Vascular Surgery

- This EPA focuses on recognizing vascular emergencies, promptly seeking assistance, and participating in preliminary management. - Examples of vascular emergencies include acute ischemia, a ruptured or symptomatic aneurysm, acute aortic syndrome (e.g. aortic dissection, thoracic rupture, occlusion), vascular trauma, symptomatic carotid disease, post-operative complications (e.g. bleeding, graft occlusion, pseudoaneurysm), or venous disease (e.g. iliofemoral DVT, phlegmasia).

Direct observation or case review by supervisor or senior trainee Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition (select all that apply): rupture/symptomatic aneurysm; acute aortic syndrome; acute mesenteric ischemia; vascular trauma; symptomatic carotid disease; post-procedure complication; venous disease; other condition - Observation: direct; case review Collect 3 observations of achievement - A variety of conditions - At least 1 direct observation - At least 2 different observers

Suggested observations: 3

- This EPA includes obtaining a patient history, performing a physical exam, ordering appropriate investigations, developing a differential diagnosis, formulating a preliminary management plan, and providing appropriate and timely medical documentation. - This EPA includes performance of a pulse exam and ankle-brachial index test (ABI).

Direct observation or case review (e.g. case discussions/presentations, review of consult letter) by supervisor or senior trainee Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition: atherosclerotic arterial disease; venous disease; aneurysmal disease; wounds; dialysis access; cerebrovascular disease; other condition - Pulse exam/ABI test: yes; no - Observation: direct; case review Collect 5 observations of achievement - A variety of conditions - At least 1 including pulse exam and ABI test - At least 3 direct observations - At least 2 different observers

Suggested observations: 5

- This EPA focuses on application of the relevant knowledge, case review, procedural flow, surgical principles, and procedural skills required to provide surgical assistance for percutaneous and open procedures.

Direct observation by surgeon, interventional radiologist or senior trainee Use Form 1. Form collects information on: - Setting: OR; angiography suite; simulation - Approach: endovascular; open; hybrid Collect 4 observations of achievement - At least 2 endovascular cases - At least 2 open cases - At least 2 different observers

Suggested observations: 4

- This EPA focuses on patients with the following acute and urgent vascular presentations: acute limb ischemia, foot related sepsis, symptomatic carotid disease, symptomatic aneurysm, acute aortic syndromes, acute mesenteric ischemia, vascular trauma, proximal deep venous thrombosis, and bleeding. - This EPA includes triaging consults, assessing and diagnosing patients, requesting relevant investigations, and initiating a comprehensive management plan. - It also includes documentation, and communication and collaboration with other services to expedite patient care. - This EPA may be observed in simulation.

Direct observation or case review by supervisor, may include feedback from patients, families and/or other health professionals Use Form 1. Form collects information on: - Setting: emergency department; ICU; ward; recovery room; clinic - Condition: acute limb ischemia; foot related sepsis; symptomatic carotid disease; symptomatic aneurysm; acute aortic syndromes; acute mesenteric ischemia; vascular trauma; proximal deep venous thrombosis; bleeding patient; other condition - Simulation: yes; no - Observation: direct; case review Collect 6 observations of achievement - A variety of presentations - At least 3 direct observations - At least 3 different observers

Suggested observations: 6

- This EPA focuses on an elective surgical consultation and includes triage, assessment, diagnosis, and comprehensive management of the following common vascular conditions: chronic arterial insufficiency (asymptomatic, claudication and limb threatening), chronic venous insufficiency, uncomplicated aortic and peripheral aneurysm, carotid disease, dialysis access, and wound assessment and management. - This EPA includes preoperative risk assessment, and communicating information regarding initial investigations and management decisions to referring services, as well as timely documentation and plans for follow-up. - It may include obtaining informed consent.

Direct observation or case review by supervisor with input from patients, families and other health professionals Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition: chronic arterial insufficiency; chronic venous insufficiency; uncomplicated aortic and peripheral aneurysm; carotid disease; dialysis access; wound assessment and management - Complexity: low; high (provide additional information) - Observation: direct; case review Collect 6 observations of achievement - A variety of presentations - At least 3 direct observations - At least 3 different observers

Suggested observations: 6

- This EPA focuses on interpretation of non-invasive, invasive and cross-sectional vascular imaging. - This includes appropriate selection, performance, and interpretation of non-invasive vascular imaging and tests, including duplex ultrasound assessment of the lower limb, aorta, and carotid artery, and reporting the findings as appropriate. - It also includes interpretation of invasive imaging, including angiograms and venograms, and cross-sectional imaging.

Direct observation and/or review of case and/or report by supervisor Use Form 1. Form collects information on: - Test (select all that apply): arterial duplex; venous duplex; plethysmography; angiogram; venogram; CT-angiogram; MR-Angiogram; other - Anatomic location: cerebrovascular; thoracic; abdominal; pelvic; upper extremity; lower extremity Collect 6 observations of achievement - A variety of cases

Suggested observations: 6

- This EPA focuses on surgical decision making and performance of common vascular procedures. - The observation of this EPA is divided into 2 parts: planning and consent; and performing the procedure. - Part A focuses on making a plan for the procedure and includes reviewing relevant imaging and other clinical information, developing a surgical approach to the case and conveying the plan, rationale, risks and alternatives to the patient in a discussion about informed consent. - Part B focuses on performing the following common vascular technical skills: open vascular exposure and closure, including common femoral artery, brachial/radial, and saphenofemoral vein junction; endovascular access, and cannulation techniques including percutaneous common femoral artery access; basic vascular techniques, including vascular control techniques, arteriotomy, vascular anastomosis, closure of arteriotomy, arterial patch angioplasty, basic arterial embolectomy, saphenectomy, fasciotomy, and amputation; basic endovascular techniques, including diagnostic angiogram (contrast, c-arm and table), guidewire and catheter basic skills for stenotic lesions, endovascular angioplasty, stenting, and vascular access closure. - These technical skills may be observed in any endovascular, open, or hybrid procedure and for patients with any condition.

Part A: Planning and consent Direct observation and case review by supervisor or senior trainee Use Form 1. Form collects information on: - Type of procedure: open; endovascular; hybrid - Procedure (write in): Collect 5 observations of achievement - At least 1 open procedure - At least 1 endovascular procedure - A mix of different procedures Part B: Performing a procedure Direct observation by supervisor or senior trainee Use Form 2. Form collects information on: - Setting: simulation lab; operating/hybrid room; other setting - Skills (select all that apply): endovascular access technique; basic endovascular technique; open vascular exposure; closure; basic vascular technique; femoral artery dissection and closure - Specific procedure (write in): Collect 25 observations of achievement - At least 5 endovascular access technique - At least 5 basic endovascular technique - At least 5 basic vascular technique - At least 5 non-femoral artery vascular exposure - At least 5 femoral artery dissection and closure - At least 2 different observers

Suggested observations: 5

- This EPA focuses on the recognition and initial management of complications from treatment, including complications from open surgery, common endovascular interventions and other medical complications. - Examples of complications from open surgery include bleeding, acute ischemia, stroke, myocardial infarction, graft failure (stenosis or thrombosis), wound complications, graft infection, and compartment syndrome. - Examples of complications from common endovascular interventions include dissection, thrombosis, perforation, pseudoaneurysm, and embolism. - This EPA includes ordering tests and investigations, and clinical monitoring as appropriate.

Direct observation and/or case review by supervisor or senior trainee Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic; recovery room; intensive care unit - Open surgery complication (select all that apply): bleeding; acute ischemia; stroke; graft failure (stenosis or thrombosis); wound complications; graft infection; paraplegia; other complication; N/A - Endovascular complication (select all that apply): dissection; thrombosis; perforation; pseudoaneurysm; embolism; hematoma; paraplegia; other complication; N/A - Other medical complications (select all that apply): cardiac; respiratory; metabolic; infectious; gastrointestinal; delirium; other complication; N/A Collect 9 observations of achievement - At least 3 open surgery post-op complications - At least 3 endovascular complications - At least 3 medical complications - At least 3 different observers

Suggested observations: 9

- This EPA includes using appropriate research methods, analyzing results, critically reflecting on the findings and disseminating the results. It may include obtaining grant funding and preparing a manuscript for publication. - This may include basic or clinical science related to vascular surgery or cardiovascular science, or medical education research. - The achievement of this EPA may be observed via submission of a manuscript suitable for submission to a peer reviewed journal, or presentation of the project at a peer-reviewed local, regional, provincial or national scientific meeting, or thesis committee.

Review of resident’s manuscript and/or presentation by research supervisor, may include input from research team members Use Form 1. Collect 1 observation of achievement

Suggested observations: 1

- This EPA focuses on medical expertise and leadership applied to the coordination of care for a group of patients, in collaboration with the interprofessional team. - This EPA includes the administrative aspects of team scheduling, the supervision of junior learners, and involvement in the quality assurance and quality improvement and patient safety aspects of the service. - This includes responsibility for discussions regarding goals of care and changes in clinical status, and for completion of clinical documentation such as progress, discharge and OR notes - The observation of this EPA is divided into 2 parts: patient care; and interprofessional care/supervision. - The patient care aspects are based on observation of at least one block/month of time. - The observation of the interprofessional care/supervision aspects of this EPA is optional and at the discretion of the program.

Part A: Patient care Direct observation by supervisor Use Form 1. Collect 4 observations of achievement - At least 2 different observers Part B: Interprofessional care/supervision (optional) Supervisor solicits feedback from multiple team members who provide feedback individually, which is then collated to one report by supervisor Use Form 3 Collect feedback on at least 1 occasion, from at least 4 team members

Suggested observations: 4

- This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex aortic pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, and closure/hemostasis. - This includes complex cases, such as juxta/suprarenal, inflammatory, and associated iliac disease. - The observation of this EPA is divided into 3 parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Anatomic location: infrarenal; juxtarenal; suprarenal; rupture; other location - Urgency: elective; urgent; emergent - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 5 observations of achievement - At least 2 high complexity - At least 3 different observers Part B: Surgical performance Direct observation by supervisor Use form 2. Form collects information on: - Type of repair: infrarenal; juxtarenal; suprarenal; rupture; other repair - Condition: standard; inflammatory; infected; ruptured; other condition - Approach: endovascular; open; hybrid - Complexity: low; high (provide additional information) Collect 6 observations of achievement - At least 1 open rupture - At least 3 endovascular (one of which is complex) - At least 3 open (one of which is complex) - At least 3 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA includes completing a workup and diagnosis, including consultation, imaging, and other investigations, as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex aortic pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, fasciotomies, and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Urgency: elective; urgent - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 5 observations of achievement - At least 2 high complexity - At least 3 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Type of repair: bypass; endarterectomy; thrombectomy; angioplasty - Anatomic location: aorta; aortoiliac; isolated iliac; femoral; proximal; distal; extra- anatomic - Condition: acute; chronic - Approach: endovascular; open; hybrid - Complexity: low; high (provide additional information) Collect 6 observations of achievement - At least 3 endovascular (one of which is complex) - At least 3 open (one of which is complex and one of which is extra-anatomic) - At least 3 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex anatomy, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, fasciotomies, peripheral aneurysm repair, interventions of the subclavian artery, and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Anatomic location: upper limb; lower limb - Urgency: elective; urgent - Complexity: low; high (provide additional information) - Observations: direct; case/chart review Collect 5 observations of achievement: - At least 1 upper anatomic location - At least 3 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Procedure: bypass; endarterectomy; thrombectomy; angioplasty; minor amputation; major amputation; other - Anatomic location: upper extremity; popliteal; tibial; other - Approach: endovascular; open; hybrid - Condition: acute; chronic - Complexity: high; low Collect 14 observations of achievement - At least 2 major amputations - At least 2 minor amputations - At least 3 endovascular (one of which is complex e.g. tibial, CTO) - At least 3 open (one upper extremity procedure and tibial bypass) - At least 3 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA includes acute (dissection, intramural hematoma, penetrating aortic ulcer) and chronic presentations (dissection, aneurysm, occlusive). - This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex aortic pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition: elective aneurysm; urgent aneurysm; chronic dissection; acute aortic syndrome; traumatic aortic injury - Anatomic location: arch; descending; thoracoabdominal - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 3 observations of achievement - At least 1 patient with acute aortic syndrome - At least 2 observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Type of repair: arch; descending; thoracoabdominal; other - Condition: aneurysm; chronic dissection; acute aortic syndrome; trauma - Approach: endovascular; open; hybrid Collect 2 observations of achievement - At least 1 endovascular approach Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 3

- This EPA includes acute and/or chronic occlusive, and aneurysmal mesenteric/renal disease. - This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition: elective aneurysm; urgent aneurysm; acute occlusive; chronic occlusive - Anatomic location: mesenteric; renal - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 3 observations of achievement - At least 1 mesenteric case - At least 1 renal case Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Anatomic location: mesenteric; renal - Condition: aneurysm; acute occlusive; chronic occlusive - Approach: endovascular; open; hybrid Collect 1 observation of achievement - At least 1 open revascularization (may include embolectomy) Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 3

- This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; consideration for cerebral protection, recognition of complex anatomy and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, cerebral monitoring and protection, and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and, a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Condition: symptomatic; asymptomatic - Anatomic location: carotid; vertebrobasilar/subclavian steal - Observation: direct; case/chart review Collect 5 observations of achievement - At least 1 vertebrobasilar/subclavian steal - At least 1 symptomatic carotid - At least 1 asymptomatic carotid - At least 3 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Type of repair: bypass; carotid endarterectomy; stent; subclavian revascularization - Condition: symptomatic; asymptomatic - Approach: endovascular; open; hybrid Collect 4 observations of achievement - At least 2 open carotid endarterectomies - At least 1 open subclavian revascularization - At least 2 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA includes providing consultation, selecting and interpreting imaging, and other investigations as appropriate, and planning and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention and closure/hemostasis. - This EPA includes patients presenting for new access creation as well as those with acute and chronic complications of hemodialysis access. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic - Urgency: elective; urgent - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 5 observations of achievement - At least 4 high complexity cases - At least 2 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Complexity: low; high (provide additional information) Collect 5 observations of achievement - At least 3 high complexity cases - At least 2 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA focuses on the diagnosis and management of vascular injuries (trauma, and iatrogenic) and oncologic reconstruction. - This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, screening and making a plan for surveillance; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, proximal and distal control, anastomosis or endovascular intervention, fasciotomies and closure/hemostasis. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic; operating room - Anatomic location: trunk; extremity; head and neck - Context: trauma; iatrogenic; oncology - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 3 observations of achievement - At least 2 different anatomic locations - At least 2 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Type of repair: primary repair; bypass; angioplasty; other - Anatomic location: trunk; extremity; neck; other - Context: trauma; iatrogenic; oncology - Approach: endovascular; open; hybrid - Complexity: low; high (provide additional information) Collect 3 observations of achievement - At least 1 trauma - At least 2 different anatomic locations Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 3

- This EPA includes upper, lower and central venous disease. - This EPA includes completing a workup and diagnosis including consultation, imaging, and other investigations as appropriate; providing conservative management, as appropriate, including risk factor modification, compression and pharmacotherapy; performing pre-operative risk assessment and preparation for surgery; obtaining informed consent; recognizing complex pathology, and selecting the operation, planning, and selecting techniques for surgical approach. - This EPA also includes performing the surgical procedure: exposure/access, endovenous techniques and image guidance. - The observation of this EPA is divided into three parts: patient assessment; surgical performance; and a log of procedures to demonstrate the breadth of experience.

Part A: Patient assessment Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: emergency department; inpatient; clinic; - Condition: ulcer; varicosities; other - Complexity: low; high (provide additional information) - Observation: direct; case/chart review Collect 5 observations of achievement - At least 2 patients with ulcers - At least 2 different observers Part B: Surgical performance Direct observation by supervisor Use Form 2. Form collects information on: - Condition: ulcer; varicosities; other - Approach: endovascular; open Collect 3 observations of achievement - At least 2 different observers Part C: Logbook Logbook of vascular surgery procedures Logbook tracks: - Procedure (write in): - Role in procedure (write in): Submit 1 logbook

Suggested observations: 5

- This EPA focuses on the medical management of patients with acute central, upper and lower extremity venous disease, and may include consideration of surgical or endovascular therapies as appropriate. - This EPA includes identifying the role and rationale for thrombectomy, thrombolysis, and inferior vena cava filters.

Direct observation and case/chart review by supervisor Use Form 1. Collect 3 observations of achievement - At least 2 different observers

Suggested observations: 3

- This EPA includes completing a workup including consultation, imaging, and other investigations as appropriate, and developing a management plan. - This EPA highlights the importance of a multidisciplinary approach to management. - This EPA may be observed in simulation.

Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Condition: congenital anomaly; vascular malformation; other condition Collect 2 observations of achievement - At least 1 congenital anomaly - At least 1 vascular malformation

Suggested observations: 2

- This EPA includes vasospastic disease, thoracic outlet syndrome (TOS), occupational syndromes, connective tissues diseases, vasculitic syndromes, fibromuscular dysplasia, popliteal entrapment, and cystic adventitial disease. - This EPA includes completing a workup including consultation, imaging, and other investigations as appropriate, and developing a management plan. - This EPA may be observed in simulation.

Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Condition: TOS; vasculitis; occupational; popliteal artery entrapment; popliteal adventitial cystic disease; connective tissue disorder; fibromuscular dysplasia; other condition - Complexity: low; high (provide additional information) Collect 3 observations of achievement - At least 3 different conditions - At least 1 TOS

Suggested observations: 3

- This EPA includes completing a workup including consultation, imaging, and other investigations as appropriate, and developing a management plan. - This includes instituting the principles of wound compression and a multidisciplinary approach to management, with consideration of medical and surgical management as appropriate. - This EPA may be observed in simulation.

Direct observation and/or case/chart review by supervisor Use Form 1. Collect 2 observations of achievement

Suggested observations: 2

- This EPA integrates the skills required to function effectively as a surgeon, including managing and prioritizing an elective and urgent surgical case load, supervising junior learners, and working effectively with other health professionals. - The observation of this EPA is based on a full day’s OR list.

Direct and indirect observation by supervisor with feedback from the healthcare team, including other physicians, nurses, junior residents, and/or other health professionals Use Form 2. Form collects information on: - Operative list: elective; urgent - Number of cases that day (write in): Collect 2 observations of achievement - At least 1 elective operative list - At least 1 urgent operative list - At least 2 different observers

Suggested observations: 2

- This EPA focuses on the management of clinical responsibilities over and above the care of individual patients. - This EPA includes triaging referrals and seeing them in an appropriate time frame, managing OR booking and scheduling, completing dictations in timely manner, reviewing test results/acting on results appropriately and in timely manner, and working effectively with the staff and/or other learners in the clinic. - This EPA may be observed in any clinic experience where the supervisor has the opportunity for a longitudinal observation of the resident.

Direct observation and review of cases/consult letters/notes by supervisor, soliciting and incorporating feedback from clinic staff and administrative personnel Use Form 1. Form collects information on: - Clinic (write in): Collect 2 observations of achievement - At least 2 different observers

Suggested observations: 2

- This EPA integrates knowledge, expertise in clinical assessment, surgical decision- making and technical expertise to manage challenging clinical cases, including those where there is uncertainty in the diagnosis and/or management. - This may include developing an appropriate plan, consulting with other physicians/surgeons, and preoperative, intraoperative and/or postoperative management. - This EPA includes long-term complications of vascular procedures. - This EPA may be observed in simulation, in presentations at case rounds, or with a clinical case.

Direct observation and/or case/chart review by supervisor Use Form 1. Form collects information on: - Setting: case rounds; simulation; clinical practice Collect 3 observations of achievement - Must include a variety of settings - At least 3 different observers

Suggested observations: 3

- This EPA may include a variety of scenarios. Examples include: a plan to act on the performance gaps identified in another EPA; a plan to prepare for fellowship training; a plan for managing a vascular surgery practice, and demonstrating understanding the practical aspects of running an office, including hiring staff, remuneration, medico-legal issues etc.; and a plan to prepare for practice in a specific setting (i.e. community) and/or a setting requiring distinct skills. - Achievement of this EPA includes providing a) the rationale for a learning plan, b) self-reflection, c) a personal needs assessment, d) time management and e) identification of the methods to achieve the personal learning plan such as literature review, clinical training, conference attendance and/or rounds attendance. - Observation of this EPA is divided into two parts: developing a plan; and implementing the plan. - The plan must be submitted for review (i.e. part A) before the midpoint of the TTP stage.

Part A: Plan Supervisor review of resident’s submission of a personal learning plan Use Form 4 Collect 1 observation of achievement Part B: Implementation and progress Direct or indirect observation of learning plan implementation by supervisor Use Form 4 Collect 1 observation of achievement

Suggested observations: 1