(PDF) McMaster Modular Assessment Program Intermediate Edition

McMAP | Intermediate Edition

Editors: Teresa Chan & Jonathan Sherbino

M

C

MAP

McMaster

Modular

Assessment

Program

Published by Academic Life in Emergency Medicine, !

San Francisco, California, USA.

First edition, April 2015.

!

Available for usage under the Creative Commons Attribution-

NonCommercial-NoDerivs 3.0 Unported!License.

!

ISBN: 978-0-9907948-2-0

i

This book is dedicated to the team hat helped to make McMAP

such a successful. We would like to thank the following individuals

for their contributions to McMAP.

The McMaster Modular Assessment Program (McMAP) Collabora-

tors are a team of 25 educators and education scientists and 2 resi-

dents from three Canadian universities (McMaster University, the

University of Alberta, and the University of Saskatchewan) and

three U.S. universities (Louisiana State University, Michigan State

University, and Oregon Health & Science University) who devel-

oped and reviewed the McMAP instruments. We would like to ac-

knowledge the hard work of their fellow McMAP Collaborators (M.

Ackerman, J. Cherian, N. Delbel, K. Dong, S. Dong, K. Hawley, M.

Jalayer, B. Judge, R. Kerr, A. Kirkham, N. Lalani, A.R. Mallin, S.

McClennan, P. Miller, A. Pardhan, G. Rutledge, K. Schiff, D. Seh-

dev, T. Swoboda, S. Upadhye, R. Valani, C. Wallner, M. Welsford,

R. Woods, and A. Zaki).

We also wish to thank the McMaster University Division of Emer-

gency Medicine administrators (Teresa Vallera, Melissa Hymers,

Neha Dharwan, and Amanda Li). In addition, the authors thank

their friends and research colleagues, Dr. Kelly Dore, Dr. Geoff Nor-

man, and Dr. Meghan McConnell, for their advice on this project.

Finally, the authors would like to thank Dr. Ian Preyra (former pro-

gram director of the McMaster Royal College Emergency Medicine

Program), Dr. Alim Pardhan (program director of the Royal College

Emergency Medicine Program), and Dr. Karen Schiff (associate

program director of the McMaster Royal College Emergency Medi-

cine Program) for providing the support, time, and mandate to im-

plement McMAP.

DEDICATION

ii

Background

The McMaster Modular Assessment Program

(McMAP) is an intentionally organized series of

interconnected work-based assessment instru-

ments. Using McMAP Junior, Intermediate and

Senior will ensure a rigorous assessment of all of

the specialist Emergency Medicine (EM) compe-

tencies that can be appropriately observed in

the clinical environment.

McMAP was developed in collaboration with 6

institutions in Canada and the United States

(McMaster University, Louisiana State University,

Michigan State University, Oregon Health & Sci-

ence University, University of Alberta, University

of Saskatchewan). It is based on a needs as-

sessment of EM residents and front-line EM

teachers and educators. Key themes that inform

McMAP are: the need for clear criterion-based

(i.e. objective) standards; the need to facilitate

regular, constructive feedback; and the need to

encourage reﬂection among learners.

About The McMAP Project

iii

About McMAP Intermediate

McMAP Intermediate addresses the core of

Emergency Medicine competencies. The trend for

continued daily targeted observation and data

capture in the passport is continued. Since

communication skills are a foundational

component of good clinical care, in McMAP

Intermediate there is a small skew towards

observing communication tasks. As an intentional

design function, McMAP Intermediate builds on

the competencies introduced in McMAP Junior.

Near the end of McMAP Intermediate, it is

suggested to add one to two blocks (four to eight

weeks) of customized assessment. (This will be

determined in part by the overall flexibility of your

residency curriculum.) Residents audit all of their

completed tasks to identify potential areas

requiring enhanced attention. With an advisor, a

resident can design a customized set of learning

objectives (i.e. list of tasks). Alternatively, a

resident who has satisfactorily completed all the

tasks, and are comfortable with their progress,

can be promoted early to McMAP Senior.

Each assessment instrument functions as a “mi-

cro” CEX – a truncated version of the mini clinical

examination exercise widely used in work-based

assessment. Each McMAP instrument involves

multiple physician competencies organized

around an essential task of an EM physician. For

example, providing discharge instructions to a

patient incorporates Medical Expert, Communica-

tor, and Collaborator competencies. However, to

the frontline user, this background curriculum

blueprinting is invisible, improving usability.

Each instrument uses choice architecture to pro-

vide “just-in-time” faculty guidance. Speciﬁcally,

checklists that deconstruct a task into simpler

sub-elements and criterion-based behavioural

anchors (e.g. clinical descriptions of various stan-

dards of performance) for scoring performance

guide faculty towards a shared mental model of

the expected standard.

For more information on the development and de-

sign of McMAP check out the innovation report

manuscript in Academic Medicine:

Chan, T., & Sherbino, J. (2015). The McMaster

Modular Assessment Program (McMAP): A Theo-

retically Grounded Work-Based Assessment Sys-

tem for an Emergency Medicine Residency Pro-

gram. Academic medicine: journal of the Asso-

ciation of American Medical Colleges.

DOI:10.1097/ACM.0000000000000707

PMID:25881648

How it Works – Big Picture

A McMAP passport consists of eight assessment

instruments organized around two related Can-

MEDS Roles. One instrument is completed per

shift. Each instrument is typically repeated once

during a one-month rotation. Depending on rota-

tion planning in your program, it is possible that

each passport will be repeated at least once a

year, ensuring adequate sampling to improve the

reliability of aggregated data.

Each instrument has two main parts. The ﬁrst

part includes the assessment matrix for the spe-

ciﬁc McMAP task assigned for the shift. The sec-

ond part includes a daily global performance as-

sessment that allows the faculty member to as-

sess and provide feedback on overall perform-

ance during the shift. Mandatory narrative com-

ments are required for both elements.

In our experience, making the narrative com-

ments mandatory serves two purposes. First, it

serves as a force-function to promote verbal feed-

back between resident and faculty at the comple-

tion of a shift. This is one of the main goals of

McMAP. Second, the qualitative data from the

narrative comments helps shape the end-of-

rotation report, providing nuance about the per-

formance of a resident.

McMAP also includes an exceptional events re-

porting system. (See Appendix A) Faculty mem-

bers can anonymously submit, on an ad hoc ba-

sis, a standardized form documenting outlier be-

haviour. This data is received by an independ-

ent party (e.g., the chair of the assessment sub-

committee of the residency training committee),

who then determines the response to this excep-

tional event.

How it Works – During a Shift

Every shift a resident is observed by a faculty

member completing a speciﬁc McMAP task. This

takes approximately ﬁve minutes. The entire pa-

tient encounter does NOT need to be directly ob-

iv

served in order to complete the assessment. For

example, a task focused on taking a history does

not require observation of the physical exam. At

or near the end of the shift, the faculty member

completes the instrument linked to the task for

the day. Completion of the form, plus discussion

of the resident’s performance during the shift,

typically requires ﬁve minutes.

Our experience suggests that it is best to allow

the resident and faculty member to negotiate at

the beginning of a shift the task to be addressed

that day. Some tasks are harder to complete than

others because of the need for speciﬁc patient

presentations (e.g. lead a resuscitation). While

McMAP has been designed to be ﬂexible to the

unpredictability of EM practice, faculty and learn-

ers should be opportunistic in choosing a

McMAP task.

Summarizing the Data

The daily data can be collated into a summary

table (see Appendix B), automatically populated

if using a digital passport or by hand if using a

paper passport. This summary table allows the

faculty supervisor responsible for completing the

end-of-rotation report to observe trends and

gaps in performance.

McMAP uses a narrative end-of-rotation report,

following a standardized template, to summarize

the data from the “performance biopsies” that

have occurred during the rotation.

Using McMAP

You are free to use McMAP in whole, or in part,

via the Creative Commons licence… In ex-

change, we ask that you identify the material as

originating from the McMaster Modular Assess-

ment Program.

If you have any suggested modiﬁcations or addi-

tions to McMAP we would be pleased to con-

sider them for incorporation into subsequent ver-

sions.

If you would like further details on how to host

McMAP on an electronic platform, please con-

tact us. We currently use a secure, free, cloud-

based platform that allows residents and faculty

to access their digital passports via mobile de-

vices or computers.

For any inquiries, please contact us at:

mcmapem@univmail.cis.mcmaster.ca.

- Teresa Chan & Jonathan Sherbino, !

Editors & Project Leads

Usage

This document is licensed for use under

the creative commons selected license: Attribution-

NonCommercial-NoDerivs 3.0 Unported.

v

1

INTERMEDIATE RESIDENT

DAILY GLOBAL RATING

Authors:

Ian Preyra

Karen Schiff

Teresa Chan

Editors:

Alim Pardhan

Jonathan Sherbino

What is the Daily Global Rating?

At the culmination of each shift, assessors (staff

physicians) are meant to complete a global rating

of the resident’s overall performance during that

shift. A copy of the global rating scale is at-

tached.

How do I use this sheet?

Raters need only choose one score (i.e. a single

number from 1 to 7), however, the descriptions are

present to clarify the various aspects of the Can-

MEDS roles that are expected at various levels.

Some raters may ﬁnd it useful to use each listed

criterion to isolate areas of weakness or strength

for the resident, but only ONE number is needed

to represent the resident’s overall progress each

day.

Why do we only have to rank residents by one

number?

Many studies of rater psychology have shown that

teachers often only really rank residents by a sin-

gle number anyways (and forms with multiple rat-

ing scales often just result in confusion and/or arti-

ﬁcial variance around the number in the rater’s

mind). Since the McMAP system facilitates daily

observations across many skills, the daily task rat-

ings better clarify the microskills required of an

emergency resident at this level. This ofﬂoads the

need to do detailed observations every day, and

allows us to harness the teacher’s ‘gestalt’ regard-

ing resident performance.

Other notes

Raters should be encouraged to use the whole

spectrum of the score, however, many residents

are rather high-functioning since they have al-

ready spent signiﬁcant time in the Emergency De-

partment (ED) during clerkship and electives.

Based on historical trends, residents often begin

around a 3 or 4 (out of 7) in the beginning of the

year, and over the course of a few blocks progress

7

COMMENTS/ CONCERNS/FEEDBACK

INTERMEDIATE RESIDENT

DAILY GLOBAL RATING

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs Assistance

2

3

4

5

6

7

Ready for to be a

Senior Resident

Any of the following apply to the PGY2

resident:

• Displays major areas of knowledge

deﬁcit (i.e. only displaying

Beginner Level knowledge).*

!

• Displays major weaknesses with

functioning in the ED environment

(culture, logistics, collaboration)

!

• Requires input, revision,

intervention or attentive

supervision from attending

throughout shift.

!

• Performs actions that place

patients at risk.*

!

• Has lapses in professional

behaviour. *

!

• Ineffectively or offensively

communicates with patient(s) or

colleague(s).*

!

• Cannot begin to remedy

knowledge gaps at the point of

care.

!

• Shows lack of insight into own

limitations or knowledge gaps.*

Most of the following apply to the

PGY2 resident:

• Integrates well within the ED

environment (culture,

logistics, collaboration)

!

• Has appropriate intermediate-

level knowledge of EM-

evidence and basic science.

!

• Independently and accurately

examines, diagnoses and

determines care plan for non-

critically ill patient(s).

!

• Performs basic procedures

safely with minimal

supervision.

!

• Effectively communicates with

patient and colleagues (e.g.

forms effective working

relationships)

!

• Is consistently professional.

!

• Develops a plan to begin

remedying knowledge gaps,

limitations, deﬁcits in

exposure.

The PGY2 displays mostly ALL of the

following:

• Functioning proﬁciently and

efﬁciently in the ED environment

(culture, logistics, collaboration)

!

• Displays thorough knowledge of

EM-evidence and basic science, or

is able to independently access this

information in a timely fashion.

!

• Able to independently and

accurately examine, diagnose and

determine care plan for most

patients (including the critically ill).

!

• Able to perform procedures safely

with minimal supervision.

!

• Communicates efﬁciently with

patients and colleagues (displays

empathy, and forms good rapport).

!

• Role models exceptional

professional behaviour.*

!

• Skilled at reﬂective practice and

insight into own limitations,

knowledge gaps; Able to self-

identify and plan for continued

improvement.

*MUST comment below or ﬂag this through the exceptional events system

2

INTERMEDIATE MODULES !

MEDICAL EXPERT & SCHOLAR

ASSESSMENT INDEX

Chest Pain Hx / Px

Point of Care Research (Own question)

Hx / Px in resuscitation

Knowledge Translation (Own question)

Procedure (complex procedure)

Knowledge Gap Identiﬁcation (Directed then self

study)

Procedural Teaching (simple procedure)

Ordering Investigations

Lead Authors:

Karen Schiff

Suneel Upadhye

Editors:

Teresa Chan

Jonathan Sherbino

9

Name of Resident: ___________Name of Assessor_________________ Date:_________

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Introduces self, establishes rapport

Obtains appropriate, focused, history of chest pain

Obtains appropriate past history (including past coronary disease, risk

factors) and medications

Asks appropriate questions to use clinical decision rules (eg PERC,

Wells...)

Completes appropriate, targeted physical exam

Recognizes acute ECG changes (if applicable)

TASK | Chest Pain History & Physical

Today’s focus is history and physical of an acute chest pain patient

The ideal patient for a PGY2 learner would be a patient who is experiencing ONGOING chest pain (e.g. a pa-

tient with ST-T wave changes). We suggest that the preceptor view the patient’s ECG with the learner, but allow

them to manage the case primarily.

The preceptor should observe the key aspects of the case (listed below).

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

INTERVIEWING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

ANY of the following:

• Superﬁcial

• Incomplete

• Highly disorganized

• Some grasp of major

elements but misses

signiﬁcant important

details.

• Slightly disorganized.

• Misses very few relevant

points (e.g. pertinent

positives or negatives).

• Organized and thorough.

• Elicits all pertinent positives

and negatives.

• Appropriately focused

• Well-organized, and

completes history in an

expeditious manner.

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Any of the following:

• Cursory

• incomplete

• inaccurate

• Unsafe for patient

• Does not examine related organ

systems (e.g. does not do lower

limb exam in patient with

shortness of breath)

• Inappropriately brief

• Minor inaccuracies.

• Maneuvers make the

patient

uncomfortable.

• Mostly complete. Only missing

specialized maneuvers

• Ensures patient safety and

comfort.

• Ineﬃcient or awkward for self

but not for patient.

All of the below:

• Complete

• Accurate focused

examination of all relevant

systems (including specialized

maneuvers)

• Comfortable, ﬂuid and

eﬃcient for both resident and

patient.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during his/

her next shift. (You do not need to record this).

10

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during his/her next

shift. (You do not need to record this).

Name of Resident: ___________Name of Assessor_________________ Date:_________

CHECKLIST

DONE

DONE BUT NEEDS ATTENTION

NOT DONE

N/A FOR CASE

Determine appropriate goal of care for patient status

Gathers appropriate information from the patient, EMS staﬀ, other sources

Recognizes potentially abnormal vital signs

Initiatives initial resuscitation (ABCs or Primary Survey)

Conducts a focused history and examination (or Secondary Survey)

Arranges for appropriate initial diagnostic tests

Appropriately documents all key assessment and intervention information in the

ED chart

Task | History & Physical in Urgent or Emergent Case

Today’s task is the assessment and initial management of an acute patient.

Ideally, the PGY2 should complete an observed initial Encounter (including History, Physical and initial management) of

an Emergency Department Patient requiring urgent/emergent care (CTAS 1 or 2). As the attending should observe this,

the patient need NOT be completely stable, but the attending should intervene if the resident is unable to complete the

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

HISTORY-TAKING SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

ANY of the

following:

• Superﬁcial

• Incomplete

• Highly disorganized

• Some grasp of major

elements but misses

signiﬁcant important details.

• Slightly disorganized.

• Misses very few relevant

points (e.g. pertinent

positives or negatives).

• Organized and thorough.

• Elicits all pertinent positives and

negatives.

• Appropriately focused

• Well-organized, and completes

history in an expeditious manner

(i.e. < 7 minutes for a STEMI).

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

PHYSICAL EXAM SKILLS!

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Any of the below:

• Cursory

• Incomplete

• Inaccurate

• Unsafe for patient

• Does not examine related organ

systems (e.g. Does not do lower limb

exam in patient with shortness of

breath)

• Inappropriately

brief

• Minor

inaccuracies.

• Maneuvers make

the patient

uncomfortable.

• Mostly complete

• Ensures patient

safety and comfort.

• Ineﬃcient or

awkward for self

but not for patient.

All of the below:

• Complete

• Accurate focused

examination of all

relevant systems

• Comfortable, ﬂuid and

eﬃcient for both resident

and patient (< 3 minutes)

11

Name of Resident: ___________Name of Assessor_________________ Date:_________

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Explains procedure (Risks, beneﬁts, complications)

Obtains consent

Uses proper personal protective equipment

Proper clean/sterile technique

Proper use of procedural equipment, and assistants where warranted

Gives appropriate aftercare instructions/orders

Documents about the procedure

Task | Complex Procedure

Today’s Focus is an observed complex procedure

The ideal patient for a PGY2 learner would be a patient who requires a fairly urgent (but not emergent) proce-

dure. Suggested procedures would include lumbar puncture, reduction, complex laceration repair, central line

insertion, intubation, arterial line insertion, chest tube insertion or other procedures as deemed appropriately

by you and the resident.

ALSO PLEASE REMEMBER TO ENTER THIS PROCEDURE IN YOUR PROCEDURE LOG!

The preceptor should observe the key aspects of the case (listed below), and intervene only as necessary.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Requires any one of the

below:

• Signiﬁcant instruction

• Assistance with

procedure

• Endangers patient.

• Prompting, but

less

instruction, no

preceptor

involvement in

actual

procedure.

• Often awkward

or tentative.

• Minimal prompting,

mostly independent

• Consistently

accurate, proper

attention to safety.

• Generally reliable,

but sometimes

awkward or

tentative.

All of the below:

• Completely

independent

• Consistently accurate.

• Proper attention to

safety of patient and

assistants.

• Fluid, economical

movements.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Action Prescription) for the

resident to attempt during his/her next shift. (You do not need to record this).

12

Name of Resident: ___________Name of Assessor_________________ Date:_________

CHECKLIST ASSESSED BY ATTENDING

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Reviews the indications and contraindications for the procedure

Explains indications, risks and beneﬁts and complications to the patient and obtains

informed consent

Collects all appropriate supplies for procedure.

Utilizes proper procedural technique (including appropriate cleansing, draping, ultrasound

guidance, sterile technique, appropriate PPE etc)

Able to navigate complications or unforeseen diﬃculties with procedure (e.g. describe an

approach, as necessary)

Able to explain to patient / nursing staﬀ post procedure care

Appropriately documents about the procedure in the chart

Able to explain all steps to the junior learner and answer questions appropriately

Major Task | Procedural Teaching (Simple Procedure)

Today’s focus is the direct observation of a PGY 2 resident teaching a simple procedure

The ideal procedure would be one where the PGY2 is familiar and very comfortable. While performing the procedure, the PGY 2 resi-

dent is to describe to a junior learner (PGY 1 or medical student) as to how to perform the procedure. Procedures may include, sutur-

ing, casting or other procedures as deemed appropriately by you and the resident.

THE PGY-2 IS TO EXPLAIN THE PROCEDURE OUT LOUD – and not to supervise the performance of the task to the junior. There is a

LEARNER card that is associated with this that the observing junior should complete.

ASSESSMENT BY PRECEPTOR | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Requires any one of the below:

• Signiﬁcant instruction

• Assistance with procedure

• Endangers patient.

• Fails to explain any aspect of the

procedure.

• Prompting, but less

instruction, no

preceptor

involvement in actual

procedure.

• Often awkward or

tentative.

• Partially describes the

procedure to

observing learner

• Minimal prompting,

mostly independent

• Consistently accurate,

proper attention to safety.

• Generally reliable, but

sometimes awkward or

tentative.

• Describes general

approach to the

observing learner.

All of the below:

• Completely independent

• Consistently accurate.

• Proper attention to safety of

patient and assistants.

• Fluid, economical movements.

• Seamlessly explains while

performing the task.

Please download the learner card (http://mcmapevents.wix.com/portal#!pgy2-downloads/c1txb) or solicit feedback from the

junior learner. Also found on the next page. Please write any feedback from the learner below:

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Action Prescription) for the resident to attempt during his/her next

shift. (You do not need to record this).

13

LEARNER REVIEW OF THE RESIDENT

TASK

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

The resident reviewed the indications and contraindications of this

procedure to me.

The resident involved me in gathering materials, and I feel I could do this

next time for a similar procedure.

The resident was a good role model for me in terms of preparation,

personal protection, and precautions to maximize patient/staﬀ safety (e.g.

wore PPE, put away sharps, did not expose me to bodily ﬂuids)

The resident was able to explain all steps of the procedure to me (this can

be done before, during, or after the procedure)

The resident involved me or taught me about the documentation and

orders around this procedure.

The best thing the resident did while teaching me this procedure was…

What is one area for improvement? (Your feedback is very valuable!)

Please return this to the FACULTY member who was observing this procedure. The junior is NOT expected to rate

the PGY2.

14

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Eﬀectively utilizes tools available

(library database, Google scholar, PubMed, EMBASE, Cochrane Review etc.)

Explains the limitations of the resources they are using.

Resident is time eﬃcient on the internet to investigate this question

Task | Point of Care Research With DIRECTION

Today’s focus is Point-of-care research

During this shift, the resident should utilize available resources to determine the answer to a point of care ques-

tion that aﬀects patient management. The attending should provide guidance in selecting a clinical question.

Alternatively, the resident may self-identify the question. (e.g. What is the role of dexamethasone in migraine

headaches?)

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Displayed any of the following

behaviours:

• Unable to ﬁnd resources in a

timely fashion.

• Exclusively utilizes and/or cites

untrustworthy or incorrect

sources. (i.e. random websites,

etc..)

$

• Was able to use

resources, but took a

long time.(i.e. > 10

minutes)

• Utilizes mostly

secondary sources

(i.e. reviews of the

articles, or digests of

articles) rather than

articles themselves.

• Finds resources in a

relatively eﬃcient time

period (i.e. <10 min).

• Navigates internet

databases or search

engines awkwardly to ﬁnd

primary sources.

$

Displayed all of the

following behaviours:

• Eﬃciently ﬁnds resources

(i.e. < 5 minutes)

• Navigates internet

databases or search

engines eﬀectively to ﬁnd

primary sources.

• Adjudicates quality of

sources (both primary &

secondary)

The Clinical Question was:

The total time to complete the research task was: ______________

(Do not include discussion time)

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift. (You do not need to record this).

Name of Resident: ___________Name of Assessor_________________ Date:_________

15

Name of Resident: ___________Name of Assessor_________________ Date:_________

Task | Knowledge Translation (Own Question)

Today’s focus is Knowledge Translation of Clinical Decision Rules

The attending should ask the resident about a well known clinical decision rule in relation to a particular case

(e.g. Pneumonia Severity Index score for a pneumonia patient, Ottawa Ankle rule, etc..).

This rule should be chosen in conjunction with the resident. The resident should then use this rule to apply it

to their decision-making for patient care. After the resident has utilized the rule, the attending should immediately

assess the resident’ ability to translate this rule into practice in the below rating tool.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

The following applies

to the resident:

• Is not able to

deﬁne the rule(s)

• Cannot apply it to

the patient.

$

• Is able to deﬁne the

rule

• Is not clear about

application of the

rule(s) to the patient.

• Is able to deﬁne the

rule

• Can determine

whether they can

apply the rule(s) the

patient

• Is unclear about

limitations and

describe the

subsequent

management steps.

$

ALL of the below apply to the

resident:

• Able to deﬁne the rule(s),

can apply it to assist

with decision making.

• Able to articulate the

limitations and describe

the subsequent

management steps.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Action Prescription) for the resident to attempt during his/her

next shift. (You do not need to record this).

THE CLINICAL DECISION RULE FOR THE DAY IS....

16

Name of Resident: ___________Name of Assessor_________________

Task | Knowledge Gap Identiﬁcation (directed)

Today’s focus is Knowledge Gap Identiﬁcation & Reﬂective Improvement (a)

This task is meant to facilitate self-directed learning. The resident is to have read and summarized the evidence be-

hind sepsis management. Based on the readings and gaps in their knowledge, the resident should identify the

tasks that they would continue to research and read about – and identify this to the attending.

Attending physician should choose 1 task to discuss, in order to ensure adequate understanding.

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING,

CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Displays poor insights into

own learning process.

• Unable to identify area(s)

for further reading

•

Displays some insight

into own learning

process.

•

Able to identify one

area for further reading,

but not the most

important area in need

of attention.

•

Unable to make a

sensible plan for further

learning.

• Displays signiﬁcant

insight into own learning

process.

• Able to identify one key

area for further learning.

• Unable to detail a clear

plan for further learning.

• Displays extensive insight

into own learning process.

• Able to identify and

articulate all area(s) for

further reading.

TASK CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

NEEDS FURTHER

CLARIFICATION

Task 1: Describes relevant pathophysiology in the septic patient

Task 2: Describes the algorithm and approach from the original Rivers Early-Goal

Directed Therapy article (NEJM 2001)

Task 3: Describes the overall utility of sepsis bundles in the care of septic

patients (evidence, controversies)

Task 4: Applies the Mortality in ED Sepsis scoring system (Risk stratiﬁcation) to

stratify one patient with possible sepsis.

Task 5: Describes the utility of lactate screening in septic/critically ill patients

(Risk stratiﬁcation)

Task 6: Describes the importance of early appropriate antibiotics in patients with

sepsis +/- hypotension

Task 7: Mechanisms of shock in the septic patient & appropriate vasopressors

for same

Task 8: Roles and limitations of early critical-care response teams in the care of

the septic patient

What diﬃculties did I have in researching/reading about sepsis?

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

17

Name of Resident: ___________Name of Assessor_________________ Date:_________

Task | Knowledge Gap Identiﬁcation (self study)

Today’s focus is Knowledge Gap Identiﬁcation & Reﬂective Improvement (b)

This task is meant to facilitate self-directed learning. The resident is to have read and summarized the evidence be-

hind a topic of their choosing & reﬂect on their learning process.

TASK

CORRECT

PARTIALLY CORRECT BUT NEEDS

ATTENTION

INCORRECT

RECORD QUESTION FROM ATTENDING HERE

What diﬃculties did I have in learning this material?

The Topic I have Read & Summarized was….

The attending physician should ask the resident one related question

Based on your discussion with the attending, identify areas for further exploration.

RATE THIS TASK | BASED ON A DISCUSSION OF THEIR SELF-DIRECTED LEARNING, RATE THIS TASK

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Displays poor insights into own learning

process.

• Unable to identify area(s) for further

reading

•

Displays some insight into own

learning process.

•

Able to identify one area for further

reading, but not the most important

area in need of attention.

•

Unable to make a sensible plan for

further learning.

• Displays signiﬁcant insight into own

learning process.

• Able to identify one key area for

further learning.

• Unable to detail a clear plan for further

learning.

• Displays extensive insight into own

learning process.

• Able to identify and articulate all area(s)

for further reading.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

18

TASK | Ordering Investigations

Today’s Focus is Investigations [based on presentation of a particular case]

The resident should without prompting from others. Based on 3 patients (ideally) with similar present-

ing complaints (e.g. chest pain)

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Any one of the below:

• Cannot select and explain

rationale for appropriate

investigations for

diﬀerential diagnosis.

• Suggests investigations

that are both unnecessary

or would possibly would

expose patient to

unnecessary harm (e.g.

CT Chest in low risk

patient with negative D-

dimer)

• Cannot describe the

clinical utility / diagnostic

accuracy of the test.

• Somewhat

incomplete, non-

focused,

• inappropriate test(s)

used

• inconsistent use of

guidelines to guide

test ordering.

• Doesn't use

hypotheses to guide

investigations

• Orders most

appropriate test(s).

• Minor omissions or

excessive-ordering

of tests.

• Uses guidelines

appropriately

• Mostly uses

hypotheses to guide

investigations

Displays all of the

following:

• Applies appropriate,

focused, timely, evidence-

informed investigations for

clinical situation.

• Clearly uses hypotheses

to guide investigations

• Consistent use of

appropriate guidelines

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift. (You do not need to record this).

Name of Resident: ___________Name of Assessor_________________

3

ASSESSMENT INDEX

Multisource Feedback

Discharge Instructions

Documentation

Delivery of Care plan to Family or Patient

Airway

Patient Care Plan Discussion with Allied Health

Mini Chart Audit

Consult Request

Lead Author:

Robert Woods

Editors:

Teresa Chan

Jonathan Sherbino

INTERMEDIATE MODULES !

COMMUNICATOR & COLLABORATOR

20

Major Task | Multi-source Feedback

Today’s focus is the Communication with Inter-professional Colleagues. (CL2.1)

Instructions to the attending: on behalf of the resident, please distribute a minimum of 5 cards to nurses,

RTs, administrative clerks that have had signiﬁcant interactions with the learner TODAY.

Do NOT give a card to patients or other learners in the department.

Please advise all participants to keep their comments anonymous and constructive. All cards must be col-

lected by the ATTENDING upon completion so they can write a SYNOPSIS (see below).

Copies of these forms can then be placed in the LOCKED McMAP box located in each of the EDs - please

make sure the Resident's Name is clearly printed on each survey. Do NOT do this task at Urgent Care Cen-

tre (as there is no lock box).

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Feedback contained red

ﬂags about

unprofessionalism or conﬂict

with colleagues

• Functions competently

with members of the

team

• Has minor points that

need improvement (e.g.

some notes by ED team

members for areas to

improve)

• Collaborates exceptionally

well with all members of the

team

• Multiple comments

attesting to the clear and

functional communication

skills for this resident.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Educational Prescription) for the

resident to attempt during his/her next shift. (You do not need to record this).

Name of Resident: ___________Name of Assessor_________________ Date:_________

Brief Synopsis of the Feedback. *

Collect the feedback cards from the ED colleagues. Write a synopsis of the feedback gathered on the communication cards and

to help guide the resident understand the comment cards. At the end of the shift compile the feedback from all the patients and

present the resident with some concrete suggestions on how they can improve. This will act as the ONLY enduring record of the

worksheets handed out to the other ED team members.

21

Major Task | Documentation

Today’s focus is to assess the completeness of the resident’s medico-legal documentation. (CM 2.3)

The attending physician should randomly rate two of the residents charts using the following checklist and rat-

ing scale. The charts (or temporary copies) of the charts should be held until a point in the shift where feed-

back can be eﬀectively given with both resident and attending physician reviewing the chart.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs Assistance:

Requires extensive charting by

attending to compensate for

missing items.

2

3

Requires signiﬁcant

charting by attending to

rectify charting.

4

5

Requires minimal charting

by attending to clarify

charting.

6

7

Ready for Next Steps:

Attending documents no additional

or further information that is not

already contained in the chart.

Resident’s chart is

described by ANY of the

below:

• Charting is incomplete

and missing key items

(noted above).

• Chart fails to provide a

synthesis of the resident’s

decision-making and

thinking process.

• Incomplete charting

• Ineﬃcient/verbose,

illegible or incoherent

documentation.

Resident’s chart is

approximately described

by the below:

• Charting fails to provide

a thorough narrative of

the patient-doctor

encounter in the ED but

to incorporates parts all

the important elements.

• Chart fails to provide a

synthesis of the

resident’s decision-

making & thinking

process.

• Hard to read.

Resident’s chart is

mostly described by

the below:

• Charting provides a

complete narrative of

the patient-doctor

encounter in the ED.

• Confusing, but still is

able to convey the

overall thinking

process to external

reader.

• Eﬃcient, legible

documentation.

Resident’s chart is described

by ALL of the below:

• Charting provides a thorough

narrative of the patient-doctor

encounter in the ED.

• Chart provides a succinct and

nuanced synthesis that fully

explains the resident’s

decision-making & thinking

process.

• Eﬃcient, legible

documentation.

Name of Resident: ___________Name of Assessor_________________ Date:_________

CHECKLIST

CHART 1

CHART 2

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

DONE

DONE BUT NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

Time of assessment & reassessments recorded

Organized & Legible

Involved Parties documented (self, attending, consultants)

including his/her signature and printed name

Initial plan documented and guides reader to understand their

thinking process.

Reassessments documented; changes noted

Results from pertinent investigations are documented.

Orders are thorough and complete (times documented)

Documents procedures appropriately

Disposition plan (i.e. discussion with consultant, Discharge

instructions, Follow-up plans) are documented.

22

Major Task | Airway

A focus this month will be for the resident to participate as the AIRWAY MANAGER during a critical

care case or procedural sedation. (ME1.1)

The junior resident should be given the task of assessing and managing the patient’s airway during a criti-

cal care case or procedural sedation. He/she may be supervised by yourself or a senior resident.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident demonstrates most of

the following or an equivalent

behaviour:

• Unable to integrate as a team

member into greater task (e.g.

providing adequate sedation

for procedure)

• Displays DISRUPTIVE

BEHAVIOUR

• Unable to communicate

patient issues to team in an

eﬃcient/timely fashion

• Many of the checklist items

(above) were not identiﬁed

Resident demonstrates most

of the following or an

equivalent behaviour:

• Could improve on certain

aspect(s) of the checklist

items

• Able to integrate into team,

but requires expert

guidance regarding big

picture (e.g. needed to be

reminded that can only do

RSI only after IV started)

• Able to perform basic

airway maneuvers, but

requires attending

assistance with more

complex tasks

Resident demonstrates most of the

following or an equivalent

behaviour:

• Completes all required tasks in

eﬃcient manner;

• Seamlessly integrates into team,

seems to appreciate greater

context of their role in the team

• Collaborates well with other team

members (e.g. arranges monitored

room with RN for Procedural

Sedation; communicate desired

drugs to nurses prior to beginning

procedure)

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident

to attempt during his/her next shift. (You do not need to record this).

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT DONE

N/A FOR

CASE

Complete a focused medical history relevant to airway management

Complete an airway assessment to determine a diﬃcult BVM (i.e. MOANS

or BOOTS) or intubation (i.e. LEMONS)

Gathers and assembles appropriate equipment

Articulates a sequential airway plan in the event of diﬃcult BVM /intubation

Appropriately selects & uses medications for RSI / PSA

Below is an Overall Rating For Integration within the Team*: If you were not the code team leader or

the proceduralist, please get feedback from these team-mates before rendering your assessment.

Name of Resident: ___________Name of Assessor_________________

23

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT DONE

N/A FOR

CASE

Informs patient of results of any investigations in simple language

Informs patient of diagnosis (if possible), other possible diagnoses, and

describes prognosis (if possible)

Informs patient of care plan (overall)

(a) explains any prescriptions (rationale for use, potential side-eﬀects)

(b) logistics of follow-up (conﬁrm phone number, give consultant contact

info, explains how to return for next day testing)

(c) contingency plan (return instructions, symptoms of serious diagnosis

or complication)

Ensures patient understands diagnosis and care plan

Minor Task | Discharge Instructions

Today’s focus is on discharge instructions. (CM 1.3)

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident displays any of the

below:

• signiﬁcant gaps in discharge

instruction (see checklist)

• Overly technical jargon

• Confusing to patient

• Conﬂict arose and escalated

Resident displays most of the below:

• Professional

• Ineﬃcient with time.

• Used complicated concepts or

jargon occasionally.

• Patients questions were answered

most of the time.

• Eventually, arrived at a plan that

was amenable to all parties.

Resident displays ALL of the

below:

• Professional

• Time Eﬃcient

• Catered to patient’s level of

understanding and needs.

• Answered questions from

patient and/or family.

• Arrived at a plan that was

amenable to all parties easily.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Educational Prescription) for the resident to attempt during his/her

next shift. (You do not need to record this).

Name of Resident: ___________Name of Assessor_________________ Date:_________

24

Minor Task | Delivery of Care plan to Family or Patient

Today’s focus is the discussion of a Patient Care Plan with Patient or their Family. (CM2.2)

Observations are based on 1-2 encounters with non-critically ill patients during your shift. Only

the discussion around the ED management plan needs to be observed, not the entire resident-

patient interaction.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident displays any of the

below:

• Overly medicalized jargon

• Confusing to patient

• Was unwilling to compromise

• Conﬂict arose and escalated

• Failed to develop rapport

with patient and family.

• Behaved awkwardly or

inappropriately with patient

and/or family as a result of

language barrier

Resident displays some of the

below:

• Built adequate rapport with

everyone present in the room.

• Ineﬃcient with time.

• Used complicated concepts or

jargon at times, but corrected

themselves.

• Patients questions were

eventually answered.

• Plan required sacriﬁces by at

least one party.

Resident displays ALL of the

below:

• Gained trust with patient and

family.

• Time Eﬃcient

• Catered to patient’s level of

understanding and needs.

• Answered questions from

patient and/or family.

• Arrived at a plan that was

easily amenable to all parties.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift. (You do not need to record this).

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Uses simple (non-medical language) to explain the likely diagnosis or

diagnostic possibilities

Explains the nature of subsequent investigations or treatments

SEE BELOW (a-d)

a) Anticipated process or problems (e.g. pain) of any procedures, as

applicable.

b) Time until results will likely be available

c) Expected length of stay

d) Expected clinical course (likely admission by others or discharge)

Ensures patient understands care plan

Gives patient an opportunity to ask questions

Willing to appropriately adjust care plan according to patient’s needs and

values

Name of Resident: ___________Name of Assessor_________________

25

Minor Task | Patient Care Plan Discussion with Other Healthcare Professionals

Today’s focus will be the discussion of Patient Care Plans with Other Healthcare Professionals (CL2.2).

The attending physician should make observations based on 1-2 encounters with nurses, RTs etc. during the

shift. Only the discussion around ED management for a speciﬁc patient needs to be observed.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift. (You do not need to record this).

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs Assistance

2

3

4

5

6

7

Ready for Next Steps

Resident displays any of the

below:

• Disruptive

• Confusing to healthcare

professional

• Was unwilling to

compromise

• Conﬂict arose and escalated

Resident displays some of the

below:

• Professional

• Ineﬃcient with time.

• Healthcare professional’s

questions were incompletely

answered.

• Arrived at a plan that

required ﬂexibility from

healthcare professional

Resident displays ALL of the below:

• Professional

• Time Eﬃcient.

• Answered questions from allied

health care member.

• Arrived at a plan that was easily

amenable to all parties.

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

Ensures healthcare professional has time to hear care plan

Explains WHAT tests/treatments have been ordered or what goals/plans have been

establish for patient

Explains WHY tests/treatments have been ordered or plans have been established

Explains URGENCY of interventions or plans

Ensures healthcare professional understands care plan

Gives healthcare professional opportunity to ask questions

Name of Resident: ___________Name of Assessor_________________ Date:_________

26

Task | Consult Request

Today’s focus is the advanced consultation request. (CL2.3)

This assessment can be for ANY patient (stable or unstable) who requires an immediate referral for a consultation

(including diagnostic imaging). The learner can be referring to another resident (e.g. the Surgical Resident, Sen-

ior Medical Resident) OR an attending physician (e.g. Peds ER, Criticall for Trauma team/Neurosurgery). Resident

has Supervisor listen (or observe) to them making a consult request.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident displayed any of the

below:

• Unprofessional

• Confusing to Consultant

Colleague

• Did not convey relevant and/or

crucial information (i.e. urgency,

important management)

• Was unwilling to compromise

• Conﬂict arose and escalated

Resident’s actions are

described by most of the

below:

• Professional

• Colleague’s questions were

answered.

• Eventually, arrived at a plan

that was amenable to all

parties.

Resident displays all of the

below:

• Professional and approachable.

• Built a good rapport.

• Answered questions from

consulted colleague.

• Arrived at a plan that was

amenable to all parties easily.

The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift. (You do not need to record this).

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT DONE

N/A FOR

CASE

Prepares data prior to initiating consultation (chart, labs, etc.)

Introduces self/role/supervisor

Obtains name of consulting physician

Highlights Reason for consult request e.g. “I have a patient with worsening COPD

that requires admission”

States urgency of consultation and establishes timeline

Has a clear Clinical Question( “Does this person have appendicitis?”) for the

consultant or presents rationale for consultation (e.g. This patients requires an

operation.)

Provides a coherent Summary of relevant ﬁndings (Hx, Px, Investigations,

Management)

Clariﬁes any details/answers questions of consultant

Documents consultation on chart

Name of Resident: ___________Name of Assessor_________________ Date:_________

27

Task | Mini Chart Audit

Today’s focus is on charting. (CM2.1) T

The attending physician should randomly select TWO charts to audit. Should take 5-6 minutes to complete.

The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be ef-

fectively given with both resident and attending physician reviewing the chart.

How well did the resident perform this task?

CHECKLIST

CHART 1

CHART 2

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT

DONE

DONE BUT

NEEDS

ATTENTION

NOT

DONE

Completes all basic identiﬁers (Self, Attending, Date, Times)

Information relevant to CC and HPI recorded

Physical Examination - relevant systems

Physical Examination - documents speciﬁc elements; avoids broad

sweeping generalizations

Relevant Investigations (e.g. ECG, relevant labs, Imaging indicated)

Documents procedures e.g. type of closure, suture type, anesthetic - type

and dose

Reassessments documented (including time); changes noted

Disposition plan documented (e.g. Consultation time/discussion; Discharge

Instructions - relevant and appropriate; Rx or continuation orders as

appropriate)

Completion of Ancillary Paperwork (Rx, referral forms, etc..)

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs Assistance in area

Requires extensive charting by

attending to compensate for

missing items.

2

3

Requires signiﬁcant charting by

attending to rectify charting.

4

5

Requires minimal charting by

attending to clarify charting.

6

7

Ready for Next Steps

Attending documents no additional

or further information that is not

already contained in the chart.

Resident’s chart is

described by ANY of the

below:

• Charting is incomplete and

missing key items (noted

above).

• Chart fails to provide a

synthesis of the resident’s

decision-making and

thinking process.

• Ineﬃcient/verbose, illegible

or incoherent

documentation.

Resident’s chart is roughly

described by the below:

• Charting fails to provide a

thorough narrative of the

patient-doctor encounter in

the ED but to incorporates

parts all the important

elements.

• Chart fails to provide a

synthesis of the resident’s

decision-making & thinking

process.

• Hard to read.

Resident’s chart is

roughly described by the

below:

• Charting provides a

complete narrative of

the patient-doctor

encounter in the ED.

• Confusing, but still is

able to convey the

overall thinking process

to external reader.

• Eﬃcient, legible

documentation.

Resident’s chart is described by

ALL of the below:

• Charting provides a thorough

narrative of the patient-doctor

encounter in the ED.

• Chart provides a succinct and

nuanced synthesis that fully

explains the resident’s

decision-making & thinking

process.

• Eﬃcient, legible

documentation.

Name of Resident: ___________Name of Assessor_________________ Date:_________

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details

to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift.

4

ASSESSMENT INDEX

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Authors:

Paul Miller

Michelle Welsford

Editor:

Teresa Chan

Jonathan Sherbino

INTERMEDIATE MODULES !

PROFESSIONAL & COMMUNICATOR

29

DEMOGRAPHICS OF PATIENT: (AGE, GENDER, CC)

DONE

DONE BUT NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

PART 1: Set the Stage

GREET: Greet the patient appropriately again (explains why they have returned)

PRIVACY: Maintain the patient’s privacy (e.g. close the door) within reasonable limits in

ED environment

PERSONAL CONNECTION (e.g. go beyond the medical issues at hand)

PART 3: Give Information

EXPLAIN PLAN: Explain the rationale for diagnostic procedures (e.g. exam, test) and help

explain the results to the patient.

TEACHING: Teach the patient about his/her own body and situation (e.g. provide

feedback from exam/tests, explain anatomy/diagnosis)

OPEN TO QUESTIONS: Encourage the patient to ask questions

AVOIDS JARGON: Adapt to the patient’s level of understanding (e.g. avoid/explain jargon)

NEXT STEPS: Explain the next step regarding the patients’ plan.

OVERALL: Understand the Patient’s Perspective

ADDRESSES WAIT TIME: Acknowledge waiting time

EMPATHY: Express caring, concern, empathy

TONE: Maintain a respectful tone

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

Major #1 | Modiﬁed SEGUE History - Part 2

Today’s focus will be on the Reassessment of Patients for Disposition

The faculty member should observe the resident’s encounter with his/her patient as he/she completes a reassess-

ment of a patient. Ideally, this should be a reassessment of a patient who is being managed by the resident (e.g.

dehydrated patient who has been given a PO ﬂuid challenge). Only the reassessment (including plan delivery)

needs to be observed, not the entire resident-patient interaction.

Name of Resident: _________ Name of Assessor______________ Date:_________

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident displayed any of below:

• Discussion incomplete.

• Encounter was disorganized

• Failed to develop rapport with patient and

family.

• Did not seek to answer family or patient

concerns.

Resident displayed some of

below:

• Slightly disorganized or

ineﬃcient manner.

• Built adequate rapport with

patient.

• Attended to answers from

patient or family.

Resident displayed all of below:

• Time eﬃcient.

• Established a good rapport &

trust with all present in the

room.

• Solicited and attended to

answers from patient or family.

Adapted from the SEGUE Checklist. [Makoul et al., The SEGUE Framework for teaching and assessing communication skills. Patient Educ Couns. 2001 Oct;45(1):

23-34.]

30

Name of Resident: _________ Name of Assessor______________ Date:_________

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

Establishes that the patient or substitute decision maker is competent.

Content & Discussion

-

Establishes the best possible environment (Minimizes interruptions; Selects the

right setting; Sits down if able; Provides appropriate privacy within resources

available.)

-

Ensures Patient understands and appreciates:

•

The plan & options

•

Indications for the procedure, foreseeable beneﬁts

•

The Risks

•

The available alternatives to the procedure.

Language & Listening

-

Avoids or deﬁnes jargon

-

Utilizes Reﬂective Listening to summarize the discussion

-

Listens and responds to questions or concerns.

Properly documents Consent (chart, speciﬁc consent form)

TOTAL

Task | Obtaining Consent

Today’s focus is obtaining consent. (P 1.4)

The attending physician should observe a consent discussion for a non-emergent intervention or procedure

(e.g. blood transfusion, central line, lumbar puncture, etc..)

OPTIONAL: For pre-reading, the resident may want to review resources from the Canadian Medical Protective

Association (CMPA):

http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/index/index-e.html >> Communica-

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

ANY OF THE

FOLLOWING:

• Seems rushed or

uncomfortable

• Poorly prepared for the

discussion.

• Required attending

physician to halt or

redirect conversation.

• Builds appropriate rapport

• Provides all options, but

requires moderate clariﬁcation

for participants to understand

plan

• Moderate role of attending

physician to steer the course

and guide decision making.

• Puts patients at ease

• Provides all options, and

requires little clariﬁcation

for participants to

understand plan.

• Minor role of attending

physician to clarify/aﬃrm

the plan for implementation.

ALL OF THE FOLLOWING:

• Puts patient at ease.

• No requirement for

attending physician to

participate.

• Identiﬁes the limits of the

discussion if disagreement

occurs (e.g. reaches a

conclusion or a neutral

decision point that may be

decided later)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to

ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during his/her

next shift.

31

Task | Audit of In-patient outcome

Today’s focus is auditing and reﬂecting on my ED care of an admitted patient (in patient). (P2.1)

From the PAST TWO shifts, the resident will choose two patients that they will continue to follow and audit as in-

patients. They should keep an anonymized version of each patient chart (e.g. photocopy without the patient name/

address) to refer to during this debrief.

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident demonstrates most of the

following or an equivalent

behaviour:

• Did not complete assignment

• Could not demonstrate evidence

of reﬂection and insight regarding

case and process (e.g. is

defensive about a learning point

that the attending identiﬁes)

• Resident demonstrates most of the

following or an equivalent behaviour:

• Identiﬁes an area for improvement

• Is able to reﬂect about the case in an

objective manner.

• Identiﬁes a speciﬁc learning objective

from each patient with the help of the

attending physician.

Resident demonstrates most of the

following or an equivalent

behaviour:

• Identiﬁes areas for improvement;

• Is able to reﬂect about the case in

an objective manner.

• Identiﬁes a speciﬁc learning

objective from each patient

without the help of the attending

physician.

Unit Number of

Patient

Initial ED

diagnosis

Consulting services

Diagnosis or

Management

Summary of Patient’s Progress in Hospital (either

by auditing patient chart on in-patient unit,

discussing with colleagues [e.g. SMR], or by

auditing dictations)

Reﬂection regarding your ED management.

Worksheet (to be completed by the resident PRIOR to shift)

The resident may choose to gather the following data in a number of ways. They may choose to round on the pa-

tient, review the patient’s in-patient chart call the admitting team for an update, or check on the computer system

for reports (consult note, Imaging report, culture report).

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift.

Name of Resident: ___________ Name of Assessor_________________ Date:_________

32

Task | End of Life & Advanced care planning

Today’s focus is establishing Goals of Care (a.k.a. End of Life Care and Advanced Care Plans). (P2.2)

The attending should listen to (or observe) the resident’s discussion of this topic with the patient. An appropriate

patient would be not in extremis or confused, has a condition which requires this care plan, is willing to engage in

discussion of End of Life care. The patient does not need to be in a conﬁrmed palliative state. The patient may

be a stable patient who is being admitted to an in-patient service.

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Seems rushed or

uncomfortable

• Poorly prepared for the

discussion.

• Required attending

physician to halt or

redirect conversation.

• Builds appropriate rapport

and demonstrates

• Provides all options, but

requires moderate

clariﬁcation for participants

to understand plan

• Moderate role of attending

physician to steer the course

and guide decision making.

• Builds appropriate rapport

and demonstrates

• Provides all options, and

requires little clariﬁcation

for participants to

understand plan.

• Minor role of attending

physician clarify/aﬃrm the

plan for implementation.

• Puts participants at

ease.

• No requirement for

attending physician to

participate.

• Identiﬁes the limits of

the discussion (e.g.

reaches a conclusion or

a neutral decision point

that may be decided

later)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add

enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift.

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT

DONE

N/A FOR

CASE

Awareness and Preparation

Ensures the pertinent participants in the discussion (i.e. relevant substitute decision

makers; patient; family)

Prepares participants for discussion; forecasts the topic; describes the goal of the

talk, asks permission

Establishes the best possible environment - Select the right setting; Sits down if

able; Provides appropriate privacy within available resources.

Content & Discussion

Ensures that patient or SDM understands options for care

Elicits speciﬁc goals of care suﬃcient to complete the Pertinent Documentation

Language & Listening

Avoids or deﬁnes Jargon

Use Reﬂective Listening to summarize the goal(s).

Documents the encounter appropriately.

Name of Resident: ___________ Name of Assessor_________________

33

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

Task | Mandatory Reporting *** PREPARATION REQUIRED***

Today’s focus is on Mandatory Reporting. (P1.3)

This assessment exercise might not be related to a patient seen during the shift, but ideally should include

patients from recent shifts. If the resident cannot recall recent patients, hypothetical scenarios may be cre-

ated to demonstrate understanding of the concepts.

ANONYMOUS PATIENT DEMOGRAPHICS (please put a *

if the patient is hypothetical)

Explain the relevant policy or law and how it

applied

To whom do you report this problem?

Be prepared to discuss the relevant policies and legislation, to whom to report, and the gaps/reasons some

conditions or concerns may not be reportable. Include a discussion of what inter-personal violence is report-

able.

Name of Resident: ___________ Name of Assessor_______________

PRIOR TO THE SHIFT:

Example from Ontario - CPSO Policy #6-12 - reference materials on Mandatory and Permission Reporting

(https://www.cpso.on.ca/policies/policies/default.aspx?id=1860)

Also consider reviewing materials on: Child Abuse, Elder Abuse; Potential violence reporting; or other re-

portable conditions. In preparation for this task, the resident should log up to 3 patients recently (within the

past 2 weeks) that they think might have a condition or situation that merits the consideration of mandatory

reporting.

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Incomplete preparation or unable to

identify even 1 example patient

• Unable to apply CPSO policy

• Familiar with majority of policies and requirements

• Unfamiliar with speciﬁc details in policy or law

• Able to apply policy to common or frequently discussed situations

(e.g. MTO form)

• Well versed with all policies/legislation

• Able to recognize and apply to patients including

rare and complicated situations

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add

enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift.

34

Minor #2 | Capacity Assessment

Today’s focus will be Capacity Assessment. (P1.2)

During this shift, the attending physician should identify a patient on whom the resident should perform a

non-emergent capacity evaluation. The ideal patient for this encounter would be a patient who may have

some memory deﬁcits, but is not a diﬃcult historian. Using the ACE tool or another method, the resident

should explain their assessment of the patient’s capacity to the supervisory attending physician. The attend-

ing will then rate the resident’s ability to assess the capacity of the patient based on their approach and the

questions they decided upon in the ACE worksheet.

OPTIONAL: In preparation, the resident may review the following paper:

1) Sussums et al., Does This Patient Have Medical Decision-Making Capacity? JAMA.

2011;306(4):420-427.

2) Also: http://www.cmaj.ca/content/155/6/657.abstract

One of the tools featured in this JAMA Rational Clinical Exam series is the “Aid to Capacity Evaluation” form.

Both you and the resident should complete a capacity assessment of the patient. Then, please rate your level

of agreement with the resident’s assessment of the patient. If possible, you may OBSERVE the resident doing

this assessment. Otherwise, you may simply make your own independent assessment.

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL

1*

Needs Assistance in this area

I completely disagree with the resident’s

assessment of the patient’s capacity for

decision making.

2*

3*

4*

I somewhat agree with the resident’s

assessment of the patient’s capacity for

decision making.

5

6

7

Ready for Next Steps

I fully agree with the resident’s

assessment of the patient’s capacity.

(i.e. both arrived at the same

impression of the patient).

Resident displayed any of below:

• The resident’s assessment of the

patient’s capacity for decision

making was inaccurate.

• S/he missed key aspects of the

capacity assessment. The resident

was unable to justify their decision.

Resident displayed some of the

below:

• S/he was able to elucidate most of

the data needed to complete the

capacity assessment and justify

their decision.

• S/he had a diﬀerent, but likely

acceptable interpretation of the

patient’s ability to make decisions.

Resident displayed all of the

below:

• The resident was able to

elucidate all the data needed to

complete the capacity

assessment.

• S/he was able to justify and

defend their decision.

*Please describe what ﬁndings were diﬀerent if you rated the resident a score of 1-4.

Name of Resident: ___________ Name of Assessor_______________ Date:_________

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt

during his/her next shift.

35

Task | SBAR (Handover)

Handover: Communication with a fellow Emergency Physician

Handover between physicians occurs in various forms within the Emergency department. Some handovers occur

at shift-change between emergency physicians and some occur at transitions of care between medical specialists.

Today you will be assessed in your handover of a patient to a physician-colleague.

For the purposes of the handover to the EP, the resident should prepare one patient near the end of the shift to dis-

cuss as a handover to the incoming attending. If the timing is not optimal, this may be a simulated handover of a

patient to the supervising attending physician (e.g. resident “hands-over” the a patient at the end of their shift to

their attending prior to going home.)

There are multiple models for handover for physician-to-physician handover. In preparation for today’s task, you should review

the SBAR model and be prepared to utilize this model to handover a patient. The SBAR model was originally developed to stan-

dardize and optimize communication between nurses and physicians.

PREREADING: Please refer to the following link and the various papers cited there.

http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBrieﬁngModel.aspx

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR

CASE

S

Situation – explains the situation requiring handover.

B

Background – succinctly summarizes the relevant ﬁndings and labs

gathered to date.

A

Assessment – provides a synthesis (e.g. summary, hypothesis)

R

Recommendation(s) – provides a plan for the in-coming team regarding

patient care or further decision making.

(e.g. “If the CT is negative, then the plan is…”)

Completes adjunctive paperwork (e.g. out-patient referrals, Rx) in preparation

for handover.

Completes adjunctive paperwork (e.g. out-patient referrals, Rx) in preparation

for handover.

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Any of the below:

• Unprofessional

• Confusing to Consultant Colleague

• Did not convey relevant and/or

crucial information (i.e. urgency,

important management)

• Was unwilling to compromise

• Conﬂict arose +/- escalated

• Professional

• Ineﬃcient with time.

Colleague’s questions were

answered. Eventually, arrived

at a plan that was amenable

to all parties.

• Professional.

• Concise & Time Eﬃcient.

• Built a good rapport.

• Answered questions from

consulted colleague.

• Arrived at a plan that was

amenable to all parties easily.

Name of Resident: ___________ Name of Assessor_______________ Date:_________

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to attempt during

his/her next shift.

36

Name of Resident: ___________ Name of Assessor_______________ Date:_________

Major Task | Documentation

Today’s focus is to assess the completeness of the resident’s medico-legal documentation. (CM 2.3)

The attending physician should randomly rate two of the residents charts using the following checklist and rating

scale. The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be

eﬀectively given with both resident and attending physician reviewing the chart.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs Assistance:

Requires extensive charting by

attending to compensate for

missing items.

2

3

Requires signiﬁcant charting

by attending to rectify

charting.

4

5

Requires minimal charting

by attending to clarify

charting.

6

7

Ready for Next Steps:

Attending documents no additional

or further information that is not

already contained in the chart.

Resident’s chart is

described by ANY of the

below:

• Charting is incomplete

and missing key items

(noted above).

• Chart fails to provide a

synthesis of the resident’s

decision-making and

thinking process.

• Incomplete charting

• Ineﬃcient/verbose,

illegible or incoherent

documentation.

Resident’s chart is

approximately described

by the below:

• Charting fails to provide

a thorough narrative of

the patient-doctor

encounter in the ED but

to incorporates parts all

the important elements.

• Chart fails to provide a

synthesis of the

resident’s decision-

making & thinking

process.

• Hard to read.

Resident’s chart is

mostly described by

the below:

• Charting provides a

complete narrative of

the patient-doctor

encounter in the ED.

• Confusing, but still is

able to convey the

overall thinking

process to external

reader.

• Eﬃcient, legible

documentation.

Resident’s chart is described

by ALL of the below:

• Charting provides a thorough

narrative of the patient-doctor

encounter in the ED.

• Chart provides a succinct and

nuanced synthesis that fully

explains the resident’s

decision-making & thinking

process.

• Eﬃcient, legible

documentation.

CHECKLIST

CHART 1

CHART 2

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT

DONE

N/A

FOR

CASE

DONE

DONE BUT

NEEDS

ATTENTION

NOT

DONE

N/A

FOR

CASE

Time of assessment & reassessments recorded

Organized & Legible

Involved Parties documented (self, attending, consultants)

including his/her signature and printed name

Initial plan documented and guides reader to understand their

thinking process.

Reassessments documented; changes noted

Results from pertinent investigations are documented.

Orders are thorough and complete (times documented)

Documents procedures appropriately

Disposition plan (i.e. discussion with consultant, Discharge

instructions, Follow-up plans) are documented.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score.

(MANDATORY)

Also, based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift.

5

ASSESSMENT INDEX

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Authors:

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Sandy Dong

Editors:

Teresa Chan

Jonathan Sherbino

INTERMEDIATE MODULES !

HEALTH ADVOCATE & MANAGER

38

Resident Name: ____________ Name of Assessor________________ Date:_________

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Unable to self-identify any areas in

need of improvement

• Unable to develop plans for

improvement even with preceptor

assistance

Requires preceptor’s assistance

to identify:

• area in need of improvement

• plan for future improvement

Able to self-identify (with minimal

preceptor assistance):

• area in need of improvement

• plan for future improvement

• Able to articulately identify area MOST in

need of improvement with no assistance

from preceptor

• Able to independently articulate plan for

improvement with minimal or no

preceptor guidance.

Resident’s self-identiﬁed area for

improvement

Preceptor’s suggestion for area of

improvement (may be similar or

diﬀerent)

Mutual agreed upon area for

improvement

Plan for success (collaboratively

developed by preceptor and

resident)

Task | Performance Improvement Part 1

Today’s focus is on personal practice improvement (M1.2)

Continuous professional development is a lifelong skill. This exercise introduces the junior resident to per-

sonal learning projects. The area or topic for improvement can be from any of the CanMEDS Roles. For

the purpose of this assessment tool, the area can be “simple” (e.g. “learn how to solve an acid-base prob-

lem etc.).

By the end of this shift, the resident, along with the preceptor identiﬁes a single area in which to improve.

IT SHOULD BE THE AREA MOST IN NEED OF IMPROVEMENT BASED ON TODAY’S PERFORMANCE.

The area and a brief plan for improvement is outlined in the following table:

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your

rating. Add enough details to ensure another faculty member can quickly understand your rationale for the

above score. (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription)

for the resident to attempt during his/her next shift.

The basis of this assessment tool is to encourage reﬂective practice and steer junior & intermediate residents towards assessment-

seeking. For futher reading or justiﬁcation for this task: Eva KW, Regehr G. Self-assessment in the health professions: a reformulation

and research agenda. Acad Med. 2005 Oct;80(10 Suppl):S46-54.

39

Major Task | Performance Improvement Part 2

Today’s focus is to check on your process regarding your personal practice improvement plan. (M1.3)

Several shifts ago, you and your preceptor made a plan. You will now discuss your progress with your preceptor re-

garding your previously identiﬁed area of improvement.

Please summarize the area you identiﬁed for improvement:

Describe some examples on

how you worked on this

identiﬁed area?

What successes have you

encountered?

What challenges have you

encountered?

What other feedback have you

received from other faculty

members on similar areas?

RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)

1

I need assistance

2

3

4

5

6

7

I’m ready for the next step

I have been unable to make

a change in this area of my

practice

I have been able to

make marginal change

in this area of practice.

I have made a substantial

change in this area of

practice.

Previously identiﬁed

weakness is no longer an

issue.

PRECEPTOR-ASSESSMENT

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident has been unable to

make a change on this area

of my practice

Resident has been able to

make marginal change in

this area of practice.

Clearly is improving.

Resident has made a

substantial change in this

area of practice.

Vastly improved from my last

observation.

Previously identiﬁed

weakness is no longer

noted.

What are your next steps?

Resident Name: ______________Name of Assessor_________________ Date:_________

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

The basis of this assessment tool is to encourage reﬂective practice and steer junior & intermediate residents towards assessment-seeking. For futher

reading or justiﬁcation for this task: Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005

Oct;80(10 Suppl):S46-54.

40

Task | Work/Life Balance

Today’s focus is to set priorities and manage time to balance patient care, practice requirements, outside

activities and personal life. (M1.4)

Residency is a busy and often stressful time. Time management and prioritization are important to success as a

resident. Often we are unable to appreciate the diﬀerence between urgency and importance. The two are not

the same. The importance of an event or task can be relative.

PRE-SHIFT ASSIGNMENT

The resident should create or produce (if he/she already has one) a calendar for the week, and a list of

tasks that need to be done in the next week.

Important

Not Important

Urgent

Not Urgent

Each calendar event and task should be placed in one of the boxes below:

Above scoring rubric is modiﬁed from a reﬂective rating schema from Donato A, George DL. Academic Medicine. 2012: 87(2), p. 188.

PLEASE CIRCLE THE BEST DESCRIPTOR OF THE RESIDENT’S REFLECTIVE ABILITY

1

Minimal or no effort.

2

3

Reporter

4

5

Interpreter

6

7

Manager/Educator

• Resident’s work

incomplete ; not

permitting an opinion

of his/her reﬂective

capacity.

• Resident has no/

minimal insight.

• Resident demonstrates

ability to record

concrete aspects of

their life (ﬁndings, what

was done).

• Resident demonstrates

ability to reﬂect

meaningfully on his/her

current situation how he/

she might have handle

identiﬁed problems.

• Resident forms an action

plan for improvement and/

or explains how to

extrapolate their reﬂection

on this activity to other

aspects of their life.

The attending and resident should have a discussion about how to manage the non-urgent, not important tasks that have been

identiﬁed. Based on the discussion, the attending should rate the resident’s ABILITY TO REFLECT on their own situa-

tion.

Resident Name: ______________ Name of Assessor_________________ Date:_________

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription)

for the resident to attempt during his/her next shift.

41

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough

details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the resident to

attempt during his/her next shift.

Task | ED Flow

Today’s focus is speciﬁc strategies to manage ED ﬂow and prevent crowding. (M2.1)

During the shift, the resident should look at the list (computer ED tracking system or chart rack) of patients yet to

be seen by a physician. The resident is to prioritize (verbally, to the preceptor) in which order the patients should

be seen. Ideally there should be between 5 - 8 patients to be seen at the time of this task. The resident may read

the triage notes of each of the patients in order to determine plan. THIS IS AN ASSESSMENT IN PLANNING - the

resident is not expected to see all these patients.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident displays any of the

following (or a similar

behaviour):

• Presents a disorganized plan

for seeing the patients.

• Uses CTAS scores ONLY to

guide who to see next.

Resident displays any of the following

(or a similar behaviour):

• Presents a plan that incorporates

CTAS scores, but also clinical

judgment regarding time expected

with each patient.

Resident displays all of the following (or

a similar behaviour):

• Presents a plan to safely and eﬃciently

triages patients in a reasonable order

(utilizing more than just CTAS score).

• Takes into account department

physical layout and workﬂow to see

patients.*

CHECKLIST

DONE

DONE BUT

NEEDS

ATTENTION

NOT DONE

N/A FOR

CASE

Utilizes acuity (e.g. CTAS scores) to explain order to see patients.

Takes into account patient factors (e.g. wait times, pain score) to determine

order.

Takes into account geography of patient location.

Instructor Hints

At the PGY-2 level, most residents are still working on addressing the presenting problem. However, they should be aware

of the eﬀects of ED crowding and how they can most eﬀectively work in a crowded ED. This exercise assumes there are

multiple patients waiting in care areas to be assessed by a physician. If that is not the case at the start of the shift, then an-

other point during the shift may be used.

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

42

P8

Task | Airway

A focus this month will be for the resident to participate as the AIRWAY MANAGER during a critical care

case or procedural sedation. (ME1.1)

The junior resident should be given the task of assessing and managing the patient’s airway during a critical

care case or procedural sedation. He/she may be supervised by yourself or a senior resident.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

Resident demonstrates most of the following or an

equivalent behaviour:

• Unable to integrate as a team member into greater

task (e.g. providing adequate sedation for

procedure)

• Displays DISRUPTIVE BEHAVIOUR

• Unable to communicate patient issues to team in

an eﬃcient/timely fashion

• Many of the checklist items (above) were not

identiﬁed

Resident demonstrates most of the following

or an equivalent behaviour:

• Could improve on certain aspect(s) of the

checklist items

• Able to integrate into team, but requires

expert guidance regarding big picture (e.g.

needed to be reminded that can only do RSI

only after IV started)

• Able to perform basic airway maneuvers, but

requires attending assistance with more

complex tasks

Resident demonstrates most of the following or an

equivalent behaviour:

• Completes all required tasks in eﬃcient manner;

• Seamlessly integrates into team, seems to appreciate

greater context of their role in the team

• Collaborates well with other team members (e.g.

arranges monitored room with RN for Procedural

Sedation; communicate desired drugs to nurses prior to

beginning procedure)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score.

(MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the

resident to attempt during his/her next shift.

CHECKLIST

DONE

DONE BUT NEEDS

ATTENTION

NOT DONE

N/A FOR CASE

Complete a focused medical history relevant to airway management

Complete an airway assessment to determine a diﬃcult BVM (i.e. MOANS or BOOTS) or intubation (i.e.

LEMONS)

Gathers and assembles appropriate equipment

Articulates a sequential airway plan in the event of diﬃcult BVM /intubation

Appropriately selects & uses medications for RSI / PSA

Below is an Overall Rating For Integration within the Team*: If you were not the code team leader or the pro-

ceduralist, please get feedback from these team-mates before rendering your assessment.

Resident Name: ______________Name of Assessor_________________ Date:_________

43

Reference: Chan, T., Orlich, D., Kulasegaram, K., & Sherbino, J. (2013). Understanding communication between emergency and consulting physicians: a

qualitative study that describes and deﬁnes the essential elements of the emergency department consultation-referral process for the junior learner.

CJEM, 15(1), 42-51. PMID: 23283122

Minor Task | Time Management

Today’s focus is Time Management. (M1.1)

A key skill for an an emergency physician is time management. You should observe how the resident:

-

organizes his/herself to complete key tasks ASIDE from the initial patient encounter and decision making

process (i.e. the resident’s eﬃciency in completing tasks that need to be done once the a care decision has

been made - consults, paperwork, reassessments)

-

prioritizes tasks to be done next

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score.

(MANDATORY)

The next step: Based on the above evidence, please give one speciﬁc suggestion (Education Prescription) for the

resident to attempt during his/her next shift.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1

Needs assistance

2

3

4

5

6

7

Ready for the next level

• Needs constant

reminders to reassess

patients.

• Ineﬃcient with time in

the department

• Needs a few

reminders about

patients.

• Returns to reassess

patients multiple

times (> 3 times)

before arriving at a

plan

• Functions

independently

regarding patient

assessments and

reassessments

• Orders appropriate

tests, reassess pts

only 2-3 times

before arriving at

diagnosis and

disposition plan.

• Is ﬂow conscious with his/

her portfolio of patients

(assessments,

reassessments,

investigations).

• Eﬃciently sees multiple

patients, arriving at

diagnosis/disposition in a

time-eﬃcient manner.

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

44

Resident Name: ______________Name of Assessor_________________ Date:_________

Major Task | Patient Survey (NOTE: THIS ACTIVITY RUNS OVER 4 PAGES)

Today’s task is to identify the needs of an individual patient. (A1.1)

Your preceptor will pick two patients (or family members) that you see today and ask them a few questions

about your discharge or admission planning process. You will mutually agree on TWO (2) patients that you

both feel are at high risk for either a poor health outcome or a repeat visit to the emergency department.

Once you have completed your care and discharge instructions, please ask the patient to wait for the pre-

ceptor to come and chat with them.

The goal of this exercise is to provide residents with useful feedback about how well they were able to incor-

porate the the key determinants of health that were relevant to patients into discharge or admission plan-

ning.

Instructor Hints

Please ask the following questions to two patients that you or the resident have identiﬁed as high risk for

either a poor health outcome or a repeat visit to the emergency department. Each encounter should take

approximately three minutes. Be prepared to take notes.

WHAT THE ATTENDING MIGHT SAY WHEN APPROACHING THE PATIENT...

Hello [insert patient name]. I am supervising Dr. X today and I would like to ask you a few questions about

the care provided by him/her.

It is my job to make sure that s/he becomes an excellent emergency physician and I would like your opinion

on how things went today.

I will be asking several other patients as well so s/he won’t know which comments came from you.

Would you be willing to talk to me for a few minutes?

Continues on next page

45

Continues on next page

Patient #1

Patient #2

1. Did Dr. X treat you with respect?

2. Did Dr. X listen to you?

3. Did Dr. X explain the following

things to you?

• Diagnosis

• Discharge plan

• Follow-up plan

• Return instructions to the

Emergency Department

4. Did Dr. X provide you with

choices and options regarding

your care plan (discharge or

admission)?

5. Do you think you can do what

Dr. X has suggested? Why or why

not?

6. Are there other important things

that Dr. X did not ask you about?

McMaster Modular Assessment Program Intermediate Edition

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