Name of Resident: Name of Assessor Date:
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
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEDetermine 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
HISTORY-TAKING SKILLS
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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
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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)
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:
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.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEExplains 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
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).
Name of Resident: Name of Assessor Date:
Major Task | Multi-source Feedback
Today’s focus is the Communication with Inter-professional Colleagues.
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).
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.
RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY1
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
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.
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.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEComplete 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.
RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY1
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).
Name of Resident: Name of Assessor Date:
Minor Task | Discharge Instructions
Today’s focus is on discharge instructions.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEInforms 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
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
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.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEUses 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
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).
Name of Resident: Name of Assessor Date:
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.