Anesthesia — Core of Discipline

C21A Providing comprehensive ongoing management of critically ill patients in an intensive care setting

- This EPA focuses on routine ICU care, including evaluating, stabilizing, admitting and providing day-to-day management for patients with common critical illness.
- This includes:
o In depth understanding of their medical condition(s)
o Creation of a comprehensive management plan (integrating best evidence) o Prioritization of patient management issues
o Ongoing reassessment and management of the clinical course
o Organizing and following up on investigations and treatments
o Leading straightforward family meetings/updates
o Thorough documentation
o Effective synthesis and handover of patient care concerns
o Recognition of when to call for assistance
- This EPA can be completed during daytime or during on-call hours.
- The observation of this EPA is divided into two parts: patient management and collaboration with the interprofessional team (multisource feedback).
- Relation with other EPAs:
- Managing resuscitative efforts in the perioperative period is the focus of EPA COD # 5.
- Managing resuscitative efforts in the parturient is the focus of EPA COD # 8

Form

F1: Observation

Milestones

• ME 1.5. Prioritize patient care on the basis of acuity and available resources

• ME 1.6. Adapt care as the patient’s clinical condition evolves

• ME 2.2. Select and interpret the results of investigations and imaging

• ME 2.2. Synthesize patient information to determine diagnosis

• ME 2.3. Work with the patients and family to establish goals of care

• ME 2.4. Develop and implement plans for the use of appropriate life-sustaining therapies (e.g. NIPPV, IPPV, dialysis, hemodynamic supports)

• ME 3.1. Integrate planned procedures or therapies into the overall plan of care

• ME 2.4. Develop and implement initial and/or ongoing management plans for patients with common ICU conditions

• ME 4.1. Determine the need and timing of consultation with other specialists

• COL 3.2. Organize safe intrahospital transport of patient to and from ICU, using all necessary human and equipment resources, recognizing when it may be inappropriate to transport patient

• COM 3.1. Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner

• COL 1.3. Communicate effectively with physicians and other colleagues in the health care professions

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

• COL 3.2. Organize the handover of care to the most appropriate physician or health care professional

• P 1.2. Demonstrate a commitment to excellence in all aspects of practice

Context Variables

No context variables defined.

Requirements

• Part A: Patient management
• Direct or indirect observation by supervisor
• Use Form 1 or local alternative. Form collects information on:
• Primary diagnosis [select all that apply]: cardiac disease; neurologic disease; respiratory disease; sepsis; trauma; shock; postoperative; other diagnosis
• Setting: ICU; NICU; PICU; coronary unit
• Timing: daytime; evening; overnight; weekend/holiday
• Setting: initial assessment; daily care
• Collect observations from a large breadth of training experience with the expectations not all will be achieved, with a minimum of 7 observations of achievement including 3 different primary diagnoses.