Adult Endocrinology and Metabolism — Core of Discipline

C3 Providing ongoing care

Key Features:
- This EPA includes clinical reassessment, further investigation, adjustment, or modification of treatment based on changes in the individual’s condition, response to therapy or goals of care, screening or monitoring for adverse effects or complications of the condition or its treatment and making decisions about discharge and/or timing of ongoing follow-up.
- The observation of this EPA is based on a single patient in any general, specialized, or longitudinal clinic.

Assessment Plan:
Direct and/or indirect observation by supervisor
Use Form 1. Form collects information on:
- Patient presentation (write in):
- Issue (select all that apply): progressive condition; initiate and/or change therapy; manage complications; arrange/review surveillance; supportive/preventive care; counsel/educate; discharge; other issue
Collect 6 observations of achievement
- At least 1 diabetes presentation
- At least 4 different presentations other than diabetes

Form

F1: Observation

Milestones

• ME 1.4. Perform a clinical assessment that addresses all relevant issues

• ME 2.2. Interpret the results of investigations performed to monitor the condition and/or treatment

• ME 2.2. Determine if there is a need to adapt the management plan based on response to therapy and/or disease progression

• ME 2.3. Integrate the patient’s and family’s perspective and context into the care plan

• L 2.1. Consider costs and resource availability when selecting diagnostic or treatment options

• ME 4.1. Implement a plan for ongoing care, follow-up on investigations, response to treatment and monitoring for disease progression

• HA 1.2. Work with the patient/family to increase their understanding of the condition and associated comorbidities, supporting their active role in disease management

• COM 5.1. Document the encounter to convey the clinical assessment and the rationale for decisions and/or recommendations

Context Variables

• Patient presentation (free-text)
• Issue (multiple-choice)
  • progressive condition
  • initiate and/or change therapy
  • manage complications
  • arrange/review surveillance
  • supportive/preventive care
  • counsel/educate
  • discharge
  • other issue

Requirements

• Collect 6 observations of achievement (minimum 6)
• At least 1 diabetes presentation (minimum 1)
• At least 4 different presentations other than diabetes (minimum 4)