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McMaster Modular Assessment Program Senior Edition

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M MAP
McMaster

C Modular
Assessment
Program

McMaster Modular Assesment

Program - Senior Edition
Editors: Teresa Chan & Jonathan Sherbino
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: 978-0-9907948-3-7

i
DEDICATION

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.

ii
 About The McMAP Project
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 in-
stitutions 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 assess-
ment of EM residents and front-line EM teachers
and educators. Key themes that inform McMAP
are: the need for clear criterion-based (i.e. objec-
tive) standards; the need to facilitate regular, con-
structive feedback; and the need to encourage
reflection among learners.
About McMAP Senior
McMAP Senior is the capstone of this workplace-
based assessment program. In McMAP Senior,
the emphasis is on Emergency Department
management, teaching/supervising junior
learners and consolidating clinical skills.
Facilitated, reflective practice continues to be
emphasized. As always, McMAP Senior builds on
the competencies addressed in McMAP Junior
and McMAP Intermediate.
Most importantly, McMAP Senior actively affirms
a culture of feedback. At the conclusion of each
shift the senior learner not only receives
feedback from faculty, but also provides
constructive, specific, observation-based
feedback to junior 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
iii
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
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
iv
of the resident’s performance during the shift, If you would like further details on how to host
typically requires five minutes. McMAP on an electronic platform, please con-
tact us. We currently use a secure, free, cloud-
Our experience suggests that it is best to allow
based platform that allows residents and faculty
the resident and faculty member to negotiate at
to access their digital passports via mobile de-
the beginning of a shift the task to be addressed
vices or computers.
that day. Some tasks are harder to complete than
others because of the need for specific patient For any inquiries, please contact us at:
presentations (e.g. lead a resuscitation). While mcmapem@univmail.cis.mcmaster.ca.
McMAP has been designed to be flexible to the
- Teresa Chan & Jonathan Sherbino,

unpredictability of EM practice, faculty and learn-
Editors & Project Leads
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- Usage
ment Program.
This document is licensed for use under the creative com-
mons selected license: Attribution-NonCommercial-NoDerivs
If you have any suggested modifications or addi-
3.0 Unported.
tions to McMAP we would be pleased to con-
sider them for incorporation into subsequent ver-
sions.

v
 SENIOR RESIDENT
DAILY GLOBAL RATING
Authors: Editors:
Jonathan Sherbino
Alim Pardhan
Karen Schiff
Teresa Chan

What is the Daily Global Rating?
At the culmination of each shift, assessors (staff physi-
cians) are meant to complete a global rating of the resi-
dent’s overall performance during that shift. A copy of
the global rating scale is attached.
How do I use this sheet?
Raters need only choose one score (i.e. a single num-
ber from 1 to 7), however, the descriptions are present
to clarify the various aspects of the CanMEDS roles
that are expected at various levels.
across many skills, the daily task ratings better clarify
the microskills required of an emergency resident at
this level. This offloads the need to do detailed obser-
vations every day, and allows us to harness the
teacher’s ‘gestalt’ regarding resident performance.
Other notes
Raters should be encouraged to use the whole spec-
trum of the score, however, many residents are rather
high-functioning since they have already spent signifi-
cant time in the Emergency Department (ED) during
clerkship and electives.

Some raters may find it useful to use each listed crite- Based on historical trends, residents often begin
rion to isolate areas of weakness or strength for the around a 3 or 4 (out of 7) in the beginning of the year,
resident, but only ONE number is needed to represent and over the course of a few blocks progress to a 6 or

1
the resident’s overall progress each day. 7 (out of 7).

Why do we only have to rank residents by one num-

ber?

Many studies of rater psychology have shown that

teachers often only really rank residents by a single
number anyways (and forms with multiple rating
scales often just result in confusion and/or artificial vari-
ance around the number in the rater’s mind). Since
the McMAP system facilitates daily observations
 SENIOR RESIDENT
DAILY GLOBAL RATING
RATE THIS TASK | SELECT NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 Ongoing support or
2 3
Needs Assistance
Any of the following apply to the
Senior Resident:
• Displays major areas of knowledge
! deficit.*
• Displays major weaknesses with
functioning in the ED environment
(culture, logistics, collaboration);
Cannot be entrusted with duties
beyond managing own portfolio of
! patients.
• Entrustable ONLY with non-urgent,
routine cases; Independently and
accurately examines, diagnoses and
determines care plan for non-
! critically ill patient(s) ONLY.
• Performs actions that place patients
! at risk.*
• Has lapses in professional
! behaviour. *
• Ineffectively or offensively
communicates with patient(s) or
! colleague(s).*
• Cannot remedy knowledge gaps at
! the point of care.
• Shows lack of insight into own
limitations or knowledge gaps.*
*MUST comment below or flag this through the exceptional events system
COMMENTS/ CONCERNS/FEEDBACK
4 7
5 6
guidance from Attending
still required
Most of the following apply to the
Senior Resident:
• Functioning proficiently and
efficiently in the ED environment
(culture, logistics, collaboration);
able to manage own patients
and one other task (teaching or
! ED leadership/management)
• Has solid knowledge of EM-
evidence and basic science, or is
able to independently access
this information in a timely
! fashion.
• Able to independently and
accurately examine, diagnose
and determine care plan for
most patients (including the
! critically ill).
• Able to perform procedures
! safely with minimal supervision.
• Communicates efficiently with
patient and colleagues (displays
empathy, and forms good
! rapport).
!
• Is consistently professional.
• Develops a plan to begin
remedying knowledge gaps,
limitations, deficits in exposure.
Ready for
Independent Practice
within an Academic / Tertiary Care centre
Generally, the Senior Resident displays
mostly ALL of the below:
• Functioning proficiently and efficiently
in the ED environment (culture,
logistics, collaboration) while juggling
all other required roles (both
supervising learners and assuming a
! leadership/managerial role)
• Displays exceptional and nuanced
knowledge of EM-evidence and basic
science, but when reaching his/her
!
limits, is able to independently access
this information in a timely fashion.
• Able to independently and accurately
examine, diagnose and determine care
plan for most patients (including the
! critically ill).
• Able to perform procedures safely and
independently without support from
! attending.
• Communicates efficiently with
patients, learners, and colleagues
(displays empathy, and forms good
rapport) even on the most stressful,
! chaotic or busiest of shifts.
• Role models exceptional professional
! behaviour.*
• Skilled at reflective practice and
insight into own limitations,
knowledge gaps; Able to self-identify
and plan for continued improvement.
7
 SENIOR MODULES 

LEADERSHIP & TEAM MANAGEMENT
Authors: Editors:

Amna Zaki Teresa Chan

Michelle Welsford Jonathan Sherbino

ASSESSMENT INDEX

Receiving Handover from Paramedics Team Leader Feedback

2
ED crowding management Managing (Potential) Conflict Situations

Time Management & Task Switching (“Multi-tasking”) SBAR

Delegation and Team Management Professional Obligations

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

ME3.2 | Supervising Procedures

Instructions to Attending: The focus is on observing the senior resident supervise a junior learner on any procedure. The at-
tending should attempt to observe as much as possible (i.e. a few spot checks), and may gather collateral information from the
junior learner, nurses or allied health (e.g. nurse doing safety checklist, sharps safety). THE SENIOR SHOULD BE VERY COM-
FORTABLE WITH THE PROCEDURE IN QUESTION. Information should be gathered from the learner as well (see next page
for learner feedback card).


Suggested encounters: Suturing, Reductions, Casting, Central line insertion

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Prepares Learner - Determines if procedure is appropriate for learner; Orients, explains or reviews
procedure or key aspects of the approach to the LEARNER (including indications, risks, benefits,
complications)
Role Models or Ensures use of PPE - Uses and/or facilitates the use proper personal protective
equipment by all parties (e.g. safe practices by learner)
Ensures Safe Practices & Proper Procedural Technique - Watches for proper use of procedural
equipment; Ensures DISPOSAL of sharps; Uses SAFETY CHECKLIST if appropriate (e.g. central line
checklist)
Identifies when (and if) to step in / take over procedure from junior - Watches for difficulty,
complications, and/or impending problems and asks junior to step aside safely.

Ensures appropriate Aftercare instructions (including handouts) are provided to patient May delegate
this task to the junior, but MUST REVIEW with junior and be available to make clarifications

Debriefs & Provides Feedback after procedure - Provides constructive feedback (including suggestions
for ‘next steps’) and reviews any difficulties or suggestions after procedure

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
Needs assistance 2 3 4 5 6 Independent Practice
Displays any of the following: • Does not clarify procedure nor • Prepares learner adequately • Prepares learner adequately
prepare junior learner (i.e. sets up (e.g. describes general • Stops junior resident if safety breach
• Puts patient at risk junior to fail) approach to the learner) occurs or is about to occur
• Observes learner completely • Proper attention to safety of patient,
• Does not allow Junior to attempt any • Does the bulk of the procedure (not • Needs a few reminders to let the learners, and self.
part of the procedure allowing junior to participate) junior attempt procedure
• Consistently accurate, proper Either:
• Fails to explain any aspect of the • Incompletely describes the attention to safety. 1) Explains if and why they need to
procedure to learner procedure to observing learner • Attempts to safely prompt or “take over” during the procedure &
assist junior during procedure then seemlessly explains while
• Awkward when supervising the (e.g. doesn’t just take over) performing the task. or
procedure • May or may not conduct debrief 2) Facilitates successful procedure.
of procedure with learner.
• Conducts debrief and reaffirms key
take home points with learner after
procedure.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

9
ME3.2 | Supervising Procedures - LEARNER FEEDBACK FORM
Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete it.
They do not need to actually provide a score. Please record any feedback from this sheet into the online form as you
see fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The resident reviewed the indications and contraindications of this

procedure to me.
The resident involved me in gathering materials, and I feel I could do this
next time for a similar procedure.
The resident was a good role model for me in terms of preparation, personal
protection, and precautions to maximize patient/staff safety (e.g. wore PPE,
put away sharps, did not expose me to bodily fluids)

The resident was able to explain all steps of the procedure to me (this can
be done before, during, or after the procedure)
The resident involved me or taught me about the documentation and orders
around this procedure.
The best thing the resident did while teaching me this procedure was…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

Please return this to the FACULTY MEMBER who was observing this procedure. The junior is NOT expected to
rate the SENIOR RESIDENT.

10
 RESIDENT ______________ Name of Assessor_________________ Date:_________

CL3.4 | Receiving Handover From Paramedics (Preferred Site: HHS)

Instructions to Attending: The resident is to be PRESENT during a transfer-of-care from paramed-
ics to the Emergency Department team. Ideally this would be for a critically ill patient (e.g. major
trauma, patient with ongoing resuscitation). The goal of this task is to observe effective communica-
tion with paramedics, and to observe the resident receive handover from paramedic regarding criti-
cally ill /injured patient.

THE ATTENDING SHOULD BRIEFLY QUIZ THE RESIDENT ABOUT PERTINENT DETAILS TO DE-
TERMINE HOW MUCH THEY RETAINED FROM THE ENCOUNTER (see items below)

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Independent Practice
2 3 4 5 6
Needs assistance

Resident displays any of the
following or similar behaviours:
• Does not listen to paramedics
or elicit handover
• Unable to incorporate
paramedic information into
initial patient assessment
• Does not clarify points of
uncertainty prior to paramedic
departure
• Does not monitor for ongoing
patient care (e.g. chest
compressions, assisted
ventilation)
• Listens to handover, but
does not elicit or recall key
information (e.g. vital signs,
interventions performed,
medications administered)*
• Asks questions about
information that was already
discussed by the
paramedics (e.g. displays
inattention).
• Ensures transition of
ongoing patient care (e.g.
chest compressions,
assisted ventilation) but this
process is VERY AWKWARD
(e.g. periodic delay or
halting)
• Actively listens and/or elicits
most of the key information
(e.g. vital signs, interventions
performed, medications
administered)*
• Recalls and DOCUMENTS
all information from
paramedics
• Ensures transition of
ongoing patient care (e.g.
chest compressions,
assisted ventilation) but it
may be SLIGHTLY
AWKWARD (e.g. very slight
delay)
Resident displays all of the
following or similar behaviours:
• Actively listens and/or elicits the
key information (e.g. abnormal
vital signs, interventions
performed, medications
administered)*
• Recalls, ACTS UPON and
DOCUMENTS all information
from paramedics
• Ensures A SMOOTH transition
of ongoing patient care (e.g.
chest compressions, assisted
ventilation)
• Does not delay handover or
resuscitation

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

11
RESIDENT ______________ Name of Assessor_________________ Date:_________

L3.5 | ED Crowding Management

Instructions to Attending:
Identify this task at the beginning of a shift. There should be at least some pressures due to ED crowding on
the shift to require physician planning and intervention to assist with ED flow. It may be ideal to involve the
charge nurse in providing feedback on this task.
Note: Senior residents may not begin to achieve competence in this skill until very late in residency.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Works with charge nurse or other staff to free up resuscitation or assessment space (e.g.
considers which patients can be removed from cardiac monitors or out of resuscitation
spaces; considers non-ED resources)

EXAMPLE: Helps to make room for in-coming patient after receiving EMS Patch

Works with nurses or other staff in one area to facilitate flow (e.g. considers which patients
can wait in a non-assessment space to wait for investigations, consultations,
reassessments)

Integrates learners and other team members to facilitate flow and assessments 

(e.g. considers how to efficiently see patients taking into account other learners and their
learning needs)

Proactively continues to manage ED during high volumes, bed-blocked, limited

assessment space. Corresponds with administration as needed with the supervision of the
attending physician.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

Resident displays any of the
following or similar behaviours:
• Relies on charge nurse or other
staff exclusively (including the
attending) to make all decisions
on flow, even when it negatively
affects patient care
• Unable to formulate or execute
plan
• Uses a few strategies to
improve flow during shift, but
NEEDS CONSIDERABLE
ASSISTANCE and
PROMPTING from attending
physician
• DOES NOT MAINTAIN OPEN
COMMUNICATION with
nursing and administrative
staff throughout the shift
• Uses several strategies to
improve flow during shift
considering patient safety at all
times.
• MAINTAINS CONSTANT
COMMUNICATION with nursing
and administrative staff
throughout shift.
• ACTIVELY IDENTIFIES problems
and REQUESTS assistance from
attending when necessary (e.g.
calling site chief; activating ED
crowding protocols.)
Resident displays any of the
following or similar behaviours:
• Works proactively with other
staff to anticipate problems (e.g.
regularly converses with Charge
Nurse to reassess bed situation)
• Works with staff to solve
problems with available space
and prolonged wait times
considering patient safety.
• ACTIVELY IDENTIFIES and
SOLVES PROBLEMS
independently (only reviewing
briefly with attending to keep
them up to date).

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence,
please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

12
RESIDENT ______________ Name of Assessor_________________ Date:_________
L3.7 | Time Management & Task Switching (“Multitasking”)
Instructions to Attending:
The senior resident should be taking on additional tasks beyond just seeing his/her own portfolio of pa-
tients (e.g. should be reviewing cases or managing administrative duties too). The attending will need to
observe the resident throughout the shift, bearing in mind the way he/she tends to do the following tasks:
1) switch between tasks (a.k.a. task-switch or multi-task);
2) handle interruptions;
3) delegate tasks;
4) juggle between new patients and reassessments.
Please also note any other behaviours that may impede or enhance the efficiency of the senior resident.

Note: Senior residents may not begin to achieve this competency until very late in residency and/or during
the first few months as a staff physician.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

7
1
2 3 4 5 6 Ready for
Needs assistance
Independent Practice

Resident displays any of the
following or similar behaviours:
• Needs constant reminders to
reassess patients
• Inefficient with time in the
department
• Unable to delegate tasks
appropriately (or fails to step in
when required)
• sees minimal number of patients
during shift (i.e. is not able to
attend to minor care area
patients)
• Is unprofessional with colleagues
when interrupted (e.g. Becomes
angry or annoyed at interruptions)
• Becomes highly focused
on his/her patients only
(e.g. loses situational
awareness, especially
when handling critical
patients)
• Needs a few reminders
about patients
• Usually spontaneously
returns to reassess
patients
• Infrequent delegation of
tasks (or steps in to help
with tasks only when
suggested by attending)
• When INTERRUPTED:
Remains professional with
colleagues, but seems
flustered or disorganized
after the interruption
• Functions independently as a
practitioner in managing his/her
own patients.
• Maintains situational
awareness, and recognizes
limits (e.g. asks for help from
attending when reaching his/
her limits)
• Consistently reassesses
patients independently, but may
be slower than an attending
• Able to delegate tasks, but may
fail to follow-up with junior
learner when dispositioning or
reassessing patients (e.g. refers
learner’s patient to medicine
without consulting the learner)
• When INTERRUPTED: Remains
professional with colleagues,
but takes some time to regain
his/her train of thought from
before the interruption (e.g.
continue reviewing, resuming
patient care)
Resident displays all of the following or
similar behaviours:
• Flow conscious with both his/her
portfolio of patients AND the patients
under the care of his/her delegates.
• Maintains situational awareness
throughout shift, even with critical
patients.
• Efficiently sees multiple patients,
juggling multiple critically ill patients at
once arriving at diagnosis and
disposition plans in time-efficient
manner
• Remembers learners - discusses
diagnosis and disposition plans
together with junior learners
• Delegates appropriately and follows-
up in a timely fashion (incorporating
learners into work flow)
• When INTERRUPTED: Remains
professional with colleagues,
seamlessly resumes patient care or
teaching tasks from before the
interruption (i.e. goes right back to
teaching after a phone call from
radiology)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

13
RESIDENT ______________ Name of Assessor_________________ Date:_________

L3.6 | Delegation and Team Management

Notes to the Attending:
Identify this task at the beginning of the shift. The senior resident should be assigned at least one junior learner. The resi-
dent will provide oversight for the learner(s)’s education during the shift in addition to their usual duties of seeing patients
and / or managing the department. The assessment should be based upon reviewing more than just one patient with the
junior learner and should also include a formative assessment of the learner.

AT THE END OF SHIFT: The staff preceptor should elicit and incorporate feedback from the junior learner about the senior’s
performance.

NB: This is different from the Teaching & Scholarship block task, they were not required to balance patient care duties with
reviewing/supervising residents.

DONE BUT
N/A FOR
CHECKLIST DONE NEEDS NOT DONE
CASE
ATTENTION

Helps determine appropriate patients/cases for the junior learner

Checks in / keeps track of the learner (e.g. time spent assessing patients, need for learner to complete patient
reassessments, time spent waiting to review patients, number of patients seen in shift)

Junior learner saw an appropriate number of patients during the shift (e.g. ~1-1.5 patients per hour)

Senior Resident saw an appropriate number of patients during the shift (e.g. around 2 patients per hour -
including learner’s patients)

Senior Resident provided education or teaching around each case (i.e at least on teaching point)

Senior Resident provided feedback on one or more CanMEDS Roles by the END OF THE SHIFT

Senior Resident provided constructive formative feedback during the shift and documents this on relevant
system (e.g. completes McMAP or end-of-shift evaluation for junior learner)

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
1 7
2 3 4 5 6
Needs assistance Ready for Independent Practice

Resident displays any of the
following or similar behaviours:
• Unable to supervise WHILE
managing patients
• Is condescending or
neglectful of the junior
learner
• Neglects patient safety
• Displays poor insight or
judgement (e.g. Does not
recognize own limits) and
does not ask for help.
• Provides some learning
experiences but struggles to
balance between managing own
patients and the learning needs of
the junior learner
• Does not always bear in mind the
junior learner’s role in the care of
the patient (e.g. discharges patients
behind the junior’s back, forgets to
call the to a resuscitation, ‘steals
procedures’)
• Requires (and requests) assistance
by attending to manage patient
care and provide good supervision.
• Provides generic, non-specific
feedback (e.g. Good job!)
• Balances educational needs
of the junior learner with
managing patient care
• May have some difficulty
with efficiency (e.g. number
of patients seen or time for
reassessments)
• Provides specific feedback,
but is non-specific in
suggestions for improvement
(e.g. Read more)
Resident displays all of the
following or similar behaviours:
• Balances educational needs with
managing patients with finesse
and ease
• Requires no additional
prompting
• Provides specific, actionable
feedback (e.g. next time, why
don’t you attempt…)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

14
RESIDENT ______________ Name of Assessor_________________ Date:_________
ME3.1 | Team Leader Feedback
Today’s focus is Leading a Team.
Perform the role of Team Leader for a critically ill / injured patient and receive some preceptored multi-source feedback
from staff physicians, residents, nurses, and other allied team.

Note: Staff physician will need to gather feedback about the resident’s performance from other team members. This is ide-
ally accomplished immediately after a resuscitation. The staff physician can record the feedback numerically or by check
boxes directly into the checklist below.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Clearly Defines / Identifies self as TEAM LEADER

COMMUNICATION - Plans and priorities clearly communicated; Tasks and orders easily understood
with clear direction

Either of the following (1 or 2)

1) Manages suggestions, conflict / disagreement during resuscitation

2) Actively solicits suggestions from the team proactively

Ensures examination and assessment are clearly communicated to scribe/recorder & the rest of the
team

Utilizes team appropriately (tailoring to level and type of expertise)

Maintains overall perspective (e.g. situational awareness) and avoids fixation error or diagnostic
momentum (esp. if patient deteriorates)

Addresses any barriers to implementation of plan

Considers patient-centred or family-centred factors (comfort, respect, wishes)

Number of Team Members Present (other than attending): ______________

FEEDBACK FROM TEAM (Record at least one piece of feedback; may be GOOD or CONSTRUCTIVE)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance
Resident displays any of the   Resident displays any of the following or Resident displays any of the following   Resident displays any of the following or
following or similar behaviours: similar behaviours: or similar behaviours: similar behaviours:
• Several (>3) of the checklist items
were not done • Several (>3) of the checklist items • Most items were done; few (i.e. < 3 • Almost all items in checklist
need attention items) needed attention completed
• Resident did not have the
confidence of the staff members • Staff members were uncomfortable • Staff members seemed comfortable • Resident had complete control of the
during the resuscitation during the resuscitation (e.g. actively during the resuscitation (e.g. only room throughout the resuscitation
disagreed with management, and SOMETIMES looked to the
• Staff physician is compelled to sought attending’s opinion before attending for affirmation) • The attending did not need to be
take over the resuscitation proceeding) present

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

15
RESIDENT ______________ Name of Assessor_____________ Date:_________

CM3.3 | Managing (Potential) Conflict Situations

Notes to the Attending:
This will be an opportunistic task, so the resident may ask you to track it after an occurrence. The
resident should track any incident where they PREVENTED or MUST MEDIATE a conflict situation.

Example situations:
- consultant resident will not attend and see a patient, or is refusing to arrange a certain test (e.g.
CT-scan)
- delay in processing an urgent order
- consultant resident attempts to complete procedure with inadequate sedation and nurses are
alarmed
- Code White
Or other scenarios as deemed appropriate by resident or staff physician.

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY

7
1 Ready for the next level
2 3 4 5 6
Needs assistance

Resident displays any of the following or     • Courteous and respectful to other  
similar behaviours: parties but seemed awkward/
uncomfortable at times in the
• Unprofessional (e.g. loses temper, situation.
engages in shouting match)
• Answers patient or colleague(s)’s
• Conflict Escalated Questions
• Did not convey relevant and/or crucial • Asks some questions to better
information (urgency, importance) understand the problem from the
other person’s perspective
• Resident unwilling to compromise to
achieve best outcome for patient • Eventually arrived at a plan that was
amenable to all parities or required
minor concessions be made by one
or more parties
Resident displays all of the following or
similar behaviours:
• Courteous, respectful, calm &
approachable
• Solicits and empathetically listens to
patient or colleague(s)’s perspectives
on the problem
• Solicits and answers patient or
colleague(s)’s questions
• Seems comfortable in the situation,
and also puts others at ease
• Arrived at a plan that was amenable to
all parties

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

16
RESIDENT ______________ Name of Assessor_____________ Date:_________

P3.1 | Providing handover (SBAR)

Handover: Communication with a fellow Emergency Physician
Handover between physicians occurs in various forms within the Emergency department. Some handovers occur at
shift-change between emergency physicians and some occur at transitions of care between medical specialists. Today
you will be assessed in your handover of a patient to a physician-colleague.

For the purposes of the handover to the EP, the resident should prepare one patient near the end of the shift to discuss
as a handover to the incoming attending. If the timing is not optimal, this may be a simulated handover of a patient to
the supervising attending physician (e.g. resident “hands-over” the a patient at the end of their shift to their attending
prior to going home.)

Suggested reference: http://safersignout.com/what-makes-a-safer-sign-out/

DONE BUT NEEDS N/A FOR

IF THE RESIDENT IS GIVING HANDOVER DONE
ATTENTION
NOT DONE
CASE

S Situation – explains the situation requiring handover.

B Background – succinctly summarizes the relevant findings and labs gathered to date.

A Assessment – provides a synthesis (e.g. summary, hypothesis)

R Recommendation(s) – provides a plan for the in-coming team regarding patient care or further decision making.
(e.g. “If the CT is negative, then the plan is…”)

Notes handover on chart and completes adjunctive paperwork (e.g. out-patient referrals, Rx, patient instructions)

Explains handover process to patients and explains which doctor is assuming care

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
7
1
2 3 4 5 6 Ready for
Needs assistance
Independent Practice

Any of the following: • Courteous and collegial • Hands over own patients well. • Courteous and collegial
• Unprofessional • Inefficient with time. • Courteous and collegial • Is able to give an overview of the entire
• Confusing to Consultant Colleague’s questions • Concise & Time Efficient. department
Colleague were answered. • Built a good rapport. • Able to answer questions about the
• Did not convey relevant • Eventually, arrived at a • Answered questions from plans for both his/her own patients,
and/or crucial information plan that was amenable colleague receiving handover. but also those of learners
(i.e. urgency, important to all parties. • Role models to learners the handover
• Arrived at a plan that was
management) • Does not discuss plan amenable to all parties easily. process.
• Was unwilling to with the patient. • Anticipates and answers all questions
• May or may not discuss plan
compromise with the patient. from
• Conflict arose and • Prepares all adjunctive materials to
escalated facilitate the care of the patient beyond
• Does not discuss plan with his/her time
the patient. • Attuned to potential cognitive errors
[Croskerry]
• Discusses handover with the patient.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

17
Name of Assessor_________________ Date:_________ PRECEPTOR SHIFT #____

P3.3 | Professional Obligations (e.g. Mandatory Reporting)

Today’s focus is on Professional Obligations (e.g. Mandatory Reporting)P1.3)
Fulfilling professional responsibilities is paramount for clinicians. Over the course of this block, the resident should iden-
tify and track any incidents where they facilitate the mandatory reporting.

If this reporting occurs with a case where the Senior Resident is supervising, they should be ready to teach around the
relevant policies and legislation. They should discuss with the learner the mechanisms and processes for reporting,
and also any potential pitfalls or barriers for reporting.

ANONYMOUS PATIENT DEMOGRAPHICS (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?

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6
Needs assistance 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, as well as the
relevant forms
• 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 common policies/legislation, as
well as the relevant forms
• Able to recognize and apply to patients including
rare and complicated situations

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

REFERENCES: Review CPSO Policy #6-12 - reference materials on Mandatory and Permissive 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 reportable
conditions.

18
RESIDENT ______________ Name of Assessor_________________ Date:_________

L3.5 | Patient Safety Leadership

Notes to the Attending:
This will be an opportunistic task, so the resident may ask you to track it after an occurrence. The resident should
track any incident where they PREVENTED or INTERVENED when a scenario affecting patient-safety arose. During
this task, the resident should recap the scenario with the attending to explain their leadership in the situation and
how his/her involvement affected patient safety.

Example situations:
- identified a “near miss” and filled out the relevant reporting documentation
- assisted in a resuscitation at the request of a colleague (e.g. when asked by Nurse or Senior Medical Resident)
- identifies and assists with a scenario involving an admitted patient warranting intervention by emergency physi-
cian
Or other scenarios as deemed appropriate by resident or staff physician.

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance

Resident displays any of the following or similar     • Courteous and respectful to other parties but  
behaviours: seemed awkward/uncomfortable at times in the
situation.
• Unprofessional (e.g. loses temper, engages in
shouting match) • Provided timely and useful assistance in solving
the problem at hand
• Conflict arose
• Answers patient or colleague(s)’s Questions
• Did not convey relevant and/or crucial information
(urgency, importance) • Asks some questions to better understand the
problem from all relevant perspectives
• Resident unwilling to compromise to achieve best
outcome for patient • Eventually arrived at a plan that was amenable to
all parities or required minor concessions be
made by one or more parties
Resident displays all of the following or similar
behaviours:
• Respectful, calm & approachable
• Expeditiously fact finds, soliciting perspectives from
all relevant parties on the problem at hand
• Provides an expert assessment and plan to solve
the problem a
• Seems comfortable in the situation, and also puts
others at ease
• Arrived at a plan that was amenable to all parties

• IF APPLICABLE: Debriefs relevant parties with

regards to the scenario; Provides teaching to
learners as needed.

• IF APPLICABLE: Notifies relevant administration to

prevent error from occurring again (e.g. completes
incident report)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence,
please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

19
 SENIOR MODULES 

COMMUNICATION & COORDINATION
Authors: Editors:

Nadim Lalani Teresa Chan

Jonathan Sherbino

ASSESSMENT INDEX

Telephone Communication Advanced Consultation Request / Out patient Referral

3
Breaking Bad News Advanced Chart Audit

Critical Incident Debriefing Communication with Nursing or other Healthcare

Professionals

Providing Handover (SBAR) End of Life & Advanced Care Planning

Receiving Handover Team Leader Feedback

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

CL 3.1 | Telephone Consultation (Receiving a Consultation)

Instructions to Attending: Focus is on observing the trainee give phone advise to a colleague [e.g. paramedic, family
physician] Ideally, observations are based on 1-2 encounters with non-critically ill patients during your shift.
Suggested encounters: Receiving patch phone requests, consultations from urgent care physician, family doctors or other phy-
sicians.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Introduces self in a polite manner with all pertinent identifiers (Name, Rank, BHP #)
Introduce self in a receptive, collegial manner and offer assistance

Gathers all the relevant information

Gather ALL information in a way that paints a clear picture of the patient/problem
(e.g. Crew Number, Referring Doctor’s name, Location)

Identifies expectations of colleague

Facilitates problem solving & establishes shared plan

a) Facilitate problem solving
b) Identify opportunities for management / mismanagement

Clarifies information
a) Clarify information
b) Acknowledge message received

Provides advice (or orders to paramedics) or education without condescension (as needed)

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

• Contact is unprofessional • Built adequate rapport • Clearly identifies self in a

• Information is incomplete • Solicited minimum receptive manner
• Information is gathered in a information required • Gathers information that
disorganized fashion • Provides answers when clearly paints a picture of the
• Interaction is not collaborative asked patient and problem
• No clarification sought • Expectations of • Identifies expectations
• No closed loop consultation or call not • Uses a collaborative approach
communication clearly elicited to problem solving
• Advice given in an • Displays closed loop
unprofessional manner (terse, communication
hierarchical, one-sided, • Provides advice in a
inattentive) professional manner
• Requires help from attending

CL3.1 The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to
ensure another faculty member can quickly understand your rationale for the above score. (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.

References
Kessler, C. S., Chan, T., Loeb, J. M., & Malka, S. T. (2013). I’m clear, you’re clear, we’re all clear: Improving consultation communication skills in
undergraduate medical education. Academic Medicine, 88(6), 753-758.

Apker, J., Mallak, LA & Gibson, SC (2007). Communicating in the “grey zone”: percpeptions about emergency physician hospitalist
handoffs and patient safety. Academic Emergency Medicine, 14(10). 884-89 21
 RESIDENT: ______________ Name of Assessor: _________________ Date:_________

CM 3.2 | Breaking Bad News

Instructions to Attending:
Focus is on observing the trainee breaking bad news to a patient/family [Bad News is defined
as “any information that adversely and seriously affects an individual [and] their future”
Ideally, 1 entire encounter should be observed.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Prepared for session [private, uninterrupted, all parties present]

Made connection [sitting position, eye contact, appropriate touch, used names]

Provided information using plain language.

Addressed emotional needs/provided comfort [verbally, non-verbally]

Invited questions [e.g. allowed enough time]

Provided next steps [e.g. viewing, organ donation]

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

• Used medical language exclusively • Did not refer to patient (or
family members) by name
• Inappropriate setting (e.g. non-private)
• Used some medical jargon
• Poor explanation of situation
• Appeared uncomfortable or
distracted
• Did not address emotional needs
• Unable to answer all questions
• Did not invite questions
• Prepared for interview (reflects on delivery
and personal emotional state)
• Used patient (or family member) names
seamlessly
• Uses plain language
• Quiet private setting with all important
and desired parties presented
• seated, attempted to make a connection
• Appeared comfortable
• Comforted patient or family
• Answered questions with ease
• Provided next steps

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure
another faculty member can quickly understand your rationale for the above score. Add enough details to ensure another faculty member can
quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give one specific suggestion
(Education Prescription) for the resident to attempt during his/her next shift.

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.

References
Back et al 2007 Breaking Bad News
Baile et al 2000 SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer [PMID: 10964998]
Benenson et al 2003 Evaluation of Emergency Medicine Resident Death Notification Skills by Direct Observation
Sobczak 2013 The procedure for death notification — ”In Person, In Time…” Ann Int Ther [PMID: 24407903]

22
 RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P3.5 | Critical Incident Debriefing

Instructions to Attending:
Focus is on observing the trainee debriefing after a critical incident [defined as as a case that has the
potential to cause significant psychologic distress [e.g. major trauma, unsuccessful resuscitation] 

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Prepared for session [private, uninterrupted, all appropriate parties present]

Described Facts of the case

Solicited thoughts from team members

Encouraged expression of team-members reactions to incident

Identified symptoms of stress

Educates regarding symptoms of emotional trauma

Answers Questions and provides guidance as needed

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

7
1
2 3 4 5 6 Ready for
Needs assistance
Independent Practice

• Poor preparation • Somewhat prepared for session • Prepared for session

• Did not invite sharing • Explains rationale for Critical • Explained rationale for Critical
• Inattentive to emotions Incident Stress Debriefing Incident Stress Debriefing
• Did not provide support • Does not achieve full buy-in from • Able to achieve buy-in from
group group
• Shares some information • Shares Information
• Does not share own reflections • Shares own reflections
• Solicits thoughts and feelings, but • Solicited thoughts feelings and
is unsure of how to handle this reactions
beyond identifying problems • Identified symptoms of stress
• Mechanistically completes all • Provided support and guidance
components, but does not follow
through on support and/or
guidance

P3.5 The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure
another faculty member can quickly understand your rationale for the above score. (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.

Reference: Everly, G. S., & Boyle, S. H. (1999). Critical incident stress debriefing (CISD): A meta-analysis. International Journal of
Emergency Mental Health, 3, 165–168. PMID 23586171

23
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P3.1a | Providing handover (SBAR)

Handover: Communication with a fellow Emergency Physician
Handover between physicians occurs in various forms within the Emergency department. Some handovers occur at
shift-change between emergency physicians and some occur at transitions of care between medical specialists. Today
you will be assessed in your handover of a patient to a physician-colleague.

For the purposes of the handover to the EP, the resident should prepare one patient near the end of the shift to discuss as
a handover to the incoming attending. If the timing is not optimal, this may be a simulated handover of a patient to the
supervising attending physician (e.g. resident “hands-over” the a patient at the end of their shift to their attending prior to
going home.)

Suggested reference: http://safersignout.com/what-makes-a-safer-sign-out/

DONE BUT NEEDS N/A FOR

IF THE RESIDENT IS GIVING HANDOVER DONE
ATTENTION
NOT DONE
CASE

S Situation – explains the situation requiring handover.

B Background – succinctly summarizes the relevant findings and labs gathered to date.

A Assessment – provides a synthesis (e.g. summary, hypothesis)

R Recommendation(s) – provides a plan for the in-coming team regarding patient care or further
decision making.
(e.g. “If the CT is negative, then the plan is…”)

Notes handover on chart and completes adjunctive paperwork (e.g. out-patient referrals, Rx, patient
instructions)

Explains handover process to patients and explains which doctor is assuming care

Raises alert for any situations that may warrant attention (i.e. patient who may pass away)

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
7
1
2 3 4 5 6 Ready for
Needs assistance
Independent Practice

Any of the following:
• 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
• Does not discuss plan with the
patient.
• Courteous and collegial
• Inefficient with time.
Colleague’s questions were
answered.
• Eventually, arrived at a plan
that was amenable to all
parties.
• Does not discuss plan with
the patient.
• Hands over own patients well.
• Courteous and collegial
• Concise & Time Efficient.
• Built a good rapport.
• Answered questions from colleague
receiving handover.
• Arrived at a plan that was amenable
to all parties easily.
• May or may not discuss plan with
the patient.
• Courteous and collegial
• Is able to give an overview of the entire
department
• Able to answer questions about the plans for
both his/her own patients, but also those of
learners
• Role models to learners the handover
process.
• Anticipates and answers all questions from
• Prepares all adjunctive materials to facilitate
the care of the patient beyond his/her time
• Attuned to potential cognitive errors
[Croskerry]
• Discusses handover with the patient.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to
ensure another faculty member can quickly understand your rationale for the above score. (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.

24
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P3.1b | Receiving handover

Handover: Communication with a fellow Emergency Physician
Handover between physicians occurs in various forms within the Emergency department. Some handovers occur at
shift-change between emergency physicians and some occur at transitions of care between medical specialists. Today
you will be assessed in your handover of a patient to a physician-colleague.

The senior resident should participate in RECEIVING handover from colleagues. The optimal shift for this will be the be-
ginning of a morning shift.

Suggested Resource: http://safersignout.com/what-makes-a-safer-sign-out/

DONE BUT NEEDS

IF THE RESIDENT IS RECEIVING HANDOVER DONE
ATTENTION
NOT DONE N/A FOR CASE

Displays closed loop communication - confirming outstanding tasks; acknowledging

urgency.
Shows mutual respect and actively cooperates

Clarifies his/her role to fulfill plan set forth

Asks relevant and pertinent questions required to complete the patient care tasks

Introduces self to patient - confirming the anticipated plan and next steps (e.g.
anticipated wait for bloodwork, ultrasound etc..)
Charting - Makes formal note on chart about receiving handover

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
1 7
2 3 4 5 6
Needs assistance Ready for Independent Practice

Any of the following:
• Unprofessional
• Confusing to Consultant
Colleague
• Was unwilling to compromise
• Conflict arose and escalated
• Does not discuss plan with
the patient.
• Courteous and collegial
• Inefficient with time.
Colleague’s questions were
answered.
• Eventually, arrived at a plan
that was amenable to all
parties.
• Does not discuss plan with the
patient.
• Courteous and collegial
• Concise & Time Efficient.
• Built a good rapport with
colleague.
• Asked relevant questions from
colleague providing handover.
• Arrived at a plan that was
amenable to all parties easily.
• Participates in discussion, but may
seem terse or awkward when
providing suggestions
• Discusses plan with the patient.
• Courteous and collegial
• Asked relevant questions from
colleague providing handover.
• Fulfills all adjunctive tasks required by
colleague that is leaving
• Attuned to potential cognitive errors
[croskerry]
• Participates in discussions when
warranted; providing suggestions
without condescension.
• Discusses plan with the patient.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty member
can quickly understand your rationale for the above score. (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.

25
 RESIDENT: ______________ Name of Assessor: _________________ Date:_________

CL3.3 | Advanced Consultation Request or Out patient Referral

Focus is on observing the senior resident request a consultation or referral in a situation where you anticipate
there to be problems. Examples will be direct discussions with attendings from other services (e.g. plastic sur-
gery outpatient referrals) or in cases where the patient is unstable or critical (e.g. stroke or STEMI an the Urgent
Care)

DONE BUT NEEDS

DONE NOT DONE N/A FOR CASE
ATTENTION

P Preparation - is prepared to provide consult

I Identifies all parties - patient, him/herself, consultant

Q Questions - Clear Clinical Question; Also is prepared to answer questions to facilitate seamless transition of
care (e.g. choice of anti-platelet therapy)

U Urgency - explains urgency to the consultant

E Educational modifications - makes necessary educational modifications, taking into account the level of
training of consulting resident when appropriate

D Debriefing & discussion (if possible): Dngages in a debriefing or discussion with the consultant to learn more
about the case

Notes consultation on chart and completes adjunctive paperwork (e.g. out-patient referrals, Rx, patient instructions)

Makes administrative arrangements (e.g. arranging ambulance) to facilitate care

Explains the consultation process and plan to the patient.

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance
Resident displayed any of the below: Resident’s actions are described by most of the Resident displays all of the below:
• Unprofessional below: • Courteous and Collegial
• Confusing to Consultant Colleague • Courteous and Collegial • Clear and concise
• Did not convey relevant and/or crucial information • Colleague’s questions were answered. • Built a good rapport.
(i.e. urgency, important management) • Eventually, arrived at a plan that was • Answered questions from consulted colleague.
• Was unwilling to compromise amenable to all parties.
• Arrived at a plan that was amenable to all parties
• Conflict arose and escalated easily.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

Reference: Chan, T., Orlich, D., Kulasegaram, K., & Sherbino, J. (2013). Understanding communication between emergency and consulting physicians: a
qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learner.
CJEM, 15(1), 42-51. PMID: 23283122
26
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
CM 3.1 | Advanced Chart Audit
Today’s focus is on charting.
The attending physician should select TWO charts to audit (OPTIMALLY, ONE SHOULD BE ON A CRITICALLY ILL PA-
TIENT). Should take 5-6 minutes to complete. Please select ONE chart where the resident primarily assessed the patient
by him/herself (e.g. sicker patient); and then one where he/she was reviewing with a junior learner. BOTH charts should
contain all relevant points below.

HINT: If a patient is about to be taken to ICU, either the resident or attending should attempt to photocopy this chart for
the purposes of the chart audit. PLEASE ENSURE ANY COPIES ARE DISPOSED OF AFTER THE AUDIT.

CHART 1 CHART 2

CHECKLIST
DONE BUT NEEDS NOT DONE BUT NEEDS
DONE DONE NOT DONE
ATTENTION DONE ATTENTION

Completes all basic identifiers (Self, Attending, Date, Times)

Information relevant
How wellto did
CC and
theHPI recordedperform
resident this task?
Physical Examination - relevant systems

Physical Examination - documents specific elements; avoids broad sweeping

generalizations

Relevant Investigations (e.g. ECG, relevant labs, Imaging indicated)

Documents procedures e.g. type of closure, suture type, anesthetic - type and dose

Reassessments documented (including time); changes noted

Disposition plan documented (e.g. Consultation time/discussion; Discharge

Instructions - relevant and appropriate; Rx or continuation orders as appropriate,
Documents discharge counselling and advice)

Completion of Ancillary Paperwork (Rx, referral forms, etc..)

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 2 3 4 5 6 7
Needs Assistance Requires significant charting by Requires minimal charting by Ready for Independent Practice
Requires extensive charting by attending to rectify charting. attending to clarify charting. Attending documents no additional
attending to compensate for or further information that is not
missing items. already contained in the chart.

Resident’s chart is described
by ANY of the below:
• Charting is incomplete and
missing key items (noted
above).
• Chart fails to provide a
synthesis of the resident’s
decision-making and
thinking process.
• Inefficient/verbose, illegible
or incoherent
documentation.
• Charting fails to provide a
thorough narrative of the patient-
doctor encounter in the ED but
still incorporates all important
elements.
• Chart fails to provide a synthesis
of the resident’s decision-making
& thinking process.
• Hard to read.
• Charting provides a
complete narrative of the
patient-doctor encounter
in the ED.
• Confusing, but still is able
to convey the overall
thinking process to
external reader.
• Efficient, legible
documentation.
Resident’s chart is described by
ALL of the below:
• 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.
• Efficient, legible documentation.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

27
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

CL3.2 | Communication with Nursing or other Health Professionals

Today’s focus will be communication between the Senior Resident and Nursing or Allied Healthcare
Professionals
The attending physician should make observations or ask for input based on multiple encounters with
nurses, RTs etc. during the shift. You may also choose to simply ask certain members of the nursing or al-
lied health teams for their input. Try to watch them work as they interact with the nurses (e.g. Charge
Nurse) to facilitate flow or management of patients (e.g. making arrangements to see multiple patients in a
specific area at once, locating a patient to a monitored bed for sedation, or arranging things for an intuba-
tion).

RATE THIS TASK | CIRCLE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
Needs Assistance Ready for
2 3 4 5 6 Independent Practice

Resident displays any of the below:
• Disruptive
• Confusing to healthcare professional
• Was unwilling to compromise
• Conflict arose and escalated
• terse, hierarchical and one-sided
Resident displays some of the below: Resident displays ALL of the below:
• Professional • Professional
• Inefficient with time. • Time Efficient
• Healthcare professional’s questions were • Answered questions from allied health care member;
incompletely answered. acting as a resource when called up
• Arrived at a plan that required flexibility from • Provides clarification or education if knowledge gap
healthcare professional identified by either party
• Arrived at a plan that was easily amenable to all
parties.

Comments/Suggestions from Allied Health & Nursing Colleagues (optional):

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

28
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P2.2 | End of Life & Advanced care planning

Today’s focus is establishing Goals of Care (a.k.a. End of Life Care and Advanced Care Plans). (P2.2)
The attending should listen to (or observe) the resident’s discussion of this topic with the patient.

The patient may or may not be in extremis. If the patient is not competent or unstable, the resident should arrange to
discuss these matters with the appropriate substitute decision maker. The patient may be a stable patient who is be-
ing admitted to an in-patient service.

The patient does not need to be in a confirmed palliative state.

**NOTE**: If the situation warrants an expedited timeline (e.g. impending urgent airway intervention), please select N/

DONE BUT NEEDS NOT N/A FOR

CHECKLIST DONE
ATTENTION DONE CASE

Awareness and Preparation

Ensures the pertinent participants in the discussion (i.e. relevant substitute decision makers;
patient; family)

Prepares participants for discussion; forecasts the topic; describes the goal of the talk, asks
permission **MAY NOT BE RELEVANT IN EMERGENT CASE**

Establishes the best possible environment - Select the right setting; Sits down if able; Provides
appropriate privacy within available resources. **MAY NOT BE RELEVANT IN EMERGENT
CASE**

Content & Discussion

Ensures that patient or SDM understands options for care

Elicits specific goals of care sufficient to complete the Pertinent Documentation

Language & Listening

Avoids or defines Jargon

Use Reflective Listening to summarize the goal(s).

**MAY NOT BE RELEVANT IN EMERGENT CASE**

Documents the encounter appropriately (e.g. completes relevant forms or charting)

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

• Seems rushed or uncomfortable
• Poorly prepared for the
discussion.
• Required attending physician to
halt or redirect conversation.
• Builds appropriate rapport and
demonstrates
• 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.
• Builds appropriate rapport and
demonstrates
• Provides all options, and
requires little clarification for
participants to understand plan.
• Minor role of attending
physician clarify/affirm the plan
for implementation.
• Puts participants at ease.
• No requirement for attending
physician to participate.
• 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 of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (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.

29
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

TASK | Feedback & Coaching

Today’s focus is to provide specific feedback to a junior learner.
During this shift, the Senior Resident should be MENTORING A JUNIOR LEARNER. At the end of the shift, the resi-
dent should provide focused and specific feedback to the junior. (Alternatively, if no junior learner is around the attend-
ing may role play a particular junior over the course of the shift and ‘review’ cases with the senior resident).

Level of the Junior Learner (Circle one):

Clinical Clerk Year 2 Clinical Clerk Year 3 PGY1 PGY2

RESIDENT: Record the Area of Improvement Discussed (i.e. topic of specific feedback).

RESIDENT: Record the feedback or coaching given.

Was this problem identified by the Senior Resident? YES NO

(Attending suggested it)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for Independent Practice
Needs assistance

Any of the following:  
• Provides confusing or
contradictory feedback
• Identifies a vague, non-
specific problem with no
suggested solution
• Provides feedback in a
derogatory or shame-based
manner
• Violates the privacy of the
junior learner (i.e. pries too
much into their personal life;
discusses feedback in front
of other learners)
• Identifies vague problem
• Provides vague, non-
specific one-way feedback
(e.g. only suggests
solutions, not interested in
what junior feels/observes)
• Awkwardly and/or
paternalistically addresses
junior
• Discusses feedback in
front of other learners
• Identifies specific problem  
• Provides at least one specific
feedback pieces of feedback
that the learner can act upon
• Does not involve junior
learner in developing a plan
for change
• Creates proper environment
for giving feedback
• Identifies specific problem in
concert with the junior learner
• Empathetically listens to Junior’s
perspective on the problem
(encourages reflective practice)
• Invites the junior learner to co-
develop a plan for change
• Seems comfortable in the
situation, and also puts the junior
at ease
• Respects the privacy of the junior
learner (e.g. finds a private place to
discuss; attending excepted)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

30
RESIDENT ______________ Name of Assessor_________________ Date:_________
ME3.1 | Team Leader Feedback
Today’s focus is Leading a Team.
Perform the role of Team Leader for a critically ill / injured patient and receive some preceptored multi-source feedback from
staff physicians, residents, nurses, and other allied team.

Note: Staff physician will need to gather feedback about the resident’s performance from other team members. This is ideally
accomplished immediately after a resuscitation. The staff physician can record the feedback numerically or by check boxes
directly into the checklist below.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Clearly Defines / Identifies self as TEAM LEADER

COMMUNICATION - Plans and priorities clearly communicated; Tasks and orders easily understood
with clear direction

Either of the following (1 or 2)

1) Manages suggestions, conflict / disagreement during resuscitation

2) Actively solicits suggestions from the team proactively

Ensures examination and assessment are clearly communicated to scribe/recorder & the rest of the
team

Utilizes team appropriately (tailoring to level and type of expertise)

Maintains overall perspective (e.g. situational awareness) and avoids fixation error or diagnostic
momentum (esp. if patient deteriorates)

Addresses any barriers to implementation of plan

Considers patient-centred or family-centred factors (comfort, respect, wishes)

Number of Team Members Present (other than attending): ______________

FEEDBACK FROM TEAM (Record at least one piece of feedback; may be GOOD or CONSTRUCTIVE)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance
Resident displays any of the   Resident displays any of the following or Resident displays any of the following   Resident displays any of the following or
following or similar behaviours: similar behaviours: or similar behaviours: similar behaviours:
• Several (>3) of the checklist items
were not done • Several (>3) of the checklist items • Most items were done; few (i.e. < 3 • Almost all items in checklist
need attention items) needed attention completed
• Resident did not have the
confidence of the staff members • Staff members were uncomfortable • Staff members seemed comfortable • Resident had complete control of the
during the resuscitation during the resuscitation (e.g. actively during the resuscitation (e.g. only room throughout the resuscitation
disagreed with management, and SOMETIMES looked to the
• Staff physician is compelled to sought attending’s opinion before attending for affirmation) • The attending did not need to be
take over the resuscitation proceeding) present

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

31
 SENIOR MODULES 

TEACHING AND SCHOLARSHIP
Authors: Editors:

Massoud Jalayer Teresa Chan

Margaret Ackerman Jonathan Sherbino

ASSESSMENT INDEX

4
Supervising Procedures (LEARNER CARD) Feedback & Coaching

Impromptu Didactic Teaching Session (LEARNER CARD) Team Leader Feedback

Clinical Supervision (LEARNER CARD) Point of Care Research (Own Question)

Role Modelling Knowledge Translation Role Modeling Health Promotion

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

ME3.2 | Supervising Procedures

Instructions to Attending: The focus is on observing the senior resident supervise a junior learner on any procedure. The at-
tending should attempt to observe as much as possible (i.e. a few spot checks), and may gather collateral information from the
junior learner, nurses or allied health (e.g. nurse doing safety checklist, sharps safety). THE SENIOR SHOULD BE VERY COM-
FORTABLE WITH THE PROCEDURE IN QUESTION. Information should be gathered from the learner as well (see next page
for learner feedback card).


Suggested encounters: Suturing, Reductions, Casting, Central line insertion

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Prepares Learner - Determines if procedure is appropriate for learner; Orients, explains or reviews
procedure or key aspects of the approach to the LEARNER (including indications, risks, benefits,
complications)
Role Models or Ensures use of PPE - Uses and/or facilitates the use proper personal protective
equipment by all parties (e.g. safe practices by learner)
Ensures Safe Practices & Proper Procedural Technique - Watches for proper use of procedural
equipment; Ensures DISPOSAL of sharps; Uses SAFETY CHECKLIST if appropriate (e.g. central line
checklist)
Identifies when (and if) to step in / take over procedure from junior - Watches for difficulty,
complications, and/or impending problems and asks junior to step aside safely.

Ensures appropriate Aftercare instructions (including handouts) are provided to patient May delegate
this task to the junior, but MUST REVIEW with junior and be available to make clarifications

Debriefs & Provides Feedback after procedure - Provides constructive feedback (including suggestions
for ‘next steps’) and reviews any difficulties or suggestions after procedure

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
Needs assistance 2 3 4 5 6 Independent Practice
Displays any of the following: • Does not clarify procedure nor • Prepares learner adequately • Prepares learner adequately
prepare junior learner (i.e. sets up (e.g. describes general • Stops junior resident if safety breach
• Puts patient at risk junior to fail) approach to the learner) occurs or is about to occur
• Observes learner completely • Proper attention to safety of patient,
• Does not allow Junior to attempt any • Does the bulk of the procedure (not • Needs a few reminders to let the learners, and self.
part of the procedure allowing junior to participate) junior attempt procedure
• Consistently accurate, proper Either:
• Fails to explain any aspect of the • Incompletely describes the attention to safety. 1) Explains if and why they need to
procedure to learner procedure to observing learner • Attempts to safely prompt or “take over” during the procedure &
assist junior during procedure then seemlessly explains while
• Awkward when supervising the (e.g. doesn’t just take over) performing the task. or
procedure • May or may not conduct debrief 2) Facilitates successful procedure.
of procedure with learner.
• Conducts debrief and reaffirms key
take home points with learner after
procedure.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

33
ME3.2 | Supervising Procedures - LEARNER FEEDBACK FORM
Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete it.
They do not need to actually provide a score. Please record any feedback from this sheet into the online form as you
see fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The resident reviewed the indications and contraindications of this

procedure to me.
The resident involved me in gathering materials, and I feel I could do this
next time for a similar procedure.
The resident was a good role model for me in terms of preparation, personal
protection, and precautions to maximize patient/staff safety (e.g. wore PPE,
put away sharps, did not expose me to bodily fluids)

The resident was able to explain all steps of the procedure to me (this can
be done before, during, or after the procedure)
The resident involved me or taught me about the documentation and orders
around this procedure.
The best thing the resident did while teaching me this procedure was…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

Please return this to the FACULTY MEMBER who was observing this procedure. The junior is NOT expected to
rate the SENIOR RESIDENT.

34
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

ME3.3 | Impromptu Didactic Teaching Session

Instructions to Attending:
This task is ideal when there is a junior learner on with a senior resident AND THERE IS A ‘SLOW’
PERIOD. During this period, the senior resident should BE PREPARED to teach the junior resident
around a topic (e.g. we have given them fair warning that they should be prepared for this on over-
night shifts and morning shifts). The attending should observe this session, and ask the juniors for
feedback as necessary (see next page for learner feedback card).

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

The Senior Resident discussed ONE KEY POINT, providing evidence where
appropriate and relevant.
The Senior Resident diagnosed the learner(s)’s knowledge of the topic
The Senior Resident organized the topic within the junior learner’s experience
(e.g. connected the topic to prior knowledge)
The Senior Resident used visual aids (e.g. ECGs, Imaging) as appropriate
The Senior Resident invited questions from the Learner
The Senior Resident provided next steps to the Learner (e.g. suggested further
reading, etc..)

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

• Was not prepared to teach
• Did not choose an appropriate
topic (i.e. too big to address; too
simple for learner)
• Did not create a supportive
environment (e.g. intimidating or
frustrating)
• Senior resident was inaccurate in
their teaching requiring the
attending to correct facts.
• Prepared to teach • Diagnosed learner to tailor teaching
• Attempted to customize lesson for (e.g. level, specialty of interest,
Learner(s), but delivery rigid / canned previous rotations)
• Learner(s) not engaged by the senior • Tailored and customized topic for
resident (e.g. Appeared learner
uncomfortable or distracted) • Engaged learner(s) and placed them at
• Knew personal knowledge limits and ease
admitted them; • Knew personal knowledge limits and
• when faced with a difficult question admitted them; role-modelled how to
turned to attending for help perform point-of-care research to find
answer independently.
• Appropriately ends teaching session
and resumes clinical care as • Appropriately ends teaching session
warranted. and resumes clinical care as warranted;
returns to the topic if possible (or
provides follow-up information via
email or handouts)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based
on the above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

35
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

ME3.3 | Impromptu Didactic Session - LEARNER FEEDBACK FORM

Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete
it. They do not need to actually provide a score. Please record any feedback from this sheet into the online form as
you see fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The Senior Resident discussed at least ONE EDUCATIONAL POINT around

a topic of interest, providing evidence where appropriate and relevant.

The Senior Resident assessed my experience with the topic and/or asked
me what I wanted to learn

The Senior Resident organized the topic within the junior learner’s
experience (e.g. connected the topic to prior knowledge)

The Senior Resident used visual aids (e.g. ECGs, Imaging) or drawings to
facilitate my learning.

The Senior Resident invited questions from me

The best thing the resident did while teaching me…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

36
RESIDENT ______________ Name of Assessor_________________ Date:_________

A3.1 | Role Modelling Health Promotion (Pointing out the ‘Teachable Moment’)
Today’s task is to identify opportunities for advocacy and health promotion WITH PATIENTS for whom
they provide care AND TO ROLE MODEL THIS TO JUNIOR LEARNERS (IF LEARNERS ARE INVOLVED)

The resident should identify at least one patient in whom they intend to discuss ONE health promotion measure you could introduce with the pa-
tient at the time of disposition (e.g. discharge, admission).

The resident should ask the attending physician to observe them counseling the patient about health promotion measures.

Rationale: There is literature to suggest that the ED may be a possible venue for initiating change (e.g. 'teachable moment'):
1) Smoking cessation: http://www.ncbi.nlm.nih.gov/pubmed/19543095
2) Smoking counselling in pts with Acute Respiratory Illness: http://www.ncbi.nlm.nih.gov/pubmed/11162344
3) Half-life of EtOH counselling: http://www.ncbi.nlm.nih.gov/pubmed/15664722
4) McBride et al., 2003 - Heuristic model for Teachable Moments: http://her.oxfordjournals.org/content/18/2/156.full.pdf+html

A3.1 | RESIDENT: Teaching Worksheet (Based on McBride et al. 2003 - Heuristic model for Teachable Moments)

1. Identify an event or situation that may be a teachable moment. (Cueing Event)

2. Identify the patient’s emotions/affect. How did/can you align your discussions to their state?

3. How can you reframe their self-concept (or social role) so as to encourage change? (e.g. “You are not just
the average smoker, you are now a parent of a child with asthma...”)

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6 Independent Practice
Needs assistance

• Unable to identify a teachable moment
for health promotion.
• Awkwardly discussed the issue with the
patient
• Is unable to arrive at a plan for
actionable change
• Does not appreciate/align their
discussion with the emotional state of
the patient
• Identified a common issue for health
promotion
• Was somewhat able to align his/her
patient educaiton to the patient’s
perspective
• Established a general (but non-
specific) plan for continued action by
the patient or family member
• Identified an important, interesting or less-
obvious health promotion problem (e.g.
family planning)
• Explained the clinical significance of the
health promotion moment to LEARNER (or
to the attending, who would substitute for a
learner)
• Establish an achievable plan of action that
the patient or family member feels is
immediately accomplishable

A3.1 The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above
evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

37
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
ME3.4 | Clinical Supervision
Instructions to Attending:
Identify this task at the beginning of the shift. The senior resident should be assigned at least one junior learner. See below for the targets for each
level of learner.
The senior resident should supervise one or more junior learner for part of today’s shift. They should act as ‘junior attending’ and review, chart, and
assume responsibility for teaching around the cases presented by the junior learner. The attending should observe these interactions, and NEAR THE
END OF THE SHIFT ask the junior resident for feedback (see Learner Feedback form on the next page)

How many learners did the senior resident supervise today? ________________(# of learners)
What level(s) were they (check all that apply): Clerk _____ R1_____ R2 ______

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

The senior resident provided the learner orientation and/or debriefing for most cases.
The senior resident NEVER left the junior unsupervised in an unsafe situation
The senior resident provided learner adequate independence to develop clinical decision making
appropriate to the learner’s level of training
The senior resident provided learner with SPECIFIC and USEFUL feedback throughout the shift
(i.e. during and between cases; hints to reassess patients)
The senior resident was mindful of patient care / flow regardless of the junior learner’s progress
(i.e. arranged to reassess patients WITH junior ASAP)
The senior resident completed a direct observation (e.g. McMAP) and/or filled out the end of
shift evaluation form
The senior resident asks questions to facilitate learning (e.g. relevant quizzing, coaching a
differential diagnosis, asking for CXR interpretation)
The senior resident answers questions and provides guidance
Completes relevant charting (or over-charting) to indicate they reviewed the case and saw the
patient, as well as any thinking processes that differed from the junior learner(s)’ (e.g. “I did not
think this patient was having aortic dissection for the following reasons…”)

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY

1 7
2 3 4 5 6
Needs assistance Ready for the next level

• Was not prepared to teach
• Did not attempt to customize learning
needs to junior
• Did not create a supportive
environment (e.g. intimidating or
frustrating)
• Directed learner exclusively to do
‘grunt work’, but did not facilitate
learner or emphasize teaching
• Senior resident was inaccurate in their
teaching requiring attending to correct
facts.
• Attempted to customize lesson for Learner(s) as
appropriate
• Learner(s) did not seem/feel engaged by the
senior resident (e.g. Appeared uncomfortable or
distracted)
• Knew own knowledge limits and admitted
them; but when senior resident was unable to
answer questions, and turned to attending for
help.
• Teaches appropriate amounts considering the
work-flow of the Emergency Department and
other patient care needs (i.e. does not teach an
entire lecture when there are 30 patients to be
seen)
• Assessed learner (level, specialty of interest,
previous rotations)
• Very prepared to teach around cases (e.g. one
learning point per patient)
• identifying specific cases for specific learners
• Engaged learner(s) and placed them at ease
• Knew own knowledge limits and admitted
them; role-modelled how to perform point-of-
care research to find answer independently.
• Provides appropriate amounts of teaching and
resumes clinical care as warranted
(considering work-flow of ED, patient care, and
learner’s needs)
• provides follow-up information via email or
handouts

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. If there was any feedback from the learner,
please transcribe below.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above
evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

38
ME3.4 | Clinical Supervision - LEARNER FEEDBACK FORM
Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete it.
They do not need to actually provide a score. Please record any feedback from this sheet into the online form as you see
fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The Senior Resident discussed at least ONE EDUCATIONAL POINT around

MOST CASES, providing evidence where appropriate and relevant.
The senior resident NEVER left the me unsupervised in an unsafe situation
(i.e. I always felt supported)
The senior resident provided me adequate independence to develop clinical
decision making appropriate to the learner’s level of training (i.e. provided me
with time or hints so I could make decisions, instead of just TELLING me
what to do)
The senior resident provided learner with SPECIFIC and USEFUL feedback
throughout the shift (i.e. during and between cases; hints to reassess
patients)
The senior resident used questions (in a non-threatening way) to prompt me
to think. His/Her questions helped guide me to answers and facilitated my
learning.
The Senior Resident invited questions FROM me

The best thing the resident did while teaching me…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

39
ME3.4 | Clinical Supervision - LEARNER FEEDBACK FORM
Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete
it. They do not need to actually provide a score. Please record any feedback from this sheet into the online form as
you see fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The Senior Resident discussed at least ONE EDUCATIONAL POINT around

MOST CASES, providing evidence where appropriate and relevant.
The senior resident NEVER left the me unsupervised in an unsafe situation
(i.e. I always felt supported)
The senior resident provided me adequate independence to develop
clinical decision making appropriate to the learner’s level of training (i.e.
provided me with time or hints so I could make decisions, instead of just
TELLING me what to do)

The senior resident provided learner with SPECIFIC and USEFUL feedback
throughout the shift (i.e. during and between cases; hints to reassess
patients)
The senior resident used questions (in a non-threatening way) to prompt
me to think. His/Her questions helped guide me to answers and facilitated
my learning.
The Senior Resident invited questions FROM me

The best thing the resident did while teaching me…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

40
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

S3.2 | Role Modeling Knowledge Translation

Notes to the Attending:
The senior resident is to use point-of-care research to facilitate the learning of a junior learner. This may be a simple review of a
clinical decision rule (e.g. Ottawa Ankle Rules), or something more complex (e.g. finding a paper on sepsis resuscitation). THE
ATTENDING does not NEED to view the entire teaching encounter, but may ask both the junior learner and/or senior resident to
recount the teaching.

DONE BUT NEEDS N/A FOR

DONE NOT DONE
ATTENTION CASE

POINT OF CARE RESEARCH

Either (Circle one of the following, whichever applies):

1) Facilitates the usage of point-of-care resources by junior learner

or

2) Role models effective utilization of tools available AND EXPLAINS TO JUNIOR LEARNER while doing
so
(e.g. Library database, Google Scholar, PubMed, EMBASE, Cochrane Review, etc..)

Explains limitations of resources to the junior learner

Time Efficient (i.e. < 5 minutes) while doing this task

Provides at least one resource for further reading (i.e. prints or emails relevant paper for junior learner)

The senior resident taught the junior resident sufficiently that they were able to answer the attending’s
questions.

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
1 7
2 3 4 5 6
Needs assistance Ready for Independent Practice

• Was unprepared to teach
• Did not tailor learning to junior
learner’s needs
• Did not create a supportive
environment (e.g. intimidating or
frustrating)
• Directed learner exclusively to do
‘grunt work’, but did not facilitate
learner or emphasize teaching
• Senior resident was inaccurate in
their teaching requiring attending
to correct facts.
• Attempted to customize lesson for
Learner(s) as appropriate
• Identified learning need
• Learner(s) did not seem/feel engaged by
the senior resident (e.g. Appeared
uncomfortable or distracted)
• Senior resident knew his/her own
knowledge limits and admitted them; but
when unable to answer questions, simply
turned to attending for help.
• Teaches appropriate amounts considering
the work-flow of the Emergency
Department and other patient care needs
(i.e. does not teach an entire lecture when
inappropriate)
• Assessed learner (level, specialty of
interest, previous rotations)
• Identified the specific needs for specific
learners
• Engaged learner(s) and placed them at
ease
• Knew own knowledge limits and admitted
them; role-modelled how to perform point-
of-care research to find answer
independently.
• Provides appropriate amounts of teaching
and resumes clinical care as warranted
(considering work-flow of ED, patient care,
and learner’s needs)
• provides follow-up information via email or
handouts

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence,
please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

41
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

S3.3 | Point of Care Research (Own Question)

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
affects patient management. The resident SHOULD self-identify the question. (e.g. What is the evidence for dexametha-
sone in migraine headaches?)

The Clinical Question was:

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Effectively utilizes tools available

(library database, Google scholar, PubMed, EMBASE, Cochrane Review etc.)
Explains the limitations of the resources they are using.
Resident is time efficient on the internet to investigate this question

(i.e. < 5 min)
Resident was able to find an adequate answer to the question

The total time to complete the research task was: ______________

(Do not include discussion time

Was this question set by the resident? YES NO

(Attending suggested it)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance
Rate Displayed any of the   • Was able to useresources, • Finds resources in a   Displayed all of the following
S following behaviours: but took a long time.(i.e. > relatively efficient time period behaviours:
E 10 minutes) (i.e. <10 min).
A
R
• Unable to find resources in • Efficiently finds resources (i.e.
C
 a timely fashion. • Utilizes mostly secondary • Navigates internet databases < 5 minutes)
H sources (i.e. reviews of the or search engines awkwardly
• Exclusively utilizes and/or articles, or digests of to find primary sources. • Navigates internet databases
cites untrustworthy or articles) rather than or search engines effectively
incorrect sources. (i.e. articles themselves. to find primary sources.
random websites, etc..)
• Adjudicates quality of
sources (both primary &
secondary)

Rate • Displays poor insights into • Displays some insight into • Displays significant insight • Displays extensive insight
I own learning process. own learning process. into own learning process. into own learning process.
N
S
I
• Unable to identify area(s) for • Able to identify one area • Able to identify one key area • Able to identify and articulate
G further reading for further reading, but not for further learning. all area(s) for further reading.
H the most important area in
T
need of attention. • Unable to detail a clear plan
for further learning.
• Unable to make a sensible
plan for further learning.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above
evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

42
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

TASK | Feedback & Coaching

Today’s focus is to provide specific feedback to a junior learner.
During this shift, the Senior Resident should be MENTORING A JUNIOR LEARNER. At the end of the shift, the resi-
dent should provide focused and specific feedback to the junior. (Alternatively, if no junior learner is around the attend-
ing may role play a particular junior over the course of the shift and ‘review’ cases with the senior resident).

Level of the Junior Learner (Circle one):

Clinical Clerk Year 2 Clinical Clerk Year 3 PGY1 PGY2

RESIDENT: Record the Area of Improvement Discussed (i.e. topic of specific feedback).

RESIDENT: Record the feedback or coaching given.

Was this problem identified by the Senior Resident? YES NO

(Attending suggested it)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for Independent Practice
Needs assistance

Any of the following:  
• Provides confusing or
contradictory feedback
• Identifies a vague, non-
specific problem with no
suggested solution
• Provides feedback in a
derogatory or shame-based
manner
• Violates the privacy of the
junior learner (i.e. pries too
much into their personal life;
discusses feedback in front
of other learners)
• Identifies vague problem
• Provides vague, non-
specific one-way feedback
(e.g. only suggests
solutions, not interested in
what junior feels/observes)
• Awkwardly and/or
paternalistically addresses
junior
• Discusses feedback in
front of other learners
• Identifies specific problem  
• Provides at least one specific
feedback pieces of feedback
that the learner can act upon
• Does not involve junior
learner in developing a plan
for change
• Creates proper environment
for giving feedback
• Identifies specific problem in
concert with the junior learner
• Empathetically listens to Junior’s
perspective on the problem
(encourages reflective practice)
• Invites the junior learner to co-
develop a plan for change
• Seems comfortable in the
situation, and also puts the junior
at ease
• Respects the privacy of the junior
learner (e.g. finds a private place to
discuss; attending excepted)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

43
RESIDENT ______________ Name of Assessor_________________ Date:_________
ME3.1 | Team Leader Feedback
Today’s focus is Leading a Team.
Perform the role of Team Leader for a critically ill / injured patient and receive some preceptored multi-source feedback
from staff physicians, residents, nurses, and other allied team.

Note: Staff physician will need to gather feedback about the resident’s performance from other team members. This is ide-
ally accomplished immediately after a resuscitation. The staff physician can record the feedback numerically or by check
boxes directly into the checklist below.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Clearly Defines / Identifies self as TEAM LEADER

COMMUNICATION - Plans and priorities clearly communicated; Tasks and orders easily
understood with clear direction
Either of the following (1 or 2)
1) Manages suggestions, conflict / disagreement during resuscitation
2) Actively solicits suggestions from the team proactively
Ensures examination and assessment are clearly communicated to scribe/recorder & the rest
of the team
Utilizes team appropriately (tailoring to level and type of expertise)
Maintains overall perspective (e.g. situational awareness) and avoids fixation error or
diagnostic momentum (esp. if patient deteriorates)
Addresses any barriers to implementation of plan
Considers patient-centred or family-centred factors (comfort, respect, wishes)

Number of Team Members Present (other than attending): ______________

FEEDBACK FROM TEAM (Record at least one piece of feedback; may be GOOD or CONSTRUCTIVE)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance
Resident displays any of the   Resident displays any of the following or Resident displays any of the following   Resident displays any of the following or
following or similar behaviours: similar behaviours: or similar behaviours: similar behaviours:
• Several (>3) of the checklist items
were not done • Several (>3) of the checklist items • Most items were done; few (i.e. < 3 • Almost all items in checklist
need attention items) needed attention completed
• Resident did not have the
confidence of the staff members • Staff members were uncomfortable • Staff members seemed comfortable • Resident had complete control of the
during the resuscitation during the resuscitation (e.g. actively during the resuscitation (e.g. only room throughout the resuscitation
disagreed with management, and SOMETIMES looked to the
• Staff physician is compelled to sought attending’s opinion before attending for affirmation) • The attending did not need to be
take over the resuscitation proceeding) present

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (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.

44
 SENIOR MODULES 

QUALITY & DECISION MAKING
Authors: Editor:

Teresa Chan Jonathan Sherbino

Kris Hawley

ASSESSMENT INDEX

5
Performance Improvement - Senior Level Obtaining Consent

ED Flow - Senior Level Quality Assurance

Time Management - Senior Level Role Modeling Health Promotion

Patient Survey Patient Safety Leadership

RESIDENT: ______________ Name of Assessor: _________________ Date:_________

ME3.2 | Supervising Procedures

Instructions to Attending: The focus is on observing the senior resident supervise a junior learner on any procedure. The at-
tending should attempt to observe as much as possible (i.e. a few spot checks), and may gather collateral information from the
junior learner, nurses or allied health (e.g. nurse doing safety checklist, sharps safety). THE SENIOR SHOULD BE VERY COM-
FORTABLE WITH THE PROCEDURE IN QUESTION. Information should be gathered from the learner as well (see next page
for learner feedback card).


Suggested encounters: Suturing, Reductions, Casting, Central line insertion

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Prepares Learner - Determines if procedure is appropriate for learner; Orients, explains or reviews
procedure or key aspects of the approach to the LEARNER (including indications, risks, benefits,
complications)
Role Models or Ensures use of PPE - Uses and/or facilitates the use proper personal protective
equipment by all parties (e.g. safe practices by learner)
Ensures Safe Practices & Proper Procedural Technique - Watches for proper use of procedural
equipment; Ensures DISPOSAL of sharps; Uses SAFETY CHECKLIST if appropriate (e.g. central line
checklist)
Identifies when (and if) to step in / take over procedure from junior - Watches for difficulty,
complications, and/or impending problems and asks junior to step aside safely.

Ensures appropriate Aftercare instructions (including handouts) are provided to patient May delegate
this task to the junior, but MUST REVIEW with junior and be available to make clarifications

Debriefs & Provides Feedback after procedure - Provides constructive feedback (including suggestions
for ‘next steps’) and reviews any difficulties or suggestions after procedure

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
Needs assistance 2 3 4 5 6 Independent Practice
Displays any of the following: • Does not clarify procedure nor • Prepares learner adequately • Prepares learner adequately
prepare junior learner (i.e. sets up (e.g. describes general • Stops junior resident if safety breach
• Puts patient at risk junior to fail) approach to the learner) occurs or is about to occur
• Observes learner completely • Proper attention to safety of patient,
• Does not allow Junior to attempt any • Does the bulk of the procedure (not • Needs a few reminders to let the learners, and self.
part of the procedure allowing junior to participate) junior attempt procedure
• Consistently accurate, proper Either:
• Fails to explain any aspect of the • Incompletely describes the attention to safety. 1) Explains if and why they need to
procedure to learner procedure to observing learner • Attempts to safely prompt or “take over” during the procedure &
assist junior during procedure then seemlessly explains while
• Awkward when supervising the (e.g. doesn’t just take over) performing the task. or
procedure • May or may not conduct debrief 2) Facilitates successful procedure.
of procedure with learner.
• Conducts debrief and reaffirms key
take home points with learner after
procedure.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

46
ME3.2 | Supervising Procedures - LEARNER FEEDBACK FORM
Instructions to the Attending: Please give this page to the Learner who is being taught and ask them to complete it.
They do not need to actually provide a score. Please record any feedback from this sheet into the online form as you
see fit.

LEARNER REVIEW OF THE RESIDENT

DONE BUT NEEDS

TASK DONE
ATTENTION
NOT DONE N/A FOR CASE

The resident reviewed the indications and contraindications of this

procedure to me.
The resident involved me in gathering materials, and I feel I could do this
next time for a similar procedure.
The resident was a good role model for me in terms of preparation, personal
protection, and precautions to maximize patient/staff safety (e.g. wore PPE,
put away sharps, did not expose me to bodily fluids)

The resident was able to explain all steps of the procedure to me (this can
be done before, during, or after the procedure)
The resident involved me or taught me about the documentation and orders
around this procedure.
The best thing the resident did while teaching me this procedure was…

What is one change that the Senior Resident could make? (Your feedback is very valuable!)

Please return this to the FACULTY MEMBER who was observing this procedure. The junior is NOT expected to
rate the SENIOR RESIDENT.

47
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

L3.1 | Time Management

L3.1 | Today’s focus is Time Management. (M1.1)

A key skill for an an emergency physician is time management. The attending should observe how the resident:
- organizes his/herself to complete key tasks ASIDE from the initial patient encounter and decision making proc-
ess (i.e. the resident’s efficiency in completing tasks that need to be done once the a care decision has been
made - consults, paperwork, reassessments)
- prioritizes tasks to be done next

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Displays situational awareness regarding the entire department (e.g. how busy, how
many beds, etc..)

Aware of human resources (e.g. nurse staffing in areas; # of house-staff)

Takes into account differing learning needs of house-staff (e.g. medical student
needing more supervision than PGY2 resident)

Takes into account extenuating circumstances that may preclude optimal efficiency
(e.g. increased time to break bad news)

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
2 3 4 5 6
Needs assistance Ready for the next level

• Needs constant
reminders to reassess
patients.
• Inefficient with decision
making
• Returns to reassess
patients multiple times (>
3 times) before arriving at
a plan
• Fails to complete
necessary paperwork
• Needs a few reminders
about patients.
• Functions independently
regarding patient
assessments and
reassessments
• Orders appropriate tests,
reassess pts only 2-3
times before arriving at
diagnosis and disposition
plan.
• Appropriately documents
(including reassessments
and auxiliary forms) up to
medicolegal standards
• Is flow conscious with
his/her portfolio of
patients (assessments,
reassessments,
investigations).
• Efficiently sees multiple
patients, arriving at
diagnosis/disposition in
a time-efficient manner.
• Appropriately
documents efficiently,
up to medicolegal
standards
• Is flow conscious with ALL
patients in the entire
department (including those of
learners’)
• Proactive with helping juniors
to execute management and
disposition
• Appropriately documents
efficiently and
comprehensively, up to
medico -legal standards
*Please take extenuating
circumstances into account; list
below if applicable.

L3.1 | The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure
another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give one
specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

48
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P3.2 | Performance Improvement - Senior Level

P3.2 Today’s focus is on personal practice improvement (M1.2)
Continuous professional development is a lifelong skill. The area or topic for improvement can be from any of
the CanMEDS Roles, preferably NOT a rare task (e.g. thoracotomy).

By the end of this shift, the resident, with minimal preceptor guidance identifies a single area in which to im-
prove. It should be the area most in need of improvement based on recent performance (e.g. today’s shift). The
area and a brief plan for improvement is outlined in the following table:

Resident’s self-identified area for

improvement

Preceptor’s suggested area for

improvement (may be similar or
different)

Final plan for going forward

The basis of this assessment tool is to encourage reflective practice and steer senior 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.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for the next level
2 3 4 5 6
Needs assistance

• Unable to self-identify any Able to self-identify (with • Able to articulately identify

areas in need of minimal preceptor area MOST in need of
improvement assistance): improvement with no
• Unable to develop plans • area in need of assistance from preceptor
for improvement even with improvement • Able to independently
preceptor assistance • plan for future articulate plan for
improvement improvement with minimal or
no preceptor guidance.

P3.2 | The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure
another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give one
specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

49
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P3.4 | Obtaining Consent

Today’s focus is obtaining consent.
The attending physician should observe a consent discussion for an acute intervention/procedure with a patient
or their substitute decision maker (Examples of situations would include, but are not limited to, emergent proce-
dures thoracocentesis, paracentesis, lumbar puncture, central line, etc..)

DONE BUT NEEDS NOT

CHECKLIST DONE
ATTENTION DONE
N/A FOR CASE

1) Establishes that the patient or substitute decision maker (SDM) is competent.

2) Content & Discussion

-Establishes the best possible environment

Ensures Patient understands and appreciates the… The plan & option; Indications; Benefits, Risks, Alternatives

3) Language & Listening

-Avoids or defines jargon

-Utilizes Reflective Listening to summarize the discussion

-Listens and responds to questions or concerns.

•4) Properly documents consent discussion

•TOTAL

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
7
1 Ready for the next level
2 3 4 5 6
Needs assistance

• Unable to build rapport • Builds rapport with patient or • Puts patient or SDM at ease.
with patient or SDM SDM • No requirement for attending
• Provides all options, but • Provides all options, and physician to participate.
explanation is confusing requires little clarification for • Identifies the limits of the
• Requires attending participants to understand discussion if disagreement
physician to steer the plan. occurs (e.g. reaches a
course and guide • Minor role of attending conclusion or a neutral
decision making. physician to clarify/affirm the decision point that may be
plan for implementation. decided later)

P3.4 | The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence,
please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

50
RESIDENT: ______________ Name of Assessor: _________________ Date:_________
L3.3 | Quality Assurance
Today’s focus is quality assurance and/or disclosure of error.
Today, the senior resident should partake in an aspect of a quality assurance protocol (e.g. radiology discrepancy call backs;
Positive culture result) that routinely occurs in your department. If a call back is required, they should review all decisions for
these protocols with the attending and also any patient-care related calls should be observed/reviewed
Readings: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924693/
https://geiselmed.dartmouth.edu/cfm/resources/ethics/chapter-12.pdf
Video: http://on.ted.com/Goldman

DONE BUT
N/A FOR
CHECKLIST DONE NEEDS NOT DONE
CASE
ATTENTION

Review Process

1) Reviews chart and new information (e.g. discrepancy, positive culture) and decides if a call back is required.

2) Determines the extent of error disclosure (e.g. reviews approach with attending).

Resident should complete ONE OF THE FOLLOWING TWO PART (i.e. A or B, not both)

Call back / Error disclosure *must actually talk to patient or SDM

1) Determines the need for a call back

2) Creates an adequate environment in which to complete call back

3) Explains nature of call back

4) Explains actions to be taken now by all parties (patient, ED team)

5a) Addresses questions or concerns expressed by that patient or family.

5b) If requested, provides the names/numbers of individuals with whom patients and families can address concerns/
questions

Dealing with Call Back / Disclosure during Patient Encounter 


*If interacting with patient who has been called back

1) Creates an adequate environment in which to address the rational for the callback

2) Explains nature of call back, consequences

3) Explains actions to be taken now by all parties (patient, ED team)

4a) Addresses questions or concerns expressed by that patient or family.

4b) If requested, provide the names/numbers of individuals with whom patients and families can address concerns/
questions

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6
Needs assistance Independent Practice

• 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.
• A bit confusing, requiring
further explanation
• Builds appropriate rapport
and efficiently establishes
plan
• Provides all options, and
requires little clarification for
participants to understand
plan.
• Clear plan established,
agreed upon by both parties.
• 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 of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the
above evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

51
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

L3.4 | ED Flow Management

Today’s focus is on specific strategies to manage ED flow and prevent crowding.
During the start of a shift or during a period during the shift when multiple patients have accumulated, the resi-
dent should look at the list (computer ED tracking system or chart rack) of patients to be seen by a physician.
The resident is to create a plan to see an appropriate amount of patients in the next hour.


The resident may read the triage notes of each of the patients in order to determine plan. The resident is ex-
pected to create and immediately implement this plan (including planning for delegation of tasks to juniors, at-
tending, nurses, etc..)

Instructor Hints
It is best to do this task on a routine day, not a day where there are hyper-acute patients (e.g. CTAS 1s) that require multiple
and ongoing rapid reassessment. You should consider having the senior resident designate patients to be seen by the at-
tending physician.

DONE BUT NEEDS

CHECKLIST DONE
ATTENTION
NOT DONE N/A FOR CASE

Utilizes acuity (e.g. CTAS scores) to develop plan.

Takes into account patient factors (e.g. wait times, pain score) to determine order.

Takes into account patient location.

Incorporates team members (learners, attending) and delegates tasks appropriately.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for the next level
Needs assistance

Resident displays any of the Resident displays any of the following (or a Resident displays all of the
following (or a similar behaviour): similar behaviour): following (or a similar behaviour):
• Presents a disorganized plan for • Presents a plan that incorporates • Presents a plan to safely and
seeing the patients. CTAS scores, but also clinical efficiently triages patients in a
• Uses CTAS scores ONLY to judgment regarding time expected reasonable order (utilizing more
guide who to see next. with each patient than just CTAS score).
• Doesn’t follow initial plan. • Considers patient location • Takes into account department
• Becomes overwhelmed with executing physical layout and workflow to
own plan and requires intervention see patients.*
from the attending. • Realizes when # patients to be
• Partially involves other team members seen exceeds own capabilities;
• Asks for help when unable to execute incorporates this into the plan.
plan as efficiently as planned

M3.1 | The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above
evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

52
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

A3.2 | Patient Survey

Today’s task is to incorporate patient feedback into a practice change.
RESIDENT: Your preceptor will pick one or two patients to solicit feedback. They will ask the question below.
Your job will be to reflect on this feedback, and determine how it will change what you do in the future.

ATTENDING: The goal of this exercise is to provide residents with useful feedback about how well they were
able to reflectively incorporate patient feedback into their future practice. The CPSO and other provincial col-
leges are moving towards patient surveys as a method for assessing physicians in practice. The goal of this
activity is to ensure our residents are ready to integrate these methods into their own professional develop-
ment with your guidance and coaching

Question to ask:
Attending should ask the following question:

“Dr. _______________ is a senior emergency medicine resident, which means he/she is a short while away
from practicing without supervision. Do you have any feedback for them based on their interaction with you?”

RECORD FEEDBACK BELOW:

Rank the resident’s ABILITY TO REFLECT on the patient’s feedback:

Do NOT rate the patient’s FEEDBACK or the Patient’s OPINION.

RATE THIS TASK | CIRCLE THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
1 7
2 3 4 5 6
Needs assistance Ready for the next level

• Could not integrate patient feedback
into their future practice
• Becomes angry or defensive when
given negative feedback
• Accepts feedback and displays • Empathetic & reflective about patient’s point of
empathy for patient’s point of view. view
• Does not identify a clear plan for • Identifies clear plan for change in future cases.
change; or, requires extensive coaching
from attending to make a plan for
change

A3.2 The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to
ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please
give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

53
RESIDENT ______________ Name of Assessor_________________ Date:_________

A3.1 | Role Modeling Health Promotion (Pointing out the ‘Teachable Moment’)
Today’s task is to identify opportunities for advocacy and health promotion WITH PATIENTS for whom
they provide care AND TO ROLE MODEL THIS TO JUNIOR LEARNERS (IF LEARNERS ARE INVOLVED)

The resident should identify at least one patient in whom they intend to discuss ONE health promotion measure you could introduce with the pa-
tient at the time of disposition (e.g. discharge, admission).

The resident should ask the attending physician to observe them counseling the patient about health promotion measures.

Rationale: There is literature to suggest that the ED may be a possible venue for initiating change (e.g. 'teachable moment'):
1) Smoking cessation: http://www.ncbi.nlm.nih.gov/pubmed/19543095
2) Smoking counselling in pts with Acute Respiratory Illness: http://www.ncbi.nlm.nih.gov/pubmed/11162344
3) Half-life of EtOH counselling: http://www.ncbi.nlm.nih.gov/pubmed/15664722
4) McBride et al., 2003 - Heuristic model for Teachable Moments: http://her.oxfordjournals.org/content/18/2/156.full.pdf+html

A3.1 | RESIDENT: Teaching Worksheet (Based on McBride et al. 2003 - Heuristic model for Teachable Moments)

1. Identify an event or situation that may be a teachable moment. (Cueing Event)

2. Identify the patient’s emotions/affect. How did/can you align your discussions to their state?

3. How can you reframe their self-concept (or social role) so as to encourage change? (e.g. “You are not just
the average smoker, you are now a parent of a child with asthma...”)

RATE THIS TASK | SELECT THE NUMBER THAT BEST DESCRIBES THE RESIDENT’S LEVEL OF PROFICIENCY
7
1 Ready for
2 3 4 5 6 Independent Practice
Needs assistance

• Unable to identify a teachable moment
for health promotion.
• Awkwardly discussed the issue with the
patient
• Is unable to arrive at a plan for
actionable change
• Does not appreciate/align their
discussion with the emotional state of
the patient
• Identified a common issue for health
promotion
• Was somewhat able to align his/her
patient educaiton to the patient’s
perspective
• Established a general (but non-
specific) plan for continued action by
the patient or family member
• Identified an important, interesting or less-
obvious health promotion problem (e.g.
family planning)
• Explained the clinical significance of the
health promotion moment to LEARNER (or
to the attending, who would substitute for a
learner)
• Establish an achievable plan of action that
the patient or family member feels is
immediately accomplishable

A3.1 The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating.

Add enough details to ensure another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above
evidence, please give one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

54
 RESIDENT: ______________ Name of Assessor: _________________ Date:_________

P2.1 Audit of In-patient outcome

Today’s focus is auditing and reflecting on the ED care of an admitted patient (in patient). (P2.1)
From TWO previous shifts, the resident will choose two patients that they will continue to follow and audit as in-patients. They should keep an ano-
nymized version of each patient chart (e.g. photocopy without the patient name/address) to refer to during this debrief.

Worksheet (to be completed by the resident PRIOR to shift)

The resident may choose to gather the following data in a number of ways. They may choose to round on the patient, review the patient’s in-patient
chart, call the admitting team for an update, or check on the computer system for reports (consult note, imaging report, laboratory report).

Summary of Patient’s Progress in Hospital

Consulting services
Unit Number of Initial ED (either by auditing patient chart on in-patient Reflection regarding your ED
Diagnosis or
Patient diagnosis unit, discussing with colleagues [e.g. SMR], or management.
Management by auditing dictations)

RATE THIS TASK | CIRCLE ONE THAT THAT BEST DESCRIBES PROFICIENCY LEVEL
1 7
2 3 4 5 6
Needs assistance Ready for Independent Practice

Resident demonstrates most of the
following or an equivalent
behaviour:
• Did not complete assignment
• Could not demonstrate evidence
of reflection and insight regarding
case and process (e.g. is
defensive about a learning point
that the attending identifies)
• Resident demonstrates most of the
following or an equivalent behaviour:
• Identifies an area for improvement
• Is able to reflect about the case in an
objective manner.
• Identifies a specific learning objective
from each patient with the help of the
attending physician.
Resident demonstrates most of the
following or an equivalent behaviour:
• Identifies areas for improvement;
• Is able to reflect about the case in
an objective manner.
• Identifies a specific learning
objective from each patient
without the help of the attending
physician.

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure
another faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give
one specific suggestion (Education Prescription) for the resident to attempt during his/her next shift.

55
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

L3.2 | Patient Safety Leadership

Notes to the Attending:
This will be an opportunistic task, so the resident may ask you to track it after an occurrence. The resident should
track any incident where they PREVENTED or INTERVENED when a scenario affecting patient-safety arose. During
this task, the resident should recap the scenario with the attending to explain their leadership in the situation and
how his/her involvement affected patient safety.

Example situations:
- identified a “near miss” and filled out the relevant reporting documentation
- assisted in a resuscitation at the request of a colleague (e.g. when asked by Nurse or Senior Medical Resident)
- identifies and assists with a scenario involving an admitted patient warranting intervention by emergency physi-
cian
Or other scenarios as deemed appropriate by resident or staff physician.

RATE THIS TASK | CIRCLE THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
7
1
2 3 4 5 6 Ready for the next level
Needs assistance

Resident displays any of the following or    
similar behaviours:
• Unprofessional (e.g. loses temper, engages
in shouting match)
• Conflict arose
• Did not convey relevant and/or crucial
information (urgency, importance)
• Resident unwilling to compromise to
achieve best outcome for patient
• Courteous and respectful to other  
parties but seemed awkward/
uncomfortable at times in the situation.
• Provided timely and useful assistance in
solving the problem at hand
• Answers patient or colleague(s)’s
Questions
• Asks some questions to better
understand the problem from all relevant
perspectives
• Eventually arrived at a plan that was
amenable to all parities or required
minor concessions be made by one or
more parties
Resident displays all of the following or
similar behaviours:
• Respectful, calm & approachable
• Expeditiously fact finds, soliciting
perspectives from all relevant parties on
the problem at hand
• Provides an expert assessment and plan
to solve the problem a
• Seems comfortable in the situation, and
also puts others at ease
• Arrived at a plan that was amenable to all
parties
• IF APPLICABLE: Debriefs relevant parties
with regards to the scenario; Provides
teaching to learners as needed.

• IF APPLICABLE: Notifies relevant

administration to prevent error from
occurring again (e.g. completes incident
report)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another faculty
member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give one specific suggestion
(Education Prescription) for the resident to attempt during his/her next shift.

56
RESIDENT: ______________ Name of Assessor: _________________ Date:_________

TASK | Feedback & Coaching

Today’s focus is to provide specific feedback to a junior learner.
During this shift, the Senior Resident should be MENTORING A JUNIOR LEARNER. At the end of the shift, the resi-
dent should provide focused and specific feedback to the junior. (Alternatively, if no junior learner is around the attend-
ing may role play a particular junior over the course of the shift and ‘review’ cases with the senior resident).

Level of the Junior Learner (Circle one):

Clinical Clerk Year 2 Clinical Clerk Year 3 PGY1 PGY2

RESIDENT: Record the Area of Improvement Discussed (i.e. topic of specific feedback).

RESIDENT: Record the feedback or coaching given.

Was this problem identified by the Senior Resident? YES NO

(Attending suggested it)

RATE THIS TASK | SELECT THE NUMBER THAT THAT BEST DESCRIBES LEVEL OF PROFICIENCY
1 7
2 3 4 5 6 Ready for Independent Practice
Needs assistance

Any of the following:  
• Provides confusing or
contradictory feedback
• Identifies a vague, non-
specific problem with no
suggested solution
• Provides feedback in a
derogatory or shame-based
manner
• Violates the privacy of the
junior learner (i.e. pries too
much into their personal life;
discusses feedback in front
of other learners)
• Identifies vague problem
• Provides vague, non-
specific one-way feedback
(e.g. only suggests
solutions, not interested in
what junior feels/observes)
• Awkwardly and/or
paternalistically addresses
junior
• Discusses feedback in
front of other learners
• Identifies specific problem  
• Provides at least one specific
feedback pieces of feedback
that the learner can act upon
• Does not involve junior
learner in developing a plan
for change
• Creates proper environment
for giving feedback
• Identifies specific problem in
concert with the junior learner
• Empathetically listens to Junior’s
perspective on the problem
(encourages reflective practice)
• Invites the junior learner to co-
develop a plan for change
• Seems comfortable in the
situation, and also puts the junior
at ease
• Respects the privacy of the junior
learner (e.g. finds a private place to
discuss; attending excepted)

The Evidence: Please provide an example of the learner’s behaviour with an explanation that supports your rating. Add enough details to ensure another
faculty member can quickly understand your rationale for the above score. (MANDATORY) Also, based on the above evidence, please give one specific
suggestion (Education Prescription) for the resident to attempt during his/her next shift.

57
APPENDIX A
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

58
APPENDIX B
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.

Junior Level Intermediate Level Senior Level

Junior Medical Expert & Scholar Intermediate Medical Expert & Scholar Senior Scholarship & Teaching
• Chest Pain Hx / Px • History & Physical during a Resuscitation or • Supervising Procedures
• Acute Back Pain Hx / Px Trauma • Impromptu Didactic Teaching Session
• Mini Trauma • Procedural Teaching (Simple Task) • Clinical Supervision
• Simple procedure  • Knowledge Gap Identification • Role Modeling Knowledge Translation
• Point of Care Research w/ Direction  • Knowledge Translation • Feedback & Coaching (Also C&C)
• Knowledge Translation • Point of Care Research (Own Question) • Team Leader Feedback (Also QDM)
• Case Presentations • Performing Complex Procedure • Point of Care Research (Own Question)
• Ordering Investigations • Chest Pain History & Physical • Role Modeling Health Promotion (Also
• Ordering investigations QDM)


Junior Communicator & Collaborator Intermediate Communicator & Collaborator Senior Communication & Collaboration
• Observed History • Airway Management (Also see M&A) • Telephone Communication
• Observed Hx with Barrier • Discharge Instructions • Breaking Bad News
• Discharge Instructions  • Delivery of Care plan to Family or Patient • Critical Incident Debriefing
• Chart Audit (Content) • Care Plan Discussion w/ RN or Allied Health • Providing Handover (SBAR) (Also L&TM)
• Chart Audit (Organization)  • Documentation (Also seen in P+C block) • Receiving Handover
• Obtaining Consent • Multi-source Feedback • Feedback & Coaching (Also S&T)
• Consult Request • Mini-Chart Audit • Advanced Consultation Request / Out pa-
• Case Presentation
 • Consultation Request (Intermediate ver.)
 tient Referral
• Advanced Chart Audit
• Communication with Nursing or other Health-
care Professionals
• End of Life & Advanced Care Planning
• Team Leader Feedback (Also QDM)

Junior Professional & Communicator
• Observed History - modified SEGUE (a)
• Capacity assessment
• Obtaining Consent
• Narcotic Prescription
• Mandatory Reporting
• Chart Audit (Organization)  • Capacity Assessment
• Chart Audit (Content)
• Consult Request (Junior)
Intermediate Professional & Communicator
• Modified SEGUE history (b)
• Obtaining Consent
• Audit of In-patient outcome
• End of Life & Advanced care planning
• Mandatory Reporting
• SBAR (Handover)
• Documentation (also see C&C)
 • Role Modeling Health Promotion
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
• Patient Safety Leadership (Also L&TM)
• Feedback and Coaching (Also S&T)

Junior Manager & Health Advocate Intermediate Manager & Health Advocate Senior Leadership & Team Management
• Performance Improvement Part 1     • Airway Management (Also see C&C block) • Receiving Handover from Paramedics
• Performance Improvement Part 2     • Performance Improvement Part 1 • ED crowding management
• Time Management • Performance Improvement Part 2 • Time Management & Task Switching
• Tech in the ED • Work/Life Balance (“Multi-tasking”)
• Work/Life Balance • ED Flow • Delegation and Team Management
• Determinants of Health • Time Management • Supervising Procedures (Also S&T)
• Patient Survey • Patient Survey • Team Leader Feedback
• Overcoming Barriers • Managing (Potential) Conflict Situations
• Providing Handover SBAR (Also C&C)
• Professional Obligations
• Patient Safety Leadership (Also QDM)

59

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