PGY3 Evaluation Framework

Trainees will be able to perform a fluent history in the content area of the experience.

1. History sketchy, incomplete, major omissions, lacks focus.
2. Often misses several aspects of history. Provides cursory detail. Not well- organized.
3. History usually complete, accurate, and organized.
4. History is thorough, logical, and complete; elicits some subtle historical points.
5. History is comprehensive and well-organized, accurate problem identification and characterization, excellent interviewing skills

Trainees will be able to perform a thorough physical examination in the content area of experience.

1. Physical examination is incomplete; misses obvious findings, major technical deficiencies, lacks focus.
2. Often unable to elicit most of the relevant findings; technique is less than adequate
3. Physical examination is carefully done; most findings detected, technically sound, organized.
4. Physical examination is complete; often detects subtle findings, sensitive to patient.
5. Very thorough physical examination; well-organized, all important findings detected, consistently finds subtle or difficult findings, patient-centered approach.

Trainees will be able to select and apply appropriate tests for common presentations in the content area.

1. Grossly inappropriate use of diagnostic tests, unable to interpret or apply results.
2. Use of diagnostic tests often inappropriate. Often unable to interpret or apply results.
3. Usually orders appropriate tests. Able to interpret and apply results of common investigations to patient care.
4. Consistently orders appropriate tests. Able to interpret and apply results for nearly all common investigations.
5. Exceptional understanding of diagnostic tests. Able to apply that knowledge in patient care even in challenging patient presentations.

Trainees will be able to formulate patient problem lists and outline a management plan for presentations common in the area of expertise

1. Assessments usually incomplete or inaccurate. Great difficulty generating differential diagnosis. Diagnostic and therapeutic plans incomplete and/or illogically derived from data.
2. Assessments often incomplete or inaccurate. Limited ability to integrate data and arrive at differential diagnosis and at diagnostic and therapeutic plans.
3. Able to solve common problems and generate reasonable differential diagnosis and management plans.
4. Consistently accurate and thorough in generating differential diagnosis and proposing plan. Able to integrate more complex issues and solve some uncommon problems.
5. Exceptional judgement. Able to generate differential diagnosis, provisional diagnosis, and provide a thorough plan of management even for complex problems.

Trainees will be able to describe benefits and risks associated with treatment in the content area.

1. Grossly unaware of benefits and risks associated with commonly prescribed treatments.
2. Understanding of benefits and risks associated with commonly prescribed treatments is superficial and lacking of information that is relevant to helping a patient make an informed choice.
3. Sound understanding of most relevant benefits and risks associated with commonly prescribed treatments.
4. Thorough understanding of almost all benefits and risks associated with most available treatments.
5. Extensive understanding of benefits and risks associated with common and uncommonly prescribed treatments. Able to discuss the evidence supporting the most commonly prescribed treatments.

Trainees will be able to describe the commonly used medications including mechanism of action, adverse effects, and drug interactions.

1. Familiarity with even most commonly used medications is grossly inadequate.
2. Superficial understanding of commonly used medications. Unable to adequately describe serious adverse effects and/or drug interactions.
3. Sound understanding of most commonly used medications including serious adverse effects and drug interactions.
4. Thorough understanding of most medications used in the content area, including mechanism of action, most adverse effects, and drug interactions.
5. Exceptional understanding of all medications used in the content area, including newly emerging/experimental drugs, and can thoroughly describe their mechanism of action, adverse effects, and drug interactions. Thoughtful approach to balancing benefits with risk for individual patients

Trainees will be able to assess the priority and urgency of new referrals, and manage their own appointment schedule to accommodate them.

1. Shows no ability or interest in triaging patients to clinic. Uninvolved in scheduling of own appointment schedule even with prompting.
2. Attempts to triage new patient referrals but decisions show lack of experience in prioritization. Requires prompting to actively manage own appointment schedule.
3. Shows interest in triaging new patient referrals, and decisions regarding prioritization are reasonable, with minimal assistance required. Manages own appointment schedule independently.
4. Independently triages new patient referrals, prioritizing appropriately, and requesting additional necessary information from referring physician in anticipation of patient visit. Actively manages own schedule.
5. As above but also critically reflects on referral and scheduling systems in place and attempts to improve them.

Trainees will manage the time in the office environment to balance patient interactions, review, teaching and administrative activities appropriately.

1. Time management poor. Completes tasks slowly and often falls behind, requiring assistance to complete patient care responsibilities. Has little time for anything other than patient care.
2. Manages to complete most important tasks related to patient care but does so slowly and occasionally has to sacrifice activities that are not directly related to a patient care.
3. Usually completes all tasks within a reasonable time frame, balancing review, teaching, and administrative activities.
4. Superior time management skills. Efficient assessments without sacrifice of quality. Can anticipate time allotment for various activities and works within these constraints.
5. As above but also reflects on clinic processes, identifying ways to improve overall efficiency of clinic activities.

Trainees will be able to prioritize patient care issues and plan follow-up appropriately.

1. Unable to prioritize issues and/or follow-up plans incomplete or inadequate.
2. Requires some assistance to prioritize issues and plan follow-up appropriately.
3. Usually able to prioritize main issues and has a reasonable approach to follow-up care.
4. Consistently able to prioritize main issues and formulates a logical and feasible follow-up plan.
5. Consistently able to prioritize all issues and formulates a logical follow-up plan that is logical, feasible, and that incorporates the patient’s individual preferences/circumstances.

Trainees will be punctual and reliable in attending the ambulatory experience.

1. Frequently late or absent. Makes little or no attempt to offer explanation. Fails to correct behaviour despite feedback.
2. Occasionally late or absent. Offers some explanation and when reminded, appears to appreciate importance of punctuality and reliability.
3. Rarely late or absent and when is so, offers reasonable explanation and pre-warning if possibly.
4. As above, plus makes attempts to find coverage for patient care activities as appropriate.
5. Always punctual and attends clinic reliably. Often comes early to prepare for clinic activities and stays late if necessary for patient care.

Trainees will complete tasks they begin, including documentation, following up tests and other aspects of patient care.

1. Tasks often incomplete. Requires significant reminders to follow-through on duties. Makes no attempt to follow-up on patient issues that arise between visits.
2. Tasks occasionally incomplete but responds to reminders from clinic staff. Attempts to manage patient issues that arise between visits.
3. Completes tasks without reminders. Manages most patient issues that arise between visits with only occasional need for guidance.
4. Consistently completes tasks without reminders and attempts to "stay ahead" by anticipating and organizing upcoming patient care duties. Independently manages all patient care issues that arise between visits.
5. As above plus actively seeks out results of investigations completed between visits and acts on urgent needs independently.

Trainees will interact with patients, families, office staff and other providers appropriately both in the office and between visits.

1. Shows disrespect or disregard when interacting with patients, families, or office staff.
2. Usually respectful of others and makes attempt to incorporate stakeholders’ views into action plan.
3. Attitudes and actions reflect respect for patients, families, and office staff and incorporates stakeholders’ views into action plan. Friendly yet professional.
4. Always respectful of others including patients, families, and office staff. Puts others at ease and builds strong working relationships.
5. As above, plus actively works towards helping patients, families, or co-workers in conflict resolve interpersonal issues.

Trainees will link patients to needed programs and services

1. Does not identify the need to access relevant community resources and services
2. Familiar with available programs and services
3. Can describe the relevance of applicable resources and services to the patient’s care
4. Can describe the steps requires to link patients to applicable programs and services; completes these steps independently when prompted
5. Completes necessary steps to access applicable resources and services independently without prompting

Trainees will ensure their patients’ access to therapies through provincial prescription drug coverage programs (e.g. ODB, Trillium, ICR)

1. Unaware of provincial public drug programs
2. Familiar with provincial public drug programs, but unable to describe them accurately
3. Can describe provincial public drug programs, including their limitations and stipulations, but does not consistently complete steps to ensure medication coverage for patients
4. Can describe provincial public drug programs and completes steps to ensure medication coverage for patients with prompting
5. Can describe provincial public drug programs and completes steps to ensure medication coverage for patients independently without prompting

Trainees will identify barriers (e.g. financial, social, psychologic) to patients’ care and develops plans to overcome them

1. Fails to identify barriers to care during the patient clinical assessment
2. Identifies barriers, but unable to generate a plan to overcome them
3. Identifies barriers, and can state a basic plan to overcome them
4. Identifies barriers, and completes steps to overcome them with prompting
5. Identifies barriers, and follows through on steps to overcome them independently without prompting

Trainees will promote disease prevention to patients

1. Does not promote disease prevention or institute preventative measures relevant to patient care
2. Identifies relevant opportunities to promote disease prevention but can not consistently describe effective strategies for disease prevention
3. Describes effective strategies for disease prevention, and implements them on most occasions
4. Consistently promotes disease prevention and institutes preventative measures
5. Consistently promotes disease prevention and institutes preventative measures, and can describe the evidence supporting them

Trainees will appropriately seek and incorporate recommendations from other health care professionals in the care of their patients (interprofessional care)

1. Cannot describe roles of allied health professionals in patient care; undermines function of interprofessional care team
2. Can describe roles of allied health professionals in patient care, but refers inappropriately
3. Appropriately requests and incorporates recommendations from other health professionals
4. As per #3, and able to achieve results in difficult situations
5. Demonstrates leadership in building and maintaining a collegial clinic environment, and in preventing and resolving conflict

Trainees will appropriately share management of patient’s care with the primary care physician and consultants (intraprofessional care)

1. Cannot describe and/or disregards the role of the primary care physician or other consultant in the context of a patient’s care plan
2. Can describe the roles of the primary care physician and other consultants in the context of a patient’s care plan, but does not share aspects of management effectively
3. Clearly establishes the role of self, primary care physician and other consultants in the context of ongoing care of the patient
4. Clearly establishes the role of self, primary care physician and other consultants and clearly conveys a shared care approach to the patient
5. As per #4, with demonstration of leadership when interacting with colleagues

Trainees will elicit patients’ concerns and views during the course of care

1. Does not elicit or acknowledge patients’ opinions or concerns; demonstrates disrespect to the patient’s concerns
2. Elicits patients’ concerns but does not acknowledge them and/or factor them into the decision making process
3. Consistently and appropriately elicits and acknowledges patients’ opinions and concerns
4. Consistently and appropriately elicits and patients’ opinions and concerns, but also acknowledges them in an articulate manner
5. As per #4, but done so consistently in a tactful, empathetic manner that puts the patient at ease.

Trainees will provide patients with essential information (e.g. diagnosis, prognosis, treatment) in a manner that encourages patient autonomy

1. Unable to describe information clearly to the patient
2. Is able to provide basic information, but the explanation is unfocused and lacks direction
3. Clearly describes essential information and confirms patient understanding
4. Clearly describe rationale, risks and benefits of therapy or investigations, and eloquently engages patients in shared-decision making
5. As per #4, but clearly articulates his/her recommendation(s) in a manner that puts the patient at ease

Trainees will write an effective consultation letter to other providers (e.g. referring or primary care physician)

1. Letters do not contain pertinent information, and lack structure, focus, clarity and/or brevity
2. Letters contain pertinent information, but lack structure, focus, clarity, and/or brevity
3. Letters contain pertinent information, and are of appropriate strcture, focus, clarify and/or brevity. Educational points to the recipient may be lacking.
4. Letters are structured, focused and of appropriate length, and include educational points to the recipient
5. As per #4, but letters consistently answer the referring physician’s questions and makes clear recommendations

Trainees will clearly and accurately document relevant aspects of patient encounters including phone or other forms of communication

1. Written documentation is unclear and the most relevant specifics of discussions are not mentioned. Documentation of phone calls are not done.
2. Written documentation includes the most relevant aspects of the encounter, but not done in a clear and/or a timely manner
3. Written documentation of encounters (including phone calls) is clear and done so in a timely manner.
4. As per #3, but specific aspects of the encounter that are most relevant (e.g. explanation of treatment risks) are mentioned.
5. Written documentation is clear, concise and done so in a timely matter. Relevant details about pertinent aspects of the encounter are clearly yet concisely reported. All discussions over the phone or other means are clearly documented.

Trainees will develop, implement and monitor a personal continuing education plan

1. Lacks initiative to learn; unable to identify areas for improvement in own knowledge, skills and/or attitudes
2. Can identify and state areas for improvement, but unable to describe a plan to address them. May not
3. Able to identify weaknesses and demonstrates an ability to address them.
4. As per #3, but demonstrates an ability to continually revise and adjust learning strategies as his/her competencies evolve.
5. Extremely motivated, actively seeks out feedback and engages in self-reflection; correctly identifies and addresses weaknesses on an ongoing basis; does so efficiently without interfering with other professional responsibilities

Trainees will be able to critically appraise the evidence-base behind their clinical decisions

1. Unable to critique scientific articles properly. Failure to understand basic epidemiologic principles.
2. Able to appraise relevant literature with guidance, but unable to apply it in the context of patient care
3. Able to critically appraise relevant literature without guidance. Able to identify recent literature relevant to a patient’s care with prompting.
4. Able to critically appraise relevant literature and identify recent literature relevant to a patient’s care without prompting.
5. As per #4, but with a thorough knowledge of epidemiologic principles, study design and biostatistics.