Internal Medicine — Foundation of Discipline

F1 Assessing, diagnosing, and providing initial management for patients with common acute medical presentations in acute care settings

Key Features:
- This EPA includes assessing and treating common acute medical presentations under remote, indirect supervision, including managing new patients overnight.
- At this level, trainees would be expected to solicit assistance from more senior residents, junior attendings, fellows, or attendings for complex presentations.

Assessment Plan:

Direct or indirect observation by supervisor (staff and/or supervising resident)

Use Form 1. Form collects information on:
- Type of observation: direct; indirect
- Location of patient visit: emergency department; ward
- Case mix: chest pain; shortness of breath; altered level of consciousness; fever; hemodynamic instability; other

Collect 10 observations of achievement
- At least 5 direct observations
- At least 3 must be in the emergency department
- A variety of the case mix
- At least 3 observations from staff

Milestones

• ME 1.1. Demonstrate compassion for patients

• ME 1.3. Apply clinical and biomedical sciences to manage common patient presentations in Internal Medicine

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced physicians and seek their assistance

• ME 1.4. Perform complete and appropriate assessments of patients with common acute medical presentations

• ME 2.1. Iteratively establish priorities as the patient’s situation evolves

• ME 2.2. Generate differential diagnoses along with appropriate diagnostic strategies

• ME 2.2. Complete patient admission as appropriate

• ME 2.4. Develop and implement initial management plans for common internal medicine presentations

• ME 3.1. Describe to patients common procedures or therapies for common conditions in Internal Medicine

• ME 3.2. Obtain informed consent for commonly performed procedures and therapies

• ME 3.3. Consider urgency, and potential for deterioration, in advocating for the timely execution of a procedure or therapy

• ME 3.4. Seek assistance, as needed, when unanticipated findings or changing clinical circumstances are encountered

• COM 3.1. Communicate the diagnosis, prognosis and plan of care in a clear, compassionate, respectful and accurate manner

• COM 4.3. Answer questions from the patient and family about next steps

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.1. Receive and appropriately respond to input from other health care professionals

• COL 3.1. Identify patients requiring handover to other physicians or health care professionals