Thoracic 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

Observation

1. ●direct
2. ●indirect (case review)
3. ●review of documentation

Case mix

1. ●acute/emergency
2. ●elective

Medical Expert

• □ME 2.1 Prioritize issues to address in the patient’s assessment and management
• □ME 2.2 Elicit a history and perform a physical exam relevant to the presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Integrate the clinical data to establish the diagnosis and, if relevant, stage, prognosis, and/or severity of the condition
• □ME 2.4 Develop a plan for management, which may include additional investigations, observation, surgery, and/or non-operative intervention
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 3.2 Obtain informed consent for any planned intervention

Communicator

• □COM 3.1 Share information with the patient and family about the patient’s condition and plans for management clearly and compassionately
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Health Advocate

• □HA 1.1 Respond to an individual patient's health 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

• □ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □ME 3.4 Assemble and verify endoscope function
• □ME 3.4 Intubate the esophagus under direct vision
• □ME 3.4 Achieve clear visualization
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Perform tissue biopsies in quantity and quality as appropriate to indication
• □ME 3.4 Identify and respond to immediate complications of the procedure, if applicable

Communicator

• □COM 5.1 Document the endoscopic procedure and its outcome, using appropriate terminology to describe findings

Collaborator

• □COL 1.2 Make effective use of nurses and/or assistants

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 3.1 Determine the safety and appropriateness of chest tube insertion and the appropriate site
• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 3.4 Prepare to obtain and handle samples, sending for appropriate testing
• □ME 3.4 Set up, position, and drape the patient for the procedure
• □ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □ME 3.4 Perform chest tube insertion, using ultrasound guidance when appropriate
• □ME 3.4 Evaluate tube position
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Document the procedure and its outcome

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

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

Medical Expert

• □ME 1.1 Demonstrate responsibility and accountability for decisions regarding patient care
• □ME 2.4 Develop and implement plans for ongoing care, discharge, and follow-up

Communicator

• □COM 3.1 Share information with patients and families about ongoing delivery of care
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Collaborator

• □COL 1.2 Consult as needed with other health care professionals
• □COL 1.3 Communicate effectively with the health care team

Leader

• □L 4.1 Manage time and prioritize tasks
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources

Professional

• □P 1.1 Behave in a professional 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. ●bronchoalveolar lavage (BAL)
2. ●bronchial brushing
3. ●bronchial biopsy
4. ●pulmonary toilet
5. ●lung isolation techniques
6. ●dual lumen intubation
7. ●bronchial blocker placement
8. ●ETT placement
9. ●other

Intubated

1. ●no
2. ●yes

Medical Expert

• □ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □ME 3.4 Assemble and verify endoscope function
• □ME 3.4 Maintain orientation, localization, and clear visualization during the procedure
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Perform the intended intervention
• □ME 3.4 Identify and respond to immediate complications of the procedure, if applicable
• □ME 2.2 Interpret the clinical significance of the findings of the endoscopic procedure

Communicator

• □COM 5.1 Document the endoscopic procedure and its outcome, using appropriate terminology to describe findings

Collaborator

• □COL 1.2 Make effective use of nurses and/or assistants

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

Procedure

1. ●thoracoscopy
2. ●thoracentesis
3. ●pleurodesis (chemical or mechanical)
4. ●placement of an indwelling catheter

Observation

1. ●direct
2. ●indirect (case review)

Procedure setting

1. ●operative
2. ●bedside

Medical Expert

• □ME 3.2 Obtain and document informed consent, explaining the risks and rationale for the procedure
• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □ME 3.4 Prepare to obtain and handle samples, sending for appropriate testing
• □ME 3.4 Set up, position, and drape the patient for the procedure
• □ME 3.4 Administer local anesthesia and/or sedation to optimize patient safety and comfort
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Recognize and manage complications
• □ME 3.4 Document the procedure and its outcome

Collaborator

• □COL 1.2 Make effective use of nurses and/or 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

Procedure

1. ●cervical incision for exposure of the esophagus
2. ●laparoscopy
3. ●laparotomy
4. ●sternotomy
5. ●thoracoabdominal incision
6. ●thoracoscopy
7. ●thoracotomy

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Select the appropriate site and technique and perform the incision
• □ME 3.4 Establish adequate exposure
• □ME 3.4 Close the incision
• □ME 3.4 Use surgical instruments and equipment correctly and in a fluid manner

Collaborator

• □COL 1.2 Make effective use of operative assistants
• □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

Procedure

1. ●bullectomy
2. ●lung biopsy
3. ●wedge resection

Condition

1. ●benign
2. ●malignant

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 intended procedure
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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

Site

1. ●airway
2. ●chest wall
3. ●esophagus/stomach
4. ●lung
5. ●mediastinum
6. ●pleura

Diagnosis

1. ●benign
2. ●malignant

Case mix

1. ●borderline pulmonary function test
2. ●borderline candidate for other reasons
3. ●needing neoadjuvant therapy
4. ●other

Medical Expert

• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.2 Select and/or interpret investigations
• □ME 2.2 Assess the patient’s candidacy for surgical intervention
• □ME 2.3 Establish goals of care with the patient and family
• □ME 2.4 Develop a plan for management which may include additional investigation, observation, and endoscopic, surgical, and/or non-operative intervention
• □ME 2.4 Select the operative approach and formulate a plan for peri- operative management
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.2 Determine if the case warrants discussion at multidisciplinary rounds

Communicator

• □COM 3.1 Provide information to the patient and family about treatment options, including the choice of surgical technique and other treatment modalities
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or recommendations

Health Advocate

• □HA 1.2 Provide recommendations for resources for patient education and support

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. ●emergency department
2. ●ICU
3. ●intra-operative consultation
4. ●PACU
5. ●ward
6. ●other

Presentation

1. ●airway emergency
2. ●hemoptysis
3. ●massive hemorrhage
4. ●mediastinitis
5. ●pericardial tamponade
6. ●shock
7. ●tension pneumothorax
8. ●other

Medical Expert

• □ME 2.1 Determine the acuity of the issue and the priorities for patient care
• □ME 1.4 Act decisively and maintain control in critical situations
• □ME 3.4 Provide airway management and/or resuscitation
• □ME 2.2 Perform a clinical assessment relevant to the patient presentation in a time-effective manner
• □ME 2.2 Select and/or interpret investigations
• □ME 2.4 Develop a plan for definitive management
• □ME 4.1 Determine appropriate disposition and/or setting for ongoing care

Communicator

• □COM 3.1 Share information with the patient and family about the patient’s condition and plans for management clearly and compassionately

Collaborator

• □COL 1.2 Interact effectively with other health care professionals

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts

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

Approach

1. ●MIS
2. ●open

Procedure

1. ●bronchoplasty
2. ●en bloc chest well resection
3. ●lobectomy-left lower
4. ●lobectomy-left upper
5. ●lobectomy-middle
6. ●lobectomy-right lower
7. ●lobectomy-right upper
8. ●pneumonectomy-left
9. ●pneumonectomy-right
10. ●segmentectomy-left lower
11. ●segmentectomy-left upper
12. ●segmentectomy-middle
13. ●segmentectomy-right lower
14. ●segmentectomy-right upper

Post-neoadjuvant therapy

1. ●no
2. ●yes

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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

Urgency

1. ●elective
2. ●emergency

Diagnosis

1. ●achalasia
2. ●antireflux
3. ●esophageal diverticulae
4. ●esophageal myotomy
5. ●esophageal perforation
6. ●giant hiatus hernia
7. ●other

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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 task

1. ●cervical anastomosis
2. ●creation of a gastric conduit
3. ●esophageal and gastric resection
4. ●intrathoracic anastomosis
5. ●lymph node dissection-abdominal
6. ●lymph node dissection-thoracic
7. ●mobilization of the cervical esophagus
8. ●placement of a feeding jejunostomy
9. ●pyloric drainage

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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. ●chest wall reconstruction
2. ●creation of a thoracostomy window
3. ●disarticulation of the costovertebral joint
4. ●first rib resection
5. ●rib plating
6. ●rib resection
7. ●sternal resection
8. ●sternoclavicular joint resection
9. ●surgical management of pectus defect
10. ●thoracoplasty

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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. ●mediastinal mass resection
2. ●pericardial window creation
3. ●pericardial resection
4. ●operative management of mediastinitis
5. ●sympathectomy
6. ●thymectomy
7. ●other

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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. ●open tracheostomy
2. ●percutaneous tracheostomy
3. ●repair of acquired tracheoesophageal fistula (TEF)
4. ●repair of tracheal injury
5. ●surgical management of tracheoinnominate fistula
6. ●tracheal resection

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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. ●plication
2. ●repair
3. ●resection with reconstruction
4. ●resection without reconstruction
5. ●other (write-in)

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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. ●decortication
2. ●resection
3. ●surgical management of complex retained hemothorax

Presentation

1. ●benign
2. ●malignant
3. ●infectious
4. ●neoplastic
5. ●trapped lung
6. ●other

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, and the intended procedure
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform the procedure skilfully and safely
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

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, and consent
• □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

Procedures

1. ●rigid bronchoscopy
2. ●EBUS
3. ●EUS
4. ●esophageal stenting
5. ●interventional management of central airway obstruction
6. ●mediastinoscopy
7. ●other (write in)

Simulation

1. ●no
2. ●yes

Medical Expert

• □ME 3.1 Determine a plan for sedation and monitoring appropriate to the patient’s condition and the clinical setting
• □ME 3.4 Select and gather appropriate ancillary equipment
• □ME 5.2 Participate in the surgical safety checklist or equivalent
• □ME 3.4 Maintain orientation, localization, and clear visualization during the procedure
• □ME 3.4 Identify key anatomic landmarks and clinically relevant findings
• □ME 3.4 Interpret the clinical significance of findings and modify the procedure as indicated
• □ME 3.4 Demonstrate appropriate and safe use of ancillary equipment (e.g. electrocautery, endoscopic ultrasound, dilation equipment)
• □ME 3.4 Demonstrate appropriate pace and progress
• □ME 3.4 Identify and respond to immediate complications of the procedure, if applicable

Communicator

• □COM 5.1 Document the endoscopic procedure and its outcome, using appropriate terminology to describe findings

Collaborator

• □COL 1.2 Communicate effectively with the health care 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

Complication

1. ●airway injury
2. ●chylothorax
3. ●dysrhythmia
4. ●esophageal anastomotic leak
5. ●hemorrhage
6. ●infection
7. ●mucus plugging
8. ●postoperative bleeding
9. ●prolonged air leak
10. ●respiratory failure

Medical Expert

• □ME 2.1 Identify patients that are at risk of clinical deterioration
• □ME 1.4 Perform a clinical assessment that addresses all relevant issues
• □ME 2.4 Provide airway management and/or resuscitation, as indicated
• □ME 2.2 Develop a differential diagnosis relevant to the patient’s presentation
• □ME 2.2 Select and/or interpret investigations
• □ME 4.1 Determine if there is a need for consultation with another specialist or service
• □ME 2.4 Develop and implement a management plan
• □ME 3.3 Consider urgency and potential for deterioration in advocating for the timely execution of a procedure or therapy

Communicator

• □COM 3.2 Communicate the reasons for unanticipated clinical outcomes and/or disclose patient safety incidents to the patient and/or family
• □COM 5.1 Document the clinical encounter to adequately convey clinical reasoning and the rationale for decisions and/or 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

Medical Expert

• □ME 2.2 Synthesize cases for discussion at multidisciplinary rounds

Communicator

• □COM 5.1 Document the encounter to convey the discussion and its outcome

Collaborator

• □COL 1.3 Work with clinical colleagues to develop and implement a management plan
• □COL 2.2 Facilitate the development of consensus when there are differences in recommendations provided by other health care professionals

Scholar

• □S 3.4 Integrate best evidence and clinical expertise

Professional

• □P 1.1 Behave in a professional 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 2.1 Triage referrals on the basis of the patient’s condition
• □ME 1.4 Perform relevant clinical assessments
• □ME 2.4 Establish patient-centered management plans

Communicator

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

Collaborator

• □COL 1.2 Work effectively with outpatient clinic staff

Leader

• □L 4.1 Manage time effectively in the outpatient clinic
• □L 4.2 Book operative cases and other procedures with appropriate urgency, duration, equipment, and patient preparation
• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinic

Scholar

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

Professional

• □P 1.1 Behave in a professional 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 3.4 Anticipate and prepare for technical challenges and/or significant findings
• □ME 3.4 Select appropriate materials and equipment for the procedure
• □ME 3.4 Manage unexpected intraoperative findings and perioperative issues, adjusting the procedure as appropriate
• □ME 4.1 Establish plans for post-operative care

Communicator

• □COM 3.1 Convey information about the procedure, operative findings, and patient status to the family clearly and compassionately
• □COM 5.1 Document surgical procedures in an accurate, complete, and timely manner

Collaborator

• □COL 3.2 Transition patient care safely to the post-operative team

Scholar

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

Professional

• □P 1.2 Prepare for the day, reviewing the list of planned procedures
• □P 4.1 Maintain professional clinical performance in demanding or stressful clinical settings

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. ●bronchial sleeve resection
2. ●superior sulcus tumour resection
3. ●other (write in)

Medical Expert

• □ME 1.3 Apply knowledge of anatomy, key landmarks, indications for surgery, and surgical approach
• □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 3.4 Use surgical instruments and equipment correctly and in a fluid manner
• □ME 3.4 Perform safe dissection
• □ME 3.4 Anticipate, recognize, and respond to intraoperative challenges
• □ME 3.4 Demonstrate intraoperative judgement

Collaborator

• □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, and consent
• □P 1.1 Work within personal limits, asking for help as needed, including from other specialties

Case description

Feedback provided

Next steps