Internal Medicine — Core of Discipline

C2a Assessing and managing patients with complex chronic conditions - Part A: Assessment, Diagnosis, and Management

Key Features:

- This EPA focuses on the care of patients with chronic disease, in any care setting, across the breadth of chronic conditions. This EPA includes clinical assessment, evidence informed decision making and judicious use of health care resources.

- This EPA includes patients whose condition is complex, and therefore requires a patient centered approach considering the patient’s treatment goals, interactions between different diseases and treatments, consideration of multimorbidity and frailty and, often, coordination with other physicians and health care professionals.

- The observation of this EPA is divided into two parts: assessment, diagnosis and management; and a patient centered approach to communication, counselling and education.

Assessment Plan:

Part A: Assessment, Diagnosis, and Management Indirect observation by supervisor

Use Form 1. Form collects information on:

- Condition: asthma; anemia; arthritis; cancer; chronic fatigue; chronic kidney disease; chronic obstructive pulmonary disease; congestive heart failure; connective tissue disease; coronary artery disease; cirrhosis; dementia; diabetes mellitus; hypertension; other
- Setting: ambulatory care; inpatient

Collect 12 observations of achievement
- Case mix must include a variety of conditions
- At least 6 in ambulatory care setting
- At least 4 different assessors

Milestones

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

• ME 2.1. Consider clinical urgency and comorbidities in determining priorities to be addressed

• ME 2.2. Select and interpret investigations based on clinical priorities

• ME 2.2. Integrate and summarize information obtained through the clinical assessment and investigations

• ME 2.4. Identify and address interactions between different diseases and different treatments

• ME 2.4. Develop patient-centered management plans that address multimorbidity, frailty and/or complexity of patient presentations

• S 3.4. Integrate best evidence and clinical expertise into decision-making

• ME 2.4. Adapt guideline-based recommendations for care to the context of the patient’s specific needs and priorities

• ME 4.1. Determine the necessity and timing of referral to another health care professional

• ME 4.1. Establish plans for ongoing care

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

• COM 5.1. Adapt record keeping to the specific guidelines of their discipline and the clinical context

• COL 1.2. Work effectively with other health care professionals, including other physicians

• L 2.1. Demonstrate resource stewardship in clinical care

• HA 1.1. Facilitate timely patient access to services and resources