Internal Medicine — Core of Discipline

C3a Providing internal medicine consultation to other clinical services - Part A: Patient Assessment and Decision-Making

Key Features:
- This EPA focuses on providing focused, timely, and collaborative medical consultations to other clinical services under remote attending supervision.
- This EPA includes applying these skills across peri-operative care, obstetrical medicine care, and medical consultation to other clinical services (e.g. surgical services, psychiatry, obstetrics and gynecology, family medicine/hospitalists).
- The observation of this EPA is divided into three parts: patient assessment and decision making; written documentation of the consultation; oral communication with the referring physician(s).

Assessment Plan:

Part A: Patient Assessment and Decision-Making Direct and/or indirect observation by supervisor

Use Form 1. Form collects information on:
- Case mix: perioperative; obstetrical medicine; other clinical service
- Setting: ambulatory; inpatient

Collect 10 observations of achievement
- At least 2 in peri-operative
- A mix of ambulatory and inpatient settings
- At least 3 different assessors

Milestones

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

• ME 2.1. Identify relevant clinical issues in a consultation request

• ME 2.2. Perform focused clinical assessments without missing key elements

• ME 2.4. Develop recommendations for management that address the consult question and consider the patient’s status and other health problems

• COL 1.2. Establish a clear agreement with the referring physician about roles and responsibilities regarding ongoing care

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

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

• P 1.1. Respect the boundaries of the consultative role within the care of the patient