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McMaster Modular Assessment Program Junior Edition

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McMAP | Junior Edition
Editors: Teresa Chan & Jonathan Sherbino
MCMAP
McMaster
Modular
Assessment
Program
Published by Academic Life in Emergency Medicine, !
San Francisco, California, USA.
First edition, April 2015.
!
Available for usage under the Creative Commons Attribution-
NonCommercial-NoDerivs 3.0 Unported!License.
!
ISBN: 978-0-9907948-1-3
i
This book is dedicated to the team hat helped to make McMAP
such a successful. We would like to thank the following individuals
for their contributions to McMAP.
The McMaster Modular Assessment Program (McMAP) Collabora-
tors are a team of 25 educators and education scientists and 2 resi-
dents from three Canadian universities (McMaster University, the
University of Alberta, and the University of Saskatchewan) and
three U.S. universities (Louisiana State University, Michigan State
University, and Oregon Health & Science University) who devel-
oped and reviewed the McMAP instruments. We would like to ac-
knowledge the hard work of their fellow McMAP Collaborators (M.
Ackerman, J. Cherian, N. Delbel, K. Dong, S. Dong, K. Hawley, M.
Jalayer, B. Judge, R. Kerr, A. Kirkham, N. Lalani, A.R. Mallin, S.
McClennan, P. Miller, A. Pardhan, G. Rutledge, K. Schiff, D. Seh-
dev, T. Swoboda, S. Upadhye, R. Valani, C. Wallner, M. Welsford,
R. Woods, and A. Zaki).
We also wish to thank the McMaster University Division of Emer-
gency Medicine administrators (Teresa Vallera, Melissa Hymers,
Neha Dharwan, and Amanda Li). In addition, the authors thank
their friends and research colleagues, Dr. Kelly Dore, Dr. Geoff Nor-
man, and Dr. Meghan McConnell, for their advice on this project.
Finally, the authors would like to thank Dr. Ian Preyra (former pro-
gram director of the McMaster Royal College Emergency Medicine
Program), Dr. Alim Pardhan (program director of the Royal College
Emergency Medicine Program), and Dr. Karen Schiff (associate
program director of the McMaster Royal College Emergency Medi-
cine Program) for providing the support, time, and mandate to im-
plement McMAP.
DEDICATION
ii
Background
The McMaster Modular Assessment Program
(McMAP) is an intentionally organized series of
interconnected work-based assessment instru-
ments. Using McMAP Junior, Intermediate and
Senior will ensure a rigorous assessment of all of
the specialist Emergency Medicine (EM) compe-
tencies that can be appropriately observed in
the clinical environment.
McMAP was developed in collaboration with 6
institutions in Canada and the United States
(McMaster University, Louisiana State University,
Michigan State University, Oregon Health & Sci-
ence University, University of Alberta, University
of Saskatchewan). It is based on a needs as-
sessment of EM residents and front-line EM
teachers and educators. Key themes that inform
McMAP are: the need for clear criterion-based
(i.e. objective) standards; the need to facilitate
regular, constructive feedback; and the need to
encourage reflection among learners.
Each assessment instrument functions as a “mi-
cro” CEX – a truncated version of the mini clinical
examination exercise widely used in work-based
assessment. Each McMAP instrument involves
multiple physician competencies organized
around an essential task of an EM physician. For
example, providing discharge instructions to a
patient incorporates Medical Expert, Communica-
tor, and Collaborator competencies. However, to
the frontline user, this background curriculum
blueprinting is invisible, improving usability.
Each instrument uses choice architecture to pro-
vide “just-in-time” faculty guidance. Specifically,
checklists that deconstruct a task into simpler
About The McMAP Project
iii
About McMAP Junior
McMAP Junior introduces learners (and faculty)
to the McMAP system. The process of daily
targeted observation, and the mechanics of
completing a digital (or paper-based, depending
on how your system) passport is introduced.
Most significantly, McMAP Junior introduces a
culture of feedback, where the conclusion of each
shift requires verbal feedback on a specific,
observed task with subsequent documentation.
McMAP Junior introduces learners (and faculty)
to the McMAP system. The process of daily
targeted observation, and the mechanics of
completing a digital (or paper-based, depending
on how your system) passport is introduced.
Most significantly, McMAP Junior introduces a
culture of feedback, where the conclusion of each
shift requires verbal feedback on a specific,
observed task with subsequent documentation.
sub-elements and criterion-based behavioural
anchors (e.g. clinical descriptions of various stan-
dards of performance) for scoring performance
guide faculty towards a shared mental model of
the expected standard.
For more information on the development and de-
sign of McMAP check out the innovation report
manuscript in Academic Medicine:
Chan, T., & Sherbino, J. (2015). The McMaster
Modular Assessment Program (McMAP): A Theo-
retically Grounded Work-Based Assessment Sys-
tem for an Emergency Medicine Residency Pro-
gram. Academic medicine: journal of the Asso-
ciation of American Medical Colleges.
DOI:10.1097/ACM.0000000000000707
PMID:25881648
How it Works – Big Picture
A McMAP passport consists of eight assessment
instruments organized around two related Can-
MEDS Roles. One instrument is completed per
shift. Each instrument is typically repeated once
during a one-month rotation. Depending on rota-
tion planning in your program, it is possible that
each passport will be repeated at least once a
year, ensuring adequate sampling to improve the
reliability of aggregated data.
Each instrument has two main parts. The first
part includes the assessment matrix for the spe-
cific McMAP task assigned for the shift. The sec-
ond part includes a daily global performance as-
sessment that allows the faculty member to as-
sess and provide feedback on overall perform-
ance during the shift. Mandatory narrative com-
ments are required for both elements.
In our experience, making the narrative com-
ments mandatory serves two purposes. First, it
serves as a force-function to promote verbal feed-
back between resident and faculty at the comple-
tion of a shift. This is one of the main goals of
McMAP. Second, the qualitative data from the
narrative comments helps shape the end-of-
rotation report, providing nuance about the per-
formance of a resident.
McMAP also includes an exceptional events re-
porting system. (See Appendix A) Faculty mem-
bers can anonymously submit, on an ad hoc ba-
sis, a standardized form documenting outlier be-
haviour. This data is received by an independ-
ent party (e.g., the chair of the assessment sub-
committee of the residency training committee),
who then determines the response to this excep-
tional event.
How it Works – During a Shift
Every shift a resident is observed by a faculty
member completing a specific McMAP task. This
takes approximately five minutes. The entire pa-
tient encounter does NOT need to be directly ob-
served in order to complete the assessment. For
example, a task focused on taking a history does
not require observation of the physical exam. At
or near the end of the shift, the faculty member
completes the instrument linked to the task for
the day. Completion of the form, plus discussion
of the resident’s performance during the shift,
typically requires five minutes.
Our experience suggests that it is best to allow
the resident and faculty member to negotiate at
the beginning of a shift the task to be addressed
that day. Some tasks are harder to complete than
others because of the need for specific patient
presentations (e.g. lead a resuscitation). While
iv
McMAP has been designed to be flexible to the
unpredictability of EM practice, faculty and learn-
ers should be opportunistic in choosing a
McMAP task.
Summarizing the Data
The daily data can be collated into a summary
table (see Appendix B), automatically populated
if using a digital passport or by hand if using a
paper passport. This summary table allows the
faculty supervisor responsible for completing the
end-of-rotation report to observe trends and
gaps in performance.
McMAP uses a narrative end-of-rotation report,
following a standardized template, to summarize
the data from the “performance biopsies” that
have occurred during the rotation.
Using McMAP
You are free to use McMAP in whole, or in part,
via the Creative Commons licence… In ex-
change, we ask that you identify the material as
originating from the McMaster Modular Assess-
ment Program.
If you have any suggested modifications or addi-
tions to McMAP we would be pleased to con-
sider them for incorporation into subsequent ver-
sions.
If you would like further details on how to host
McMAP on an electronic platform, please con-
tact us. We currently use a secure, free, cloud-
based platform that allows residents and faculty
to access their digital passports via mobile de-
vices or computers.
For any inquiries, please contact us at:
mcmapem@univmail.cis.mcmaster.ca.
- Teresa Chan & Jonathan
Sherbino, !
Editors & Project Leads
Usage
This document is licensed for use under the creative com-
mons selected license: Attribution-NonCommercial-NoDerivs
3.0 Unported.
v
1
JUNIOR RESIDENT
DAILY GLOBAL RATING
Authors:
Ian Preyra
Karen Schiff
Teresa Chan
Editors:
Alim Pardhan
Jonathan Sherbino
What is the Daily Global Rating?
At the culmination of each shift, assessors (staff
physicians) are meant to complete a global rating
of the resident’s overall performance during that
shift. A copy of the global rating scale is at-
tached.
How do I use this sheet?
Raters need only choose one score (i.e. a single
number from 1 to 7), however, the descriptions are
present to clarify the various aspects of the Can-
MEDS roles that are expected at various levels.
Some raters may find it useful to use each listed
criterion to isolate areas of weakness or strength
for the resident, but only ONE number is needed
to represent the resident’s overall progress each
day.
Why do we only have to rank residents by one
number?
Many studies of rater psychology have shown that
teachers often only really rank residents by a sin-
gle number anyways (and forms with multiple rat-
ing scales often just result in confusion and/or arti-
ficial variance around the number in the rater’s
mind). Since the McMAP system facilitates daily
observations across many skills, the daily task rat-
ings better clarify the microskills required of an
emergency resident at this level. This offloads the
need to do detailed observations every day, and
allows us to harness the teacher’s ‘gestalt’ regard-
ing resident performance.
Other notes
Raters should be encouraged to use the whole
spectrum of the score, however, many residents
are rather high-functioning since they have al-
ready spent significant time in the Emergency De-
partment (ED) during clerkship and electives.
Based on historical trends, residents often begin
around a 3 or 4 (out of 7) in the beginning of the
year, and over the course of a few blocks progress
to a 6 or 7 (out of 7).
7
COMMENTS/ CONCERNS/FEEDBACK
JUNIOR RESIDENT
DAILY GLOBAL RATING
RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs Assistance
2
3
4
5
6
Any of the following apply to the
PGY1 resident:
• Displays major areas of knowledge
deficit.*
• Displays major weaknesses with
functioning in the ED environment
(culture, logistics, collaboration)
• Requires input, revision,
intervention or attentive
supervision from attending
throughout shift.
• Performs actions that place
patients at risk.*
• Has lapses in professional
behaviour. *
• Ineffectively or offensively
communicates with patient(s) or
colleague(s).*
• Shows lack of insight into own
limitations or knowledge gaps.*
Most of the following apply to the
PGY1:
• Displays some minor weaknesses
with functioning in the ED
environment (culture, logistics,
collaboration)
• Displays appropriate beginner-
level knowledge of EM-evidence
and basic science.
• Independently and accurately
examines and diagnoses non-
emergent patient.
• Formulates basic plans regarding
diagnostics, patient care and
disposition.
• Performs basic procedures safely
with supervision.
• Is consistently professional.
• Effectively communicates with
patient and colleagues (e.g.
communicates to form adequate
relationships)
• Identifies knowledge gaps,
limitations, deficits in exposure.
*MUST comment below or flag this through the exceptional events system
2
JUNIOR MODULES !
MEDICAL EXPERT & SCHOLAR
ASSESSMENT INDEX
ASSESSMENT INDEX
Chest Pain History & Physical
Point of Care Research With DIRECTION
Acute Back Pain History & Physical
Knowledge Translation
Mini Trauma Assessment
Case Presentations
Procedure (simple procedure – suturing,
splinting)
Ordering Investigations
Lead Authors:
A. Rebecca Mallin
Rob Kerr
Editors:
Teresa Chan
Jonathan Sherbino
9
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Introduces self, establishes rapport
Obtains appropriate, focused, history of chest pain
Obtains appropriate past history (including past coronary disease, risk
factors) and medications
Asks appropriate questions to use clinical decision rules (eg PERC,
Wells...)
Completes appropriate, targeted physical exam
Recognizes acute ECG changes (if applicable)
TASK | Chest Pain History & Physical
Today’s focus is history and physical of an acute chest pain patient
The ideal patient for a PGY1 learner would be a stable patient. We suggest that the preceptor view the patient’s
ECG prior to the beginning of the case.
The preceptor should observe the key aspects of the case (listed below).
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
ANY of the following:
Superficial
Incomplete
Highly disorganized
Some grasp of major
elements but misses
significant important
details.
Slightly disorganized.
Misses very few relevant
points (e.g. pertinent
positives or negatives).
Organized and thorough.
Elicits all pertinent positives
and negatives.
Appropriately focused
Well-organized, and completes
history in an expeditious
manner.
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Any of the following:
Cursory
incomplete
inaccurate
Unsafe for patient
Does not examine related organ
systems (e.g. does not do lower
limb exam in patient with
shortness of breath)
Inappropriately brief
Minor inaccuracies.
Maneuvers make the
patient
uncomfortable.
Mostly complete. Only missing
specialized maneuvers
Ensures patient safety and
comfort.
Inecient or awkward for self but
not for patient.
All of the below:
Complete
Accurate focused examination
of all relevant systems
(including specialized
maneuvers)
Comfortable, fluid and ecient
for both resident and patient.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident
to attempt during his/her next shift. (You do not need to record this)
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
10
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Introduces self, establishes rapport
Obtains appropriate, focused, history of back pain
Obtains appropriate past history (including appropriate red flags such as
fever, focal complaints, etc..)
Physical Examination: appropriate musculoskeletal examination
Physical Examination: appropriate neurologic examination
TASK | Acute Back Pain History & Physical
Today’s focus is history and physical of an acute back pain
The ideal patient for a PGY1 learner would be a stable, ambulatory patient who has presented to the emer-
gency department with acute back pain.
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
INTERVIEWING SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
ANY of the following:
Superficial
Incomplete
Highly disorganized
Some grasp of major
elements but misses
significant important
details.
Slightly disorganized.
Misses very few
relevant points (e.g.
pertinent positives or
negatives).
Organized and
thorough.
Elicits all pertinent
positives and negatives.
Appropriately focused
Well-organized, and
completes history in an
expeditious manner.
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
PHYSICAL EXAM SKILLS!
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Any of the below:
Cursory
Incomplete
Inaccurate
Unsafe for patient
Does not examine related
organ systems (e.g. Does not
do lower limb exam in patient
with shortness of breath)
Inappropriately
brief
Minor
inaccuracies.
Maneuvers make
the patient
uncomfortable.
Mostly complete. Only
missing specialized
maneuvers
Ensures patient safety
and comfort.
Inecient or awkward
for self but not for
patient.
All of the below:
Complete
Accurate focused
examination of all relevant
systems (including
specialized maneuvers)
Comfortable, fluid and
ecient for both resident
and patient.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
11
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Obtains relevant history from patient or EMS or witness
Conducts primary survey (ABCDE)
Conducts secondary survey of all systems
Demonstrates spinal precautions, utilizing the Canadian C-spine Rules
appropriately to risk stratify the patient’s neck injury
Recognizes potentially limb-/life-threatening injuries
Considers mechanism of injury in assessment
Orders appropriate investigations
TASK | Mini Trauma
Today’s Focus is an Initial Encounter with a Trauma Patient
The ideal patient for a PGY1 learner would be a stable patient who is on a backboard, collared from a recent
motor vehicle collision (MVC). The resident should be observed completing a primary and secondary sur-
vey. The attending should elicit his/her thoughts including initial investigations and/or presumptive diagnosis
but NOT management of problems found.
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Displays ANY of the
following:
Missing key elements of
trauma history
Unsafe in exam (e.g. spinal
precautions)
Misses some key
points of primary
survey exam but
maintains patient
safety.
Orders limited
investigations,
inappropriate or
unnecessary
investigations.
Complete Primary
examination.
Recognizes severity of
illness appropriately.
Thorough, but
incomplete listing of
investigations needed.
Displays ALL of the
following:
Performs complete primary
survey and secondary
survey.
Displays understanding of
injury patterns related to
mechanism.
Complete listing of
investigations required. (e.g.
including slit lamp exam
with fluorescein post-air bag
deployment)
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
12
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Explains procedure (Risks, benefits, complications)
Obtains consent
Uses proper personal protective equipment
Proper clean/sterile technique
Proper use of procedural equipment, and assistants where warranted
Gives appropriate aftercare instructions/orders
Appropriately documents the procedure in the medical record.
MAJOR TASK | Procedure (simple procedure – suturing, splinting)
Today’s Focus is an observed Procedure
The ideal patient for a PGY1 learner would be a stable patient who requires a common simple procedure.
The preceptor should observe the key aspects of the case (listed below), and intervene only as necessary.
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY:
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Requires any one of the below:
Significant instruction
Assistance with majority of
the procedure
Endangers patient.
Prompting, but
less instruction,
no preceptor
involvement in
actual procedure.
Often awkward
position or
movement
Minimal prompting,
mostly independent
Consistently accurate,
proper attention to
safety.
Generally competent,
but sometimes
awkward.
correct sequence of
steps but not ecient
use of time
All of the below:
Completely independent
Consistently accurate.
Proper attention to safety of
patient and assistants.
Fluid, economical
movements.
Please write the type of Procedure: __________________________________________________________________
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
13
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Eectively utilizes tools available
(library database, Google scholar, PubMed, EMBASE, Cochrane Review
etc.)
Explains the limitations of the resources they are using.
Resident is time ecient on the internet to investigate this question
TASK | Point of Care Research With DIRECTION
Today’s focus is Point-of-care research
During this shift, the resident should utilize available resources to determine the answer to a point of care
question that aects patient management. The attending should provide guidance in selecting a clinical
question. Alternatively, the resident may self-identify the question. (e.g. What is the role of dexamethasone
in migraine headaches?)
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Displayed any of the following
behaviours:
Unable to find resources in a
timely fashion.
Exclusively utilizes and/or
cites untrustworthy or
incorrect sources. (i.e. random
websites, etc..)
#
Was able to
useresources, but
took a long time.(i.e.
> 10 minutes)
Utilizes mostly
secondary sources
(i.e. reviews of the
articles, or digests of
articles) rather than
articles themselves.
Finds resources in a
relatively ecient time
period (i.e. <10 min).
Navigates internet
databases or search
engines awkwardly to
find primary sources.
#
Displayed all of the
following behaviours:
Eciently finds resources
(i.e. < 5 minutes)
Navigates internet
databases or search
engines eectively to find
primary sources.
Adjudicates quality of
sources (both primary &
secondary)
The Clinical Question was:
The total time to complete the research task was: ______________
(Do not include discussion time)
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
14
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Defines the PERC rule appropriately
- describes study inclusion criteria, exclusion criteria
Applies the PERC rule appropriately
Defines the Wells PE Score appropriately
- describes study inclusion criteria, exclusion criteria
Applies the Wells PE Score appropriately
Explains limitations of each of the respective scores / rules
Is able to describe the link between the Well’s PE score and the PERC
rule.
Utilizes D-dimer appropriately in the context of these rules to guide
management decisions (i.e. was the ordering of the d-dimer appropriate)
Interprets the D-dimer appropriately to guide management / treatment
decisions
TASK | Knowledge Translation
Today’s focus is the Knowledge Translation: Utilization and application of the Wells Score and PERC rule for
Pulmonary Embolus.
For a given patient with Chest Pain, the resident will need to describe the application of the Well’s PE score, the
PERC score, and the role of diagnostic tests in relation to the results of these scores.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Displays the following
behaviours:
Not able to define the rule(s)
or literature
cannot apply it to the patient.
#
Able to define the
rule
is not clear about
application of the
rule(s) or literature
to the patient.
Able to define the rule,
and apply the rule(s) the
patient
Is unclear about
limitations of the rule(s)
or literature
cannot describe the
subsequent
management steps.
#
Displays all of the following
behaviours:
Is able to define the rule(s)
or literature, can apply it to
assist with decision making.
Is able to articulate the
limitations and describe the
subsequent management
steps.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
15
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Defines the Canadian C-spine rule appropriately
- describes study inclusion criteria, exclusion criteria
Applies the Canadian C-spine rule appropriately
Defines the Nexus rule appropriately
Applies the Nexus rule appropriately
Aware of limitations of each of the respective rules
Describes the next step for a particular patient with regards to applying
EITHER or BOTH of the rules.
TASK | Knowledge Translation
Today’s focus is the Knowledge Translation
The resident compares and contrasts the dierence between the NEXUS C-spine rules and the Canadian C-
spine rules. For a given patient involved in a minor trauma, the resident will need to describe the application of
the CCR and Nexus rules and how each rule applies to their patient.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Displays any of the following
behaviours:
Not able to define the rule(s
cannot apply it to the patient.
#
Able to define the
rule
is not clear about
application of the
rule(s) to the
patient.
Able to define the rule,
and apply the rule(s) the
patient
Is unclear about
limitations of the rule(s)
cannot describe the
subsequent
management steps.
#
Displays all of the following
behaviours:
Is able to define the rule(s),
can apply it to assist with
decision making.
Is able to articulate the
limitations and describe the
subsequent management
steps.
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
16
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
TASK | Case Presentations & Patient Management
Today’s focus is the Case Presentation.
Based on three to four case presentations, the attending should rate the resident with regards to their syn-
thesis of their history (Hx), physical examination (Px), initial management (e.g. pain control), investigatory
plan:
As optional pre-reading the junior resident may read (NOT REQUIRED):
Davenport C, et al. The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a
Theme. ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687.
This paper and a related supplemen) are available here:
http://lifeinthefastlane.com/2009/06/ed-case-presentation-for-medical-students/
!
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Displayed any of the following
behaviours:
Missing key history and/or
physical exam component;
Unable to form a coherent
synthesis of their dierential dx;
Failure to propose an initial
management and/or
investigatory plan
Misses some key
points on Hx/Px;
Provides a partial
but incomplete
DDx;
Provides a partial
initial investigatory
or management
plan that lacks
some key element
May be missing some
minor elements of Hx/
Px;
Provides a thorough
synthesis and DDx;
Provides a relatively
thorough investigatory
and management plan
that covers all key
elements but omits
some minor
components or overly
inclusive diagnostic plan
that is unwarranted.
Complete Hx/Px described;
Provides thorough synthesis
and DDx;
Provides a complete
investigatory and
management plan that is
comprehensive and
complete with no
omissions.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
17
TASK | Ordering Investigations
Today’s Focus is Investigations [based on presentation of a particular case]
The resident should without prompting from others. Based on 3 patients (ideally) with similar present-
ing complaints (e.g. chest pain)
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Any one of the below:
Cannot select and explain
rationale for appropriate
investigations for
dierential diagnosis.
Suggests investigations
that are both unnecessary
or would possibly would
expose patient to
unnecessary harm (e.g. CT
Chest in low risk patient
with negative D-dimer)
Cannot describe the clinical
utility / diagnostic accuracy
of the test.
Somewhat
incomplete, non-
focused,
inappropriate test(s)
used
inconsistent use of
guidelines to guide
test ordering.
Doesn't use
hypotheses to guide
investigations
Orders most
appropriate test(s).
Minor omissions or
excessive-ordering of
tests.
Uses guidelines
appropriately
Mostly uses
hypotheses to guide
investigations
Displays all of the
following:
Applies appropriate,
focused, timely, evidence-
informed investigations for
clinical situation.
Clearly uses hypotheses to
guide investigations
Consistent use of
appropriate guidelines
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
3
ASSESSMENT INDEX
ASSESSMENT INDEX
Observed Hx
Discharge Instructions
Observed Hx with Barrier
Chart Audit (Content)
Obtaining Consent
Chart Audit (Organization)
Case Presentation
Consult Request
Lead Authors:
Margaret Ackerman
Kristopher Hawley
Editors:
Teresa Chan
Jonathan Sherbino
JUNIOR MODULES !
COMMUNICATOR & COLLABORATOR
19
RESIDENT ______________ Name of Assessor_________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Introduces self & explains role in care team
Finds out names of any additional family/friends present in the room
Asks patient if they would like to have friends/family present or not
Starts with open ended questions and moves into closed ended questions
Finds out the patient’s biggest concern/question needing to be answered
Task | Observed Hx
Today’s focus is to observing the resident taking a history. (CM 1.1)
Ideally, observations are based on 1-2 encounters with non-critically ill patients during your shift. Only the his-
tory needs to be observed, not the entire resident-patient interaction.
OBSERVED HISTORY!
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OBSERVED HISTORY!
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OBSERVED HISTORY!
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OBSERVED HISTORY!
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OBSERVED HISTORY!
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OBSERVED HISTORY!
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OBSERVED HISTORY!
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displays any of the
below:
History incomplete.
Information gathered in a
disorganized or incomplete
manner.
Failed to develop rapport with
patient and family.
Did not seek to answer family
or patient concerns.
Resident displays most of
the below:
Elicited information in
slightly disorganized or
inecient manner.
Built adequate rapport
with patient.
Solicited and attended to
answers from patient or
family.
Elicited information in a time
ecient manner. Established
a strong rapport with all
present in the room.
Gained trust with patient/
family.
Solicited and attended to
answers from patient or
family.
All elements of checklist
completed
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
20
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Diagnoses communication barrier
Develops appropriate strategy to address barrier (e.g. contacts translator)
Maintains appropriate non-verbal cues with patient (where culturally
appropriate), even if using other communication strategies (e.g.
translator)
Takes extra time for patient encounter to ensure complete history
obtained, and patient’s concern/question is determined
Task | Observed Hx with Barrier
Today’s task is to observe the resident completing a History with a Patient who has an identifiable communica-
tion barrier. (CM 1.2)
Barriers may include language, physical disability, delirium, dementia etc. Observations are based on at least one en-
counter with a non-critically ill patients during your shift. Only the history needs to be observed, not the entire
resident-patient interaction.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the
resident to attempt during his/her next shift. (You do not need to record this).
OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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OBSERVED HISTORY WITH BARRIER!
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displays any of the
below:
History incomplete.
Did not identify barrier
Did not use appropriate
strategy to overcome barrier
Failed to develop rapport with
patient and family.
Behaved awkwardly or
inappropriately with patient
and/or family as a result of
language barrier
Resident displays most of
the below:
Obtains the minimum of
relevant and important
information .
Elicited information in
slightly disorganized or
inecient manner.
Built adequate rapport with
all present in the room.
Solicited and attended to
answers from patient or
family.
Required assistance from
others (Attending, senior
resident, RN).
Resident displays all of the
below:
Obtained history in a time
ecient manner.
Utilized resources (including
translators) well.
Built strong rapport with all
present in the room.
Gained trust with patient and
family.
Answered questions well.
RESIDENT ______________ Name of Assessor_________________ Date:_________
21
RESIDENT ______________ Name of Assessor_________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT
DONE
N/A FOR CASE
Establishes that the patient or substitute decision maker is competent.*
Content & Discussion
Content & Discussion
Content & Discussion
Content & Discussion
Content & Discussion
Establishes the best possible environment (Minimizes interruptions; Selects the right
setting; Sits down if able; Provides appropriate privacy within available resources)
Ensures patient understands and appreciates:
The intended plan for the procedure
Indications for the procedure (Why you are doing the procedure?), foreseeable benefits
The Risks of the procedure
The available alternatives to the procedure.
Listening & Language
Listening & Language
Listening & Language
Listening & Language
Listening & Language
Avoids or defines medical jargon during the discussion
Utilizes Reflective Listening to Summarize the discussion
Listens and responds to questions or concerns.
Appropriately documents consent process (chart, specific consent form)*
Task | Obtaining Consent
Today’s focus is obtaining consent. (P 1.4)
The attending physician should observe a consent discussion for a procedure. Ideally, consent discussion should be around
a non-emergent major or involved intervention or procedure (e.g. blood transfusion, central line, lumbar puncture, etc..).
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Confusing to patient or SDM
(excessive slang, jargon)
Poorly prepared for the
discussion.
Provided misleading or
incomplete information
Did not listen to patient or
SDM
Required attending
physician to halt or redirect
conversation.
Seems rushed or
uncomfortable
Builds appropriate
rapport
Provides all options, but
approach confusing to
patient or SDM
Minimal role of
attending physician to
steer the course and
guide decision making.
Establishes trusting
therapeutic relationship
with patient or SDM
(beyond appropriate
rapport)
Provides all options, and
requires little clarification
for participants to
understand plan.
Minor role of attending
physician clarify/arm
the plan for
implementation.
Puts participants at ease.
Provides all options, patient or
SDM seem to understand the
plan
No requirement for attending
physician to participate.
If conflict or disagreement
arises - Identifies the limits of
the discussion (e.g. reaches a
conclusion or a neutral decision
point that may be decided later)
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
22
RESIDENT ______________ Name of Assessor_________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Informs patient of results of any investigations in simple language
Informs patient of diagnosis (if possible), other possible diagnoses, and
describes prognosis (if possible)
Informs patient of care plan (overall)
(a) explains any prescriptions (rationale for use, potential side-eects)
(b) logistics of follow-up (confirm phone number, give consultant contact info,
explains how to return for next day testing)
(c) contingency plan (return instructions, symptoms of serious diagnosis or
complication)
Ensures patient understands diagnosis and care plan
Task | Discharge Instructions
Today’s focus is on discharge instructions. (CM 1.3)
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displays any of the
below:
significant gaps in discharge
instruction (see checklist)
Overly technical jargon
Confusing to patient
Conflict arose and escalated
Resident displays most of the below:
Professional
Inecient with time.
Used complicated concepts or jargon
occasionally.
Patients questions were answered
most of the time.
Eventually, arrived at a plan that was
amenable to all parties.
Resident displays ALL of the
below:
Professional
Time Ecient
Catered to patient’s level of
understanding and needs.
Answered questions from patient
and/or family.
Arrived at a plan that was
amenable to all parties easily.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
23
RESIDENT ______________ Name of Assessor_________________ Date:_________
CHECKLIST
CHART 1
CHART 1
CHART 1
CHART 1
CHART 2
CHART 2
CHART 2
CHART 2
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT
DONE
N/A FOR
CASE
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
Information relevant to CC and HPI recorded
Physical Examination - relevant systems recorded
Physical Examination - documents specific elements; avoids
general statements
Interpretation of Results of ECG, relevant labs, Imaging recorded
Documents procedures appropriately
Reassessments documented; changes noted
Discharge Instructions documented.
Completion of Ancillary Paperwork (Prescriptions, referral forms,
CCAC, etc..)
Minor Task | Chart Audit (Content)
Today’s focus is on chart content. (CM 1.5)
The attending physician should select two charts from patients who have been discharged from ED.
The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be eec-
tively given with both resident and attending physician reviewing the chart.
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1
Needs Assistance in area
Requires extensive charting by
attending to compensate for
missing items.
2
3
Requires significant
charting by attending to
rectify charting.
4
5
Requires minimal charting by
attending to clarify charting.
6
7
Ready for Next Steps
no additional documentation
required by attending
Charting is incomplete and
missing key items (noted
above).
There is no organized
synthesis of the resident’s
decision-making and
thinking process.
All key elements are
present,but minor (and
contributing) elements
of the patient-doctor
encounter are missing
Chart fails to provide
logical a synthesis of
the resident’s decision-
making & thinking
process.
All elements (see above)
are addressed.
Charting provides a
complete narrative of the
patient-doctor encounter
in the ED.
Chart does not fully
explain the resident’s
decision-making &
thinking process.
All elements (see above)
are addressed.
Charting provides a
thorough narrative of the
patient-doctor encounter
in the ED.
Chart provides a succinct
and nuanced synthesis
that fully explains the
resident’s decision-making
& thinking process.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
24
RESIDENT ______________ Name of Assessor_________________ Date:_________
Minor Task | Chart Audit (Organization)
Today’s focus is chart organization.
Today, the attending physician will examine any Two charts and complete the mini-chart audit for the organiza-
tion of the resident’s charting. This should take 2-3 minutes to complete.
The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be eec-
tively given with both resident and attending physician reviewing the chart.
CHECKLIST
CHART 1
CHART 1
CHART 1
CHART 1
CHART 2
CHART 2
CHART 2
CHART 2
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
Legible
Organized
Supervising Emergency Physician recorded
Timing of all encounters (assessment,
reassessments, discussions with consultants
recorded)
Discharge Instructions or Consult request recorded
Signed with signature and printed name
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1
Needs Assistance in area
Requires extensive charting by
attending to compensate for
missing items.
2
3
Requires significant charting by
attending to adjust or rectify
charting.
4
5
Requires minimal
charting by attending to
clarify charting.
6
7
Ready for Next Steps
Attending documents no additional or
further information that is not already
contained in the chart.
Charting is incomplete and
missing key items (noted
above).
Charting is disorganized and
the reader cannot follow the
writer’s thought process
Requires extensive charting
by attending to compensate
for missing items.
Charting disorganized
Charting dicult to read
Charting omits only 1-2
important details from the
encounter, is mostly
complete
Charting equires significant
charting by attending to
adjust or rectify charting.
Charting organized.
Charting at times
dicult to read
Chart omits only
minor details from
the encounter
Chart can stand
alone without
adjunctive charting
Charting provides a thorough
narrative of the patient-doctor
encounter in the ED.
Chart provides a succinct and
nuanced synthesis that
highlights pertinent positives
and negatives
Chart can stand alone without
adjunctive charting
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
25
RESIDENT ______________ Name of Assessor_________________ Date:_________
Task | Consult Request
Today’s focus is the consultation request. (CL 1.1)
The ideal scenario for this assessment will be in a case with a stable patient who requires referral for admis-
sion. Preferably, the learner should be referring to another resident (e.g. the Surgical Resident, Senior Medi-
cal Resident). Resident has Supervisor listen (or observe) to them making a consult request.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displayed any of the below:
Unprofessional
Confusing to Consultant Colleague
Did not convey relevant and/or
crucial information (i.e. Urgency,
important management)
Was unwilling to compromise
Conflict arose and escalated
Resident’s actions are
described by most of the
below:
Professional
Colleague’s questions were
answered.
Eventually, arrived at a plan
that was amenable to all
parties.
Resident displays all of the below:
Professional and approachable.
Built a good rapport.
Answered questions from
consulted colleague.
Arrived at a plan that was
amenable to all parties easily.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Action Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
CHECKLIST
DONE
DONE BUT NEEDS ATTENTION
NOT DONE
N/A FOR CASE
Introduces Self: Name and Role in ED
Gives Emergency Physician Supervisor name
Highlights Reason for consult request “I have a patient with
worsening COPD” or Clinical Question “Does this person have
appendicitis?”
Provides patient demographics & identifying data (e.g. Name, Age,
Location)
Provides focused HPI - concise and succinct
Provides important ED results - lab and imaging
Clarifies/answers Consultant’s questions
Documents name of consultant and time of consultation request
26
RESIDENT ______________ Name of Assessor_____________ Date:_________
TASK | Case Presentations & Patient Management
Today’s focus is the Case Presentation.
Based on three to four case presentations, the attending should rate the resident with regards to their syn-
thesis of their history (Hx), physical examination (Px), initial management (e.g. pain control), investigatory
plan:
As optional pre-reading the junior resident may read (NOT REQUIRED):
Davenport C, et al. The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a
Theme. ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687.
This paper and a related supplemen) are available here:
http://lifeinthefastlane.com/2009/06/ed-case-presentation-for-medical-students/
!
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Needs assistance
2
3
4
5
6
7
Ready for the next level
Displayed any of the following
behaviours:
Missing key history and/or
physical exam component;
Unable to form a coherent
synthesis of their dierential dx;
Failure to propose an initial
management and/or
investigatory plan
Misses some key
points on Hx/Px;
Provides a partial
but incomplete
DDx;
Provides a partial
initial investigatory
or management
plan that lacks
some key element
May be missing some
minor elements of Hx/
Px;
Provides a thorough
synthesis and DDx;
Provides a relatively
thorough investigatory
and management plan
that covers all key
elements but omits
some minor
components or overly
inclusive diagnostic plan
that is unwarranted.
Complete Hx/Px described;
Provides thorough synthesis
and DDx;
Provides a complete
investigatory and
management plan that is
comprehensive and
complete with no
omissions.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
4
ASSESSMENT INDEX
ASSESSMENT INDEX
SEGUE
Narco*c+Rx
Capacity+Assessment+
Mandatory+Repor*ng
Obtaining+Consent
Chart+Audit+Organiza*on
Consult+Request
Chart+Audit+Content
Authors:
Sarah McClennan
Joe Cherian
Editor:
Teresa Chan
Jonathan Sherbino
JUNIOR MODULES !
PROFESSIONAL & COMMUNICATOR
28
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
DEMOGRAPHICS OF PATIENT: (AGE, GENDER, CC)
DONE
DONE BUT NEEDS
ATTENTION
NOT
DONE
N/A FOR
CASE
PART 1: Set the Stage
PART 1: Set the Stage
PART 1: Set the Stage
PART 1: Set the Stage
PART 1: Set the Stage
GREET: Greet the patient appropriately
PRIVACY: Maintain privacy (e.g. close the door) within limits in ED environment
REASON FOR VISIT: Establish a reason for the visit
AGENDA: Outline an agenda for the visit (e.g. issues, sequence)
PART 2: Elicit Information
PART 2: Elicit Information
PART 2: Elicit Information
PART 2: Elicit Information
PART 2: Elicit Information
PHYSICAL FACTORS: Explore the physical/physiological factors
PSYCHOSOCIAL FACTORS: Explore the psychosocial/emotional factors (e.g. living situation, family relations, stress)
PREVIOUS TREATMENTS: Discuss antecedent treatments (e.g. last visit, other care)
QUESTIONS: Avoids leading questions
DON’T INTERRUPT: Give the patient opportunity/time to talk (e.g. don’t interrupt)
LISTEN: Give the patient undivided attention (e.g. face the patient, verbal acknowledgement, nonverbal feedback)
RECAP: Check/clarify information
OVERALL: Understand the Patient’s Perspective
OVERALL: Understand the Patient’s Perspective
OVERALL: Understand the Patient’s Perspective
OVERALL: Understand the Patient’s Perspective
OVERALL: Understand the Patient’s Perspective
ADDRESSES WAIT TIME: Acknowledge waiting time
EMPATHY & PERSONAL CONNECTION: Express caring, concern, empathy Makes personal connection during visit
TONE: Maintain a respectful tone
PATIENT VIEW & AFFECT ON LIFE: Elicit the patient’s view of health and/or progress
Comments (Give Evidence of what the resident did well, AND how the resident can make steps to improve) (MANDATORY):
Comments (Give Evidence of what the resident did well, AND how the resident can make steps to improve) (MANDATORY):
Comments (Give Evidence of what the resident did well, AND how the resident can make steps to improve) (MANDATORY):
Comments (Give Evidence of what the resident did well, AND how the resident can make steps to improve) (MANDATORY):
Comments (Give Evidence of what the resident did well, AND how the resident can make steps to improve) (MANDATORY):
Task | Modified SEGUE History - Part 1
Today’s focus will be on the initial assessment of patients. (P1.5a)
The faculty member should observe the resident’s initial encounter with his/her patient. Only the initial assessment needs to be observed, not the entire
resident-patient interaction.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displayed any of below:
History incomplete.
Information gathered in a disorganized or incomplete
manner.
Failed to develop rapport with patient and family.
Did not seek to answer family or patient concerns.
Resident displayed some of below:
Elicited information in slightly disorganized or
inecient manner.
Built adequate rapport with patient. Solicited and
attended to answers from patient or family.
Resident displayed all of below:
Elicited information in a time ecient manner.
Established a strong rapport with all present in the
room.
Gained trust with patient/family.
Solicited and attended to answers from patient or
family.
Adapted from the SEGUE Checklist. [Makoul et al., The SEGUE Framework for teaching and assessing communication skills. Patient Educ Couns. 2001 Oct;45(1):23-34.]
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY)
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident
to attempt during his/her next shift. (You do not need to record this)
29
Task | Capacity Assessment ** TWO PAGE TASK**
Today’s focus will be Capacity Assessment. (P1.2)
During this shift, the attending physician should identify a patient on whom the resident should perform a non-
emergent capacity evaluation. The ideal patient for this encounter would be a patient who may have some
memory deficits, but is not a dicult historian. Using the ACE tool or another method, the resident should ex-
plain their assessment of the patient’s capacity to the supervisory attending physician. The attending will then
rate the resident’s ability to assess the capacity of the patient based on their approach and the questions they
decided upon in the ACE worksheet.
In preparation, the resident may read the following paper:
1) Sussums et al., Does This Patient Have Medical Decision-Making Capacity? JAMA.
2011;306(4):420-427.
2) Also: http://www.cmaj.ca/content/155/6/657.abstract
One of the tools featured in this JAMA Rational Clinical Exam series is the “Aid to Capacity Evaluation” form.
(A modified version of this form is seen on the right)
Both you and the resident should complete a capacity assessment of the patient. Then, please rate your level
of agreement with the resident’s assessment of the patient. If possible, you may OBSERVE the resident doing
this assessment. Otherwise, you may simply make your own independent assessment.
Instructions for Resident on the Scoring ACE Worksheet
1. Domains 1-4 evaluate whether the person understands their current medical problem, the proposed treatment
and other options (including withholding or withdrawing treatment). Domains 5-6 evaluate whether the person
appreciates the consequences of their decision.
2. For domains 1-6, if the person responds appropriately to open-ended questions, score YES. If they need re-
peated prompting by closed-ended questions, sore UNSURE. If they cannot respond appropriately despite re-
peated prompting, score NO.
3. For domain 7, if the person appears depressed or psychotic, then decide if their decision is being aected by
the depression or psychosis. For domain 7a, if the person appears depressed, determine if the decision is af-
fected by depression. Look for the cognitive signs of depression such as hopelessness, worthlessness, guilt, and
punishment. For domain 7b, if the person may be psychotic, determine if the decision is aected by delusion/
psychosis.
4. Record observations which support your score in each domain, including exact responses of the patient.
5. Remember that people are presumed capable. Therefore, for your overall impression, if you are uncertain, then
err on the side of calling a person capable.
This tool is meant to assist residents to think about capacity assessments of a patient. It has been adapted for
our use with permission from the authors at the University of Toronto’s Joint Centre for Bioethics. The informa-
tion contained in this document is for general information only and is not intended for commercial use. It is not
legal advice and is not a substitute for the advice of a qualified practitioner in your home jurisdiction. There are
no warranties or representations of any kind as to this document’s accuracy or that of the materials contained
in it. The members of the University of Toronto’s Joint Centre for Bioethics and the McMAP team from McMas-
ter University assume no liability or responsibility for any errors or omissions in this document’s contents.
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
30
Aid To Capacity Evaluation (ACE) Worksheet (For Resident use only)
ITEM
ITEM
WHAT QUESTION WOULD YOU USE TO
ASSESS THIS ITEM?
WHAT QUESTION WOULD YOU USE TO
ASSESS THIS ITEM?
OBSERVATIONS BY RESIDENT
OBSERVATIONS BY RESIDENT
PATIENT DEMONSTRATES THIS FACTOR
PATIENT DEMONSTRATES THIS FACTOR
PATIENT DEMONSTRATES THIS FACTOR
ITEM
ITEM
WHAT QUESTION WOULD YOU USE TO
ASSESS THIS ITEM?
WHAT QUESTION WOULD YOU USE TO
ASSESS THIS ITEM?
OBSERVATIONS BY RESIDENT
OBSERVATIONS BY RESIDENT
YES
UNSURE
NO
1. Able to understand medical problem
1. Able to understand medical problem
2. Able to understand proposed treatment
2. Able to understand proposed treatment
3. Able to understand option of refusing
3. Able to understand option of refusing
4. Able to understand option of refusing
proposed treatment (including withholding
or withdrawing proposed treatment)
4. Able to understand option of refusing
proposed treatment (including withholding
or withdrawing proposed treatment)
5. Able to appreciate reasonably
foreseeable consequences of accepting
proposed treatment
5. Able to appreciate reasonably
foreseeable consequences of accepting
proposed treatment
6. Able to appreciate reasonable
foreseeable consequences of refusing
proposed treatment (including withholding
or withdrawing proposed treatment)
6. Able to appreciate reasonable
foreseeable consequences of refusing
proposed treatment (including withholding
or withdrawing proposed treatment)
7a. The person’s decisions are aected
by depression
7a. The person’s decisions are aected
by depression
7b. The person’s decisions are aected
by psychosis.
7b. The person’s decisions are aected
by psychosis.
Definitely Capable
Probably Capable
Probably Capable
Probably Incapable
Probably Incapable
Definitely Incapable
Definitely Incapable
Definitely Incapable
Definitely Incapable
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
Comments about the next step:
OVERALL IMPRESSION | CIRCLE ONE
CONTINUE TO NEXT PAGE FOR RESIDENT RATING SHEET>>>
31
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Action Prescription) for the resident to attempt during
his/her next shift. (You do not need to record this).
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1*
Needs Assistance in this area
I completely disagree with the resident’s
assessment of the patient’s capacity for
decision making.
2*
3*
4
I somewhat agree with the resident’s
assessment of the patient’s capacity for
decision making. (e.g. chose Definitely vs.
Probably capable)
5
6
7
Ready for Next Steps
I fully agree with the resident’s
assessment of the patient’s capacity. (i.e.
both arrived at the same impression of
the patient).
Resident displayed any of below:
The resident’s assessment of the
patient’s capacity for decision making
was inaccurate.
S/he missed key aspects of the
capacity assessment. The resident was
unable to justify their decision.
Resident displayed some of the below:
S/he was able to elucidate most of
the data needed to complete the
capacity assessment and justify their
decision.
S/he had a dierent, but likely
acceptable interpretation of the
patient’s ability to make decisions.
Resident displayed all of the below:
The resident was able to elucidate
all the data needed to complete the
capacity assessment.
S/he was able to justify and defend
their decision.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
*Please describe what findings were dierent if you rated the resident a score of 1-3.
Continued from Previous (For Attending Use)
How did the resident perform in assessing this patient’s capacity?
The following is now the regular McMAP rating form for the attending to com-
plete regarding the resident’s performance of today’s task on patient capacity.
32
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT
DONE
N/A FOR
CASE
Establishes that the patient or substitute decision maker is competent.
Content & Discussion
Content & Discussion
Content & Discussion
Content & Discussion
Content & Discussion
-Establishes the best possible environment (Minimizing interruptions; Select the
right setting; Sits down if able; Provides appropriate privacy within resources
available.)
-Ensures Patient understands and appreciates:
The plan & options
Indications for the procedure (Why you are doing the procedure?),
foreseeable benefits
The Risks
The available alternatives to the procedure.
Language & Listening
Language & Listening
Language & Listening
Language & Listening
Language & Listening
-Avoids or defines jargon
-Utilizes Reflective Listening to summarize the discussion
-Listens and responds to questions or concerns.
Properly documents Consent (chart, specific consent form)
TOTAL
Task | Obtaining Consent
Today’s focus is obtaining consent. (P 1.4)
The attending physician should observe a consent discussion for a non-emergent intervention or procedure (e.g.
blood transfusion, central line, lumbar puncture, prescription for steroids, etc..)
OPTIONAL: For pre-reading, the resident may want to review resources from the Canadian Medical Protective As-
sociation (CMPA): http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/index/index-e.html
>> Communications >> Informed Consent.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
ANY OF THE
FOLLOWING:
Seems rushed or
uncomfortable
Poorly prepared for the
discussion.
Required attending
physician to halt or
redirect conversation.
Builds appropriate rapport
Provides all options, but
requires moderate
clarification for participants to
understand plan
Moderate role of attending
physician to steer the course
and guide decision making.
Puts patients at ease
Provides all options, and
requires little clarification
for participants to
understand plan.
Minor role of attending
physician to clarify/arm
the plan for
implementation.
ALL OF THE FOLLOWING:
Puts patient at ease.
No requirement for
attending physician to
participate.
Identifies the limits of the
discussion if disagreement
occurs (e.g. reaches a
conclusion or a neutral
decision point that may be
decided later)
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Action Prescription) for the resident to attempt during
his/her next shift. (You do not need to record this).
33
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR CASE
Name of patient
Unique patient identifier confirmed
Date of prescription
Name of drug
Quantity of drug written (redundantly written in digits & words)
Prescriber name
Prescriber Licensing body ID number (e.g. CPSO)
Writes Legibly, and ensures there is little chance of altering the prescription
*Explains the indications for the medication to the patient.*
*Screens for addiction history; warns patient as warranted.*
*Explains activities that the patient should NOT engage in while under the
influence of the medication.
*Clarifies any questions that the patient may have regarding the prescription
to the best of their ability.*
Task | Narcotic Rx
Today’s focus is on narcotic prescriptions. (P1.1)
Resident will provide one to three narcotic prescription to preceptor to be verified for in accordance with
narcotics safety and awareness act. At least one encounter should be observed by the attending physi-
cian in order to complete items with a *.
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
REVIEW OF THE PRESCRIPTION (1-3 RX REVIEWED)
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
More than 3 major items
missing.
1-2 items missing consistently with
each prescription.
All elements satisfactorily
completed
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
REVIEW OF THE DISCHARGE INSTRUCTIONS (1 OBSERVATION)
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Omits all of the discharge
instructions for the opioid
Rx.
Omits 1 item for the
discharge instructions for
the opioid Rx
Discusses all elements of
discharge instructions thoroughly
but is slightly unclear or
confusing. (e.g. uses jargon etc..)
Discharge instructions are
clear and the patient has no
questions
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
34
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Mandatory Reporting *** PREPARATION REQUIRED***
Today’s focus is on Mandatory Reporting. (P1.3)
This assessment exercise might not be related to a patient seen during the shift, but ideally should include pa-
tients from recent shifts. If the resident cannot recall recent patients, hypothetical scenarios may be created to
demonstrate understanding of the concepts.
PRIOR TO THE SHIFT:
Review CPSO Policy #6-12 - reference materials on Mandatory and Permission Reporting
(https://www.cpso.on.ca/policies/policies/default.aspx?id=1860)
Also consider reviewing materials on: Child Abuse, Elder Abuse; Potential violence reporting; or other report-
able conditions. In preparation for this task, the resident should log up to 3 patients recently (within the past
2 weeks) that they think might have a condition or situation that merits the consideration of mandatory report-
ing.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Incomplete preparation or
unable to identify even 1
example patient
Unable to apply CPSO
policy
Familiar with majority of policies and
requirements
Unfamiliar with specific details in policy or
law
Able to apply policy to common or
frequently discussed situations (e.g. MTO
form)
Well versed with all policies/
legislation
Able to recognize and apply to
patients including rare and
complicated situations
ANONYMOUS PATIENT
DEMOGRAPHICS
(e.g. 57 yo M, bit by dog)
Please put a * if the patient is
hypothetical
Explain the relevant policy or law and how it applied
To whom do you report this
problem?
Be prepared to discuss the relevant policies and legislation, to whom to report, and the gaps/reasons some condi-
tions or concerns may not be reportable. Include a discussion of what inter-personal violence is reportable.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the
resident to attempt during his/her next shift. (You do not need to record this).
35
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Chart Audit (Organization)
Today’s focus is chart organization.
Today, the attending physician will examine any Two charts and complete the mini-chart audit for the organiza-
tion of the resident’s charting. This should take 2-3 minutes to complete.
The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be eec-
tively given with both resident and attending physician reviewing the chart.
CHECKLIST
CHART 1
CHART 1
CHART 1
CHART 1
CHART 2
CHART 2
CHART 2
CHART 2
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
Legible
Organized
Supervising Emergency Physician recorded
Timing of all encounters (assessment,
reassessments, discussions with consultants
recorded)
Discharge Instructions or Consult request recorded
Signed with signature and printed name
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1
Needs Assistance in area
Requires extensive charting by
attending to compensate for
missing items.
2
3
Requires significant charting by
attending to adjust or rectify
charting.
4
5
Requires minimal
charting by attending to
clarify charting.
6
7
Ready for Next Steps
Attending documents no additional or
further information that is not already
contained in the chart.
Charting is incomplete and
missing key items (noted
above).
Charting is disorganized and
the reader cannot follow the
writer’s thought process
Requires extensive charting
by attending to compensate
for missing items.
Charting disorganized
Charting dicult to read
Charting omits only 1-2
important details from the
encounter, is mostly
complete
Charting requires significant
charting by attending to
adjust or rectify charting.
Charting organized.
Charting at times
dicult to read
Chart omits only
minor details from
the encounter
Chart can stand
alone without
adjunctive charting
Charting provides a thorough
narrative of the patient-doctor
encounter in the ED.
Chart provides a succinct and
nuanced synthesis that
highlights pertinent positives
and negatives
Chart can stand alone without
adjunctive charting
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to attempt
during his/her next shift. (You do not need to record this).
36
CHECKLIST
CHART 1
CHART 1
CHART 1
CHART 1
CHART 2
CHART 2
CHART 2
CHART 2
CHECKLIST
DONE
DONE BUT NEEDS
ATTENTION
NOT
DONE
N/A FOR
CASE
DONE
DONE BUT NEEDS
ATTENTION
NOT DONE
N/A FOR
CASE
Information relevant to CC and HPI recorded
Physical Examination - relevant systems recorded
Physical Examination - documents specific elements; avoids
general statements
Interpretation of Results of ECG, relevant labs, Imaging recorded
Documents procedures appropriately
Reassessments documented; changes noted
Discharge Instructions documented.
Completion of Ancillary Paperwork (Prescriptions, referral forms,
CCAC, etc..)
Task | Chart Audit (Content)
Today’s focus is on chart content. (CM 1.5)
The attending physician should select two charts from patients who have been discharged from ED.
The charts (or temporary copies) of the charts should be held until a point in the shift where feedback can be eec-
tively given with both resident and attending physician reviewing the chart.
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1
Needs Assistance in area
Requires extensive charting by
attending to compensate for
missing items.
2
3
Requires significant
charting by attending to
rectify charting.
4
5
Requires minimal charting by
attending to clarify charting.
6
7
Ready for Next Steps
no additional documentation
required by attending
Charting is incomplete and
missing key items (noted
above).
There is no organized
synthesis of the resident’s
decision-making and
thinking process.
All key elements are
present,but minor (and
contributing) elements
of the patient-doctor
encounter are missing
Chart fails to provide
logical a synthesis of
the resident’s decision-
making & thinking
process.
All elements (see above)
are addressed.
Charting provides a
complete narrative of the
patient-doctor encounter
in the ED.
Chart does not fully
explain the resident’s
decision-making &
thinking process.
All elements (see above)
are addressed.
Charting provides a
thorough narrative of the
patient-doctor encounter
in the ED.
Chart provides a succinct
and nuanced synthesis
that fully explains the
resident’s decision-making
& thinking process.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Educational Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
37
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Consult Request
Today’s focus is the consultation request. (CL 1.1)
The ideal scenario for this assessment will be in a case with a stable patient who requires referral for admis-
sion. Preferably, the learner should be referring to another resident (e.g. the Surgical Resident, Senior Medi-
cal Resident). Resident has Supervisor listen (or observe) to them making a consult request.
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident displayed any of the below:
Unprofessional
Confusing to Consultant Colleague
Did not convey relevant and/or
crucial information (i.e. Urgency,
important management)
Was unwilling to compromise
Conflict arose and escalated
Resident’s actions are
described by most of the
below:
Professional
Colleague’s questions were
answered.
Eventually, arrived at a plan
that was amenable to all
parties.
Resident displays all of the below:
Professional and approachable.
Built a good rapport.
Answered questions from
consulted colleague.
Arrived at a plan that was
amenable to all parties easily.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Action Prescription) for the resident to
attempt during his/her next shift. (You do not need to record this).
CHECKLIST
DONE
DONE BUT NEEDS ATTENTION
NOT DONE
N/A FOR CASE
Introduces Self: Name and Role in ED
Gives Emergency Physician Supervisor name
Highlights Reason for consult request “I have a patient with
worsening COPD” or Clinical Question “Does this person have
appendicitis?”
Provides patient demographics & identifying data (e.g. Name, Age,
Location)
Provides focused HPI - concise and succinct
Provides important ED results - lab and imaging
Clarifies/answers Consultant’s questions
Documents name of consultant and time of consultation request
5
ASSESSMENT INDEX
ASSESSMENT INDEX
Performance+Improvement+Part+1
Time+Management
Performance+Improvement+Part+2
Tech+in+the+ED
Work/Life+Balance
Determinants+of+Health
Pa*ent+Survey
Overcoming+Barriers
Lead Authors:
Dashminder Sehdev
Rahim Valani
Editors:
Teresa Chan
Jonathan Sherbino
JUNIOR MODULES !
HEALTH ADVOCATE & MANAGER
39
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Unable to self-identify any
areas in need of
improvement
Unable to develop plans for
improvement even with
preceptor assistance
Requires preceptor’s
assistance to identify:
area in need of
improvement
plan for future
improvement
Able to self-identify
(with minimal preceptor
assistance):
area in need of
improvement
plan for future
improvement
Able to articulately identify
area MOST in need of
improvement with no
assistance from preceptor
Able to independently
articulate plan for
improvement with minimal or
no preceptor guidance.
Resident’s self-identified area for
improvement
Preceptor’s suggestion for area of
improvement (may be similar or
dierent)
Mutual agreed upon area for
improvement
Plan for success (collaboratively
developed by preceptor and resident)
Task | Performance Improvement Part 1
Today’s focus is on personal practice improvement (M1.2)
Continuous professional development is a lifelong skill. This exercise introduces the junior resident to personal
learning projects. The area or topic for improvement can be from any of the CanMEDS Roles. For the purpose of
this assessment tool, the area can be “simple” (e.g. “learn how to solve an acid-base problem etc.).
By the end of this shift, the resident, along with the preceptor identifies a single area in which to improve.
IT SHOULD BE THE AREA MOST IN NEED OF IMPROVEMENT BASED ON TODAY’S PERFORMANCE.
The area and a brief plan for improvement is outlined in the following table:
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the
resident to attempt during his/her next shift. (You do not need to record this).
The basis of this assessment tool is to encourage reflective practice and steer junior & intermediate residents towards assessment-seeking. For
futher reading or justification for this task: Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad
Med. 2005 Oct;80(10 Suppl):S46-54.
40
Task | Performance Improvement Part 2
Today’s focus is to check on your process regarding your personal practice improvement plan. (M1.3)
Several shifts ago, you and your preceptor made a plan. You will now discuss your progress with your preceptor
regarding your previously identified area of improvement.
Please summarize the area you identified for improvement:
Describe some examples on how you
worked on this identified area?
What successes have you
encountered?
What challenges have you
encountered?
What other feedback have you
received from other faculty members
on similar areas?
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
RESIDENT’S SELF-ASSESSMENT (COMPLETE BEFORE PRECEPTOR GIVES ASSESSMENT)
1
I need assistance
2
3
4
5
6
7
I’m ready for the next step
I have been unable to
make a change in this area
of my practice
I have been able to
make marginal change
in this area of practice.
I have made a substantial
change in this area of
practice.
Previously identified
weakness is no longer an
issue.
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
PRECEPTOR-ASSESSMENT
1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Resident has been unable
to make a change on this
area of my practice
Resident has been able to
make marginal change in
this area of practice.
Clearly is improving.
Resident has made a
substantial change in this
area of practice.
Vastly improved from my
last observation.
Previously identified
weakness is no longer
noted.
What are your next steps?
RESIDENT: ______________ Name of Assessor: ______________ Date:_________
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The basis of this assessment tool is to encourage reflective practice and steer junior & intermediate residents towards assessment-seeking. For
futher reading or justification for this task: Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda.
Acad Med. 2005 Oct;80(10 Suppl):S46-54.
41
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Work/Life Balance
Today’s focus is to set priorities and manage time to balance patient care, practice requirements, outside
activities and personal life. (M1.4)
Residency is a busy and often stressful time. Time management and prioritization are important to success as a
resident. Often we are unable to appreciate the dierence between urgency and importance. The two are not the
same. The importance of an event or task can be relative.
PRE-SHIFT ASSIGNMENT
The resident should create or produce (if he/she already has one) a calendar for the week, and a list of
tasks that need to be done in the next week.
Important
Not Important
Urgent
Not Urgent
Each calendar event and task should be placed in one of the boxes below:
Above scoring rubric is modified from a reflective rating schema from Donato A, George DL. Academic Medicine. 2012: 87(2), p. 188.
PLEASE CIRCLE THE BEST DESCRIPTOR OF THE RESIDENT’S REFLECTIVE ABILITY
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PLEASE CIRCLE THE BEST DESCRIPTOR OF THE RESIDENT’S REFLECTIVE ABILITY
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1
Minimal or no effort.
2
3
Reporter
4
5
Interpreter
6
7
Manager/Educator
Resident’s work
incomplete ; not
permitting an
opinion of his/her
reflective capacity.
Resident has no/
minimal insight.
Resident
demonstrates ability to
record concrete
aspects of their life
(findings, what was
done).
Resident demonstrates
ability to reflect
meaningfully on his/her
current situation how he/
she might have handle
identified problems.
Resident forms an action
plan for improvement
and/or explains how to
extrapolate their reflection
on this activity to other
aspects of their life.
The attending and resident should have a discussion about how to manage the non-urgent, not important tasks that have been
identified. Based on the discussion, the attending should rate the resident’s ABILITY TO REFLECT on their own situa-
tion.
42
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Major Task | Patient Survey (NOTE: THIS ACTIVITY RUNS OVER 4 PAGES)
Today’s task is to identify the needs of an individual patient. (A1.1)
Your preceptor will pick two patients (or family members) that you see today and ask them a few ques-
tions about your discharge or admission planning process. You will mutually agree on TWO (2) patients
that you both feel are at high risk for either a poor health outcome or a repeat visit to the emergency de-
partment. Once you have completed your care and discharge instructions, please ask the patient to wait
for the preceptor to come and chat with them.
The goal of this exercise is to provide residents with useful feedback about how well they were able to
incorporate the the key determinants of health that were relevant to patients into discharge or admission
planning.
Instructor Hints
Please ask the following questions to two patients that you or the resident have identified as high risk for
either a poor health outcome or a repeat visit to the emergency department. Each encounter should
take approximately three minutes. Be prepared to take notes.
WHAT THE ATTENDING MIGHT SAY WHEN APPROACHING THE PATIENT...
Hello [insert patient name]. I am supervising Dr. X today and I would like to ask you a few questions
about the care provided by him/her.
It is my job to make sure that s/he becomes an excellent emergency physician and I would like your opin-
ion on how things went today.
I will be asking several other patients as well so s/he won’t know which comments came from you.
Would you be willing to talk to me for a few minutes?
43
Continues on next page
Patient #1
Patient #2
1. Did Dr. X treat you with respect?
2. Did Dr. X listen to you?
3. Did Dr. X explain the following
things to you?
Diagnosis
Discharge plan
Follow-up plan
Return instructions to the
Emergency Department
4. Did Dr. X provide you with
choices and options regarding your
care plan (discharge or admission)?
5. Do you think you can do what Dr.
X has suggested? Why or why not?
6. Are there other important things
that Dr. X did not ask you about?
Other Questions
44
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Patients perceived that resident showed
signs of disrespect or ill-regard for them
(the patient).
Patients perceived that resident mis-
understood them or left them
unsatisfied with answers
Patients perceived that resident
provided a reasonable care plan and
answered most questions.
Patients perceived that resident provided clear explanations
and helped them to navigate and understand the healthcare
system.
No question unanswered and nothing wanting.
Attending’s Suggestion(s) for improvement based on patient feedback.
At the end of the shift compile the feedback from all the patients and present the resident with some con-
crete suggestions on how they can improve.
Continued from previous page...
45
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Time Management
Today’s focus is Time Management. (M1.1)
A key skill for an an emergency physician is time management. You should observe how the resident:
-organizes his/herself to complete key tasks ASIDE from the initial patient encounter and decision mak-
ing process (i.e. the resident’s eciency in completing tasks that need to be done once the a care deci-
sion has been made - consults, paperwork, reassessments)
-prioritizes tasks to be done next
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her
next shift. (You do not need to record this).
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1
Needs assistance
2
3
4
5
6
7
Ready for the next level
Needs constant
reminders to reassess
patients.
Inecient with time in
the department
Needs a few
reminders about
patients.
Returns to reassess
patients multiple
times (> 3 times)
before arriving at a
plan
Functions
independently
regarding patient
assessments and
reassessments
Orders appropriate
tests, reassess pts
only 2-3 times
before arriving at
diagnosis and
disposition plan.
Is flow conscious with
his/her portfolio of
patients (assessments,
reassessments,
investigations).
Eciently sees multiple
patients, arriving at
diagnosis/disposition in a
time-ecient manner.
46
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
Task | Technology in the ED
Today’s task is to employ information technology appropriately for patient care and eciently use electronic information
systems to access relevant scientific, clinical and administrative information. (M1.5)
The resident should be able to navigate an ED tracking system and electronic health record. The resident should also be aware of
the issues of privacy, confidentiality and the need to protect the information available. During a shift, the resident should demon-
strate the ability to use the department’s IT for the following tasks.
CHECKLIST
DEMONSTRATES THIS
THROUGHOUT SHIFT
(WHEN NECESSARY)
DEMONSTRATES THIS
AT TIMES DURING
SHIFT (WHEN
NECESSARY)
DOES NOT
DEMONSTRATE THIS
DURING SHIFT
N / A
Patient tracking
e.g. clicks on patients, logs consults
Facilitates Order entry (either by others – RN/Unit Clerks; or
by selves if applicable)
e.g. does not utilize the nurses’ station computer to look up labs
when nursing colleague needs to enter orders, print labels, etc..
Utilizes EMR (electronic medical record) when looking up
past results
e.g. able to utilize all records available (Provider Portal, Clinical
Connect, Meditech)
Retrieving diagnostic imaging
e.g. able to utilize relevant database (PACS, EMR)
Participates in Radiology QA process
e.g. able to create note on preliminary reads for films
Utilizes technology to enhance patient flow
e.g. The resident should be able to recognize when results are
taking too long and direct an inquiry regarding a computer issue
or a lab issue; groups their course through the department in an
ecient manner based on tracking board information
Respects confidentiality
The resident should log out after walking away from the
computer that is not in an enclosed physician space.
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1
Needs Assistance
2
3
4
5
6
7
Ready for Next Steps
Resident displayed any of
below:
Is careless with access to
information (e.g. stays
logged in at multiple
stations)
Is unable to use
technology to assist with
patient care tasks.
Resident displayed some of
below:
Respects confidentiality.
Awkwardly navigates the
computer system, but is able
to access information as
necessary.
At times, unaware of
workspace issues regarding
computers (e.g. uses an RN-
designated computer).
Resident displayed all of below:
Respects confidentiality.
Utilizes technology to enhance his/
her performance in the ED.
uses technology fluidly and without
diculty
Is fully aware of workspace issues
regarding computers.
The Evidence: Please provide an example with an explanation that supports your rating (MANDATORY):
The next step: Based on the above evidence, please give one specific suggestion (Education Prescription) for the
resident to attempt during his/her next shift. (You do not need to record this).
47
Task | Determinants of Health! ! ! ! PREPARATION REQUIRED
Today’s task is to identify the determinants of health and explain their eect our ED patients. (A1.2) During the
shift, the resident must keep an ‘advocacy watch log’.
The aim of the task is to assess whether a learner can identify the social determinants of health. During the shift, the
resident needs to identify AT LEAST 3 (but up to 5) patients that may experience diculty with navigating the healthcare
system.
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1
Needs assistance
2
3
4
5
6
7
Ready for Next Step
Resident demonstrates any of
the following or an equivalent
behaviour:
Could not identify any barriers
to health for his/her patients
Did not describe a single
measure s/he took to help a
patient overcome barrier to
health
Resident demonstrates most of
the following or an equivalent
behaviour:
Identified similar barriers to
health (e.g. socioeconomic
factors) among patients listed
Described a simple intervention
s/he took to help a patient
overcome barrier to health (e.g.
filled out CCAC form)
Resident demonstrates most of the
following or an equivalent behaviour:
Able to identify a diverse set of
potential barriers to health for patients
listed;
Described a complex or nuanced
intervention s/he took to help a patient
overcome barrier to health (e.g. helped
patient who was subject to spousal
abuse find a safe place to stay upon
discharge).
Patient
(De-identified data – e.g. 89 year old
female)
Chief Complaint / Diagnosis
Problem that may arise for this patient due to a social barrier (e.g. language barrier, illiteracy, lack of funds, etc..)
PRIOR TO SHIFT THE RESIDENT SHOULD READ THE FOLLOWING ARTICLE:
(The document below is a digestible primer on the social determinants of health. It serves to create a foundation for identifying barriers
to health encountered by patients, based on multiple socio-economic and cultural factors).
Social Determinants of Health: The Canadian Facts by Juha Mikkonen & Dr. Dennis Raphael, 2010
http://www.thecanadianfacts.org/The_Canadian_Facts.pdf
The Evidence: Preceptor is to ask resident to describe one patient encounter in detail and specifically describe how they address the
barriers to health. Please briefly outline what they did well, and how they might improve their health advocacy.
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
48
The exceptional events are any observed performances that suggest that a resident is performing in
an exceptional way. This can be either an especially good performance, or one that suggests that
they are in need of special assistance. Of note, this system has helped to flag residents who are both
outperforming peers (e.g. ran an exceptional resuscitation), and also underperforming or displaying
unprofessional behaviour.
Notably, this facet of the McMAP increases the sensitivity of the entire system, allowing the program
director to gather more information about
APPENDIX A
49
Below is the overall task index. Do note that some tasks are found in more than one level. These are
sometimes intentionally spaced to reaffirm concepts, and sometimes these tasks are named the
same but have different (increasingly difficult) anchors/rubrics.
APPENDIX B
50
Junior Level
Junior Medical Expert & Scholar
Chest Pain Hx / Px
Acute Back Pain Hx / Px
Mini Trauma
Simple procedure!
Point of Care Research w/!Direction!
Knowledge!Translation
Case Presentations
Ordering Investigations
Junior Communicator & Collaborator
• Observed History
• Observed Hx with Barrier
• Discharge Instructions!
• Chart Audit (Content)
• Chart Audit (Organization)!
• Obtaining Consent
• Consult Request
• Case Presentation"
Junior Professional & Communicator
Observed History - modified SEGUE (a)
Capacity assessment
Obtaining Consent
Narcotic Prescription
Mandatory Reporting
Chart Audit (Organization)!
Chart Audit (Content)
Consult Request (Junior)
Junior Manager & Health Advocate
Performance Improvement Part 1 ! !
Performance Improvement Part 2 ! !
Time Management
Tech in the ED
Work/Life Balance
Determinants of Health
Patient Survey
Overcoming Barriers
Intermediate Level
Intermediate Medical Expert & Scholar
History & Physical during a Resuscitation or
Trauma
Procedural Teaching (Simple Task)
Knowledge Gap!Identification
Knowledge Translation
Point of Care Research (Own Question)
Performing Complex Procedure
Chest Pain History & Physical
Ordering investigations
Intermediate Communicator & Collaborator
• Airway Management (Also see M&A)
• Discharge Instructions
• Delivery of Care plan to Family or Patient
• Care Plan Discussion w/ RN or Allied Health
• Documentation (Also seen in P+C block)
• Multi-source Feedback
• Mini-Chart Audit
• Consultation Request (Intermediate ver.)"
Intermediate Professional & Communicator
Modified SEGUE history (b)
Obtaining Consent
Audit of In-patient outcome
End of Life & Advanced care planning
Mandatory Reporting
Capacity Assessment
SBAR (Handover)
Documentation (also see C&C)"
Intermediate Manager & Health Advocate
Airway Management (Also see C&C block)
Performance Improvement Part 1
Performance Improvement Part 2
Work/Life Balance
ED Flow
Time Management
Patient Survey
Senior Level
Senior Scholarship & Teaching
Supervising Procedures
Impromptu Didactic Teaching Session
Clinical Supervision
Role Modeling Knowledge Translation
Feedback & Coaching (Also C&C)
Team Leader Feedback (Also QDM)
Point of Care Research (Own Question)
Role Modeling Health Promotion (Also
QDM)"
Senior Communication & Collaboration
• Telephone Communication
• Breaking Bad News
• Critical Incident Debriefing
• Providing Handover (SBAR) (Also L&TM)
• Receiving Handover
• Feedback & Coaching (Also S&T)
• Advanced Consultation Request / Out pa-
tient Referral
• Advanced Chart Audit
• Communication with Nursing or other Health-
care Professionals
• End of Life & Advanced Care Planning
• Team Leader Feedback (Also QDM)
Senior Quality Decision Making
Performance Improvement (Senior version)
ED Flow (Senior version)
Time Management (Senior version)
Patient Survey
Team Leader Feedback (Also C&C)
Obtaining Consent
Quality Assurance
Role Modeling Health Promotion
Patient Safety Leadership (Also L&TM)
Feedback and Coaching (Also S&T)
Senior Leadership & Team Management
Receiving Handover from Paramedics
ED crowding management
Time Management & Task Switching
(“Multi-tasking”)
Delegation and Team Management
Supervising Procedures (Also S&T)
Team Leader Feedback
Managing (Potential) Conflict Situations
Providing Handover SBAR (Also C&C)
Professional Obligations
Patient Safety Leadership (Also QDM)
... The McMaster Modular Assessment Program (McMAP) is a programmatic assessment system that collects and combines data from 58 WBA instruments based on emergency medicine (EM) clinical tasks. [19][20][21][22] McMAP has been in operation since 2012. The instruments are divided into three levels (junior, intermediate, senior) and comprehensively ...
Article
Background: Assessing resident competency in emergency department settings requires observing a substantial number of work-based skills and tasks. The McMaster Modular Assessment Program (McMAP) is a novel, workplace-based assessment (WBA) system that uses task-specific and global low-stakes assessments of resident performance. We describe the evaluation of a WBA program 3 years after implementation. Methods: We used a qualitative approach, conducting focus groups with resident physicians in all 5 postgraduate years (n = 26) who used McMAP as part of McMaster University's emergency medicine residency program. Responses were triangulated using a follow-up written survey. Data were analyzed using theory-based thematic analysis. An audit trail was reviewed to ensure that all themes were captured. Results: Findings were organized at the level of the learner (residents), faculty, and system. Residents identified elements of McMAP that were perceived as supporting or inhibiting learning. Residents shared their opinions on the feasibility of completing daily WBAs, perceptions and utilization of rating scales, and the value of structured feedback (written and verbal) from faculty. Residents also commented extensively on the evolving and improving feedback culture that has been created within our system. Conclusion: The study describes an evolving culture of feedback that promotes the process of informed self-assessment. A programmatic approach to WBAs can foster opportunities for feedback although barriers must still be overcome to fully realize the potential of a continuous WBA system. A professional culture change is required to implement and encourage the routine use of WBAs. Barriers, such as familiarity with assessment system logistics, faculty member discomfort with providing feedback, and empowering residents to ask faculty for direct observations and assessments must be addressed to realize the potential of a programmatic WBA system. Findings may inform future research in identifying key components of successful implementation of a programmatic workplace-based assessment system.
... Recently, a validated examination was developed to assess physician transfusion medicine knowledge using 23 questions on subjects identified by transfusion medicine content experts as being highly im- portant[52]. Programs of assessment are being developed to marry theory-based assessment instruments with work-based tasks to provide frequent, criterion-based, authentic assessment of learners[53]. Simulation laboratories are being implemented in a variety of educational settings[54]and might serve a future purpose in transfusion medicine, for example, to simulate transfusion reactions on highfidelity models or to create safe laboratory environments for learning about immunohematology. Future research will be needed to develop and validate additional methods for assessment of competencies specific to transfusion medicine training. ...
Article
Full-text available
Transfusion medicine training in Canada is currently undergoing a transformation from a time- and process-based curriculum to a competency-based medical education framework. Transfusion medicine is the first accredited postgraduate medical education training program in Canada to adopt a purely competency-based curriculum. It is serving as an example for a number of other postgraduate medical training programs undergoing a similar transition. The purpose of this review is to highlight the elements of competency-based medical education, describe its application to transfusion medicine training, and report on the development and implementation of the new transfusion medicine curriculum in Canada.
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