its outcome

Professional

• □P 1.1 Disclose the role of surgical learners in the patient’s procedure and 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

Role of resident

1. ●primary assistant to the operator
2. ●secondary assistant to the operator

Role of observer

1. ●surgeon
2. ●senior resident
3. ●other

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 1.3 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 Provide and/or use operative assistance effectively
• □COL 1.2 Work effectively with the OR team

Professional

• □P 1.2 Prepare for the case, reviewing relevant patient information and imaging
• □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

Surgical complexity

1. ●major
2. ●minor

Patient complexity

1. ●low
2. ●high

Medical Expert

• □Part A: ME 1.3 Apply clinical and biomedical sciences to manage core patient presentations in surgical practice
• □Part A: ME 1.4 Perform a focused clinical assessment that addresses all relevant issues
• □Part A: ME 3.4 Perform wound surveillance and dressing care
• □Part A: ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □Part A: ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □Part A: ME 5.2 Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety
• □Part A: ME 4.1 Develop and implement a plan for post-operative, immediate and/or long-term care

Collaborator

• □Part A: COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □Part A: COL 3.2 Communicate with the patient’s primary health care professional about the patient’s care
• □Part A: COL 3.2 Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues
• □Part A: COL 3.2 Arrange for the appropriate resources and allied health care assistance to be available for the surgical patient
• □Part B: COL 1.2 Demonstrate understanding of the roles and scopes of practice of other health care providers related to surgical practice
• □Part B: COL 1.3 Integrate the patient’s perspective and context into the collaborative care plan
• □Part B: COL 2.1 Actively listen to and engage in interactions with collaborators
• □Part B: COL 3.2 Arrange for the appropriate resources and health care assistance to be available for the surgical patient

Leader

• □Part A: L 1.4 Access supports and notification processes to enhance patient safety in their institution

Health Advocate

• □Part A: HA 1.2 Select patient education resources related to surgical practice
• □Part A: HA 1.3 Anticipate and advocate for the perioperative needs of patients belonging to vulnerable and marginalized populations
• □Part A: HA 1.3 Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients, including screening for child abuse, elder abuse, intimate partner abuse and domestic violence
• □Part B: HA 1.1 Demonstrate an approach to working with patients to advocate for health services or resources

Professional

• □Part A: P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures, and clinical practice guidelines
• □Part B: P 4.1 Regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

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 complication

1. ●post-operative fever
2. ●low urine output
3. ●hypotension
4. ●chest pain
5. ●shortness of breath
6. ●bleeding
7. ●delirium
8. ●ileus
9. ●other complication

Hemodynamic status

1. ●stable
2. ●unstable

Medical Expert

• □ME 1.3 Apply clinical and biomedical sciences to manage core patient presentations in surgical practice
• □ME 1.4 Perform a focused clinical assessment that addresses all relevant issues
• □ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance
• □ME 2.2 Develop a specific differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret appropriate investigations and/or imaging with sufficient attention to clinical details
• □ME 3.3 Consider urgency and potential for deterioration, in advocating for the timely execution of a procedure or therapy
• □ME 4.1 Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved
• □ME 4.1 Ensure follow-up on results of investigation and response to treatment
• □ME 4.1 Implement a post-operative care plan for patients with a complicated post-operative course
• □ME 4.1 Identify the need for and timing of consultation with another physician or health care professional
• □ME 5.1 Recognize the occurrence of a patient safety incident

Communicator

• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, management plan and/or discharge plan
• □COM 3.1 Convey information about the post-operative care and issues, immediate and long-term, clearly and accurately
• □COM 3.2 Describe the steps in providing disclosure after a patient safety incident
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions

Collaborator

• □COL 1.1 Receive and appropriately respond to input from other health care professionals

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures, and clinical practice guidelines

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

Assessor’s role

1. ●junior learner
2. ●senior resident
3. ●faculty

Scholar

• □S 2.4 Identify the learning needs of a junior learner
• □S 2.1 Identify behaviours associated with positive and negative role-modelling
• □S 2.2 Create a positive learning environment
• □S 2.3 Identify unsafe clinical situations involving learners and manage them appropriately
• □S 2.3 Demonstrate an understanding of the role of appropriate supervision
• □S 2.4 Plan learning activities appropriate to the level of the learner
• □S 2.5 Provide written or oral feedback to other learners, faculty and other members of the team

Professional

• □P 3.3 Contribute to the assessments for other learners on their clinical rotation

Case description

Feedback provided

Next steps