Foundations to Discipline

  • Key Features

    • This EPA focuses on recognizing when a patient requires timely intervention and/or an increased level of care, and initiating necessary interventions including pediatric basic life support and advanced life support, when needed.

    • It includes identifying when further assistance is required and promptly seeking it.

    • This EPA does not include the delivery room setting and does not include leading the resuscitation or ongoing management of the patient.

    • This EPA may be observed in simulation.

    Assessment Plan

    • Direct observation or case review by supervisor or senior resident

    Collect 5 observations of achievement

    • At least 1 neonate

    • At least 1 infant

    • At least 1 preschool, school age or adolescent

    • At least 3 different clinical presentations

    • No more than 2 simulations

    • At least 1 observation by a pediatrician

    • At least 3 different observers

  • Key Features

    • This EPA focuses on recognizing the features of normal and abnormal fetal to neonatal transition and responding appropriately, providing standard newborn care and initiating basic neonatal resuscitation (NRP), when needed.

    • It includes identifying when further assistance is required and collaborating with the neonatal resuscitation team.

    • This includes term and near term deliveries where there are no expected congenital anomalies. This EPA does not include high risk deliveries, antenatal consultation/care, care beyond initial management of resuscitation (feeding, ongoing NICU care), or nursery care.

    • This EPA may be observed in the delivery room or in a simulation setting.

    Assessment Plan

    • Direct observation by supervisor, which may include input from members of the neonatal resuscitation team

    Collect 5 observations of achievement

    • No more than 2 in simulation

    • At least 3 initiations of resuscitation

    • At least 2 different observers

  • Key Features

    • This EPA includes providing care to healthy newborns and includes the routine screening newborn exam, and discharge counselling.

    • This EPA is divided into two parts: initial assessment of newborns; and, discharge assessment.

    • The discharge assessment aspect of this EPA includes planning follow-up and providing anticipatory guidance and counselling for healthy newborn care.

    Assessment Plan

    • Direct observation by supervisor, senior resident, nurse practitioner, or advanced care nurse

    Collect 5 observations of achievement

    • At least 2 different observers

  • Key Features

    • This EPA includes providing care to healthy newborns and includes the routine screening newborn exam, and discharge counselling.

    • This EPA is divided into two parts: initial assessment of newborns; and, discharge assessment.

    • The discharge assessment aspect of this EPA includes planning follow-up and providing anticipatory guidance and counselling for healthy newborn care.

    Assessment Plan

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

    Collect 5 observations of achievement

    • At least 2 different observers

  • Key Features

    • This EPA includes performing a comprehensive and/or targeted history and physical examination for a patient with a new presentation.

    • It also includes developing a differential diagnosis and initial management plan, and presenting the case to a supervisor.

    • Examples of common problems include neonatal abstinence syndrome, poor weight gain, hypoglycemia, hyperbilirubinemia, respiratory distress and the neonate at risk for sepsis.

    Assessment Plan

    • Direct observation or case review by supervisor

    Collect 3 observations of achievement

    • At least 2 different presentations

  • Key Features

    • This EPA includes performing a comprehensive and/or targeted history and physical examination for a patient with a new presentation or an exacerbation of a preexisting illness that is common in pediatric care.

    • It also includes developing a differential diagnosis and initial management plan, and presenting the case to a supervisor.

    • This EPA does not include assessing and managing patients who are critically ill or have complex multisystem problems.

    Assessment Plan

    • Direct observation or case review by supervisor, subspecialty resident or senior resident

    Collect 10 observations of achievement

    • At least 5 direct observations of a component of history and/or physical

    • At least 1 from each age group

    • At least 5 types of condition

    • At least 1 observation for each of respiratory distress, dehydration and fever

    • At least 5 observations by an attending physician

    • At least 5 different observers

  • Key Features

    • This EPA includes identifying opportunities and providing developmentally appropriate anticipatory guidance and preventive care for patients and their families.

    • This includes guiding healthy habits (e.g., diet and nutrition, physical activity, sleep), preventing injuries and illness, advising regarding immunizations for children and contacts, performing appropriate screening, and supporting mental health.

    • This EPA also includes applying knowledge of social determinants of health, dynamics of family functioning (including parental mental health), and the specific challenges faced by vulnerable populations.

    Assessment Plan

    • Direct observation and/or case review by supervisor, subspecialty resident, senior resident, nurse practitioner or physician assistant

    Collect 5 observations of achievement

    • At least 1 direct observation

    • At least 1 from each age group

    • At least 1 chronic disease

    • At least 1 vulnerable population

    • At least 2 different observers

  • Key Features

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

    • Procedures include: bag valve mask ventilation; cardiopulmonary resuscitation (ventilation and massage, defibrillation in core); intraosseous injection; lumbar puncture in neonates and infants; changing tracheostomy tubes for obstruction or decannulation; needle thoracostomy in neonate.

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

    Assessment Plan

    • Direct observation by supervisor

    Collect 12 observations of achievement (those marked with an asterisk may be observed in simulation)

    • At least 4 bag valve mask ventilation in neonate/infant (no simulation), preschool* and school age/adolescent*

    • At least 2 cardiopulmonary resuscitation*

    • At least 1 changing tracheostomy tubes for obstruction or decannulation*

    • At least 2 intraosseous injection*

    • At least 2 lumbar punctures in neonates/infants

    • At least 1 needle thoracostomy in neonate* (clinical setting recommended, but simulation is acceptable)

  • Key Features

    • This EPA focuses on the application of communication skills and strategies to convey information, engaging the patient and/or family in shared decision-making.

    • This EPA also includes teaching the patient and/or family about the diagnosis and management.

    • This does not include complex situations such as discussions involving disclosing serious diagnoses, end-of-life decision-making, or suspected child maltreatment.

    Assessment Plan

    • Direct observation by supervisor, or Core or TTP resident

    Collect 5 observations of achievement

    • At least 1 neonate, infant or preschool

    • At least 1 school age

    • At least 1 adolescent

    • At least 2 observations by supervisor

    • At least 2 different assessors

  • Key Features

    • This EPA focuses on the application of written communication skills in a variety of formats such as assessment/progress notes; consult letters; discharge summaries; consult requests.

    • This includes a synthesis of the pertinent clinical findings, investigations, management plan, and clinical reasoning, as well as clear documentation of the plan for further care.

    • Any documents submitted for review must be the sole work of the resident.

    Assessment Plan

    • Review of documentation by supervisor, clinical associate, subspecialty resident or senior resident

    Collect 4 observations of achievement

    • At least 1 admission note

    • At least 1 discharge summary

    • At least 1 progress note

    • At least 1 consult letter

  • Key Features

    • This EPA focuses on communicating acute and ongoing information about a group of patients with varying complexity between colleagues at times of transition in physician responsibility.

    • It includes handover when going off duty, at the end of a rotation, and/or at the end of call shifts.

    Assessment Plan

    • Direct observation by supervisor, or Core or TTP resident, which may include review of sign-out sheet, electronic document or other communication tool

    Collect 2 observations of achievement

  • Key Features

    • This EPA focuses on transferring patients from one hospital setting to another or to other health care facilities, and discharging patients.

    • This includes summarizing the hospital course and any remaining issues, coordinating ongoing care/follow-up and providing all needed documentation (e.g., summary, prescription) in a timely manner.

    • This also includes oral or written transfer of information and responsibility of patient care from one practitioner to another.

    • This EPA does not include complex patients (Core).

    Assessment Plan

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

    Collect 4 observations of achievement

    • At least 1 of each transition type

    • At least 2 different observers