Core of Discipline

Short title (medSIS): COD-EPA NEWBORN RESUSCITATION

Description:

• This EPA focuses on applying neonatal resuscitation guidelines, as relevant, and working effectively with the resuscitation team.

• This includes high-risk deliveries.

• This includes providing stabilization and arranging transfer to the NICU, as relevant.

Assessment plan:

• Direct observation, case presentation or review of written documentation by supervisor, senior resident, nurse practitioner, or advanced care nurse

• Use form 1. Form collects information on:

  • Gestational age (write in):

• Collect 3 observations of achievement

  • At least 2 observers

Milestones:

• Recognize one’s own limits and seek assistance as needed (ME 1.4)

• Determine the acuity of the issue and the priorities for patient care (ME 2.1)

• Perform the sequence of neonatal resuscitation as per established protocols (ME 3.4)

• Integrate planned procedures or therapies into resuscitative efforts (ME 3.1)

• Maintain capacity for professional clinical performance in stressful situations (P 4.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• NICU - McMaster

• Level 2 Nursery (community)

• Community

Short title (medSIS): COD-EPA CRITICALLY ILL RESUSCITATION

Description:

• This EPA focuses on the resuscitation and stabilization of critically ill pediatric patients of all ages.

• This EPA includes identifying priorities for management and the need for intensivist and/or other specialist support.

• It includes participating in a debrief session after the acute event.

• This EPA does not include ongoing inpatient management of acutely ill pediatric patients.

• This EPA may be observed in the simulation setting

Assessment plan:

• Direct observation by supervisor

• Use form 1. Form collects information on:

  • Age: neonate; infant; preschool; school age; adolescent

  • Setting: inpatient; outpatient; emergency department; community; on call/after hours; simulation

  • Presentation (check all that apply): respiratory; hemodynamic; fluid and electrolyte/metabolic; neurologic; other presentation (please specify)

• Collect 5 observations of achievement

  • At least 1 neonate

  • At least 1 infant/preschool

  • At least 1 school aged

  • At least 1 adolescent

  • No more than 1 in simulation setting

  • At least 1 of each presentation

Milestones:

• Work effectively as the leader of a resuscitation team (COL 1.2)

• Determine the acuity of the issue and the priorities for patient care (ME 2.1)

• Focus the assessment, performing in a time-effective manner without excluding key elements (ME 2.2)

• Develop and implement focused treatment strategies (ME 2.4)

• Determine the need for and timing of referral to another health care professional (ME 4.1)

• Apply closed loop communication in urgent or crisis situations to work effectively with physicians and other colleagues in the health care professions (COL 1.3)

• Maintain capacity for professional clinical performance in stressful situations (P 4.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• CTU including night float and weekend call

• Pediatric Emergency Medicine

• Pediatric Intensive Care Unit (PICU) including night float and weekend call

• Community

Short title (medSIS): COD-EPA COMPLEX PATIENTS

Description:

• This EPA builds on the skills achieved in the Foundations stage to focus on obtaining a history and completing a physical exam for patients with undifferentiated, complex single system or multiple active competing conditions at varying levels of chronicity.

• This includes patients with medical and/or psychosocial issues who may be unstable and/or uncooperative.

• It includes developing a prioritized problem list with a differential diagnosis.

• This EPA does not include ongoing management of the patient.

Assessment plan:

• Direct observation or case review by supervisor

• Use Form 1. Form collects information on:

  • Observation: direct; case review

  • Setting: inpatient; outpatient; emergency department; community; on call/after hours; NICU; PICU

  • Age: neonate; infant; preschool; school age; adolescent

  • Type of condition (check all that apply): respiratory; gastrointestinal; ID; cardiac; rheumatic/musculoskeletal; hematology/oncology; endocrine; neurology; renal/genitourinary; otolaryngology/ophthalmology; dermatology; genetic; mental health; developmental/behavioural/psychosocial; allergy/immunology

  • Complexity: low; medium; high

  • Acuity: emergent; urgent; non-urgent

• Collect 4 observations of achievement.

  • At least 2 direct observations

  • No more than 1 in a neonate

  • At least 3 different types of conditions

  • No more than 2 assessments with the same type of condition

  • At least 2 different assessors

Milestones:

• Gather a history, including all pertinent medical and psychosocial issues (ME 2.2)

• Manage the flow of complex patient encounters (COM 2.2)

• Perform the physical exam in a manner that minimizes discomfort or distress, without excluding key elements (ME 2.2)

• Seek and synthesize relevant information from other sources (e.g., family, medical record) (COM 2.3)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Resident Continuity Clinic

• Community

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent Medicine

• Allergy/Immunology

• Cardiology

• Child Maltreatment

• Developmental Pediatrics

• Endocrinology

• Gastroenterology

• Genetics/metabolics

• Infectious Diseases

• Nephrology

• Mental Health

• Respirology

Short title (medSIS): COD-EPA MANAGING PEDIATRIC PATIENTS

Description:

• This EPA focuses on assessing, diagnosing and providing management for patients with an acute presentation.

• This includes patients with a new presentation, as well as patients with acute exacerbations or decompensations of a chronic disorder and/or complications of treatment or the condition.

• It also includes arranging for inpatient, emergency, or outpatient follow-up.

• This EPA does not include resuscitation of critically ill or injured patients.

Assessment plan:

• Direct observation or case review by supervisor, TTP or subspecialty resident, clinical associate or nurse practitioner

• Use form 1. Form collects information on:

  • Ages: neonate; infant; preschool; school age; adolescent

  • Setting: inpatient; outpatient; emergency department; community; NICU; PICU

  • Type of condition (check all that apply): respiratory; gastrointestinal; ID; cardiac; rheumatic/musculoskeletal; hematology/oncology; endocrine; neurology; renal/genitourinary; otolaryngology/ophthalmology; dermatology; genetic; allergy/immunology

• Collect 8 observations of achievement.

  • At least 6 direct observations

• At least 2 of each age group: neonate; infant/preschool; school aged; adolescent

• No more than 2 observations with the same type of condition as the primary presenting medical problem

• At least 6 observed by supervisor

• At least 3 different assessors

Milestones:

• Perform a clinical assessment that addresses all relevant issues (ME 1.4)

• Integrate best evidence and clinical expertise into decision-making (S 3.4)

• Develop and implement a management plan that considers all of the patient’s health problems and context (ME 2.4)

• Integrate the patient’s and family’s perspective and context into the care (COL 1.3)

• Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression (ME 4.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Pediatric Emergency Medicine

• Resident Continuity Clinic

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent Medicine

• Allergy/Immunology

• Cardiology

• Child Maltreatment

• Developmental Pediatrics

• Endocrinology

• Gastroenterology

• Genetics/metabolics

• Infectious Diseases

• Nephrology

• Mental Health

• Respirology

Short title (medSIS): COD-EPA ONGOING MANAGEMENT

Description:

• This EPA focuses on providing ongoing comprehensive management that includes implementing screening, surveillance, or monitoring strategies, assessing medication adherence and effects, as well as addressing patient and family concerns, and providing education and appropriate follow-up.

• It includes identifying patients with a fluctuating clinical course, recognizing the need for change or escalation of therapy, and implementing a therapeutic plan.

• This EPA may include patients whose condition is complex, and therefore requires a consideration of the patient’s treatment goals, interactions between different diseases and treatments, consideration of multimorbidity and frailty and, often, coordination with other physicians and health care professionals.

• This EPA includes providing anticipatory guidance to the patient and family in the primary care role for overall health maintenance and/or surveillance, and advocating for the patient’s health care needs.

• This may include the management of patients who are technology dependent

Assessment plan:

• Direct observation or case review by supervisor

• Use form 1. Form collects information on:

  • Observation: direct; case review

  • Type of condition: respiratory; gastrointestinal; ID; cardiac; rheumatic/musculoskeletal; hematology/oncology; endocrine; neurology; renal/genitourinary; otolaryngology/ophthalmology; dermatology; genetic; allergy/immunology

  • Setting: inpatient; outpatient; emergency department; community; NICU; PICU; home

• Collect 8 observations of achievement

  • At least 3 direct observations

  • At least 8 different conditions

  • At least 1 community setting

  • At least 5 different observers

Milestones:

• Consider comorbidities and clinical urgency in determining priorities to be addressed (ME 2.1)

• Integrate and summarize information obtained through the clinical assessment and investigations (ME 2.2)

• Identify and address interactions between different diseases and different treatments (ME 2.4)

• Develop and implement a management plan that considers all of the patient’s health problems and context (ME 2.4)

• Adapt guideline-based recommendations for care to the context of the patient’s specific needs and priorities (ME 2.4)

• Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression (ME 4.1)

• Work effectively with other health care professionals, including other physicians (COL 1.2)

• Facilitate timely access to services and resources in the health or social system(s) (HA 1.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Resident Continuity Clinic

• Neonatal Intensive Care Unit (NICU) - McMaster

• Level 2 Nursery (Community)

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent Medicine

• Allergy/Immunology

• Cardiology

• Child Maltreatment

• Developmental Pediatrics

• Endocrinology

• Gastroenterology

• Genetics/metabolics

• Infectious Diseases

• Nephrology

• Mental Health

• Respirology

Short title (medSIS): COD-EPA MENTAL HEALTH

Description:

• This EPA focuses on the recognition, assessment, and management of mental health issues.

• Examples include patients with ADHD; anxiety disorder; conversion disorder; early psychosis; eating disorders; mood disorders; obsessive compulsive disorder; oppositional/disruptive and conduct disorders; substance abuse disorders, including tobacco/nicotine products; and suicidal ideation, intent, and attempts

Assessment plan:

• Direct observation or case review by supervisor

• Use form 1. Form collects information on:

  • Type of observation: direct; case review

  • Condition: ADHD; anxiety disorder; conversion disorder; early psychosis; eating disorder; mood disorder; obsessive compulsive disorder; oppositional/disruptive and/or conduct disorder; substance abuse; suicidal ideation, intent, and attempts

  • Setting: inpatient; outpatient; emergency department; community; longitudinal clinic

• Collect 5 observations of achievement.

• At least 2 by direct observation

• At least 5 different conditions

• At least 1 in longitudinal clinic

• At least 2 in the community

• At least 3 different observers

Milestones:

• Perform a clinical assessment that addresses all relevant issues (ME 1.4)

• Use screening tools and validated questionnaires, as applicable (ME 2.2)

• Synthesize biological, psychological, and social information to determine a diagnosis (ME 2.2)

• Develop and implement a management plan that considers all of the patient’s health problems and context (ME 2.4)

• Determine the need for and timing of referral to another health care professional (ME 4.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Adolescent Medicine

• Developmental Pediatrics

• Mental Health

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Resident Continuity Clinic

• Pediatric Emergency Medicine

Short title (medSIS): COD-EPA DEVELOPMENTAL BEHAVIOURAL

Description:

• This EPA focuses on the recognition, assessment, and management of behavioural, developmental, and school issues.

• Examples include patients with autistic spectrum disorders, common behaviour problems, isolated and global learning difficulties, isolated and global developmental disorders, and sleep hygiene issues and sleep disorders.

Assessment plan:

• Direct observation or case review by supervisor

• Use form 1. Form collects information on:

  • Type of observation: direct; case review

  • Condition: autistic spectrum disorder; common behaviour problem(s); learning difficulty; developmental disorder; sleep hygiene issue and/or sleep disorder

  • Setting: inpatient; outpatient; emergency department; community; longitudinal clinic

• Collect 5 observations of achievement.

  • At least 2 by direct observation

  • At least 4 different conditions

  • At least 2 in longitudinal clinic

  • At least 2 in the community

  • At least 3 different observers

Milestones:

• Perform a clinical assessment that addresses all relevant issues (ME 1.4)

• Adapt the clinical assessment to the child’s age and developmental stage (ME 2.2)

• Synthesize biological, psychological, and social information to determine a diagnosis (ME 2.2)

• Develop and implement a management plan that considers all of the patient’s health problems and context (ME 2.4)

• Determine the need for and timing of referral to another health care professional (ME 4.1)

• Develop a plan for ongoing management and follow-up (ME 4.1)

• Support and educate professionals in other sectors, including daycare and school teachers, in their interactions with the patient and family (COL 1.3)

• Facilitate timely access to services and resources in the health and/or social system(s) (HA 1.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Developmental Pediatrics

• Mental Health

• Community

• Resident Continuity Clinic

• Adolescent

• Child Maltreatment

• Pediatric Emergency Medicine

Short title (medSIS): COD-EPA MALTREATMENT

Description:

• This EPA focuses on recognizing and managing patients who have experienced physical, emotional, and/or sexual maltreatment or neglect, or in whom it is suspected.

• It also includes recognizing when a patient is at risk, when there may be a detrimental imbalance between care needs and care provided, or when police and/or social services need to be engaged.

• This EPA does not include preparing legal reports or testifying in court about alleged child abuse and/or neglect.

Assessment plan:

• Direct observation by supervisor

• Use form 1. Form collects information on:

  • Age: neonate; infant; preschool; school age; adolescent

  • Type of maltreatment: physical; emotional; sexual; neglect; Munchausen by proxy

• Collect at least 3 observations of achievement.

  • At least 1 physical maltreatment (including suspected)

  • At least 1 sexual maltreatment (including suspected)

  • At least 1 neglect (including suspected)

Milestones:

• Recognize sentinel clinical findings suggesting child maltreatment and/or neglect, including injuries, behavioural and emotional changes and other clinical signs (ME 2.2)

• Assess a child for signs and symptoms of child maltreatment and/or neglect (ME 2.2)

• Document evidence of child maltreatment, including the use of diagrams and photographs as appropriate (COM 5.1)

• Develop and implement a management plan that considers all of the patient’s health problems and context (ME 2.4)

• Determine the need to involve specialized care professionals, child protective services, or law enforcement (ME 4.1)

• Adhere to requirements for mandatory reporting (P 3.1)

• Apply relevant aspects of child welfare legislation (P 3.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Child Maltreatment

• Pediatric Emergency Medicine

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Intensive Care Unit (PICU) including night float and weekend call

• Community

Short title (medSIS): COD-EPA CORE PROCEDURES

Description:

• This EPA includes determining which procedures are necessary and appropriate to the situation.

• Procedures include: accessing port-a-cath; cardiopulmonary resuscitation (defibrillation); chest tube; ear curettage; G-tube reinsertion; immunization (intramuscular); immunization (subcutaneous); intubation; IV insertion; lumbar puncture with/without injection in preschool/school age child; managing occlusion in long-term access line; nasogastric tube; nasopharyngeal swab; obtaining an EKG; phlebotomy; surfactant administration; throat swab; umbilical arterial line; umbilical venous line; urinary catheterization

• Some procedures may be observed in a simulation setting, including Pediatric Advanced Life Support (PALS) or Neonatal Resuscitation Program (NRP) and/or mock codes.

• This EPA does not include other commonly performed procedures that are present in the other stages of training (Foundations).

Assessment plan:

• Direct observation by supervisor

• Use form 2. Form collects information on:

  • Procedure: access port-a-cath; cardiopulmonary resuscitation (defibrillation); chest tube; ear curettage; G-tube reinsertion; immunization (intramuscular); immunization (subcutaneous); intubation; IV insertion; lumbar puncture with/without injection; manage occlusion in long-term access line; nasogastric tube; nasopharyngeal swab; obtain EKG; phlebotomy; surfactant administration; throat swab; umbilical arterial line; umbilical venous line; urinary catheterization

  • Setting: clinical; simulation

  • Age: neonate; infant; preschool; school age; adolescent

  • Gender: female; male

• Collect 33 observations of achievement (those marked with an asterisk may be observed in simulation).

  • At least 1 access port-a-cath*

  • At least 1 cardiopulmonary resuscitation (defibrillation)*

  • At least 2 chest tubes*

  • At least 2 ear curettage

  • At least 1 G-tube reinsertion*

  • At least 2 immunizations (intramuscular and subcutaneous)*

  • At least 3 intubations in neonates/infants

  • At least 2 IV insertions, including one infant/preschool age

  • At least 2 lumbar puncture with/without injection in preschool age/school age

  • At least 1 manage occlusion in long-term access line*

  • At least 3 nasogastric tubes in neonates/school age

  • At least 1 nasopharyngeal swab

  • At least 1 obtain EKG

  • At least 3 phlebotomies

  • At least 2 surfactant administration in neonate

  • At least 1 throat swab

  • At least 1 umbilical arterial line

  • At least 2 umbilical venous line

  • At least 2 urinary catheterization (1 in a boy; 1 in a girl)

Milestones:

• Obtain and document informed consent, explaining the risks and rationale for a proposed procedure (ME 3.2)

• Select and provide sedation and local analgesia, as appropriate (ME 3.4)

• Perform the procedure in a skilful and safe manner (ME 3.4)

• Communicate effectively with patient and/or assistant(s) during the procedure (COL 1.2)

• Recognize and manage complications (ME 3.4)

• Document the procedure and outcome (COM 5.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

Access port-a-cath* (1)

• Academic Half Day Skills Workshop

Cardiopulmonary resuscitation (defibrillation)* (1)

• Academic Half Day Skills Workshop

• NRP/PALS

• Pediatric Emergency Medicine

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Anaesthesia

Chest tubes* (2)

• Academic Half Day Skills Workshop

• Pediatric Emergency Medicine

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Ear curettage (2)

• Pediatric Emergency Medicine

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

G-tube reinsertion* (1)

• Academic Half Day Skills Workshop

• Pediatric Emergency Medicine

• Community

• Clinical Teaching Unit (CTU) including night float and weekend call

Immunizations (intramuscular and subcutaneous)* (2)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Level 2 Nursery (community)

• Community

• Pediatric Emergency Medicine

• Resident Continuity Clinic

• Neonatal Intensive Care Unit (NICU) - McMaster

Intubations in neonates/infants (3)

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Anaesthesia

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

IV insertions, including one infant/preschool age (2)

• Anaesthesia

• Community

• Level 2 Nursery - community

Lumbar puncture with/without injection in preschool age/school age (2)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Emergency Medicine

• Community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Manage occlusion in long-term access line* (1)

• Academic Half Day Skills Workshop - complex care

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Emergency Medicine

• Community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Nasogastric tubes in neonates/school age (3)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Level 2 Nursery - community

• Neonatal Intensive Care Unit (NICU) - McMaster

• Anaesthesia

• Pediatric Emergency Medicine

• Community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Nasopharyngeal swab (1)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Emergency Medicine

• Community

Obtain EKG (1)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Emergency Medicine

• Community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Phlebotomies (3)

• Anaesthesia

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Level 2 Nursery - community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

Surfactant administration in neonate (2)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Level 2 Nursery - community

Throat swab (1)

• Clinical Teaching Unit (CTU) including night float and weekend call

• Pediatric Emergency Medicine

• Community

Umbilical arterial line (1)

• Level 2 Nursery - community

• Neonatal Intensive Care Unit (NICU) - McMaster

Umbilical venous line (2)

• Level 2 Nursery - community

• Neonatal Intensive Care Unit (NICU) - McMaster

Urinary catheterization (1 in a boy; 1 in a girl)

• Pediatric Emergency Medicine

• Community

• Clinical Teaching Unit (CTU) including night float and weekend call

• Level 2 Nursery - community

• Neonatal Intensive Care Unit (NICU) - McMaster

• Anaesthesia

Short title (medSIS): COD-EPA EMOTIONALLY CHARGED DISCUSSIONS

Description:

• This EPA focuses on the application of advanced communication and conflict resolution skills to address difficult situations that may involve patients, families, and/or members of the health care team.

• This EPA may be observed in any scenario that is emotionally charged. Examples include managing conflict (parent/physician; patient/physician; patient/parent; physician/health care professional), disclosing unexpected complications and/or medical errors, addressing non-adherence with treatment plan (e.g., vaccine refusal), and breaking bad news.

• This EPA does not include end-of-life discussions (TTP).

• This EPA includes documentation of the encounter.

• This EPA may be observed in a simulation setting.

Assessment plan:

• Direct observation by supervisor with review of documentation

• Use form 1. Form collects information on:

  • Type of communication: addressing non-adherence with treatment plan; breaking bad news; disclosing unexpected complication and medical errors; managing conflict

  • Setting: inpatient; outpatient; ICU; simulation

  • Adolescent: yes; no

  • Interpreter: yes; no

• Collect 5 observations of achievement.

  • At least 3 different types of communication

  • At least 1 from each of setting

  • At least 1 observation of a communication with an adolescent

  • At least 4 different supervisor observers

Milestones:

• Ensure the physical environment is suitable for the nature of the situation (e.g., privacy, safety) (COM 1.2)

• Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately (COM 1.5)

• Share information and explanations that are clear and accurate (COM 3.1)

• Communicate in a manner that is respectful, non-judgmental and culturally aware (COM 4.1)

• Listen to understand and acknowledge other perspectives (COL 2.2)

• Document the clinical encounter to reflect discussion and decisions (COM 5.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent Medicine

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Resident Continuity Clinic

• Child Maltreatment

• Endocrinology

• Mental Health

Short title (medSIS): COD-EPA COORDINATING TRANSITIONS COMPLEX

Description:

• This EPA builds on the skills of Foundations, adding patient care scenarios that are more complex (from a medical, social, psychosocial perspective) as well as transitions that may require coordination of multiple teams or professionals.

• This includes assessing the needs of the patient and family, orchestrating the team that will be involved in the patient’s care, making optimal use of community resources, providing handover to receiving physicians, and ensuring that patient’s family understands the current status of the patient health care needs and the management and follow-up plan.

• This EPA includes: inter-facility or intra-hospital transfer of a patient; movement of patients between health care professionals and/or settings, including admission from community setting, emergency department, different level of care within a hospital, and transfer of care from one practitioner to another; discharging a patient from an inpatient facility; and, transition of care to the adult setting.

Assessment plan:

• Direct observation and/or case review by supervisor, senior resident, nurse practitioner or other with expertise in transitions

• Use form 1. Form collects information on:

  • Case complexity (select all that apply): medical; multisystem; social; other complexity

  • Transition type (select all that apply): transfer of care; discharge

  • Settings: inpatient; outpatient; emergency department; community; PICU; NICU

  • Age: neonate; infant; preschool; school age; adolescent

• Collect 4 observations of achievement.

• At least 1 of each transition type

• At least 2 different observers

Milestones:

• Integrate clinical information to determine the patient’s clinical status and health care needs (ME 2.2)

• Apply knowledge of the resources and/or services available in other care settings (L 2.1)

• Establish plans for ongoing care, follow-up on investigations, response to treatment and/or monitoring for disease progression (ME 4.1)

• Consult as needed with other health care professionals, including other physicians (COL 1.2)

• Work with other health care professionals to address barriers to access to resources and services (HA 1.1)

• Convey information and provide anticipatory guidance to the patient and family regarding the patient’s care needs and treatment plan (COM 3.1)

• Select and/or provide access to family education resources (HA 1.2)

• Communicate effectively with the accepting physician, providing a summary of patient issues and ongoing guidance for care (COL 3.2)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Level 2 Nursery (community)

• Neonatal Intensive Care Unit (NICU) - McMaster

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent Medicine

• Endocrinology

Short title (medSIS): COD-EPA LEADING INPATIENT TEAM

Description:

• This EPA focuses on the efficient leadership of an inpatient service in the role of the senior resident.

• This includes organizing and delegating the daily workload for the medical team, working effectively with the interprofessional team, coordinating patient management and discharge plans and using available resources judiciously.

• At this stage, this EPA does not include the role of the most responsible physician for medical decisions.

• The observation of this EPA is not based on a single patient encounter, but rather on the resident performance over a period of at least one week.

Assessment plan:

• Direct and indirect observation by supervisor, of at least one week of clinical activity, with input from other team members and health professionals (nurse, clinical assistant, other health professionals, other residents or students)

• Use form 1.

• Collect 2 observations of achievement.

Milestones:

• Manage time and prioritize tasks (ME 4.1)

• Delegate responsibilities to members of the health care team appropriate to their scope of practice and level of expertise (COL 1.2)

• Communicate effectively with physicians and other health care professionals (COL 1.3)

• Apply a broad base and depth of knowledge to manage the breadth of pediatric patient presentations (ME 1.3)

• Determine the need for and timing of referral to another health care professional (ME 4.1)

• Coordinate investigation, treatment and follow-up when multiple physicians and health care professionals are involved (ME 4.1)

• Exhibit appropriate professional behaviours (P 1.1)

• Demonstrate a commitment to patient safety and quality improvement (P 2.2)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

Short title (medSIS): COD-EPA SCHOLARLY ACTIVITY

Description:

• The observation of this EPA is based on completion of a scholarly project.

• This may include basic or clinical science related to pediatric medicine, advocacy, medical education, patient safety, QI, knowledge translation, and others at the discretion of the program director.

• This EPA includes reviewing and appraising relevant literature, using appropriate methods, analyzing findings, critically reflecting on the findings, discussing what the project has added to the field of inquiry, and disseminating results in some format (e.g., grand rounds, research day, manuscript suitable for journal submission) at the discretion of the program director.

• It includes preparation of an abstract, structured progress report, and/or manuscript.

Assessment plan:

• Research supervisor recommends achievement of the EPA to the competence committee.

• Use form 4.

• Collect 1 observation of achievement.

Milestones:

• Pose questions that are appropriately constructed and amenable to scholarly inquiry (S 4.4)

• Organize work to manage clinical, scholarly, and other responsibilities (L 4.1)

• Identify, consult, and collaborate with content experts and others in the conduct of scholarly work (S 4.4)

• Collect data for a scholarly project (S 4.4)

• Perform data analysis (S 4.4)

• Integrate existing literature and findings of data collection (S 4.4)

• Identify areas for further investigation (S 4.4)

• Summarize and communicate the findings of research and scholarly inquiry (S 4.5)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Resident Scholarly Project

Short title (medSIS): COD-EPA TEACHING

Description:

• The focus of this EPA is the role of the pediatrician as a teacher of junior learners, other residents, physicians, other health professionals and the public.

• This includes formal and informal teaching, as well as assessing and providing constructive feedback to junior learners.

• Examples of formal and informal teaching include: didactic sessions (e.g., grand rounds, academic half day, prepared teaching sessions with staff, formal undergraduate medical courses, small group formal session, large group formal session, conference presentation, community presentations), informal (i.e., impromptu) didactic sessions, physical examination skills teaching, procedural skills teaching and bedside teaching.

• The observation of this EPA is divided into two parts: providing teaching; and assessing and providing constructive feedback.

Assessment plan:

Part A: Providing teaching

• Direct observation by physician or TTP resident, including feedback from learners if possible

• Use form 1. Form collects information on:

  • Teaching event: academic half day session; bedside teaching; community presentations; conference presentation; grand rounds; large group formal session; informal/impromptu teaching; physical examination skill teaching; prepared teaching sessions with staff; procedural skills teaching; small group formal session; undergraduate medical course; other teaching event

• Collect 4 observations of achievement.

  • A variety of teaching events

Part B: Assessing and providing constructive feedback to junior learners

• Direct observation by supervisor with input from the junior learner

• Use form 1. Form collects information on:

  • Challenging situation: yes; no

  • Simulation: yes; no

• Collect 2 observations of achievement.

  • At least 1 challenging situation

Milestones:

Part A: Teaching

• Identify the learning needs and desired learning outcomes of others (S 2.4)

• Develop learning objectives for a teaching activity adapting to the audience and setting (S 2.4)

• Apply knowledge of the biomedical and clinical sciences relevant to Pediatrics (ME 1.3)

• Present information in an organized manner to facilitate understanding (S 2.4)

• Provide adequate time for questions and discussion (S 2.4)

Part B: Providing feedback

• Create a safe space for feedback to be given and received (S 2.2)

• Identify behaviours to continue as well as those for improvement (S 2.5)

• Provide examples of learner performance to support the overall assessment (S 2.5)

• Provide specific actionable suggestions for improvement of performance (S 2.5)

• Complete learner assessments in a timely fashion (P 1.1)

Mapped to the following training experiences:

Those in colour denote direct mapping, those in typical font denote those that may be possible during this rotation

• Clinical Teaching Unit (CTU) including night float and weekend call

• Community

• Teach/Medical Education

• Level 2 Nursery (community)

• Pediatric Intensive Care Unit (PICU) - including night float and weekend call

• Adolescent medicine

• Cardiology

• Developmental Pediatrics

• Developmental Pediatrics

• Endocrinology

• Gastroenterology

• Infectious Diseases

• Nephrology

• Respirology