Critical Care Medicine — Transition to Discipline

TTD1 Assessing and providing initial management for new patients admitted to the ICU or seen in consultation

Key Features:
- This EPA focuses on the initial medical care of patients who are critically ill, including assessment, initial diagnosis, preliminary management, including management of clinical deterioration.
- An important feature of this EPA is the timely and appropriate recognition of the need for additional assistance.
- This EPA may be observed in a variety of clinical settings, including the intensive care unit, emergency room, and on the wards.
- This EPA does not include resuscitation (TTD2), nor developing a fully matured differential diagnosis for complex presentations, or a complete management plan (F1).

Assessment plan:
Direct observation and/or case review by attending physician or senior trainee
Use Form 1. Form collects information on:
- Observation: direct; indirect
Collect 2 observations of achievement
- At least 1 direct observation
- At least 2 different observers

Form

F1: Observation

Milestones

• ME 1.4. Perform focused clinical assessments that address all relevant issues

• ME 2.1. Prioritize issues to address in the patient’s assessment and
  management

• ME 1.4. Recognize urgent problems and one’s own limitations, and seek assistance as needed

• ME 1.6. Identify clinical situations in which complexity, uncertainty, and ambiguity may play a role in decision-making

• ME 2.3. Ascertain the patient’s goals of care and ensure care is aligned with those goals, as the patient’s situation evolves

• ME 2.2. Develop an initial diagnosis relevant to the patient’s presentation

• COM 4.1. Communicate in a manner that is respectful, non-judgmental, and culturally aware

• COM 5.1. Document relevant information

• COL 1.2. Seek and respond to input from other health care professionals

• COL 1.3. Communicate clearly and directly to promote understanding in the health care team

• L 2.1. Consider health care resources and costs when determining the investigation and management plan

• HA 1.1. Facilitate timely access to limited health care resources

Context Variables

• Observation (single-choice)
  • direct
  • indirect

Requirements

• Collect 2 observations of achievement (minimum 2)
• At least 1 direct observation (minimum 1)
  • Only counts when Observation is direct
• At least 2 different observers (minimum 2)
  • Counted once per distinct Assessor