Transition to Practice

Short title (medSIS): TTP-EPA LEADING INPATIENT SERVICE

Description:

• This EPA focuses on the independent management of an inpatient service in the role of the physician most responsible for patient care. Building on the competencies of the Core stage, this includes application of the knowledge, skills and attitudes expected of an independently practicing physician.

• This includes responsibility for the overall safe quality care of acute and chronic patients, working effectively with the interprofessional team, completing administrative tasks, bed management, and supervising, coaching, assessing and providing feedback for junior learners.

• The observation of this EPA is divided into two parts: patient care; interprofessional interaction/supervision.

• The patient care aspects of this EPA are based on at least one week of observation caring for a patient population that is reflective of a general pediatric practice in the local context.

Assessment plan:

Part A: Patient Care

• Direct and indirect observation by supervisor

• Use form 1. Form collects information on

  • Complexity and volume of case load: low; high

  • Setting (write-in):

• Collect 3 observations of achievement

  • At least 1 case load of high complexity

  • 2 different supervisors

Part B: Interprofessional care/supervision of junior learners

• Feedback from multiple observers compiled by supervising pediatrician

• Use form 3. Form collects information on:

  • Includes feedback from (select all that apply): nurse; clinical assistant; consulting physician; social worker; other trainee (e.g., subspecialty resident, junior resident, medical student); other health care professional

• Collect feedback from at least 3 observers on one occasion during Transition to Practice.

Milestones:

Part A: Patient Care

• Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician (ME 1.1)

• Perform relevant and time-effective clinical assessments (ME 1.4)

• Prioritize patients based on the urgency of clinical presentations (ME 1.5)

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

• Develop plans for patient care that anticipate clinical response and progress to other settings of care, including home (ME 2.4)

• Integrate supervisory and teaching responsibilities into the overall management of the clinical service (L 4.1)

• Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings (P 4.1)

• Coordinate treatment and follow-up across care settings (ME 4.1)

Part B: Interprofessional care/supervision

• Assign tasks and responsibilities to other team members, commensurate with their skills and patient complexity (COL 1.2)

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

• Respond appropriately to input from other health care professionals (COL 1.1)

• Respond punctually to requests from patients or other health care professionals (P 1.1)

• Create a positive learning environment (S 2.2)

• Intervene when behaviours toward colleagues and/or learners undermine a respectful environment (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) - Junior Attending

• Community

Short title (medSIS): TTP-EPA OUTPATIENT LONGITUDINAL

Description:

• This EPA focuses on the longitudinal management of a general pediatric outpatient clinic in the role of the physician most responsible for patient care.

• This includes responsibility for medical care decisions, time and caseload management, follow-up on investigations and accessibility in between clinic visits.

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

Assessment plan:

• Direct and/or indirect observation by supervisor(s), with input from nurse, clerk +/- other health care professionals

• Use form 3.

• Collect observations at 1-3 months intervals with at least 2 observations of achievement.

Milestones:

• Select investigation strategies demonstrating awareness of availability and access in the outpatient setting (ME 2.2)

• Formulate treatment plans that are suitable for implementation in the outpatient setting (ME 2.4)

• Provide accurate, timely and relevant written information to the referring/primary care physician (COL 1.3)

• Manage time effectively to maintain clinic flow (L 4.1)

• Work effectively with outpatient clinic staff and managers (COL 1.2)

• Respond punctually to requests from patients or other health care professionals (P 1.1)

• Manage clinic booking and scheduling (L 4.2)

• Review and act on incoming test results in a timely manner (L 4.2)

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

• Resident Continuity Clinic

Short title (medSIS): TTP-EPA GOALS OF CARE

Description:

• This EPA focuses on the application of communication skills to lead discussions with patients and families about progression of illness and evolution of the goals of care.

• This includes patients with complex medical issues and/or life-limiting conditions for whom decisions regarding goals of care may impact plans for management.

• This EPA includes the legal and ethical aspects of these discussions and decisions.

• It may also include providing referral to resources to support ongoing patient care and/or bereavement resources for the family.

• This EPA may be observed in simulation.

Assessment plan:

• Direct observation by supervisor

• Use form 1. Form collects information on:

  • Setting: clinical; simulation

• Collect 2 observations of achievement.

  • No more than 1 in simulation

Milestones:

• Identify patients with life-limiting conditions, including those for whom the burden of disease-modifying treatment or investigations may be greater than the clinical benefit. (ME 2.1)

• Share information about diagnosis and prognosis clearly and compassionately (COM 3.1)

• Gather information about the patient’s beliefs, values, preferences, context and expectations with regard to their care (COM 2.1)

• Establish goals of care in collaboration with the patient and/or family (ME 2.3)

• Develop management plans that accurately reflect the patient and/or family’s goals of care (ME 2.4)

• Document the clinical encounter to accurately reflect the 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

• Quality of Life and Advanced Care (QoLA)/Palliative Care

• Complex Care

• Clinical Teaching Unit (CTU) - Junior Attending

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

Short title (medSIS): TTP-EPA FAMILY TEAM MEETINGS

Description:

• This EPA focuses on leading meetings for the purposes of discussing clinical status and management, clarifying patient/family expectations, setting treatment goals, reviewing patient progress and/or discharge planning.

• This includes leading the discussion, attending to meeting flow and organization, encouraging participation from all members, integrating information from the interprofessional team, promoting patient-centred goal-setting, and facilitating discharge planning.

• This EPA includes identifying and managing conflict between patients, families, other physicians, and other health care providers, as well as complex communication scenarios such as those needing the use of an interpreter.

Assessment plan:

• Direct and/or indirect observation by supervisor, with input from others

• Use Form 1. Form collects information on:

  • Type of meeting: family; team

  • Type of observation (select all that apply): direct; based on feedback from others

  • Simulation: yes; no

• Collect 4 observations of achievement.

  • At least 2 of each meeting type

  • At least 1 direct observation by a supervising pediatrician

Milestones:

• Demonstrate responsibility and accountability for decisions regarding patient care, acting in the role of most responsible physician (ME 1.1)

• Share information with patients, families and other health care providers in a manner that respects patient privacy and confidentiality, and enhances understanding (COM 5.3)

• Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe (COM 4.1)

• Facilitate interprofessional meetings, ensuring engagement and participation of attendees and appropriate time management (L 4.2)

• Implement strategies to promote understanding, manage differences, and resolve conflicts in a collaborative manner (COL 2.2)

• Manage one’s own non-verbal communication skills in difficult situations (COM 1.4)

• Intervene when behaviours among colleagues and/or learners undermine a respectful environment (P 1.1)

• Establish management plans in patient encounters when there are significant disagreements about what is achievable (ME 2.4)

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) - Junior Attending

• Community

• Quality of Life and Advanced Care (QoLA)/Palliative Care

• Complex Care

Short title (medSIS): TTP-EPA QI

Description:

• This EPA includes the review and analysis of a patient safety event and identification of the human, system and other factors leading to the event.

• This includes a review of expected standards or outcomes of health care delivery, analysis of the reasons for the gap in desired outcome, and may include suggestions for potential improvement.

• The observation of this EPA requires that the resident participates in the analysis but it is not necessary for the resident to implement or participate in the implementation of any changes.

• This EPA may be observed via presentation of findings (e.g., at rounds or to a committee) or via submission of a report.

• This EPA may be observed using a simulated patient safety case.

Assessment plan:

• Direct observation of case presentation by supervisor

• Use form 1.

• Collect 1 observation of achievement.

Milestones:

• Identify the circumstances contributing to an adverse event (ME 5.1)

• Identify the impact of human and system factors on health care delivery (L 1.1)

• Perform data analysis (S 4.4)

• Integrate existing standards for health care delivery with findings of data collection (L 1.1)

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

• Identify changes in practice/clinical care to prevent adverse events (L 1.1)

• Demonstrate an understanding of the operations of pediatric health care delivery (L 3.1)

• Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment (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

• QI sessions during Academic Half Day and Presentation at Morbidity & Mortality Rounds

• Clinical Teaching Unit (CTU) - Junior Attending

• Pediatric Intensive Care Unit (PICU)