1. John Doe’s Educational Achievement Data Competencies CanMeds ACGME Activities and Responsibilities Event based Date of report: October 5, 2011

2. John Doe’s Competency-Based Achievements: CanMeds Performance levels 1 – Novice 2 – Intermediate 3 – Expert Related Activity: University of Toronto MD Program Date of report: Oct 5, 2011 Date of achievement: May 30, 2008

3. John Doe’s Competency-Based Achievements: CanMeds Performance levels 1 – Novice 2 – Intermediate 3 – Expert Related Activity: University of Toronto MD Program As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. See full framework As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. See full framework Date of report: Oct 5, 2011 Date of achievement: May 30, 2008

4. John Doe’s Competency-Based Achievements: CanMeds Performance levels 1 – Novice 2 – Intermediate 3 – Expert Related Activity: University of Toronto MD Program Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient- centered medical care See full framework Date of report: Oct 5, 2011 Date of achievement: May 30, 2008

5. John Doe’s Competency-Based Achievements: CanMeds Performance levels 1 – Novice 2 – Intermediate 3 – Expert Related Activity: University of Toronto MD Program Performance levels Novice: demonstrates behaviors expected of a first year trainee. Requires close supervision. Intermediate: demonstrates behaviors expected of a trainee after 2 years. Requires some supervision. Expert: demonstrates behaviors expected of a trainee at the completion of training. No supervision required. Performance levels Novice: demonstrates behaviors expected of a first year trainee. Requires close supervision. Intermediate: demonstrates behaviors expected of a trainee after 2 years. Requires some supervision. Expert: demonstrates behaviors expected of a trainee at the completion of training. No supervision required. Date of report: Oct 5, 2011 Date of achievement: May 30, 2008

6. John Doe’s Competency-based Achievements: ACGME Performance levels 1 – Beginner 2 – Adv Beginner 3 – Competent 4 – Adv Competent 5 – Mastered Related Activity: University of Maryland Pediatrics Residency Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011

7. John Doe’s Competency-based Achievements: Patient Care Performance levels 1 – Beginner 2 – Adv Beginner 3 – Competent 4 – Adv Competent 5 – Mastered Learner provided works: Spanish asthma brochure Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011

8. John Doe’s Competency-based Achievements: Gathering Essential Information Benchmark to Peers Date of report: Oct 5, 2011 Date of achievement: Sep 10, 2011

9. John Doe’s Competency-based Achievements: Gathering Essential Information – Benchmark to Peers Peer group: Institution Date of report: Oct 5, 2011 Date of achievement: Sep 10, 2011

10. John Doe’s Competency-based Achievements: Medical Knowledge Identifies evidence-based resources to answer basic and clinical science questions. Met Met With Concerns □ Did Not Meet □ Insuff Evid □ Evidence: Brief Summary: Applies core concepts of pathophysiology to new problems in the basic and clinical sciences relevant to medicine. Met □ Met With Concerns Did Not Meet □ Insuff Evid □ Evidence: Brief Summary: Identifies and acknowledges gaps in knowledge and develops and implements plans to correct. Met Met With Concerns □ Did Not Meet □ Insuff Evid □ Evidence: Brief Summary: Achieves breadth and depth of knowledge in the curricular threads (eg. physiology, pharmacology, etc.). Met Met With Concerns □ Did Not Meet □ Insuff Evid □ Evidence: Brief Summary: Justify your decision Medical Knowledge Competency Met Met With Concerns □ Did Not Meet □ Insuff Evid □ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011

11. John Doe’s Activities and Responsibilities StatusActivitySummary Arterial puncture for blood gas analysis Entrustment Details Intravenous catheter insertionEntrustment Details... Manage patients with common, single system diagnoses who require a hospital setting In progress Details Care of a healthy newbornEntrustment Details Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011

12. John Doe’s Activities and Responsibilities: Activity Details * Date of report: Oct 5, 2011 Date of achievement: Jun 1, 2008 Context: University of Toronto MD Program Intravenous Catheter Insertion Exam: Clinical Skills OSCE Exam 1, May 1, 2008 Passed Additional Criteria: Satisfactory completion of 4 intravenous catheter insertions as determined by supervising faculty member.

13. John Doe’s Activities and Responsibilities: Activity Details Manage patients with common, single system diagnoses who require a hospital setting: Assessment Peer group: Institution cohort Subcompetencies Supervision October 5, 2011 Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011 Context: University of Maryland Pediatrics Residency

14. John Doe’s Activities and Responsibilities: Activity Details Manage patients with common, single system diagnoses who require a hospital setting: Assessment Peer group: Institution cohort Subcompetencies Supervision October 5, 2011 Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011 August 2011 Details Context: University of Maryland Pediatrics Residency

15. John Doe’s Activities and Responsibilities: Activity Details Manage patients with common, single system diagnoses who require a hospital setting: Assessment Peer group: Institution cohort Subcompetencies Supervision October 5, 2011 Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011 Level 2: Expected Elements: Tries to approach the physical examination with attention to the developmental and emotional state of the child by altering the flow to attend to those areas causing most distress towards the end, with some lapses due to: a) inexperience with specific examination maneuvers, b) strict adherence to an examination template for fear of errors of omission, and c) inexperience in judging triggers for distress based on developmental age. (continue) Details Context: University of Maryland Pediatrics Residency

16. John Doe: Activity-specific Subcompetencies Manage patients with common, single system diagnoses who require a hospital setting Date of report: October 5, 2011 PC: Perform complete and accurate physical examinations (psychomotor performance) Perform complete and accurate physical examinations (approach) Perform complete and accurate physical examinations (approach to focused exam) (continued) Context: University of Maryland Pediatrics Residency

17. John Doe: Activity-specific Subcompetencies Manage patients with common, single system diagnoses who require a hospital setting Date of report: October 5, 2011 PC: Make informed diagnostic & therapeutic decisions that result in optimal clinical judgment PC: Develop & carry out management plans ICS: Communicate effectively with patients, families, & the public, as appropriate, across a broad range of socioeconomic & cultural backgrounds Date of report: October 5, 2011 Context: University of Maryland Pediatrics Residency

18. John Doe’s Activities and Responsibilities: Activity Details Manage patients with common, single system diagnoses who require a hospital setting: Level of Supervision Peer group: Institution cohort Assessment October 5, 2011 Date of report: Oct 5, 2011 Date of achievement: Oct 5, 2011 Details Context: University of Maryland Pediatrics Residency

19. John Doe’s Activities and Responsibilities: Activity Details Care of a healthy newborn, Awarded August 18, 2011 by Thelonius Smith October 5, 2011 Peer group: Institution cohort Subcompetencies Supervision Trajectory view Assessment Details Context: University of Maryland Pediatrics Residency

20. John Doe’s Activities and Responsibilities: Activity Details Care of a healthy newborn, Awarded August 18, 2011 by Thelonius Smith October 5, 2011 Peer group: Institution cohort Assessment Level of Supervision Details Context: University of Maryland Pediatrics Residency

21. YearQuarter 1 (Jun - Aug) Quarter 2 (Sep - Nov) Quarter 3 (Dec – Feb) Quarter 4 (Mar – May) 05 – 06 06 – 07 07 – 08 08 – 09 03 01 02 01 02 01 02 01 02 Coursework leading to MD/primary degree Coursework beyond MD/primary degree Enrichment, priority Enrichment John Doe’s Educational Trajectory * John Doe, December 8, 2009 http://www.example.edu/portfolio/1234 02 Intravenous Catheter Insertion

22. YearQuarter 1 (Jun - Aug) Quarter 2 (Sep - Nov) Quarter 3 (Dec – Feb) Quarter 4 (Mar – May) 09 – 10 10 – 11 11 – 12 01 02 01 Residency Training Additional Coursework beyond MD/primary degree Leave of absence John Doe’s Educational Trajectory & Awarded Responsibilities John Doe, October 5, 2011 http://www.example.edu/portfolio/2234 03 Care of a Healthy Newborn

23. John Doe’s Event-based Achievements* USMLE Step 1, May 15, 2007 Score: 230 Mean: 225 Standard deviation: 20 2 digit score: 80 NBME Obstetrics and Gynecology Subject Exam, April 15, 2008 Score: 76 Mean: 72.8 Standard Deviation: 7.9 Percentile: 69 University of Toronto Medical School Year 3 OSCE, May 1, 2008 Passed Date of report: Oct 5, 2011

24. John Doe’s Event-based Achievements* USMLE Step 2 CK, March 15, 2009 Score: 210 Mean: 225 Standard deviation: 20 2 digit score: 78 USMLE Step 2 CS, April 15, 2009 Pass USMLE Step 3, May 15, 2010 Score: 230 Mean: 225 Standard deviation: 20 2 digit score: 82 Date of report: October 5, 2011

25. John Doe’s Event-based Achievements Medicine Clerkship, 9/25/07-12/15/07 Grade: Proficient Comments: Interacted exceptionally well with patients and staff. Benchmark to peers Dermatology Clerkship, 1/29/08-2/10/08 Grade: Satisfactory Comments: Hard worker, good attitude. Date of report: Oct 5, 2011

26. John Doe’s Event-based Achievements: Medicine Clerkship: Benchmark to Peers Date of report: Oct 5, 2011 Date of achievement: Dec 15, 2007