Internal Medicine — Core of Discipline

C4a Assessing, resuscitating, and managing unstable and critically ill patients - Part A: Patient Care

Key Features:
- This EPA focuses on leading and participating in the resuscitation of unstable patients.
- This includes the assessment and management of critically ill patients in the acute care setting, including level two intensive care units, with remote attending physician supervision.
- This EPA does not include managing invasive ventilation, continuous renal replacement therapy, or patients requiring a level one intensive care unit for other reasons (e.g., trauma, multi-organ dysfunction syndrome, or invasive monitoring such as right heart catheters and intracranial pressure monitors).
- The observation of this EPA is divided into two parts: patient care; interprofessional work. The observers for Part B must be individuals who have had multiple interactions with the resident throughout a training experience.

Assessment Plan:

Part A: Patient Care

Direct and/or indirect observation by supervisor (faculty (CCM staff, CCU staff, CTU staff), or CCM, CTU fellows)

Use Form 1. Form collects information on:
- Presentation: shock; systemic inflammatory response syndrome/sepsis; acute respiratory distress; unstable cardiac rhythms; acute coronary syndrome; seizures/altered level of consciousness

Collect 14 observations of achievement
- A variety of presentations
- At least 4 different assessors

Milestones

• ME 1.5. Prioritize patients on the basis of clinical presentations

• ME 1.6. Seek assistance in situations that are complex or new

• ME 2.2. Focus the assessment, performing in a time-effective manner without excluding key elements

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

• ME 2.2. Synthesize patient information to determine differential diagnosis

• ME 2.3. Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes

• ME 2.3. Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued

• ME 2.4. Develop and implement focused treatment strategies

• ME 2.4. Manage hemodynamic support, non-invasive ventilation, and monitoring

• L 4.2. Lead resuscitation teams delivering Acute Cardiac Life Support or care directed at other unstable medical conditions

• ME 2.4. Develop a plan to deal with clinical uncertainty

• ME 3.1. Integrate planned procedures of therapies into global assessment and management plans

• ME 3.3. Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

• ME 3.4. Competently perform resuscitation protocols

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

• COM 1.5. Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately

• COM 1.5. Establish boundaries as needed in emotional situations

• COM 3.1. Provide information to patients and their families clearly and compassionately

• COL 3.2. Organize the handover of care to the most appropriate physician or health care professional