RESIDENT:
Name of Assessor:
Date:
TASK | Mini Trauma
Today’s Focus is an Initial Encounter with a Trauma Patient
The ideal patient for a PGY1 learner would be a stable patient who is on a backboard, collared from a recent motor vehicle collision (MVC). The resident should be observed completing a primary and secondary sur- vey. The attending should elicit his/her thoughts including initial investigations and/or presumptive diagnosis but NOT management of problems found.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEObtains relevant history from patient or EMS or witness
Conducts primary survey (ABCDE)
Conducts secondary survey of all systems
Demonstrates spinal precautions, utilizing the Canadian C-spine Rules appropriately to risk stratify the patient’s neck injury
Recognizes potentially limb-/life-threatening injuries
Considers mechanism of injury in assessment
Orders appropriate investigations
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
Displays ANY of the following:
• Missing key elements of trauma history
• Unsafe in exam (e.g. spinal precautions) / • Misses some key points of primary survey exam but maintains patient safety.
• Orders limited investigations, inappropriate or unnecessary investigations. / • Complete Primary examination.
• Recognizes severity of illness appropriately.
• Thorough, but incomplete listing of investigations needed. / Displays ALL of the following:
• Performs complete primary survey and secondary survey.
• Displays understanding of injury patterns related to mechanism.
• Complete listing of investigations required. (e.g. including slit lamp exam with fluorescein post-air bag deployment)
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).
RESIDENT: STAFF: DATE:
MAJOR TASK | Procedure (simple procedure – suturing, splinting)
Today’s Focus is an observed Procedure
The ideal patient for a PGY1 learner would be a stable patient who requires a common simple procedure. 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
Appropriately documents the procedure in the medical record.
Please write the type of Procedure:
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
Requires any one of the below:
• Significant instruction
• Assistance with majority of the procedure
• Endangers patient. / • Prompting, but less instruction, no preceptor involvement in actual procedure.
• Often awkward position or movement / • Minimal prompting, mostly independent
• Consistently accurate, proper attention to safety.
• Generally competent, but sometimes awkward.
• correct sequence of steps but not efficient use of time / 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 (Education Prescription) for the resident to attempt during his/her next shift. (You do not need to record this).
RESIDENT:
Name of Assessor:
Date:
TASK | Case Presentations & Patient Management
Today’s focus is the Case Presentation.
Based on three to four case presentations, the attending should rate the resident with regards to their syn- thesis of their history (Hx), physical examination (Px), initial management (e.g. pain control), investigatory plan:
As optional pre-reading the junior resident may read (NOT REQUIRED):
Davenport C, et al. The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme. ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687.
This paper and a related supplemen) are available here: http://lifeinthefastlane.com/2009/06/ed-case-presentation-for-medical-students/
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY1
Needs assistance / 2 / 3 / 4 / 5 / 6 / 7
Ready for the next level
Displayed any of the following behaviours:
•Missing key history and/or physical exam component;
•Unable to form a coherent synthesis of their differential dx;
•Failure to propose an initial management and/or investigatory plan / •Misses some key points on Hx/Px;
•Provides a partial but incomplete DDx;
•Provides a partial initial investigatory or management
plan that lacks some key element / • May be missing some minor elements of Hx/ Px;
• Provides a thorough synthesis and DDx;
• Provides a relatively thorough investigatory and management plan that covers all key elements but omits some minor components or overly inclusive diagnostic plan that is unwarranted. / • Complete Hx/Px described;
• Provides thorough synthesis and DDx;
• Provides a complete investigatory and management plan that is comprehensive and complete with no omissions.
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).
RESIDENT:
Name of Assessor:
Date:
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 PROFICIENCY1
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).
RESIDENT
Name of Assessor
Date:
Task | Observed Hx
Today’s focus is to observing the resident taking a history.
Ideally, observations are based on 1-2 encounters with non-critically ill patients during your shift. Only the his- tory needs to be observed, not the entire resident-patient interaction.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEIntroduces self & explains role in care team
Finds out names of any additional family/friends present in the room
Asks patient if they would like to have friends/family present or not
Starts with open ended questions and moves into closed ended questions
Finds out the patient’s biggest concern/question needing to be answered
OBSERVED HISTORY
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:
• History incomplete.
• Information gathered in a disorganized or incomplete manner.
• Failed to develop rapport with patient and family.
• Did not seek to answer family or patient concerns. / Resident displays most of the below:
• Elicited information in slightly disorganized or inefficient manner.
• Built adequate rapport with patient.
• Solicited and attended to answers from patient or family. / • Elicited information in a time efficient manner. Established a strong rapport with all present in the room.
• Gained trust with patient/ family.
• Solicited and attended to answers from patient or family.
• All elements of checklist completed
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).
RESIDENT
Name of Assessor
Date:
Task | Observed Hx with Barrier
Today’s task is to observe the resident completing a History with a Patient who has an identifiable communica- tion barrier.
Barriers may include language, physical disability, delirium, dementia etc. Observations are based on at least one en- counter with a non-critically ill patients during your shift. Only the history needs to be observed, not the entire resident-patient interaction.
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEDiagnoses communication barrier
Develops appropriate strategy to address barrier (e.g. contacts translator)
Maintains appropriate non-verbal cues with patient (where culturally appropriate), even if using other communication strategies (e.g. translator)
Takes extra time for patient encounter to ensure complete history obtained, and patient’s concern/question is determined
OBSERVED HISTORY WITH BARRIER
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:
• History incomplete.
• Did not identify barrier
• Did not use appropriate strategy to overcome barrier
• 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 most of the below:
• Obtains the minimum of relevant and important information .
• Elicited information in slightly disorganized or inefficient manner.
• Built adequate rapport with all present in the room.
• Solicited and attended to answers from patient or family.
• Required assistance from / Resident displays all of the below:
• Obtained history in a time efficient manner.
• Utilized resources (including translators) well.
• Built strong rapport with all present in the room.
• Gained trust with patient and family.
• Answered questions well.
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).
RESIDENT
Name of Assessor
Date:
Task | Obtaining Consent
Today’s focus is obtaining consent.
The attending physician should observe a consent discussion for a procedure. Ideally, consent discussion should be around a non-emergent major or involved intervention or procedure (e.g. blood transfusion, central line, lumbar puncture, etc..).
CHECKLIST / DONE / DONE BUT NEEDS ATTENTION / NOT DONE / N/A FOR CASEEstablishes 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 available resources)
Ensures patient understands and appreciates:
•The intended plan for the procedure
•Indications for the procedure (Why you are doing the procedure?), foreseeable benefits
•The Risks of the procedure
•The available alternatives to the procedure.
Listening Language
Avoids or defines medical jargon during the discussion
Utilizes Reflective Listening to Summarize the discussion
Listens and responds to questions or concerns.
Appropriately documents consent process (chart, specific consent form)*
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
• Confusing to patient or SDM (excessive slang, jargon)
• Poorly prepared for the discussion.
• Provided misleading or incomplete information
• Did not listen to patient or SDM
• Required attending physician to halt or redirect conversation. / • Seems rushed or uncomfortable
• Builds appropriate rapport
• Provides all options, but approach confusing to patient or SDM
• Minimal role of attending physician to steer the course and guide decision making. / • Establishes trusting therapeutic relationship with patient or SDM (beyond appropriate rapport)
• 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.
• Provides all options, patient or SDM seem to understand the plan
• No requirement for attending physician to participate.
• If conflict or disagreement arises - 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 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).
RESIDENT
Name of Assessor
Date: