Anesthesia — Foundation of Discipline

F10 Assessing, diagnosing and managing patients with common medical or surgical presentations in acute care settings, and advancing their care plans.

Key Features:
- This EPA focuses on assessment and management of acute conditions in settings
other than perioperative care.
- This EPA focuses on the care provided to patients throughout the course of a hospital
stay. It includes the initial consultation and the process of admitting a patient to hospital. It also includes ongoing reassessment of clinical status and management of the evolving clinical course including further investigations, possible complications, and response to treatment.
- This EPA also includes regular communication with the patient and/or family regarding the results of testing and/or treatment as well as further management plans.
- For the purposes of this EPA, ongoing care includes the transitions from one physician to another as may occur during day to night time transition and/or transfer to another care setting.
- This EPA may include a variety of conditions: surgical condition, chest pain, gastrointestinal bleeding, shortness of breath, acute kidney injury, weakness, nausea and vomiting, fever, altered mental status, toxidromes, delirium, overdose, pain, acute abdominal pain, hemodynamic instability of any cause, etc.
- This is a complex EPA with multiple components for observation: patient assessment and management; communication with patient/family; handover; admission to hospital.
- This EPA may be observed in surgical/medical wards or critical care or in the emergency room (initial medical or surgical consultation). It is not expected that all milestones will be observed in every encounter.

Form

F1: Observation

Milestones

• ME 1.3. Apply clinical and biomedical sciences to manage patient presentations in anesthesiology, internal medicine and surgery

• ME 1.3. Apply knowledge of the pathophysiology and clinical presentations of common medical and/or surgical conditions

• ME 1.4. Perform focused clinical assessments

• COM 2.2. Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses

• COM 2.3. Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent

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

• ME 2.2. Synthesize patient information to determine diagnosis

• ME 2.4. Develop and implement initial management plans

• ME 4.1. Coordinate investigation, treatment, and follow-up plans when multiple physicians and healthcare professionals are involved

• ME 4.1. Ensure follow-up on results of investigation and response to treatment

• ME 5.2. Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

• COM 1.1. Communicate in a way that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

• COM 1.5. Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state

• COM 3.1. Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family

• COM 3.1. Use language free of medical jargon

• COM 4.3. Answer questions from the patient and family

• COM 5.1. Document information about patients and their medical conditions
  in focused, clear, coherent, legible progress notes, handover notes, and/or discharge summaries

• COL 1.1. Contribute effectively in interprofessional teams by respecting established rules of their team, eliciting, engaging and valuing input from all healthcare professionals.

• COL 1.2. Describe the roles and scopes of practice of other health care providers related to the discipline: e.g. role of general surgeon when on general surgery rotation

• COL 2.2. Listen to understand and find common ground with collaborators

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

• COL 3.2. Communicate with physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

• COL 3.2. Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues

• COL 3.2. Recognize and act on patient safety issues in the transfer of care

• COL 3.2. Summarize patient issues for concise, prioritized presentation to other team members.

• COL 3.2. Communicate with the patient’s primary health care professional about the patient’s care

• S 2.4. Demonstrate basic skills in teaching others, including peers

• S 3.4. Incorporate evidence-based medicine into clinical practice

• P 1.1. Independently manage specialty-specific issues surrounding confidentiality, intervening when confidentiality is breached

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

• HA 1.3. Work with the patient and family to identify opportunities for disease prevention, health promotion, and health protection

Context Variables

• Location (single-choice)
  • ER
  • ICU
  • medical ward
  • surgical ward
  • other location
  • coronary care unit
• Observer (single-choice)
  • staff
  • senior resident
• Type of condition (single-choice)
  • fever
  • chest pain
  • altered LOC
  • other condition
  • surgical condition
  • shortness of breath
  • hemodynamic instability
• Type of observation (single-choice)
  • direct
  • case review
• Focus of observation (single-choice)
  • handover
  • communication with patient
  • (select all that apply) patient assessment and management

Requirements

• Collect a minimum of 8 observations (minimum 8)
• At least 4 observations of achievement for patient assessment, diagnosis and/or management (including at least 1 staff and both medical and surgical conditions)
• At least 2 observations of handover (including 1 staff observation)