Entrustable Professional Activities
for
Critical Care
Medicine
2019
VERSION
1.0
2. Foundations
3. Core
T2D EPA
#2: Initiating and leading resuscitation for unstable
patients
T2D EPA #3: Performing the basic procedures of CCM
T2D EPA #4: Coordinating patient care and supporting
team members in the ICU setting
T2D EPA
#5: Transferring clinical information between health
care providers at handover
T2D EPA
#6: Providing routine updates to patients or families
Transition to
Discipline EPA #1
Recognizing, assessing, and providing initial management
for patients who are
critically ill, seeking assistance when appropriate
Key
Features:
- This EPA focuses on the initial medical care of patients who are
critically ill, including
assessment, initial diagnosis, and preliminary management. An
important feature of
this EPA is the timely and appropriate recognition of the need for
additional
assistance
- It may include the recognition of clinical deterioration of a
patient already in the
intensive care unit.
- This EPA may be observed in a variety of clinical settings,
including the intensive
care unit, emergency room, and on the wards
- This EPA does not include resuscitation (TTD2), nor developing a
fully matured
differential diagnosis for complex presentations, or a complete
management plan
(F1)
Assessment
plan:
Direct observation and/or case review by attending physician or
senior trainee
Use Form 1. Form collects information on:
- Observation: direct; indirect
Collect 2 observations of achievement.
- At least 1 direct observation
- At least 2 different observers
Relevant
Milestones:
1 ME 1.4 Perform focused clinical assessments that address
all relevant issues
2 ME 2.1 Prioritize issues to address in the patient’s
assessment and
management
3 ME 1.4 Recognize urgent problems and one’s own
limitations, and seek
assistance as needed
4 ME 1.6 Identify
clinical situations in which complexity, uncertainty, and ambiguity
may play a role in decision-making
5 ME 2.3 Ascertain
the patient’s goals of care and ensure care is aligned with those
goals, as the patient’s situation evolves
6 ME 2.2 Develop
an initial diagnosis relevant to the patient’s presentation
7 COM 3.1 Communicate
in a clear, compassionate, respectful, and accurate manner
to the patient and family
8 COM 5.1 Document relevant information
9 COL 1.2 Seek and respond to input from other health care
professionals
10 COL 1.3 Communicate
clearly and directly to promote understanding in the health
care team
11 L 2.1 Consider
health care resources and costs when determining the investigation
and management plan
12 HA 1.1 Facilitate
timely access to limited health care resources
Back to
Transition to Discipline
Transition to Discipline EPA #2
Initiating and leading resuscitation for unstable patients
Key
Features:
- This EPA focuses on initiating and leading resuscitation for
critically ill patients,
following the principles of crisis resource management.
Assessment
plan:
Direct observation by ED physician, senior trainee, or other
health care professionals (i.e.
code/MET nurse)
Use Form 1. Form collects information on:
- Condition: cardiac arrest; respiratory failure; sepsis; shock;
other (write in)
- Context: clinical; simulation
Collect 2 observations of achievement.
- At least 1 clinical encounter
- At least 2 different observers
Relevant
Milestones:
1 ME 2.2 Provide assessment and initial stabilization of
ABCs (Airway,
Breathing, and Circulation)
2 ME 1.4 Recognize urgent problems and one’s own
limitations and seek
assistance as needed
3 L 4.2 Lead the resuscitation team effectively, ensuring
clear roles and
responsibilities for team members, setting priorities,
providing constructive
intervention when required, and re-evaluating patient and
situation
frequently
4 COL 1.3 Communicate with the health care team using
clear language,
knowledge sharing and summarizing clinical evolution.
5 COL 2.2 Communicate orders clearly citing names (or
other identification)
and using closed loop communication
Back to
Transition to Discipline
Transition to Discipline EPA #3
Performing the basic procedures of CCM
Key
Features:
- This EPA includes determining which procedures are necessary and
appropriate to
the situation.
- Procedures include bag-valve-mask (BVM) ventilation with
oropharyngeal airway
(OPA)/nasopharyngeal airway (NPA) insertion, chest compressions
and defibrillation,
routine arterial line insertion, central venous catheterization,
and intra-osseous
placement.
- This EPA does not include other commonly performed procedures
that are present in
the other stages of training (Foundations 3 and Core 4)
Assessment
plan:
Direct observation by supervisor
Use Form 2. Form collects information on:
- Procedure: central line (internal jugular, subclavian, femoral);
arterial line; bagmask
ventilation with oropharyngeal airway; intra-osseous placement,
chest
compressions, defibrillation
- Setting: clinical; simulation
Collect 9 observations of achievement.
- At least 2 central line insertions
- At least 2 arterial line insertions
- At least 2 episodes of bag-mask ventilation with OPA insertion
- At least 1 intra-osseous placement (may be observed in
simulation)
- At least 1 observation of chest compressions (may be observed in
simulation)
- At least 1 observation of defibrillation (may be observed in
simulation)
- At least 2 observers
Relevant
Milestones:
1 ME 3.1 Preprocedure plan: Gather/assess required
information to reach
diagnosis and determine correct procedure required
2 ME 3.4 Case preparation: Patient correctly prepared and
positioned,
understands approach and required instruments, prepared to
deal with
probable complications
3 ME 1.3 Knowledge of specific procedural steps:
Understands steps of
procedure, potential risks, and means to avoid/overcome
them
4 ME 3.4.Technical performance: Efficiently performs
steps, avoiding pitfalls
and respecting soft tissues
5 ME 3.4 Visuospatial skills: 3D spatial orientation and
able to position
instruments/hardware where intended
6 ME 3.4 Efficiency and flow: Obvious planned course of
procedure with
economy of movement and flow
7 ME 3.4 Postprocedure plan: Appropriate complete post
procedure plan
8 COL 1.3 Professional and effective
communication/utilization of staff
Back to
Transition to Discipline
Transition to Discipline EPA #4
Coordinating patient care and supporting team members in
the ICU setting
Key
Features:
- This EPA focuses on organizational skills and role modeling.
- It includes coordinating patient care, demonstrating leadership,
and supporting
junior learners.
- This EPA is not based on the resident leading the entire team
through rounds or
managing all patients.
Assessment
plan:
Direct observation by supervisor. Each observation should include
multiple days of service.
Use Form 1.
Collect 2 observations of achievement
- At least 2 different observers
Relevant
Milestones:
1 S 2.3 Assign and prioritize tasks for junior residents
2 S 2.3 Supervise learners to ensure they work within their
limitations, ensuring
patient safety
3 COL 1.2 Identify the roles and scopes of practice of
health care providers
related to Critical Care Medicine and utilize their
expertise appropriately
4 COL 2.1 Actively
listen to and engage in interactions with collaborators
5 P 2.1 Role-model behaviours that demonstrate
accountability to patients,
society and the profession.
6 P 1.1 Complete assigned responsibilities, including
following up with junior
residents on tasks that they were assigned.
7 ME 5.2 Use
cognitive aids such as clinical care paths to enhance patient safety
Back to
Transition to Discipline
Transition to Discipline EPA #5
Transferring clinical information between health care
providers at handover
Key
Features:
- This EPA focuses on the communication required for safe handover
within the critical
care patient team or as the patient leaves the unit to another
health care setting
- It includes the timely written documentation of the events while
in the ICU (including
appropriate record-keeping, daily events), as well as verbal
handover when going off
duty and at the end of call shifts.
Assessment
plan:
Direct observation and/or review of documentation (chart, handover
paperwork,
transfer/discharge note) by supervisor and/or physician receiving
handover
Use Form 1. Form collects information on:
- Observation (select all that apply): direct handover
observation; chart review;
handover paperwork; transfer/discharge note
Collect 3 observations of achievement.
- At least 2 direct observations
- At least 1 transfer/discharge note
- At least 1 observation by supervisor or senior trainee in CCM
- At least 1 observation by physician from another team receiving
handover
Relevant
Milestones:
1 ME 1.5 Prioritize among patients based on clinical
acuity
2 ME 4.1 Establish plans for ongoing care, including
follow-up on
investigations and response to treatment
3 COL 3.2 Describe
specific information required for safe and effective handover
during transitions in care
4 COM 5.1 Organize
information systematically within an electronic or written medical
record
5 COM 5.1 Maintain
accurate and up-to-date problem lists
6 COM 5.1 Document
information about patients and their medical conditions in a
manner that enhances intra- and interprofessional care
7 COL 3.1 Identify
patients requiring handover to other physicians or health care
professionals
8 COL 3.2 Summarize patient issues, including plans to
deal with ongoing
concerns
9 COL 3.2 Provide anticipatory guidance for issues that
are likely to arise
10 COL 1.3 Communicate
clearly and directly to promote understanding in the health
care team
Back to
Transition to Discipline
Transition to Discipline EPA #6
Providing routine updates to patients or families
Key
Features:
- This EPA focuses on the application of medical expertise and
communication skills to
summarize medical conditions and plans for the day to patients and
families in the
ICU setting
- It does not include managing challenging conversations, such as
end-of-life
discussion or disclosure of adverse events
Assessment
plan:
Direct observation by supervisor
Use Form 1. Form collects information on:
- Condition: (write in)
Collect 2 observations of achievement.
- At least 2 observers
Relevant
Milestones:
1 P 1.2 Ensure
that the patient and family are informed about the diagnosis and plan
of care
2 COM 1.1 Introduce oneself and explain one’s role in the
interprofessional
team
3 COM 1.1 Communicate using a patient-centered approach
that facilitates
patient trust and autonomy and that is characterized by
empathy, respect,
and compassion
4 COM 3.1 Convey information about medical course and
management plan
clearly and accurately
5 COM 3.1 Use appropriate language and avoid medical
jargon
6 COM 1.4 Identify,
verify and validate non-verbal cues on the part of the patient and
/or family.
7 COM 3.1 Use strategies to verify and validate the
understanding of the
patient and family.
8 COM 5.1 Document
the clinical encounter to accurately reflect the discussion and
decisions
9 P 1.1 Respect
diversity and difference, including but not limited to the impact of
socio-economic background, gender, religion and cultural beliefs
on decision making
Back to
Transition to Discipline
Foundations
EPA #3: Performing the common procedures of CCM
Foundations
EPA #4: Teaching and supervising junior physicians
and other health care professionals
Foundations
EPA #5: Developing and implementing learning plans
Foundations
EPA #7: Co-leading multidisciplinary teams
Evaluating, stabilizing, and managing patients presenting
with common ICU
Conditions
Key
Features:
- This EPA focuses on routine ICU care, including evaluating,
stabilizing, admitting,
and providing day-to-day management for patients with
uncomplicated critical
illness.
- This includes: diagnosis and management of the presenting
problem, management
of any underlying conditions, prevention and management of common
ICU
complications, and attention to and management of nutrition,
sedation, and
analgesia.
- This EPA does not include patients with complex, poorly
differentiated or multi-type
shock/organ dysfunction, polypharmacy overdose, multi-system or
multicomorbid
illness, multi-system trauma, and transplant, nor the critically
ill obstetrical patient.
Assessment
Plan:
Direct observation and/or review of admission/case discussion by
attending physician or
senior resident with feedback from bedside RN, charge RN, RRT,
and/or junior trainees
Use Form 1. Form collects information on:
- Setting: initial assessment; daily care
- Presentation: surgical; medical
- Primary diagnosis: (write in)
Collect 6 observations of achievement.
- At least 3 initial assessment
- At least 3 daily care
- Variety of medical and surgical presentations
Relevant
Milestones:
1 ME 1.3 Apply
knowledge of basic physiology to the management of common ICU
conditions
2 ME 1.4 Perform focused clinical assessments that address
all relevant issues
3 ME 1.6 Develop
a plan that considers the current complexity, uncertainty and
ambiguity in a clinical situation
4 ME 2.2 Select and interpret the results of
investigations and imaging
5 ME 2.3 Work
with the patient and family to establish goals of care
6 ME 2.4 Develop and implement initial and/or ongoing
management plans for
patients with common ICU conditions
7 ME 2.4 Develop
plans to monitor the evolution of the clinical course and/or the
patient’s response to treatment
8 ME 3.1 Integrate
planned procedures or therapies into the overall plan of care
9 ME 4.1 Determine the need and timing of consultation
with other specialists
10 ME 5.2 Organize
safe intrahospital transport of patient to and from ICU, using all
necessary human and equipment resources, recognizing when it may
be
inappropriate to transport patient
11 COL 1.2 Implement
a multidisciplinary approach to the care of ICU patients
12 COL 1.3 Engage in respectful shared decision-making
with physicians and
colleagues in other health care professions
13 P 2.2 Demonstrate
a commitment to patient safety and quality improvement
through adherence to institutional policies and procedures
Evaluating and managing uncomplicated and/or routine
patients requiring
mechanical ventilation
Key
Features:
- This EPA focuses on applying knowledge of invasive and
non-invasive (NIV)
mechanical ventilation, its indications and complications.
- It includes the initiation, maintenance, weaning, and
discontinuation of mechanical
ventilation in the context of common clinical scenarios with
respiratory failure due to
pulmonary and non-pulmonary reasons.
- This EPA may be observed during clinical assessment, patient
rounds, or while
teaching other trainees.
- This EPA does not include patients with complicated, severe,
refractory disease (e.g.
severe hypoxic or hypercapnic respiratory failure, severe airway
obstruction,
patient/ventilator asynchrony, complicated waveform analysis,
etc.).
Assessment
Plan:
Direct and indirect observation by attending physician or senior
trainee with input from
registered respiratory therapist(s) (RRT)
Use Form 1. Form collects information on:
- Ventilation technique: invasive; non-invasive
- Case mix (select all that apply): initiation;
maintenance; weaning; discontinuation
- Reason for resp support: pulmonary; non-pulmonary
Collect 9 observations of achievement.
- At least 1 non-invasive ventilation for each case mix
- At least 1 invasive ventilation for each case mix for a patient
with pulmonary reasons
for respiratory support
- At least 6 observations by attending physicians
Relevant
Milestones:
1 ME 1.3 Apply knowledge of respiratory physiology and
cardiopulmonary
interactions
2 ME 1.6 Develop
a plan that considers the current complexity, uncertainty, and
ambiguity in a clinical situation
3 ME 2.2 Interpret diagnostic imaging of the respiratory
system
4 ME 2.4 Develop and implement an initial management plan
for
uncomplicated patients requiring non-invasive or invasive
ventilation
5 ME 3.2 Ensure
that the patient and family are informed about the risks and benefits
of each treatment options in the context of best evidence and
guidelines
6 ME 5.2 Use
cognitive aids such as clinical care paths to enhance patient safety
7 COM 3.1 Use
strategies to verify and validate the understanding of the patient and
family
8 COM 4.3 Answer
questions from the patient and family about next steps
9 COL 1.2 Seek and respond to input from other health care
professionals
Performing the common procedures of CCM
Key
Features:
- This EPA focuses on determining which procedures are necessary
and clinically
appropriate, and performing common procedures as outlined below.
- Procedures include airway management skill in uncomplicated
patients; arterial line
insertion in complicated patients; cardioversion; central venous
line insertion; chest
tube insertion; lumbar puncture; paracentesis; thoracentesis; and
transcutaneous
pacing.
- This EPA includes using ultrasonography for procedural guidance
where appropriate.
- This EPA may be observed in various clinical settings and
simulation.
Assessment
Plan:
Direct observation by attending or consultant physician, or TTP
level trainee with input from
bedside RN, RRT, NP or PA
Use form 2. Form collects information on:
- Procedure[select all that apply]: airway management;
intubation; arterial line;
cardioversion; central venous line; lumbar puncture; open chest
tube; Seldinger
chest tube; paracentesis; thoracentesis; transcutaneous pacing
- Complexity: complicated/urgent; uncomplicated
- Ultrasound guidance: yes; no
- Setting: clinical; simulation
- Site: not applicable; brachial; femoral; jugular; radial;
subclavian; other (write in)
Collect 27 observations of achievement.
- At least 5 airway management in clinical setting including
intubation
- At least 2 physician assessors for airway management
- At least 5 arterial line insertions in clinical setting
- At least 1 arterial line insertion each at femoral and radial
site
- At least 5 central line insertions
- At least 1 central line insertion each at jugular, femoral and
subclavian site
- At least 2 cardioversions
- At least 2 lumbar punctures
- At least 1 open chest tube
- At least 1 Seldinger chest tube
- At least 2 paracentesis
- At least 2 thoracentesis
- At least 2 transcutaneous pacing
Relevant
Milestones:
1 ME 3.1 Preprocedure plan: Gather/assess required
information to reach
diagnosis and determine correct procedure required
2 ME 3.4 Case preparation: Patient correctly prepared and
positioned,
understands approach and required instruments, prepared to
deal with
probable complications
3 ME 1.3 Knowledge of specific procedural steps:
Understands steps of
procedure, potential risks, and means to avoid/overcome
them
4 ME 3.4.Technical performance: Efficiently performs
steps, avoiding pitfalls
and respecting soft tissues
5 ME 3.4 Visuospatial skills: 3D spatial orientation and
able to position
instruments/hardware where intended
6 ME 3.4 Efficiency and flow: Obvious planned course of
procedure with
economy of movement and flow
7 ME 3.4 Postprocedure plan: Appropriate complete post
procedure plan
8 COL 1.3 Professional and effective
communication/utilization of staff
Teaching and supervising junior physicians and other
health care professionals
Key
Features:
- This EPA focuses on informal/bedside teaching (i.e. teaching a
procedure, reviewing
a case in person or by phone) and helping junior learners identify
their own gaps in
knowledge and skill, and to develop a plan for their acquisition.
- This EPA may be completed in a simulation setting.
Assessment
Plan:
Direct observation by attending physician, senior resident in
Critical Care Medicine, or other
faculty/consultants with input from junior trainees and/or other
health care professionals
Use Form 1. Form collects information on;
- Teaching activity: teaching a procedure; telephone support;
other (write in)
- Setting: clinical; simulation
Collect 4 observation of achievement.
- At least 1 teaching a procedure
- At least 1 telephone support
Relevant
Milestones:
1 S 2.1 Use strategies for deliberate, positive
role-modelling
2 S 2.2 Create a positive learning environment
3 S 2.4 Identify
the learning needs and desired learning outcomes of others
4 COL 1.2 Assign tasks and responsibilities to other team
members,
commensurate with their skills and patient complexity
5 COL 2.1 Delegate
tasks and responsibilities in a respectful manner
6 S 2.3 Provide learners with opportunities for
appropriate clinical
responsibility
7 S 2.3 Supervise learners to ensure they work within
their limitations,
ensuring patient safety
8 S 2.5 Provide feedback to enhance learning and
performance
9 P 1.1 Intervene
when behaviours toward colleagues and/or learners undermine a
respectful environment
10 S 2.3 Identify unsafe clinical situations involving
learners and manage them
appropriately
Developing and implementing learning plans
Key
Features:
- This EPA includes reflecting on performance feedback, knowledge
& skill gaps and
planning for growth in current practice as well as future
practice, including career
path.
- This includes selecting appropriate electives and clinical
experiences, conferences
and other educational opportunities based on identified knowledge
or skill gaps and
future career path.
- The observation of this EPA may be achieved via interactions
with a supervisor/
mentor or via guided self-reflection.
- The self-reflection requires submission of written documentation
that includes
identified learning needs and how the resident has facilitated
growth in their domain.
Assessment
Plan:
Interaction with supervisor/mentor: Direct and/or indirect
observation by academic advisor,
mentor, academic supervisor, and/or program director based on
ongoing interaction, and
supplemented by any written documentation the resident submits
(e.g. reflective journal,
documentation of learning activities)
Or
Guided self-reflection: Submission to Competence Committee of
written documentation
and/or reflective journal.
Use Form 4.
Collect 1 observation of achievement.
Relevant
Milestones:
1 S 1.1 Create
and implement a learning plan
2 S 1.1 Identify
learning needs to enhance competence across all CanMEDS roles and
generate immediate and longer-term career goals
3 S 1.2 Identify
opportunities for learning and improvement by reflecting on and
assessing performance using various internal and external data
sources
4 S 3.1 Generate
focused questions that address practice uncertainty and knowledge
gaps
5 S 3.4 Integrate
best evidence and clinical expertise into decision-making
6 L 4.2 Adjust
educational experiences to gain competencies necessary for future
independent practice
7 P 1.2 Demonstrate
a commitment to excellence in all aspects of practice
8 P 2.1 Demonstrate
a commitment to maintaining and enhancing competence
Identifying and providing care for patients’ and their
family’s needs around the
end-of-life
Key
Features:
- This EPA focuses on the application of communication skills to
support patients and
families. At this stage, it is limited to clinical interactions
that are not characterized
by conflict.
- This includes breaking bad news and leading goals of care
discussions, and building
consensus around end-of-life decision making such as withdrawal of
life sustaining
therapies and potential organ and tissue donation.
- This EPA may be observed in the ICU, in the ER, on the inpatient
ward or in a
simulated setting.
Assessment
Plan:
Direct observation by attending physician with input from TTP
level trainee, bedside RN,
social worker, family and/or chaplain
Use form 1. Form collects information on:
- Activity observed: family discussion/meeting; note written after
meeting; simulated
activity; other (write in)
Collect 5 observations of achievement.
- At least 1 family meeting/discussion
- At least 1 review of written documentation of the meeting
Relevant
Milestones
1 COM 1.1 Develop trusting and supportive relationships
with families in
distress
2 COM 3.1 Convey
information about diagnosis and prognosis clearly and
compassionately
3 COM 3.1 Use
appropriate language and avoid medical jargon
4 COM 3.1 Use strategies to verify and validate the
understanding of the
patient and/or family.
5 ME 2.3 Work with the patient and family to establish
goals of care
6 ME 2.4 Develop palliative care management plans that
align with patient
and family goals of care
7 COM 1.4 Respond
to non-verbal communication and use appropriate non-verbal
behaviours to enhance communication
8 COM 1.5 Manage
emotionally charged conversations including breaking bad news
and end of life conversations
9 COM 1.5 Recognize
when personal feelings in an encounter are valuable clues to the
patient’s emotional state
10 COM 5.1 Document
the clinical encounter to accurately reflect discussion and
decisions
11 HA 1.1 Facilitate
access to bereavement support for a patient’s family, as
appropriate
12 P 1.3
Recognize and respond to the moral and ethical challenges in end of
life care
13 P 4.1 Exhibit self-awareness, recognizing and managing the
impact of end of life
care on personal well-being and professional performance
Co-leading multidisciplinary teams
Key
Features:
- This EPA focuses on the resident’s role in leading rounds and
the coordination of
patient care throughout the clinical day.
- This includes managing time and resources, building consensus,
directing
discussions, collaborating with consulting services, teaching
junior trainees, engaging
family members as appropriate, and ensuring clear communication
among all team
members.
- This EPA does not include the overall responsibility for patient
care, that is a
responsibility of a later stage, nor making management decisions
for individual
patients, providing updates to families, and participating in
family meetings.
Assessment
Plan:
Direct observation by attending physician or senior resident in
CCM with input from the
interprofessional team, junior trainees, and/or consultants
Use form 1. Form collects information on:
- Acuity within the unit: high; medium; low
Collect 5 observations of achievement.
- At least two observations on days of high acuity level
Relevant
Milestones:
1 ME 1.5 Prioritize
among patients based on clinical acuity
2 L 4.1 Manage time and prioritize tasks
3 COL 1.2 Make
effective use of the scope and expertise of other health care
professionals
4 COL 2.1 Delegate tasks and responsibilities in a
respectful manner
5 COL 1.3 Contribute
to quality patient care by sharing medical expertise
6 COL 1.3 Communicate effectively with other physicians
and health
professionals
7 COL 2.2 Work effectively with other health care
professionals to develop
plans for clinical care when there are differences in
opinion and/or
recommendations
8 L 4.1 Integrate supervisory and teaching
responsibilities into the overall
management of the clinical service
9 ME 3.1 Integrate
planned procedures and therapies into the overall plan of care
10 L 2.1 Allocate health care resources for optimal
patient care
11 P 1.1 Demonstrate
appropriate professional behaviours
12 P 1.1 Respond
punctually to requests from other health care professionals
Core EPA #1: Managing patients with respiratory failure
Core EPA
#2: Managing patients with multisystem organ dysfunction
Core EPA
#3: Managing the resuscitation of critically ill
patients
Core EPA
#4: Performing the advanced procedures of CCM
Core EPA
#6: Identifying, assessing, and managing potential organ
donors
Core
EPA #7: Recognizing and
providing care for patients who are vulnerable
Core
EPA #8: Managing the transport of patients who are
critically ill
Core EPA
#9: Leading daily clinical rounds
Core EPA
#11: Supervising, assessing, and coaching junior
colleagues
Core EPA
#12: Participating in and/or contributing to scholarly
activity
Managing patients with respiratory failure
Key
Features:
- This EPA focuses on applying knowledge of respiratory physiology
and
pathophysiology for different modes of ventilation, while
considering the interactions
with other organ systems (e.g. cardiac and neurologic).
- This EPA includes assessment, diagnosis and management of
hypoxemia,
hypercarbia and mixed respiratory failure, including patients
requiring mechanical
ventilation to support other organ failure, and patients with
complex respiratory
failure including severe acute respiratory distress syndrome
(ARDS).
- This EPA includes recognizing and managing complications from
mechanical
ventilation, as well as weaning patients from ventilation, and
identifying candidates
for tracheostomy.
- This EPA does not include airway management except the
management of
tracheostomies. It does not include routine indications for
mechanical ventilation (i.e.
postop facial surgery), nor does it include the chronic technology
dependent patient.
Assessment
Plan:
Direct observation and/or case discussion by a supervisor,
registered respiratory therapist
or respiratory therapy educator
Use Form 1. Form collects information on:
- Etiology: (write in)
- ARDS: yes; no
- Case mix (select all that apply): initiation of
ventilation; maintenance of ventilation;
weaning of ventilation; discontinuation of ventilation
- Mode of ventilation: (write in)
- Tracheostomy candidate: yes; no
- Setting: clinical; simulation
Collect 6 observations of achievement
- At least 3 different etiologies of respiratory failure
- At least 1 patient with ARDS
- At least 5 in clinical setting
- At least 3 different assessors
Relevant
milestones:
1 ME 1.3 Apply
knowledge of respiratory physiology and cardiopulmonary interactions
2 ME 1.6 Adapt
care to address complexity in the patient situation
3 ME 1.4 Perform
focused clinical assessments that address all relevant issues
4 ME 2.2 Integrate information from the clinical
assessment to formulate an
understanding of the patient’s condition
5 ME 2.2 Interpret diagnostic imaging of the respiratory
system
6 ME 2.4 Develop and implement management plans for
patients requiring
non-invasive or invasive ventilation, including weaning
from prolonged
and/or complicated mechanical ventilation
7 ME 3.1 Determine the need for and timing of tracheostomy
8 COL 1.3 Communicate
effectively with other physicians and health professionals
9 S 3.4 Integrate best evidence and clinical expertise into
decision-making
Managing patients with multisystem organ dysfunction
Key
Features:
- This EPA includes the management of patients with multisystem
organ dysfunction
that may arise from any pathophysiology.
- This EPA includes the monitoring of organ dysfunction, managing
medications based
on the pharmacology and degree of organ dysfunction, and
supporting the patient to
allow for organ recovery where possible.
Assessment
Plan:
Direct observation or case review by supervisor, with input from
nursing staff
Use Form 1. Form collects information on:
- Etiology of organ failure (select all that apply):
cardiogenic shock; distributive shock;
hypovolemic shock; obstructive shock; multi-system trauma;
multi-system gravid;
myocardial infarction; sepsis; polypharmacy overdose; other (write
in)
- Organ failure (select all that apply): brain; heart;
kidney; liver; skin; other (write in)
Collect 10 observations of achievement.
- At least 2 patients with shock
- At least four different types of organ failure
- At least 5 different observers
Relevant
milestones:
1 ME 1.6 Recognize
and respond to the complexity, uncertainty, and ambiguity
inherent in medical practice
2 ME 1.4 Perform
focused clinical assessments that address all relevant issues
3 ME 2.1 Consider
clinical urgency, feasibility, availability of resources, and
comorbidities in determining priorities to be addressed
4 ME 2.4 Develop,
in collaboration with the patient and family, a plan to deal with
clinical uncertainty
5 ME 2.4 Establish a patient-centred management plan that
considers all of
the patient’s health problems
6 ME 2.2 Prescribe and adjust medications in the setting
of organ dysfunction
7 ME 3.3 Prioritize
a procedure or therapy, considering clinical urgency and potential
for deterioration
8 ME 4.1 Implement a patient-centred plan that supports
ongoing monitoring
of clinical status and response to treatment
9 ME 4.1 Ensure
detailed and complete follow-up and handover of all patients under
the resident’s care
10 ME 4.1 Determine the need and timing of referral to
other specialists
11 COM 5.1 Document
management plans in an accurate, complete, timely and
accessible manner
12 COL 1.2 Consult
effectively and in a timely manner with other members of the
health care team and other services
13 ME 2.1 Identify patients for whom the patient perceived
burden of disease
modifying therapy or investigations is greater than the
clinical benefit
14 ME 2.3 Recognize
and respond to signs that it is time to transition care away from a
disease modifying approach
15 L 2.1 Use
clinical judgement to make optimal use of limited resources
16 P 1.3 Manage
ethical issues encountered in the clinical setting
17 S 3.4 Integrate best evidence and clinical expertise into
decision-making
Managing the resuscitation of critically ill patients
Key
Features:
- This EPA includes the rapid detection and correction of life
threatening situations
such as hypoxia, end organ hypoperfusion, dysrhythmias and raised
intracranial
pressure, as well as the management of patients in cardiac arrest.
- It may include patients with a variety of underlying medical
comorbidities and in a
variety of clinical situations, such as traumatic shock, septic
shock, traumatic brain
injury, and cardiogenic shock.
- It includes the application of advanced crisis resources
management skills to guide
the team functioning.
Assessment
Plan:
Direct observation by supervisor
Use Form 1. Form collects information on:
- Case mix: cardiac arrest; respiratory failure; sepsis; shock;
trauma; other (write in)
Collect 10 observations of achievement
- At least 5 different examples of the case mix
- At least 5 different assessors
Relevant
milestones:
1 ME 2.2 Provide
assessment and initial stabilization of ABCs
2 ME 2.4 Provide
concurrent treatment and ongoing assessment of the patient’s
clinical condition
3 ME 2.4 Reassess, re-evaluate and adjust resuscitative
and diagnostic efforts
as appropriate
4 ME 5.2 Demonstrate situational awareness, avoid fixation
error
5 ME 4.1 Ask for additional assistance and/or other
services when indicated
6 COL 1.2 Delegate tasks and direct team members to aid in
resuscitation
7 COL 1.3 Use closed loop communication
8 P 4.1 Maintain
capacity for professional clinical performance in stressful situations
9 ME 1.4 Act decisively and maintain control of crisis
situations
10 ME 2.2 Recognize when ongoing resuscitation efforts are
no longer effective
and should be discontinued
11 ME 2.4 Manage
hemodynamic support and monitoring
12 ME 2.4 Manage
non-invasive and/or invasive ventilation
13 ME 3.1 Integrate
planned procedures or therapies into resuscitative efforts
14 ME 3.3 Triage
a procedure or therapy, taking into account clinical urgency, potential
for deterioration, and available resources
15 L 4.2 Establish
clear leadership in resuscitative efforts
16 COL 1.2 Seek
and respond to input from other health care professionals
Performing the advanced procedures of CCM
Key
Features:
- This EPA focuses on determining which procedures are necessary
and appropriate to
the patient’s condition, and performing the following procedures
required for the care
of complex or unstable patients, including:
o brachial arterial line insertion
o central venous line and dialysis line insertion in unstable or
complex patients
o bronchoscopy
o conscious sedation
o intubation in a patient with a difficult airway/unstable situation
o Point-of-Care Ultrasound (PoCUS)
o transvenous pacing and/or testing of pacers
o pulmonary artery catheter insertion
- This EPA includes using ultrasonography for procedural guidance,
where appropriate.
- This EPA may be observed in clinical or simulation settings.
- The observation of this EPA is divided into two parts: technical
procedures; and
POCUS procedures.
Assessment
Plan:
Part A: Procedures
Direct observation by supervisor with input from other health
professionals
Use Form 2. Form collects information on:
- Procedure: arterial line insertion; central line insertion;
dialysis line insertion;
bronchoscopy; conscious sedation; intubation; pulmonary artery
catheterization;
testing of epicardial pacer; transvenous pacemaker insertion
- Complex/unstable patient: yes; no
- Site: not applicable; brachial; femoral; jugular; radial;
subclavian; other (write in)
- Setting: clinical; simulation
Collect 17 observations of achievement.
- At least 2 brachial arterial line insertions
- At least 3 central line insertions in unstable patients
- At least 2 dialysis line insertions
- At least 3 bronchoscopies
- At least one cricothyrotomy, may be in simulated setting
- At least 2 conscious sedation
- At least 1 intubation in a patient with a difficulty
airway/unstable situation
- At least 1 testing of epicardial pacer
- At least 1 transvenous pacemaker insertion
- At least 1 pulmonary artery catheterization
Part B: PoCUS
Direct observation and/or review of images by supervisor
Use Form 2. Form collects information on
- PoCUs procedure: lung; cardiac and volume status; other
- Complex/unstable patient: yes; no
Collect 10 observations of achievement
- At least 5 lung
- At least 5 cardiac and volume status
Relevant
milestones:
Part A: Procedures
1 ME 3.1 Preprocedure plan: Gather/assess required
information to reach
diagnosis and determine correct procedure required
2 ME 3.4 Case preparation: Patient correctly prepared and
positioned,
understands approach and required instruments, prepared to
deal with
probable complications
3 ME 1.3 Knowledge of specific procedural steps: Understands
steps of
procedure, potential risks, and means to avoid/overcome
them
4 ME 3.4.Technical performance: Efficiently performs
steps, avoiding pitfalls
and respecting soft tissues
5 ME 3.4 Visuospatial skills: 3D spatial orientation and
able to position
instruments/hardware where intended
6 ME 3.4 Efficiency and flow: Obvious planned course of
procedure with
economy of movement and flow
7 ME 3.4 Postprocedure plan: Appropriate complete post
procedure plan
8 COL 1.3 Professional and effective communication/utilization
of staff
Part B: PoCUS procedures
1 ME 3.4 Adjust instrument settings appropriately to
optimize image quality
2 ME 3.4 Obtain standard views
3 ME 2.2 Recognize clinically significant findings in a
POCUS examination
Caring for patients with chronic and/or organ
support-dependent critical illness
and their primary caregiver(s)
Key
Features:
- This EPA includes the coordination and care for chronic and/or
ventilator dependent
critically ill patients in the ICU or other settings.
- This EPA requires longitudinal engagement with the patient,
family, and
multidisciplinary team.
- It includes tasks such as orchestrating family meetings,
developing and leading the
implementation of care plans including possible homecare, or
transfer to community
hospital or long-term care facilities.
- It requires the coordination of multidisciplinary teams and
advocacy at the patient
and system level.
Assessment
Plan:
Direct observation and/or case discussion by supervisor with or
without input from
physiotherapist, social worker, registered respiratory therapist,
patient or family.
Use Form 1.
Collect 1 observation of achievement.
Relevant
milestones:
1 ME 1.6 Adapt
care as the complexity, uncertainty, and ambiguity of the patient’s
clinical situation evolves
2 ME 2.1 Identify
patients for whom the patient perceived burden of disease modifying
therapy or investigations is greater than the clinical benefit
3 ME 2.3 Recognize
and respond to signs that it is time to transition care away from a
disease modifying approach
4 COM 2.1 Gather
information about the patient’s beliefs, values, preferences, context
and expectations with regards to their care
5 ME 2.3 Address
the impact of the medical condition on the patients’ ability to pursue
life goals and purposes
6 ME 2.3 Work with the patient and family to establish
goals of care
7 COM 3.1 Provide
information on diagnosis and prognosis in a clear, compassionate,
and respectful manner
8 COM 4.3 Use communication skills and strategies that
help the patient and
family make informed decisions
9 ME 2.2 Select
investigations and therapies appropriate to the patient’s goals of care
10 ME 2.4 Develop and implement management plans that
support
achievement of the patient’s goals of care
11 ME 4.1 Coordinate ongoing care when multiple physicians
and health care
professionals are involved
12 HA 1.1 Facilitate timely patient access to services and
resources
Identifying, assessing, and managing potential organ
donors
Key
Features:
- This EPA includes the identification of potential organ donors
(by both neurological
and circulatory criteria), referral to the local organ donation
organization or program,
and communicating with families about the opportunity for
donation, but does not
include obtaining consent for donation.
- This EPA includes the assessment of death by neurological
criteria, the physiological
management of the potential organ donor, and collaboration with
the donation
physician, donation coordinator and other members of the donation
team.
- The observation of this EPA is divided into two parts: organ donor
identification and
management; NDD declaration.
Assessment
Plan:
Part A: Organ donation
Direct observation and/or case review by supervisor
Use Form 1.
Collect 2 observations of achievement
Part B: NDD declaration
Direct observation by supervisor
Use Form 1
Collect 2 observations of achievement
Relevant
milestones:
Part A: Organ donation
1 ME 2.2 Recognize and respond to clinical features that
identify opportunities
for organ donation
2 COM 3.1 Convey the option of organ and tissue donation
as part of end-oflife
discussions with family members
3 HA 1.1 Facilitate
access to bereavement support for a patient’s family, as
appropriate
4 COM 5.1 Document the organ donation assessment and
discussion,
completing all required documentation
5 ME 2.4 Develop and implement management plans to
maintain organ donor
homeostasis with appropriate hemodynamic, respiratory,
temperature,
urine output, fluid, electrolyte, and glucose targets
6 COL1.2 Work effectively with organ procurement
organization personnel,
transplant surgeons, and in-hospital diagnostic services
to ensure complete
evaluation of individual organ/tissue suitability for
transplant
7 ME 4.1 Establish
plans for ongoing care of potential organ donors, incorporating
considerations of patient comfort and family concerns
8 P 1.3 Manage
ethical issues encountered in the clinical setting
Part B: NDD declaration
1 ME 2.2 Exclude reversible causes of coma
2 ME 2.2 Assess brainstem reflexes and response to pain
3 ME 2.2 Perform an apnea test
4 ME 2.2 Use ancillary testing when appropriate
5 ME 1.3 Apply guidelines for the determination of NDD
status
6 P 3.1 Adhere to regulations regarding NDD declaration
Recognizing and providing care for patients who are
vulnerable
Key
Features:
- This EPA includes providing care for patients who are mentally and/or physically frail,
living alone, victims of crime, victims of abuse, unable to
manage their own health
risks, or who have a detrimental imbalance between care needs
and care provided.
- It includes recognizing when a
patient is vulnerable, has no next-of-kin, or when
police and/or social services need to be engaged, and working
with the health care
team towards a health care outcome that respects the wishes of
the patient.
Assessment
Plan:
Case review by supervisor with or without input from other
healthcare professionals
Use Form 1.
Collect 2 observations of achievement
- At least 2 different assessors
Relevant
milestones:
1 ME 2.2 Recognize
and respond to clinical features that identify a patient is
vulnerable
2 COM 1.1 Communicate using a patient-centred approach
that facilitates
patient trust and autonomy and that is characterized by
empathy, respect,
and compassion
3 COM 1.6 Assess
a patient’s decision-making capacity
4 COM 1.6 Tailor
approaches to decision-making to patient capacity, values, and
preferences
5 ME 2.3 Establish
goals of care
6 ME 2.4 Develop and implement management plans that
consider all of the
patient’s health problems, their social context and their
expressed wishes in
collaboration with the interprofessional team
7 HA 1.1 Facilitate timely access to resources and/or
agencies to address
health needs of the patient
8 HA 1.1 Describe
risk factors that may indicate that a patient is the victim of intimate
partner violence, child abuse or neglect, youth violence, sexual
assault, elder abuse,
or human trafficking
9 ME 4.1 Determine
the need for referral to spiritual care, psychiatry, social work, or
medicine services
10 COL 1.3 Work effectively with the patient’s primary
care physician, and/or
community liaisons and services, as needed
11 P 3.1 Fulfil
the requirements of the physician’s duty to report, including
communicable disease, and suspected child, domestic or elder abuse
Managing the transport of patients who are critically ill
Key
Features:
- This EPA focuses on managing the transport of critically ill patients
within the
hospital as well as between healthcare centres, by ground or by
air.
- It may include being physically present during transfer, or
providing advice to the
transferring centre and transport team.
- This EPA does not include managing discharge nor facilitating
the transfer of patients
to a chronic care facility.
- This EPA may be observed in a simulated activity.
Assessment
Plan:
Direct observation or case review by supervisor
Use Form 1. Form collects information on:
- Transport context: in-hospital; interhospital
- Setting: clinical; simulation
- Complexity: simple; complex
Collect 2 observations of achievement
- At least 1 in-hospital transport of a complex patient
- At least 1 interhospital transport (may be simulation or call
line)
Relevant
milestones:
1 ME 2.2 Interpret
clinical information gathered by another health professional, along
with the results of investigations, for the purposes of diagnosis
and management
2 ME 2.4 Determine the setting of care appropriate for the
patient’s health
needs
3 ME 2.4 Plan the logistics of transfer including
stabilization and procedures
prior to transfer, equipment and personnel requirements,
methods of
monitoring and assessment during transport
4 COL 3.2 Demonstrate safe handover of care, using both
verbal and written
communication, during a patient transition to a different
health care
professional, setting, or stage of care
5 COM 5.1 Document telephone advice provided and the care
provided during
transport
Leading daily clinical rounds
Key
Features:
- This EPA focuses on leading the daily care for all patients in
the ICU.
- This includes leading team discussions and developing management
plans for all
patients (complex and routine), guiding junior residents through
their tasks,
conducting investigations, communicating and engaging other health
professionals as
part of the interprofessional team, and seeking and providing
appropriate consults to
other services.
- It includes transfer and discharge planning, as well as
communication with patients
and families during rounds.
- This EPA requires time management skills to balance patient care
with teaching
responsibilities, consideration of bed management issues, triaging
of consults outside
the ICU, and the management of disruptions.
- This EPA does not include the safety competencies, end of life
discussions nor formal
family meetings.
Assessment Plan:
Direct observation by supervisor, with input from other health
care professionals
Use form 1. Form collects information on:
- ICU location: (write in)
Collect 5 observations of achievement
- At least 2 different ICU locations
- At least 3 observers
Relevant
milestones:
1 ME 1.3 Apply
a broad base and depth of knowledge in clinical and biomedical
sciences to manage the breadth of patient presentations in the ICU
2 ME 1.4 Perform
focused clinical assessments that address all relevant issues
3 ME 1.5 Prioritize among patients based on clinical
acuity
4 ME 1.5 Carry
out professional duties in the face of multiple, competing demands
5 ME 1.6 Recognize
and respond to the complexity, uncertainty, and ambiguity
inherent in medical practice
6 ME 2.4 Establish patient centered management plans
7 L 4.1 Integrate supervisory and teaching
responsibilities into the overall
management of the clinical service
8 P 4.1 Manage
the mental and physical challenges that impact physician wellness
and/or performance in demanding or stressful clinical settings
9 COL 2.1 Delegate tasks and responsibilities in a
respectful manner
10 L 2.1 Allocate
health care resources for optimal patient care
11 L 4.1 Manage time and prioritize tasks
12 S 2.4 Demonstrate
basic skills in teaching others
13 S 3.4 Integrate
best evidence and clinical expertise into decision-making
Identifying and addressing patient safety incidents and
contributing to a culture of
Safety
Key
Features:
- This EPA includes recognizing when a patient has experienced an
adverse event,
classifying it as a patient safety incident, and assessing and
managing the patient’s
condition.
- It includes documenting the incident per local institutional processes
for institutional
safety monitoring programs.
- It also includes disclosing the event to the patient and/or
family, which may be
observed in simulation setting.
- The EPA also includes following appropriate protocols,
checklists and/or institutional
policy in delivering safe patient care, and supporting other team
members to do the
same.
Assessment
Plan:
Direct observation and/or document or report review, or case
discussion by supervisor, QI
leader, unit manager, or unit director
Use Form 1. Form collects information on:
- Setting: clinical; simulation
- Disclosure observed: yes; no
Collect 2 observations of achievement
- At least 1 disclosure (may be simulation)
Relevant
milestones:
1 ME 5.1 Identify a patient safety incident in a timely
manner
2 ME 5.1Identify
the clinical circumstances contributing to an adverse event
3 ME 5.1 Mitigate further injury from adverse events, as
appropriate
4 ME 2.4 Develop
and implement initial management plans
5 COM 3.2 Communicate the reasons for unanticipated clinical
outcomes and
disclose patient safety incidents
6 COM 3.2 Apologize
appropriately for a harmful patient safety incident
7 COM 4.3 Answer
questions from the patient and family about next steps
8 ME 5.1 Document harmful patient safety incidents as per
institutional
processes
9 ME 5.1 Identify
changes in practice/clinical care to prevent similar events
10 P 4.1 Apply
strategies to mitigate the personal impact of patient safety events
Supervising, assessing, and coaching junior colleagues
Key
Features:
- This EPA focuses on providing constructive feedback in a manner
aligned with
coaching and/or performance improvement and recognizing the need
for potential
remediation.
- This includes assisting learners (rotating residents/students)
in difficulty.
Assessment
Plan:
Direct observation by supervisor with input from learner(s)
Use Form 1.
Collect 3 observations of achievement.
- At least 3 different observers
Relevant
milestones:
1 P 1.1 Complete learner assessments in a timely fashion
2 S 2.5 Identify learner behaviors to support / continue
as well as those for
improvement
3 S 2.5 Provide specific suggestions for improvement of
performance
4 S 2.5 Provide narrative comments that support coaching /
assessment
Participating in and/or contributing to scholarly activity
Key
Features:
- This EPA includes a literature review, knowledge about ethics
applications, any
needed regulatory module(s), understanding assessment and critique
methods, data
collection, critical appraisal of literature, and contribution to
a knowledge translation
activity.
- Scholarly activities include clinical, basic science, education,
or health systems
research, and patient safety and quality improvement.
- This EPA does not include completion of a formal scholarly
project (TTP),
independent trial design, grant writing, specific teaching, nor an
independent QI
project.
Assessment
Plan:
Review of status of current scholarly project by supervisor,
mentor, or research coordinator
Use Form 1
Collect one observation of achievement
Relevant
milestones:
1 S 4.4 Generate a focused question for scholarly
investigation
2 S 3.3 Critically
evaluate the integrity, reliability, and applicability of health-related
research and literature
3 S 4.3 Secure
a supervisor’s commitment for a scholarly project
4 S 4.5 Summarize the findings of a literature review
5 S 4.4 Select appropriate methods of addressing a given
scholarly question
6 S 4.2 Apply
ethical principles in research, quality improvement or other scholarly
work
7 S 4.4 Collect data for a scholarly project
8 P 1.2 Demonstrate
a commitment to excellence in all aspects of practice
T2P EPA #1: Coordinating the delivery
of resources and care for patients who are critically ill
T2P EPA
#2: Debriefing resuscitations and other critical events
T2P EPA
#4: Demonstrating self-directed personal and
professional development
T2P EPA
#5: Conducting scholarly work
Coordinating the delivery of resources and care for
patients who are critically ill
Key
Features:
- This EPA focuses on managing the flow through the ICU: triaging
referrals, managing
discharges, surge and epidemic planning, delegation of
responsibilities, collaborating
with other health professionals and demonstrating judicious use of
resources.
- This EPA may be observed in and out of the ICU, including remote
sites.
- The observation of this EPA must be based on a block of time of
at least a day, and
preferably a week
- The observation of this EPA is not based on running rounds or
providing care for
individual patients, but rather the management of the unit as a
whole
Assessment
Plan:
Direct and/or indirect observation by physician, nurse clinician
or charge nurse
Use Form 1.
Collect 4 observations of achievement.
- At least 2 direct observations by nurse
- At least 2 direct or indirect observations by physician
- At least 4 separate encounters
Relevant
milestones:
1 ME 1.1 Demonstrate
responsibility and accountability for decisions regarding patient
care
2 ME 1.5 Prioritize
among patients based on clinical acuity
3 ME 1.5 Carry
out professional duties in the face of multiple, competing demands
4 L 2.1 Allocate health care resources for optimal patient
care
5 S 3.4 Integrate best evidence and clinical expertise
into decision-making
6 ME 4.1 Coordinate
the involvement of consulting services in patient care
7 COL 2.2 Work effectively with other health care
professionals to develop
plans for clinical care when there are differences in
opinion and/or
recommendations
8 L 4.1 Manage time and prioritize tasks
9 L 4.1 Integrate
supervisory and teaching responsibilities into the overall
management of the clinical service
10 P 4.1 Manage the mental and physical challenges that impact
physician
wellness and/or performance in demanding or stressful
clinical settings
Back to Transition to
Practice
Debriefing resuscitations and other critical events
Key
Features:
- This EPA includes leading the healthcare team in the immediate
debriefing post
critical event to identify opportunities for future improvement in
patient care.
- It includes developing an environment in which team members’ views
are
encouraged and respected.
- This EPA also includes providing, and/or identifying resources
for emotional and
psychological support for the health care team.
- This EPA does not include systems-level review, such as those
that would be
conducted for sentinel events or other patient safety concerns.
Assessment:
Direct observation by supervisor and/or other health professional
Use Form 1.
Collect 2 observations of achievement.
- At least one observation by physician
- Ideally one observation by other health professional
- At least two separate debriefing events
Relevant
milestones:
1 L 1.2 Establish a safe environment for debriefing
critical events
2 COL 1.3 Convey
the purpose of debriefing an event to the health care team
3 COL 1.3 Facilitate discussions within the health care
team, ensuring
everyone has the opportunity to participate
4 S 2.5 Role model self-assessment and feedback seeking
behaviour
5 L 1.2 Encourage all members of the team to identify
opportunities to
improve patient care
6 L 1.1 Summarize debriefing discussions, identifying
potential improvements
in health care delivery
7 P 4.3 Recognize,
support and respond effectively to colleagues in need
Back to Transition to
Practice
Contributing to continuous quality improvement initiatives
that address system level safety or quality concerns
Key
Features:
- This EPA includes the review and analysis of a set of events,
data or outcomes to
ascertain the quality of healthcare delivery
- It focuses on an analysis of the reasons for any gap in desired
outcomes, and may
include suggestions for potential improvement
- The observation of this EPA requires that the resident complete
the analysis but it is
not necessary for the resident to implement or participate in the
implementation of
any changes
- Examples may include quality assurance of outcome measures in
the intensive care
unit, an analysis of a patient safety event, or a review of a
series of patient
outcomes
- This EPA may be observed via presentation of findings (e.g. at
rounds or to a
committee) or via submission of a report
Assessment
Plan:
Direct and/or indirect observation by supervisor and/or QI lead
Use Form 1
Collect one observation of achievement
Relevant
Milestones:
1 L 1.1 Gather information for the purposes of quality
assurance or
improvement
2 S 4.4 Perform data analysis
3 L 1.1 Integrate
existing standards for health care delivery with findings of data
collection
4 L 1.1 Identify potential improvement opportunities
5 L 1.1 Identify the impact of human and system factors on
health care
delivery
6 L 3.1 Demonstrate
an understanding of the operations of the intensive care unit
7 L 3.2 Facilitate
change in health care to enhance services and outcomes
8 S 3.4 Integrate
best evidence and clinical expertise into decision-making
9 P 2.2 Demonstrate
a commitment to patient safety and quality improvement
initiatives within their own practice environment
Back to Transition to
Practice
Demonstrating self-directed personal and professional
development
Key
Features:
- The EPA focuses on integrating professional, personal and family
priorities in a
sustainable manner.
- It involves developing a personal learning plan for future
practice and ongoing
professional development.
- It also includes developing a strategy for managing finances,
insurance, medical
legal responsibilities and other issues related to the clinical
practice environment.
- The observation of this EPA is based on the resident submitting
their plan for
ongoing learning to the Competence Committee, and meeting
regularly with their
faculty advisor, mentor or program director to discuss their
wellness and professional
development.
Assessment
Plan:
Part A: Learning plan
Competence Committee reviews the resident’s submission of a
learning plan geared to
progression of competence
Part B: Mentorship discussions
Direct observation by faculty advisor, mentor, or program
director.
Use Form 1
Collect one observation
Relevant
milestones:
Part B: Mentorship discussions
1 P 2.1 Demonstrate
a commitment to maintaining and enhancing competence
2 ME 1.4 Demonstrate
an awareness of the context of practice, including what is
required to practice safely and effectively
3 S 1.2 Identify opportunities for learning and
improvement by reflecting on
and assessing performance using various internal and
external data sources
4 S 1.1 Identify
learning needs to enhance competence across all CanMEDS roles and
generate immediate and longer-term career goals
5 HA 2.3 Identify
and respond to unmet health care needs within one’s practice
6 S 3.1 Generate focused questions to address practice uncertainty
and
knowledge gaps
7 L 4.2 Reconcile
expectations for practice with job opportunities and workforce needs
8 S 1.1 Create and implement a learning plan
9 L 4.2 Choose educational experiences to gain
competencies necessary for
future unsupervised practice
10 P 4.2 Develop a strategy to manage personal and
professional demands for
a sustainable independent practice
11 P 3.1 Fulfil
professional standards of practice by participating in programs that
record continuing professional development (e.g. Royal College
Maintenance of
Certification Program)
Back to Transition to
Practice
Conducting scholarly work
Key
Features:
- This EPA includes all aspects of performing scholarly work:
identification of a
question for investigation, literature review, data gathering,
data analysis, reflective
critique and dissemination.
- This may include scholarly research, quality assurance, or
educational projects.
- The assessment of this EPA is based on the submission of a
completed scholarly
project, and may also include observation of the presentation of
the scholarly work.
Assessment
Plan:
Supervisor review of resident scholarly work
Use Form 1
Collect one observation of achievement
Relevant
Milestones:
1 L 4.1 Organize work to manage clinical, scholarly and
other responsibilities
2 S 4.4 Identify, consult and collaborate with content
experts and others in
the conduct of scholarly work
3 S 4.4 Generate
a focused question for scholarly investigation
4 S 3.3 Critically
evaluate the integrity, reliability, and applicability of health-related
research and literature
5 S 4.5 Summarize
the findings of a literature review
6 S 4.4 Select
appropriate methods of addressing a given scholarly question
7 S 4.2 Apply
ethical principles in research, quality improvement or other scholarly
work
8 S 4.4 Collect
data for a scholarly project
9 S 4.4 Perform data analysis
10 S 4.4 Integrate existing literature and findings of
data collection
11 S 4.4 Identify
areas for further investigation
12 S 4.5 Summarize and communicate the findings of
research and scholarly
inquiry