 the trainee saw a 68 year old female who did not speak English presenting with urticaria, chest pain and sore throat _x000D_
They had previously been assessed in the ED the night prior, treated with Benadryl and steroid and d/c home _x000D_
Represented as rash worse and also having other symptoms _x000D_
 the trainee took a thorough history though use of translation service and performed a full physical exam _x000D_
The trainee had a broad differential diagnosis of potential causes (anaphylaxis, acs, pe, myo/pericarditis, pneumonia, paraneoplastic syndrome) and stated that they wanted to cast a broad net with regards to their workup as despite the translation service it was still difficult to get a clear clinical picture of what was going on/timecourse of symptoms. I prompted  the trainee regarding risk stratification of pulmonary embolism and we reviewed inclusion criteria for PERC, wells stratification (which scores can have d-dimer to rule out and which will need CTPE even if d-dimer negative). Also prompted to to do bedside u/s on patient ? pericardial effusion (even in COVID can and should still do bedside u/d if this is on your ddx). The patient ultimately ended up responding to full anaphylaxis treatment (rash resolved and subjectively breathing improved), ended up having a significantly elevated d-dimer (>20000) and CTPE showed "tree in bud" appearance NYD. They was handed over to oncoming MD. Well done but received some prompting regarding investigations to be ordered and will look up wells/PERC as end of shift learning goal.

the trainee developed a good empathetic rapport with family and was quick support their decision to seek care for their 14 day old infant. They was able to elucidate the main concerns and did a good overall exam. I suggested a more efficient way to exam femoral pulses in the neonate. Their conclusion was that the infant was well and the expressed concerns were not indicative of underlying pathology. I had to take over regarding discharge information to give clear concise information on periodic breathing and laryngomalcia.

the trainee recognized the potential for a complicated airway and requested the appropriate equipment for back-up airway support. They understood the team roles in the room and ensured all were comfortable. I did not need to be there for this successful intubation and for appropriate management of the case.

- difficult patient, paralyzed, no collateral information, vague complaint of leg pain
- limited initial imaging (ie. XR / US) due to lack of collateral info
- after detailed review able to appreciate subtle findings of unilateral leg edema
- was VERY receptive to feedback/ learning opportunity

Reminders about protecting perineum and helping to coach an unmedicated multip

Solid and sensible decision making around child with rlq pain. Clear discussion with family around diagnostic uncertainty

Needed some prompting to consider sinister causes of vertigo in a patient who had already been assessed by their family doctor. Some anchoring on the existing diagnosis. I have seen you manage other patients with vertigo with more ease than this patient.

Very independent required very minimal oversight. History physical exams and management plans were all very thorough.

Good recognition of sick child, complex history of previous DKA and pancreatitis.  
Plan + reassessment in place

a young female presenting with persistent vomiting in pregnancy. The trainee had a solid approach to workup (though had to be reminded of the need for a U/A) and excellent initial management plan.

 the trainee  discussed the prognosis and recommended a care plan to the wife in a clear and polite manner. The conversation was direct and informative. I felt there was a clear plan and explanations given as to why this was the best way to go. Provided support and was empathetic.

Difficult presentation and complex patient.  Was able to decipher objectively and make the diagnosis despite distractors.  Clear management and disposition plan.

Independently managed multiple trauma patient with appropriate decision making and priorities

 the trainee saw a 16 year old with DKA, first presentation of IDDM. They identified quickly that the patient was very unwell(GCS 14, tachycardic, soft BP) and that they required immediate fluid resuscitation. I had to prompt because they got a bit preoccupied that we had no exact weight, and lost some time trying to determine how much fluid to give. I stepped in with a crude weight and bolus estimate and we got the 500cc bolus started.

Pt presented with LUQ pain, concern for pleuritic nature. PMHx identified through record search: prev recent dx subsegmental PE, in addition to hepatic steatosis. _x000D_
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Appropriate differential considering thoracic & abdominal sources. Discussion surrounding efficiency vs. staged CT scanning (CT PE/abdo pelvis vs. PE --> Abdo pelvis). Discussion with radiology regarding the utility of a staged scan given need for contrast. _x000D_
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Good consideration regarding pt care- attempt to reduce radiation/contrast load vs. Time in department/efficience to diagnosis

Resident took charge of code-stroke patient which involved co-ordination of Criticall and Neurologic consultation, with sensitive timelines

Overall well managed cannabis overdose. Cognizant of resource utilization.

the trainee was very helpful in getting a team and more junior resident ready for this patient, especially given that they needed an airway urgently, and in the time of Covid we had to treat the patient as positive._x000D_
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They asked for appropriate medications for intubation, reminded the team the patient was on warfarin and needed PCC, helped the junior learner appropriately gown up, and was calm throughout. Great work Sey.

2/2 successful intubation plus 4 Igels successfully inserted. Good work

Appropriate exam with eye pressures, and slit lamp with fluoresceine.  Encouraged to optimize slit lamp when it's been messed up.   And remember to ask about contacts

great communication surrounding appropriate doses
Review procedural sedation doses vs intubation doses
review rate of infusion - bolus vs slow push
considered patient factors in choosing sedation technique

 the trainee took handover from one of our ED colleagues on a 830 am SPH shift _x000D_
There were 4 handovers they took from the outgoing doc, several of them were hand throughs _x000D_
 the trainee did very well at getting the handover story, asking a few pertinent questions and then took over care of patients. They reassessed each handover themself. On this occasion, there were some concerns with the plans laid out by the outgoing doc and sothe trainee adjusted the management of these patients (had one patient who was otherwise going to be a d/c, ordered additional labs on a patient and ordered advanced imaging for a back pain patient ).the trainee did very well at not being confrontational but rather accepting the other doc's plan and then reassessing and adjusting how they felt was best. This is a very collaborative practice that I hope they continues (night shifts are challenging, especially now that the night doc at SPH gets two sets of handovers and is solo coverage for a bit of time). While it can be frustrating to re-do/reassess these patients, you will appreciate the collegiality if/when you are the night doc and might be in this position. _x000D_
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Tip going forward: continue to take as much handover as you can and work on this on flow shifts/busy department shifts. This was a nice day as we had a leisurely pace at the start of the shift so you could reassess handovers in timely fashion, but can often be very challenging when department is crazy busy - tip for this is to try and make sure you sort out handovers in first 1-2 hours of your shift (do you agree with the plan/anything else you need to order) - if you leave these until the end of the shift/until the CT scan/labs return and you decide you wish you could have done something differently, it can end up being an additional handover which gets messier/can lead to misses_x000D_
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Well done

discussed the urgency regarding the immediate procedural sedation with which agent and reduction before xray due to cutaneous compromise. Reduced and sugartong cast and xray referral

Thorough and accurate assessment. Good clinical judgement. Good rapport and communication with families.

HIV+ patient with sepsis with multiple potential sources. Saw the patient and did a really good history and outlined reasonable management. Prompted on coverage of anaerobes given potential abd source. Prompted to add albumin to properly interpret VBG in a puffy patient with potential liver/renal failure. Prompted to order endocarditis protocol rather than standard septic cultures given possibility of endocarditis. All of these were relatively minor and due to the complex patient, but were still part of the first steps of management.

-Good job with initial vitals and history. Would like you to immediately consider PE with this story as the most likely diagnosis. Identifying that as a most likely diagnosis can help in communication with your staff. I would see having this basic information as being important in the mobilization of the team to allow clear communication with your attending._x000D_
-Quickly identified the patient losing their pulse_x000D_
-Bed needs to be laid flat when you begin CPR_x000D_
-Good job noting that you need to call a code and get help by doing so.

Good management plan on maintaining flow, . Successful in directing me to patients.

Got pulled into procedures while leading. Work on staying above the fray.

Managed completely independently. Very good assessment, repair and appropriate follow-up arranged.

64 F vaginal bleeding post-hysterectomy. Jehovah's Witness. The trainee managed this patient independently in terms of work-up, DDx, consultation and disposition.

Suitably concerned about this pregnant patient with hemoptysis. Escalated care with staff MD early and advocated well for her with other services. Led to a good thorough discussion with staff MD about approach to thrombosis in pregnant patients and how to counsel patients like this

Managed an undifferentiated septic patient independently. Lactate 7, no clear source. Stabilized hemodynamics, and took broad approach to sepsis NYD.

Doing well, good follow up with nurses re: tasks and organizing reassessment of patients.

Excellent assessment of complex agitated delirium patient; resuscitated and managed very well.

This case illustrated the importance of methodical and comprehensive evaluation of non-specific back pain. Needed some guidance regarding disposition

Great advocacy for the patient. Perfect management of withdrawal.

Identified correct diagnosis. Discussion With me made certain of they're own assumptions

Thorough assessment of patient with vomitting. Good clinical gestalt regarding nonsurgical abdomen and approach to symptom management when symptoms refractory to medical management.

 the trainee had a family and patient interaction that was quite challenging with regards to disposition, pt was having recurrent falls for unknown reason and was adamant that they was doing fine living independently. They navigated around this quite well.

Prompted to avoid pressure on perineum in setting of no epidural until head crowing.

Asked the trainee to perform LP on patient. 

explained risks of procedure appropriately and had good success with LP. Patient tolerated well .

Low resource setting with complex patient with lymphedema ... suggested further workup, referral, and differentials, and coached local staff through workup available locally, at referral Center, and what could be considered but not available given setting

Patients with neurological symptoms are often nonspecific in their description of findings - this patient was certainly in that category. The key is to ask the story a few times to see if the patient's story remains "stable". Even when you're staff some day, you can use this trick.

 the trainee dealt with a patient with headache. Their initial approach was good, but we discussed a more thorough way to organize their DDX so that they can rely less on memory and more on compartmentalization.

Thorough assessment of sick patient with complicated history. Cast a broad diagnostic net and initiated appropriate empiric management

Remember to run a checklist with all the players before starting the procedure. 
Have your emergency drugs ready (ie pressors). A procedural sedation is potentially a general anesthetic and hemodynamic instability may happen.

Good assessment of pt with overdose and suicidal it’s, appropriate involvement of psych

1 year old M, elective surgery, no pmedhx.
IV start, LMA airway, discussion of laryngospasm.

Good initial assessment and plan. Good discussion regarding next steps.

Diagnosed, admitted, prepped and managed independently.
(Case - 45 yo M with biliary colic hx, u/s showing non-mobile stone in neck gallbladder->early chole->admit for lap chole.)

Was an active part of the team of MD's (residents, staff) on a busy night shift. 

Was helpful teaching medical student. 

Interactive with nursing.

Sedated shoulder dislocation and helped manage axillary hemorrhage during reduction

Excellent execution of line insertion (radial ant, femoral CVL, IJ dialysis). 
No concerns. Excellent technique and skills. Excellent knowledge.

Was safe and planned ahead aware of what needed to happen after first attempt was not successful- took feedback well.

This was a complex Possible abuse case with multiple speculations and possible paranoid perceptions from the reporting parent.   Able to determine from history that despite all the strange reports of non-specific vague symptoms the child was clinically well and did not require major ED workup. Recognised that getting the CAAP Team involved was paramount. Suggest in all cases of complex possible abuse always call CAS to notify even though CAS had directed originally to come

 the trainee placed a rhinorocket in an elderly patient on dual anti-platelet therapy. Wore ppe, instructed patient regarding procedure, placed rocket and achieved hemostasis and provide patient with adequate d/c and f/up instructions

Young man with atypical chest pain and an abnormal ECG. They identified the cause of the abnormality and developed a safe plan for evaluation and follow up by GP

 the trainee did very well. Independently assessed and triaged patient appropriately. They suggested rate/rhythm control for the patient which was appropriate. I reminded them to check for a TSH level. Outside of that, well done.

Accepted a good handover from EMS and asked appropriate questions to clarify necessary points.

Nothing specific. Comprehensive management plans like all patients on this rotation. No concerns.

did well looking for a recurrent abcess,  the trainee just hadn't seen a thrombophlebitis in this context prior

the trainee managed the care of a patient presenting with altered LOC, tachycardic and low temp. They recognized early that this could represent a septic picture, however given the patients complex PMHx maintained a broad differential appropriately. Throughout the case we discussed a number of things including indications to send urine investigations in confused patients in their work. The trainee performed an appropriate comprehensive work-up, however could improve their overall care my monitoring and managing investigations more closely - e.g. prompting for XRays when they do not seem to be happening, ensuring urine output/investigations sent and moving to foley catheter if inability to void. We also discussed the importance of obtaining collateral history in altered patients, and situations where we are unable to determine a source of infection in the ED (i.e. The occult sepsis) and the internal conflict we as ED physicians face in these situations.
the trainee demonstrated good self-awareness when they specifically requested I examine the patient and provide a direct opinion.
Overall i felt this was a useful case for the trainee to manage, and was impressed by their thoughtfulness in regards to IX and management.

They was able to determine all appropriate labs. They appropriately suggested bedside u/s; due to finding of NDIUP, suggested formal u/s.

the trainee assessed a middle aged man with a hx of IVDU who presented with fever and a rapidly progressing skin infection. They quickly identified the cellulitis with blistering (non-hemorrhagic) and the possibility of nec fasc. They knew the ABX to choose off the top of their head (Tazo/Vanco/Clinda). They went in to see the patient and directed me to get orders written. This was a great use of resources and I was impressed they had the confidence to do this. We did not have all of our investigations back when our shift ended, but the trainee had an appropriate handover plan - have Plastics see in am given that the symptoms had not progressed while in the ED and that they would be in the hospital in the next couple hours.

Well done initial trauma management.   Promoting around management of unexpected deterioriateion.  Role of repeated fast, and imaging.     Nice job in limiting imaging to nexessary tests only.

the trainee performed a primary survey and efast on a level one trauma. The efast was incorporated after D and anterior exposure prior to log rolling (based on my guidance). Efast was performed quickly and they was adept at identifying lung slide bilaterally at 2 spots each side, and performed abdominal fast identifying appropriate landmarks and requirements to visualize (including tip of liver and the diaphragm). Clearly knows them ultrasounds (and was keen to learn cardiac views as well). Awesome work.

Overall good approach and management. The trainee  has not seen that many patient's with trachs in the past and we discussed and approach to management of the trach patient and how to trouble shoot resp distress.

Slit lamp examination in both acute glaucoma and corneal ulcer was excellent.

 the trainee  worked a moderately busy shift at SPH with me. They saw patients in appropriate priority and with reasonable speed. Minor prompt was provided including earlier consultation of IM in a patient with a few minor labs pending. They appropriately used order sets to begin workups on patients (e.g. abdominal pain) shortly before seeing them to facilitate flow. I saw multiple lower acuity patients throughout the shift but  the trainee  was able to keep up with the medium and higher acuity patients. They spontaneously saw the CTAS 1/2 patients when they were arriving. Discussed potential ways to become more efficient including bulk charting  and using triage notes to keep track of who had been charted on and who hadn't. Overall, progressing well with this EPA. I think  the trainee  saw complex patients at a rate of >/= 1.5 per hour while leading all aspects of their care.

kept track of own cases, called consultants and followed up on bw appropriately.  Continue to look at XR films in a timely manner to promoted discharge and flow

 the trainee assessed an older patient with end stage cancer who presented with nausea and vomiting. They utilized the health record to accurately establish the diagnosis and treatment options. They established goals of care and baseline function for the patient, ordered investigations and provided symptoms relief. They identified need for admission and navigated the uncertainty of which service to admit to. They were correct to admit to internal medicine, but I suggested they talk to Oncology first to save the potential triple phone call situation. I observed them make their phone calls to consultants and they followed a clear 5Cs approach.

the trainee diagnosed and cared for a patient in the ED with a live ectopic pregnancy. They was forced to do so from the WR due to ED bed block. The patient unfortunately suffered a a syncopal episode in the WR. We did not have the opportunity to discuss this, but this case highlights the importance of patient advocacy and communication with colleagues - upon recognizing the live-ectopic and urgent consultation, advocating for a monitored room and ensuring communication with nursing triage staff and charge nurse re the acuity of the situation, as well as ensuring such discussions are documented is of utmost importance.
the trainee appropriately immediately reassessed the patient and provided ongoing care until Gyne was able to take over.

prompted about suturing mouth laceration and discussed specifics of suture choice (dissolvable vs. non dissolvable)

good secondary survey on a patient with multiple injuries
built rapport well with a patient in a domestic violence situation - reviewed importance of outpatient resources

 the trainee is doing well, professional, thorough and simple case presentations they are getting the hang of.

Airway assessment with just minor points omitted. Discussion of options for airway management led to the final appropriate choice.

Excellent BMV technique, 2 flawless LMA insertions, 2 CMAC Intubations with good views and checking ventilation

The history and Physical or thorough and presented in a concise focused manner. Investigations interpretation of the investigations and management P:  Or all complete and appropriate. The trainee is functioning above what's expected at this point in their training.

Despite a complex patient background, an appropriate series of investigations were undertaken to investigate the change in mental status. Communicated effectively to senior resident and managed very well.

I was able to watch the trainee independently come up with a plan for a shoulder reduction in a patient with first time dislocation. I took care of the sedation and wanted to see them do the reduction in follow-up to the last shift I had with them wherein they learned the fares technique for the first time. _x000D_
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They came up with an appropriate plan of techniques to try and was successful with this._x000D_
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Next steps will be to have a parallel plan for sedation AND reduction

the trainee and I managed a PEA arrest in conjunction with another doc/resident who were overlapping on shift with us. _x000D_
Patch was cardiac arrest with ongoing CPR _x000D_
Patient arrived in PEA with lucas/ongoing CPR in progress, received several doses of EPI. _x000D_
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On arrival +PEA arrest _x000D_
the trainee delegated appropriately for epi and pulse/rhythm check after transfer over to bed. Patient had rosc so began post code management: - plan for intubation, investigations etc. They had ordered some bicarb/calcium but did not close loop with RN staff so not given initially. Patient went into PEA again. At this point prompted the trainee to close loop for calcium/bicarb with RN staff and it was given. ROSC achieved and maintained at this point. Pressors initiated and patient intubated, lined and consulted to ICU. _x000D_
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Overall, patient was managed well. Maintained ROSC, found to have bilateral PEs and admitted to ICU. Feedback for the trainee is to a) give specific directed orders in this situation so that meds/orders don't get missed. Challenging in code/COVID precautions as fewer hands on deck and harder to hear with masks/PPE but important to focus on this so things don't get missed. 2) Prioritize time for thinking out loud and thinking in your head. Useful to get feedback from room and have discussion but can detract from room being aware of what you actually want/orders especially if they are not phrased in a direct way.

first knee aspiration, performed successfully on first attempt with only verbal review of steps

Great femoral CVL. Performed the entire procedure with no assistance.
Very professional and respectful.

The Trainee has excellent knowledge.

We had a patient with massive upper GI . they did 
an impressivee management and knew who to call and what to do.

I felt comfortable to leave them alone to manage him.

Has previous US experience and this is evident._x000D_
Contributed to the learning experience and assisted other learners

 the trainee saw a ~80 year old male with a 12 week history of early satiety and upper abdominal mass _x000D_
They effectively communicated to the radiologist to get an u/s done at the end of the day and found a large AAA with impending rupture. They informed patient and nursing staff of this pathology and had patient moved to an appropriate area of the ED. They then called the vascular surgeon who initially suggested outpatient follow-up in their clinic on Monday; however, they persisted by calling them back, emphasizing their concerns for the patient and had them come in and admit the patient. While I offered to make the second call to the vascular surgeon, they took the initiative to do it and got the best outcome for the patient. Great work.

First ever shoulder reduction. Difficult to reduce but the trainee was able to do it without staff intervention (just verbal guidance required).

the trainee identified the diagnosis and reason for DKA, performed appropriate investigations, and managed accordingly with proper order of treatment. Consulted to Internal Medicine as required. Performed completely independently.

identified TBI requiring CT Scan in an infant. 
Fall from father's arms - boggy hematoma, irritability.

Advocated for the patient and appropriately resuscitated. Good management plans. Good team player.

the trainee identified and arranged appropriate management of a cauda equina patient without needing any assistance from me. Well done. The trainee is doing well with progressing through the straightforward bread and butter presentations in emerg.

the trainee did a nice job ensuring them patient got an imaging study. They had a young female with acute on sub-acute LLQ pain that they wanted an US for a possible ovarian cyst, on a Sunday morning. The Radiologist tried to convince them to not do the study, but the trainee was persistent yet professional in them request. The study got done and the patient had a hemorrhagic cyst that required follow-up imaging in a couple of weeks._x000D_
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We discussed strategies for this in the future:_x000D_
1. Give only what you are looking for and what imaging study you want, avoid the H&P. Radiologists are not clinicians, so they should not be talking you out of a diagnosis that you are worried about. It is in their realm to more suggest an alternative modality for the diagnosis in question._x000D_
2. They are unlikely to refuse a study, but rather try to get you to withdraw the request. Try to stay quiet. If it escalates, you can be direct 'I am not sure why you are trying to talk me out of ordering this imaging study. I am worried about condition x and I would like your assistance with imaging to find out...'

Try to do more of a quick history and start resusc early then fill in details after .

Reliable P/E and hx including social
Considered emergent complications.
Encouraged to go straight to relevant test avoiding interim testing that won't change end point tests

the trainee performed a hematoma block independently and placed the patient in finger traps.
Together we performed a hanging reduction and casting, and the trainee performed a three point reduction.
We discussed the various approaches there are to these reductions and casting, and I shared mine including reducing while still in weighted finger traps as allows for single person reduction and casting, the practice of emphasizing the fracture direction before reduction to allow for more mobility, and applying gentle traction during the three point reduction.
With little input the trainee was able to successfully reduce and cast the patient, achieving a satisfactory reduction of what was a very shortened, angulated and comminuted DR fracture.
Next time the patient may benefit from enhanced analgesic as the reduction was painful.

Excellent work on the psych cases. Had very thorough management plans of his own and had good approach to safe dispositions and what to look for in the safety assessment and how to communicate this effectively to staff MD.

Exceptional management, documentation and treatment. The trainee truly goes above and beyond in patient care that is above them expected level. Exceptional data collection, documentation and communications skills.

Managed a complex patient extremely well. Did an excellent job of coordinating difficult care

Was able to independently conduct a trauma survey (primary and secondary)

Solid assessment of a very sick oncology patient that was hypotensive - able to identify unstable and unwell.

I was really impressed with the trainee's management of this case! We had a few minutes notice from EMS so we discussed the plan. They had a well thought out plan (evidence oriented and organized in a pragmatic way in terms of escalation to next level of meds and potential need for intubation). Once the patient arrived, they calmly and quickly assessed and determined the patient was showing signs of improvement and that intubation would not be needed. They only correction i made was when assigning GCS in this patient as though they was not speaking spontaneously, i felt a more robust effort to get the patient to talk was warranted (as without doing so, the GCS would be incongruently low given other findings of eye opening to voice and localizing pain). Patient then did have another seizure as Dilantin was just getting set up and again the trainee seemed clam and able to work through next steps without any trouble. Great work!

Adult woman presents for abdominal pain, diagnosed with fecal loading.

 the trainee  did a good job of reassuring and assessing a very scared man who suffered a significant laceration to their right wrist. They appropriately irrigated the wound and dressed, they needed reminder to splint to reduce further retraction of tendons, as well as pain control. They provided appropriate additional care (ancef, tetanus etc) and inquired as to the nature of the laceration which was not in keeping with mechanism demonstrating their maturity. They made appropriate referrals, and importantly, did not 'over' manage the patient by attempting to repair structures outside of their scope of practice.

Made early resuscitative actions allowing quick turnaround. Adjusted plan once objective data available.

Excellent organizational skills managing complex plan for child (?brain tumor)

Excellent clinical care. comprehensive assessment and excellent management plan.

Bug bite, localized reaction:dealt with child in foster care completely independently and did ancillary paperwork.

Pre-eclampsia requiring supplemental oxygen, BP management, and urgent CS. Great pickup on US and ongoing followup of patient.

Took control and appropriately donned N95 for AGMP procedures and then from lead to Airway management once MRP arrived on scene

Very thorough assessment and all relevant information relayed. Good bedside manner.

Intermittent observation. For this particular procedure, I did not need to be present.

Great job with a potentially unstable (but in the end quite stable) bradycardic patient with hypotension. The trainee had their potential therapies outlined to me. They chose the management approach (fluids), ordered appropriate labs and consulted cardiology with supervision only and no assistance.

continue to keep it simple. when giving D/C instructions, less it more.

 the trainee assessed an older patient with CP who had just been discharged from hospital for pneumonia. They were clearly confused and delirious.  the trainee identified this, but still tried to get through a history of the patient. They then moved to checking mental status/orientation which was significantly altered. I encouraged them to either abort the history early in these situations, or ask questions that require more than a yes/no answer. Get your history through collateral sources in these patients.

good smooth airway management
very good 2 hand bag mask technicque
good airway algorithm
good intubation approach

In the midst of a code (very ill child), need IV access (asthma attack): I told the trainee to do it and they proceeded successfully.
Very helpful in a stressful situation.

Overall approach to patient ans scenario very strong. Good room awareness and involvement without becoming overly involved. Relaxed but firm approach. Knew ETT set up as well as all equipment for needle cric and requested both, knew drugs and appropriate dosing. Able to move team on when clinical situation deteriorated. _x000D_
Ensure to draw up medications for resuscitation in intubation/peri-arrest pediatric patient including atropine and epinephrine or nor-epi, and request help - in this case ENT/Anesthesia.

the trainee saw a young patient (recent immigrant) who presented to the ED under MHA triaged as depression/suicidal ideation. They took a great hx and discovered that the patient was not actually suicidal and that there was ++ stressors with their father which led to an argument and the patient yelling "maybe I will just kill myself" in response to the fight. The trainee was able to connect with the patient and get + background history, determined that the patient was not depressed and not actively suicidal. The trainee offered resources; however patient declined, and ensured they had an appropriate place to go from the ED (staying with family friends).

Functioning well in the ED environment. Good initial plans. Takes feedback and suggestion well. Occasionally gets overwhelmed with multiple inputs coming it at once (i.e. at the end of the shift).

learner accurately appreciated the complexity of youth etoh /hypothermic and potential for trauma. Completed full tox screen and CT head and facial bones (+ve for medial orbital wall fracture). Able to accurately interpret osmol gap. We discussed role of thiamine and folic acid in acute youth intoxication (this order was cancelled)

Appropriate history and physical.
Relevant DDx with good plan and management.
I suggested doing bedside US but otherwise this patient was very competently managed.

the trainee has a very positive, cheerful attitude. they have excellent judgement and great command of them skills. They dealt with a complex logistic situation with a patient from a peripheral hospital who was significantlyinjured but did not need admission. They assessed the level of trauma and treated the obvious injuries. Spoke to specialists includeing the trauma doctor and the orthopaedic surgeon. Arranged a consultation with the ophthalmologist and dealt with three levels of management to get the patient back to their home hospital. All done efficientlhy and and with a polite firm attitude_x000D_
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RND

Acted as TTL to coordinate and initiate care
Good organization
Good communication
Good management of competing priorities.

appropriate management of this patient without need for staff involvement. great knowledge of serotonin syndrome,  AG met acidosis.  be mindful of reflexive lab ordering.

Independently performed and interpreted abdominal ultrasound for free fluid. It was negative. Results confirmed by CT.

Good understanding of mechanism of injury and signs. Ability to test for injury observed. Some minor adjustments to how to test more consistently taught.

 the trainee did an excellent job of coordinating care in this patient. Specifically, they clearly described the case to the consultant Urologist off site and got the patient transported to the required expert care in the fastest modality while still considering their safety (the couple's car rather than a delayed EMS transfer). They also had the foresight to get the nurses to complete the required OR package so there would be no delay at the other site and sent a message regarding the transfer modality / timeline to the physician via ACAL. No prompts were required, but I did approve some steps when looked to for support.

We did a central line together yesterday and at the time I gave him a few suggestions. Did it completely independently today without me needing to provide and help

Overall  the trainee performed well on this shift. Some feedback and learning points:_x000D_
1. Trauma assessment of 18yo female involved in skidoo accident:  the trainee had a high index of suspicion for occult fracture in this pt. Pain of L spine/sacrum was out of proportion to physical exam and initial radiological findings. Appropriately advocated for CT pelvis - although the radiologist reported as N, on further review, a fracture of the sacrum was found. _x000D_
Learning points: Examine for pelvic instability once. Repeat exam/pressure on the pelvic girdle could potentially make a stable pelvic fracture unstable. If you don't feel movement/crepitus, move on with the exam. If you do, pelvic binder asap. _x000D_
- Remember to provide analgesia prior to log roll if there is an injury that will be painful with movement._x000D_
2. Pt with psychiatric presentation had had been drinking ETOH:_x000D_
Overall good assessment and safety profile done. Identified that the pt had been drinking ETOH but no other substances ingested._x000D_
Things to consider: in a patient that presents with psychiatric illness and has ingested ETOH but is clear, able to provide a good history and appears reliable with no previous hx of overdose, will lab investigations change your psychiatric mgmt? _x000D_
- Even though someone may have ingested ETOH, if they are lucid, able to provide a good hx and deemed competent on your assessment, a SDM cannot be implemented  just due to intoxication alone. You need to make a case that they are at risk of hurting them selves/someone else or are incapable of making safe decisions regarding their care due to substances ingested. _x000D_
3. 28yo female, pregnant with bronchitis vs pneumonia: Again, good assessment completed. Appropriate ddx and mgmt plan._x000D_
Learning points: Review use of puffers and dosing. Remember that you can use diagnostic imaging in pregnancy IF it will contribute to or change your mgmt. Consider discussing the possibility of post viral cough vs possible asthma mgmt in a stepwise approach if there is a concern about asthma as an underlying contributor to the overall clinical picture_x000D_
4. 41yo presenting with vag bleed/recent TA. Good resuscitation and assessment. Consider looking at previous labs/ehealth - this patient had dropped them hbg in the last 5 weeks. Appropriate consultation to gyne._x000D_
5. 46yo with headache and clival tumor: Again good assessment, particularly neuro assessment. _x000D_
Learning points: in complicated pts who present with a worsening of ongoing symptoms, remember to look back at previous visits/consults to see what the physical findings were at that point then figure out what is different/what has changed that prompted the current visit. This will help with urgency of investigations/involvement of consultants. _x000D_
Good use of ESR to rule in/out other reasons for headache and visual disturbance.

 the trainee was able to ascertain that child was in compensated shock and needed IV therapy. They needed some support to ensure most rapid method of administration. They ordered appropriate blood tests to check inflammation and electrolytes. Followed through with maintenance fluids and then appropriate disposition management.

Excellent airway assessment and initiation of work up for pt w torticollis and to dollar swelling

 the trainee is improving every shift with regards to providing unprompted and timely advice/differentials about and to patients and families. They need to continue to bolster their knowledge base with paediatric specific texts which they have been directed to. They are motivated and enthusiastic re: this endeavour and I have no doubt they will accomplish this task.

Overall very well done history on a teenager. Always remember the SHADES/HEADSSS history and in girls who have had menarche, to do a menstrual history.

-Organize your stuff more so that it can easily be grabbed in order of how you use it._x000D_
-Good job needle tracking. Make sure to have negative pressure on the entire time._x000D_
-Do not take hands off the needle while it is in the patient! Need to keep a hand on it to prevent movement. It didn't move in this case fortunately._x000D_
-Pull out your needle before you do the ultrasound. There is no benefit to leaving it in during the ultrasound and there is the potential for increased tissue damage._x000D_
-Remove all of the ultrasound goop BEFORE you dilate or push the CVL in. This makes it a lot easier to pull the skin taught and prevents your hands from getting all slick and goopy.

ETT - thorough pre-op a/w assessment, indicated need for ETT (thyroid surgery). Safe and gentle insertion of ETT. Good communications of findings.

Discussed what elements/factors contribute to a dx of a septic stone/pyelonephritis; utility of a CRP. Imaging is not always required in every case of renal colic but if a pt has fever, elevated WBC, obstructive symptoms, consider imaging and early consultation. Appropriately started early antibiotics, excellent consultation done with Urology. Again, prompt follow up on diagnostic tests. Very well done.

Complex patient with septic shock, respiratory failure. 
Thorough assessment, management plan, and execution in an efficient manner

Occasional prompting and teasing out of specifics required to hone in on diagnosis.

This pt looked much older than them stated age- they had a hx of COPD and was on home O2. The trainee performed a thorough history and physical in appropriate PPE. They had a broad differential with a working diagnosis on pneumonia. They chose appropriate antibx for CAP (ceftriaxone, azithro). They evaluated the pts social situation and admitted the pt appropriately.

Excellent rapid assessment and treatment  of multiple diverse patients on a very busy day with limited resources. Excellent flow management skills. Effective and clear communicator, easy to work with and an absolute asset on shift.

the trainee successfully completed multiple U/S guided and landmark based central line placements. They are aware of the indications, contraindications, complications, and processes associated with the procedures. They handled any challenges during the procedures adeptly. They also practiced peripheral iv placements at the session. I am confident that  the trainee is competent to perform these procedures independently. They collaborated effectively with them colleagues at the session.

1st ever FIB on a real patient - talked them through it. Performed well.

Managed chest pain presentation well.  Worked through differential diagnosis of chest pain and criteria to discharge home.

Independently managed patients with simple complaints.
Saw many eye complaints.

Discussion around managing patient expectations, especially when presenting from remote communities to Saskatoon hospitals. Appropriate work up and differential, convinced the patient to stay for a CT abdomen, and follow up with PCP in home community,

1 year old with a finger tip amputation. Had everything set up and ready to proceed prior to sedation. The procedurist was scrambling a bit for supplies and  the trainee did well in their role of administering sedation and not taking over the procedure. Chose an appropriate agent, redosing throughout as needed without any complications related to the sedation. We had a discussion afterwards about the timing of redosing which  the trainee was receptive to. No concerns.

Thorough assessment of a patient returning for worsening symptoms. Appropriate re-look at prior tests and taking the next steps.

Walked through the procedure prior to. Good discussion on pharmacological choices. Managed safely with backup close at hand.

Had an elderly patient with an ICH. Communicated well with family to discuss goals and diagnosis. I literally didn't need to be there.

Great patient advocate, good discussion of disposition based on results

Excellent rapport with  consult service.  A complex oncology patient.

High functioning resident, at level of SMR . Strong management skills and assessment of high acuity septic patient in ED

the trainee performed a ketamine sedation in the ER on a child that needed a fracture reduction. They adequately obtained verbal consent from parents, determined that the child is ASA 1 and and ER sedation would be safe. They applied their  knowledge of pharmacology and delivered the ketamine in aliquots, they also pre medicated with Ondansetron. The trainee collaborated well with ortho/RT and the nurses.

Appropriate consideration of Ddx and tailored assessment and workup for this patient presenting with resp distress including most likely PNA as well as various cardiac ethology (primarily CHF). Involved RT to titrate oxygen therapy appropriately including consideration of Optiflow once PNA dx was established from CHF. Independent management of this patient to disposition to CTU for admission.

flank pain/LLQ pain, thorough hx and ddx
ER post op GYN complication, thorough hx and physical and blood, did a PCOS US for cardio/resp, amazed me with skill, certified in states and Saudi not Canada, very open about this and therefore did not document
MW polyhydraminio consult

Doing really well. We didn't discuss this but keep in mind how presales/inotropic agents will falsely make the heart appear to function better than in reality. Image acquisition was great despite the patient's body habitus. Continue to develop a systematic assessment to assessment of both lvef and RV strain as this will make you more efficient and thorough.

Recognized the role for cpr in pea arrest . Good technique. Identify when needing to switch out.

The Trainee recognized the patient's respiratory distress, concisely outlining her vital instability and recruiting SMR on call, RT, and nurse support, also making time to call the patient's next of kin to update of development and to discuss GOC.

the trainee worked up a complex patient with ?secondary Parkinsonism. They had a good approach and differential for this patient and did a good complete hx and pe

excellent reduction of distal radius fracture. Proper technique. Performed largely independently - only provided some suggestions/tips.

required prompting optho treatment. Eye rinse done _x000D_
Did well with inserted with appropriate sedation

Excellent communication with patient and family. Very empathetic

Well done, LP s aren't easy, positioned the patient well, pt was nervous due to an previous experience as a child, but was calm throughout, first attempt missed, appropriate re-positioning and local applied, which led to success, well done!

Accurate descriptions of pediatric rashes. Managed independently.

 the trainee assessed an older First Nations female with SOB and total body pain. It was case where it was difficult to separate signal from noise as the patient had an emotional need to share that their 'body was unhealthy' but by doing so was giving very vague information.  the trainee patiently listened to their symptoms and was able to make their feel heard but also pick out the salient points to narrow in on a diagnosis. They was able to determine they had a history of COPD, was wheezy on exam and had unilateral B-lines on lung US. They had recently been on Clavulin and appropriately chose another class of ABX to treat their exacerbation, along with other treatments for COPD.

Excellent rapport and communication with the healthcare team. The trainee took charge of patient transport (agitated patient, requiring O2, additional sedation in the CT scanner). Was able to identify the need for more sedation, communicated this to the team, used Vocera to communicate with the ED team to get more medications brought up to the room. Helped radiology techs with patient positioning for XR.

-Asked for oxygen before getting an oxygen saturation, but the sat did come back before it was placed. Generally want to see an oxygen before putting on nasal prongs provided that the patient isn't in extremis - helpful for figuring out how hypoxic they are._x000D_
-Good communication with one task at a time with the nurse. Clear prioritization._x000D_
-Didn't notice the bradycardia until prompted on the phone. This was partially an issue of the different monitor (sim artifact), but it is an important vital sign to think of. ECG was ordered early regardless._x000D_
-When prompted by the attending you came up with the placement of pads independently._x000D_
-It seemed like you really put things together when you summarized on the phone. Try summarizing yourself during the case to get to the same conclusions.

the trainee saw a patient that had a mild chemical exposure to them hands who developed a severe rash. They came up with a viable differential diagnosis that included dangerous items and, I think, came up with a plan which was prudent and safe including the use of steroids and antibiotics. They also arranged wound care and dermatology referral. While we discussed the case, I had nothing to add to them care.

Managed patient thoroughly with appropriate measures. Excellent job.

 the trainee did a great job with a lumber puncture on a neonate with fever < 28 days of life. The LP was successful on the 3rd attempt. _x000D_
My observations of  the trainee were the following:_x000D_
1. Great communication with the mother. _x000D_
2. Calm demeanour even after 2 failed attempts. Did not show any signs that he's frustrated after the first 2 attempts (parents were also given the permission to be at the bedside which added to the stress of the situation) _x000D_
3. Talking out loud when trouble shooting is great  "I wasn't midline on the last poke" "I might need to change the angle this time"_x000D_
4. Professionalism and keen on learning: This LP could have been done by the admitting service but  the trainee stayed late after their shift to complete the task.

Good job with initial assessment, history, initial orders with titration of O2, and call to attendings in terms of what you are worried about. Good job getting lytic ready even though decision to give it is complicated. This is a step beyond what I would have expected but shows that you are thinking ahead. Could have also started heparin. Next step would be assessing right heart strain with ultrasound.

managed a patient with pancreatitis independently
keep considering the role of social history and patient's interest in quitting 
good connection with capacity to create a safe care plan
clear referral to internal medicine

The trainee did a thorough assessment of a young woman with crossed sensory findings and soft examination findings. accurately localized and had the correct diagnosis (MS) at the top of their differential

Thorough assessment and good plan for this patient. They took the initiative to see if ICDs could be interrogated at SPH and when not had the plan to discuss with Cardiology. They discussed the case through ACAL and transferred the patient.

Needed a few prompts to identify some pediatric specific considerations in critically ill EKG (e.g. reference ranges, repolarization patterns)

Doing well - continue to practice airway instrumentation. Had good discussion about pressors

identified a sick patient - abnormal vitals, exertional dyspnea. Ordered appropriate tests. Disposition accurate.

Made a quick and thorough assessment. Gathered the appropriate information to prepare a patient for surgery.

Nerve block and laceration repair with a CC2. they were very patient in their approach and provided great instruction to the student for proper suturing technique.

72 year old female, IJ insertion, INR 5.5 
Good approach to puncture, technically challenging procedure. Work on having tools readily available to you (no reaching!). Work on localizing vein with ultrasound. Good job.

 the trainee  was able to analyze the situation and determine expectation from caregiver and patient and help come up with follow up plan after doing a risk assessment in the ED. This was a relatively complex domestic situation.

well done. established rapport with family and was able to have this conversation and was comprehensive

 the trainee appropriately assessed and worked up a pt with uncomplicated renal colic. I have no concerns with their performance. their communication skills with the patient were excellent and they followed up investigations in a timely manner.

Good assessment of fluid status and IVC in a patient with post dialysis syncope - very flat IVC

Able to teach PGY1 during the shift
Run the whole acute department

I obtained feedback from 2 of our more senior nurses on their interactions with them and the patients. Both nurses felt  the trainee was doing excellent. Specifically, they noted communication with them was clear, that they spend appropriate time with their patients and is especially good with providing clear discharge instructions to the patients. They found them very collegial and easy to work with. They also appreciated that they did things like bring the charts to the clerk if they were going in that direction just to be helpful. Way to represent!

 the trainee assessed an 85 y o female with acute abdominal pain who also had some subacute worsening of their lip tremors from Parkinson's and an episode of their chronic stable angina that morning. Their presentation did not initially prioritize the different complaints and focus on the abdominal pain. It took them90mins to do their assessment as there were some issues with the patient needing to void, the unit assistants asking them to order tests, etc. I gave the trainee the feedback that in future cases, they needs to really focus on the main complaint and form a DDx and plan for it. For sub-acute concerns that are not as serious (ie. The tremors), they can be addressed in the community after discharge or as in-patient. When patients tell you about multiple symptoms, ask them 'If you hadn't had the abdominal pain today, would you have come to the ED for your tremors? Who would have called for follow-up?' I also encouraged the trainee to have a concrete DDx and plan BEFORE they orders investigations. Nurses and unit clerks are asking if you want tests to be helpful, not because you have to. Tests have a purpose which require you think through your DDx and plan as to what that purpose is. I have challenged the trainee to take no more than 30 minutes to assess a complex patient, document it and present it to their supervisor. This will allow them to cognitively off-load that patient so they can go in with a clear head to the next one. Thinking half-way through each patient then coming up with actual plans after investigations is not a good way to practice. The next step is to anticipate how long the investigations will take and think about disposition barriers. With the patient today, we put in a catheter for retention that is likely multi-factorial (constipation, ? infection, ? element of chronic retention/atonic bladder). Getting the OP plan set-up (Trial without catheter by home care in a week, etc.) while we are acutely managing their constipation in the ED will make their discharge more efficient.

Small movements
Setup the room
Landmarks + tactile feel of procedure

Great work on this case. Was able to elicit the contributing underlying sexual trauma history in a sensitive and empathetic manner. Discussed with consulting services well and advocated strongly for they're patient.

Patient needed BiPAP. He identified that. Communication could have been slightly clearer with the staff.

 the trainee saw a toxic tylenol ingestion. We talked a little bit about the utility / dis-utility of order a 1 hour level. Other than such minor points they managed the case independently and ensures they used the correct units on the rumack-matthew nomogram (a common mistake is to use the american units) and had taken the time to make an evernote note for just this situation.

Good differentials and presentations. Trustworthy assessments and had a keen sense of the patients safety/appropriateness for discharge

Was able to work with patient with coaching to achieve a vaginal birth.

The trainee went through the entire case themself, we then met, they gave the entire history in a fashion that I could understand and was brief enough that I could keep it in my head, and had a reasonable differential and plan.

Used glidescope for predicted difficult airway. No problems encountered. Observed.

Abdominal pain in patient that did not speak English: excellent job obtaining hx from pt who did not speak English. appropriate ddx and work up. appropriate use of google translate

19 F with chronic abdominal pain. Multiple presentations for the same over the last week. The trainee did a good job of managing expectations with this patient (and them accompanying mother) from the outset of the patient encounter.

I say ""I needed to be there just in case"" because during the discharge portion of the encounter I had to intervene due to unreasonable expectations and largely behavioural issues with the patient. They and their mother required quite a bit of redirection and reassurance.

Was aware of medication options and proper doses. Had room set up well and safe for sedation. Was able to re-dose medication as needed. No concerns.

Overall a pleasure to work with. Presents in a clear and organized manner. Thorough hx taking and examination and appropriate differentials. Anticipates that patient's course through emergency and has safe and logical disposition plans.

 the trainee did a great job talking with the pt and guardian ( the brother), thorough hx, called peds psych for further eval and management. They agreed to see. Brother and pt pleased with care. Then the brother and pt wanted to leave bc it was taking a long to be seen by psych and couldn't be given an exact time. The brother had secured a counsellor in the community who was going to see the pt right away upon leaving the ER.  the trainee did a great job explaining the concern for the pt and the benefits of peds psych help. I spoke with them as well and but seemed to make it worse. They were very insistent on leaving.  the trainee considered forming for safety of pt. Rightly so. Further discussed guardian issues, getting counselling, and could RTC if failed. They signed an AMA form, and went to counselling in community. Complex social, enviro issues.  the trainee did a good job navigating personalities, pressures, and safety.

Good shift with good variety of patients. Strong initially histories and differentials. No concerns at this time.

the trainee handled this case independently. They assessed the patient, asked for RN help and monitors right away. They asked for them to be put on NP and titrated O2 appropriately. The pt was wheezy and had a productive cough. They ordered puffers and went to write out the rest of their orders out very efficiently; including blood cultures and antibiotics. The nurses were comfortable with their management and appreciated the written orders.

Adequate assessment and appropriate titration of meds for smooth sedation and procedure.

Assessed very agitated altered patient and appropriately recognized that staff was required to assist with sedation for further monitoring and assessment.

Good history and physical exam. Preliminary management was complete for patient with CHF and respiratory tract infection. For the future, remember to repeat trop in patient presenting with cardiac complaints.

ketamine use was appropriate. good use of iv and good anesthesia record

Nursemaid elbow: performed well and appropriately followed up results of procedure.

The trainee went through a thorough differential and did appropriate diagnostic testing and consulted cardiology all in a timely fashion. They then collated data well and made a final clear disposition

 the trainee went to see this patient as soon as RN shared pt was tachycardia. We discussed steps of primary -  the trainee chose to perform bedside u/s before auscultation, but they were done within minutes of each other and u/s gave us more information in this case. We also discussed XR vs CT chest as initial imaging - PTX was large enough to be seen on plain film which was accessed quickly (and gave diagnosis quickly), as compared to CT that took quite some time._x000D_
 the trainee took ownership of patient, with explaining what was happening and consulting with the trauma team.

Good history 
Collateral other sources
Assess safety 
Need to review previous notes for diagnostic clarity

Accurate history and physical exam with plan to rule out surgical pathology.

Abd pain - requiring workup and reflection of DDX with atypical presentation of pyelonephritis with AKI.

Difficult discussion around possible I&D with anxious patient. Good advocate for guidance by evidence.

Well performed intubation of potentially difficult airway secondary to oropharyngeal burns.

Great gyne assessment. Query bartholin cyst with atypical presentation. Good gyne exam and appropriate care plan for patient developed. Solid work.

make sure always document visual acuity. learned how to properly flip lid

the trainee did well completing a primary and secondary survey and ordering ancillary testing while considering diagnostics. Mechanism of injury was very high risk in this patient and the trainee was able to ensure that even subtle primary complaints were investigated in a timely fashion. Overall they was approachable, respectful and very easy to teach and engage with.

the trainee saw an elderly woman in their 70s who presented with complaints of abdominal pain and dizziness. They was able to tease out that these were unrelated complaints and initiated appropriate investigations on on both an inpatient and outpatient basis. We specifically discussed the utility of imaging in elderly patients with abdominal pain. We also had a brief discussion on reasons why elderly patients are more difficult to assess with respect to abdominal pain. The trainee ultimately decided to CT the patient and they was found to have diverticulitis._x000D_
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At discharge, the trainee appropriately gave antibiotics with a good approach for analgesia in this patient. They also gave clear return to care instructions. The only additions for had to their discharge instructions was to always discuss aspects surrounding opiate safety and bowel care.

-Good job getting vitals and initial history_x000D_
-Good labeling of sepsis and ordering of septic workup. Try not to do a list of labs with verbal orders. Got fluids ordered at the same time._x000D_
-Ordered oxygen when dropped below 92% which is reasonable._x000D_
-The patient stopped responding to you but you didn't seem to take note of that immediately. This is difficult with manikins, but be sure to pay attention that!_x000D_
-Good job thinking ahead to next step with consideration of 'pressors' but if you do want the nurse to begin getting this ready (as you suggested) be sure to specify which one. Nice that you know your pressor doses, but you forgot the '/kg/' part the first time you said it. Watch that - those need to be very specific!

Took history and completed physical exam and completed admission order.

Excellent efficiency and covered all important points of history and physical. Continue to present impression and plan in systematic way

By taking a detailed history and physical exam, the trainee was able to make a diagnosis of an anal fissure in a 4 year old. We took the opportunity to review various causes of bloody stool in infancy and childhood. Once again, their documentation was great, containing all relevant information with little extraneous information.

the trainee undertook initiative to r/o cholecystitis in a patient that had a suggestive history. They independently undertook bedside US to r/o and confirmed formally.

the trainee saw a patient that crashed their motorcycle at 130 kph. They triaged as a trauma level 4. Their primary and secondary surveys were methodical and complete. They correctly identified extremities that needed to be x-rayed. I had did not need to be there for their assessment. Their initial prediction for this patient was they would likely be able to go home, which was entirely correct. However we discussed visualizing them going home and which tests we would need to do to safely send them home, in light of their mechanism of injury. They had fairly large abrasions to both flanks so we expanded their investigations to include a CT Abdo in addition to head and neck. They diagnosed their metacarpal fracture and independently put on a slab after discussion with plastics. (although, they could use more practice with slabs so that the finished product looks more professional. It was functional, just not pretty).

This was actual a renal scan to assess for hydronephrosis. Excellent image generation.

 the trainee saw a 26 year old male in DKA _x000D_
Good recognition of DKA and initiation of appropriate initial treatments and investigated for precipitating causes_x000D_
Followed treatment protocol appropriately and consulted ICU for admission (patient not unstable but DKA's in Regina require ICU admit). Consider reviewing Canadian guidelines to ensure have specific diagnostic criteria memorized. Well done.

Excellent work good landmarks and good guidance to nervous patient

Was able to manage, assess, and diagnosis critically ill patient

 the trainee identified a Brugada pattern on ECG and made arrangements with cardiology for appropriate disposition in the case of a young man with syncope.

the trainee saw a young man with eye trauma secondary to being hit in the eye with an air hose
Did a comprehensive eye exam and documented all pertinent findings
Wanted me just to double check and ensure my slit lamp exam was concurrent with their which it was leading to the ""I needed to be there just in case" rating

Safe initial approach for elderly discussed, airway concerns identified (discussed dentures IN for bagging - so leave in first initially, and OUT for intubation). Pt required more sedation then expected for elderly, petite patient - discussed reviewing MAR - in this case, multiple anti-psychotics (>4) likely increase propofol need.

 the trainee  successfully managed and reduced a distal radius fracture with excellent pain management and reduction and casting technique.

the trainee's assessment and management of this patient was efficient and appropriately addressed the severity of the patient's clinical presentation. They identified the patient as being in urgent need of assessment based on the triage and nursing notes. Their physical exam was complete including a rectal examination (only perianal sensation was not assessed during their exam). They immediately requested an MRI and spoke to the neurosurgeon on call to ensure expedited specialist assessment post MRI. The trainee's  managed this case independently and professionally.

 the trainee had questions about seritonergic syndrome and direction with its management

 the trainee  saw a 23 year old female patient at SCH who frequently presents to the ED with abdominal pain. They assessed them the patient appropriately and noted that on today's presentation they had more focal RLQ tenderness. They ordered and abdominal w/up and eventually an u/s to assess for new causes of them chronic pain. Ultimately the u/s was unable to visualize the appendix but given them reassuring labs and no secondary signs of appendicitis on u/s, they discharged them with f/up. _x000D_
_x000D_
 the trainee  did well at recognizing that even patients who frequently present to the ED with chronic issues could have new pathology and appropriately assessed for this and ultimately was okay with not having a definitive diagnosis given the reassuring nature of w/up and provided comprehensive RTC instructions. Well done.

 the trainee  demonstrated clear and appropriate hand over to the receiving ERP. Their patient summaries were succinct and their ability to answer follow up questions about each patient was strong. Interestingly, when handing over a chesty pain patient,  the trainee  omitted that they have spoken with Cardio about OP follow up and that they agreed (pending N troponin). Both I and the receiving ERP offered them feedback that in handover, while such info is not mandatory, it is certainly welcome information since the receiving ERP has only a superficial understanding of the patient. They were open to this feedback.

Assessment was good and patient looked well but needed to take into consideration that an apnea and cyanotic Episode in most cases will likely need further work up and monitoring

 the trainee clearly explained to rest of team their primary plan and back-up plan, gathered all necessary materials and performed intubation independently.

the trainee and I saw a ~70 year old female
PMHx of ALS and on chronic vent for this 
1 day hx of hematuria, fever and decreased from them baseline LOC 
Temp 38.3 BP 60-70 systolic and HR 130

They directed nursing staff to start IV and start fluids, RT there to hook up to usual vent settings and then performed initial physical exam and investigations to look for source/organ dysfunctions (septic/cardiac up) and started broad spectrum antibiotics (tazo & vanco) once labs were drawn. Very appropriate initial treatment (look for source and start early goal directed therapy).I assisted with some of the more advances aspects of case management (d/w family, decision when to start pressors) but their initial management was exactly what was called for in the case. Well done.

Appropriate initial response to resuscitation and primary assessment. Gathered clinical information on the patient and goals of care with the family. Appropriately made palliative based on age and comorbidities.

Case: 70 yo F resp distress, wheezy, COPD exacerbation.
First case initiating BiPAP.

Without asking for the feedback, I was approached by members of the healthcare team who wished to recognize how nice it was to work with  the trainee - they found them approachable, respectful and knowledgeable. In 15 years of practice, this has only happened on 2 or 3 other occasions.

Good recognition of probable tox cause while keeping differential open

Slow and methodical. Very safe. Great situational awareness. _x000D_
Strong resident. Need to be there in case for troubleshooting. Can work on ultrasound guided needle insertion.

4yo with febrile seizure
comfortable and confident with diagnosis and management. Knew all  features of simple febrile seizure.

the trainee inserted a CVL independently. They set up their table appropriately and maintained their sterile field. They used ultrasound to find the best spot where the vein was beside the artery rather than above. They attained flash right away. They momentarily lost it but was able to trouble shoot and ensure they was in again by drawing back. They finished the rest of the procedure smoothly and sutured it in place.

 the trainee saw a patient who presented with a classic panic attack. They appropriately performed a history and physical exam and was able to rule out most other etiologies, calm the patient, and ensure that they were comfortable with outpatient family physician follow up. I saw them after and confirmed their findings and the appropriateness of the plan.

Complex patient characteristics. Acutely unwell. Near independent management with coaching from R5 and myself.

This was a great learning experience from an unexpected walk-In level one trauma to city hospital._x000D_
_x000D_
The patient had a deep laceration involving their left temporal scalp and pre auricular area of the face, with transaction of at least two branches of the temporal artery and injury to the facial nerve._x000D_
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the trainee did an rapid and thorough primary assessment; then moved on to repair of the laceration under direct visualization, stopping bleeding with a combination of horizontal and SI sutures using high grade silk and prolene._x000D_
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The traineefollows up with a secondary survey after bleeding was controlled, identified potential facial nerve injury, and arranged antibiotics, txa, and tetanus._x000D_
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This was a good learning opportunity about the importance of 0 silk sutures in scalp/arterial lacerations; as they allow deep bites into the galea, and are strong enough to allow good tie offs in critical situations. Well done the trainee!

 the trainee was tasked to take care of a teenager with poly pharmacy overdose. They assessed the teen and promptly requested vital signs and a toxicology workup. They also realized that the patient had failed the system and was not managed well for their mental health. They also made sure that the child was formed due to risk of flight and collaborated well with poison control, the mental health team and explained things to the patient's family as the situation evolved. I honestly did not need to be there to help the trainee manage the teen's medical & mental health needs. At the end of our shift the trainee was asking for constructive feedback; I explained how well they managed the patient but how time consuming and distracting such cases could be in a busy emergency department, I challenged the trainee to work on efficiently multi tasking and prioritizing their tasks. I have no doubt that they will be working on this moving forward.

Very interesting presentation. Came in as stroke alert with STE on ECG. GCS low but pt protecting airway, DNR/DNI but family wanted pt resuscitated until a more definitive Dx was given. Presumed intracranial hemorrhage on presentation with possible dissection given ST changes. Cardio wanted to take to cath lab, Neuro wanted to take to CT. Pt was very hypertensive (SBP > 220) Cardio, Neuro attended but ER treated BP, and with discussion decided not to intubate, pt made it to CT, had scan showing large intracranial hemorrhage with poor prognosis and ultimately made CTC. A good case in the discussion of when to intervene and when not to intervene. I think resident learned from this case about when to stop and think more macroscopically about presentations rather than just the medical presentation. We could have intubated, but not doing this gave family a chance to interact somewhat to patient before they died.

 the trainee successfully practiced multiple U/S guided and landmark based central line placements. They are aware of the indications, contraindications, complications, and processes associated with the procedures. They handled some challenging situations adeptly. and should be able to perform these procedures independently. The trainee collaborated effectively with a colleague partner.

Was able to come with appropriate differential for limping child. Although child looked well, there is a need to to r/o important diagnosis like septic hip and osteomyelitis

the trainee identified the rhythm as a possible SVT vs VT and appropriately determined management for both. They was aware of the possible concerns of a rapid SVT being a VT and the failings of all scoring systems to distinguish between them. They noted the features that could be consistent with VT. They appropriately sought cardiology consultation without prompting and knew why. I am confident that they could have managed this patient safely and independently.

good use of EDUS in detection of abdominal free fluid - appropriate management_x000D_
my only involvement with the case was in the confirmation of EDUS findings

advocated for non-OHIP patient in opioid withdrawal in ER setting that is not yet equipped for suboxone initiation. Knowledgable about suboxone initiation/COWs score/ alternatives if cannot start in ER.

 the trainee easily identified a patient with a complication of them advanced cancer and that them current therapeutic options and home care situation were not enough to support the patient and that they would require high level of palliation and hospice care, they coordinated an admission to increase the patients level of palliative care and provided appropriate symptom control

Good ABC management of a trauma patient in sim with multiple injuries. Some delay in transferring the patient and ordering investigations. Appropriate level of knowledge for pre-ATLS.

Sedation for Afib with propofol.

Good airway checklist and consent before hand. Sedation was smooth. 

Did not need to intervene

 the trainee assessed a well-appearing infant with a several day history of inguinal/scrotal mass. Appropriately identified inguinal hernia and the need to refer to surgery.

Manual skills excellent
Prompted for a single subtle point in wound management
Otherwise entirely independent

Managed patient well, suggest ordering a few tests that you would not have

Actively seeking out patients in which experience is deficient, with thorough assessment and plan subsequently.

Clinically assessed and disposed patient safely and appropriately. Great work.

Great job with chest tube insertion on trauma rotation. Only gave small tips on how to improve (e.g. smaller skin incision, chest tube taping after insertion)

Discussion of CVL insertion with practice in simulation area. They was able to place CVL along with discussion of indications and contraindications

2 conscious sedations in one shift.
Propofol + fentanyl, ketamine for second

RT in room, orthodox doing hip reduction. I did not need to be present and resident assessed airway, had plan with drugs (Ketamine and Propofol) and elderly patient who was frail thus used only 0.25mg/kg on meds which worked really well and pt did not need any more sedation and indeed if would have given more probably would have been over-sedated. Was a really good sedation by resident.

appropriate work up and management of SVT.  Used vagal maneuvers successfully

Technically good reduction attempt. Make sure you have a plan for alternate techniques if the reduction does not immediately succeed, and move on to alternates.

Interesting young female with knee pain/myeloproliferative disorder

Crystal meth - lactate elevated.
Altered
Rational approach
Consider thiamine

 the trainee assessed this high risk NSTEMI pt in a less than ideal clinical area (waiting room/EMS holding). Accurately diagnosed/managed pt with appropriate transfer and plan.

There was a stat call to resus for a pt dropped off at the door. When the trainee arrived they was calm and started a primary survey while IV access was being attained and narcan was being drawn up. They continued to carefully follow the pt in the ED and gave the pt more narcan when the pt RR started slowing without any one noticing. They completed a thorough history finding that the pt was on methadone. They recognized the long lasting effects of methadone in forming their disposition plan.

Successful intubation while CPR ongoing. Good approach and set up.

Good patient assessment for sedation and did well with anticipation medication needs

Independly managed multiple trauma patient with appropriate decision making and priorities

REview procedural sedation doses vs intubation doses

built rapport well wiht a patient in a domestic violecnec situation - reivewed importance of outpatient resources

Pew-eclampsia requiring supplemental oxygen, BP management, and urgent CS. Great pickup on US and ongoing followup of patient.

Nerve block and laceration repair with a CC2. they was very patient in they're approach and provided great instruction to the student for proper suturing technique.

Complex patiient charateristics.  Acutely unwell.  Near independent management with coaching from R5 and myself.