Internal Medicine — Core of Discipline

C5 Performing the procedures of Internal Medicine

Key Features:
- This EPA includes all of the following: consent; preparation; performance; post-procedural care including documentation; and managing any immediate complications.

Assessment Plan:

Direct observation by supervisor

Use Form 1. Form collects information on:
- Setting: clinical; simulation
- Procedure: airway management & endotracheal intubation; arterial line catheter insertion; central line placement; thoracentesis; paracentesis; lumbar puncture; joint arthrocentesis
- Site: not applicable; femoral; internal jugular; subclavian; knee; other joint
- Use of ultrasound guidance: yes; no

Collect 21 observations of achievement
- At least 1 of each procedure in the clinical setting
- At least 5 central line placements using ultrasound guidance
- Must include different sites
- At least 3 thoracentesis
- At least 3 paracentesis
- At least 3 lumbar puncture
- At least 2 arthrocentesis
- At least 1 knee
- At least 3 airway management (bag and mask ventilation) and endotracheal intubations
- At least 2 arterial line catheter insertions

Form

F1: Observation

Milestones

• ME 3.2. Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure

• ME 3.4. Perform pre-procedural tasks in a timely, skillful, and safe manner
  - Establish and maintain a sterile field
  - Maintain universal precautions
  - Handle sharps safely
  - Hand-cleanse, gown and glove

• ME 3.4. Perform procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 3.4. Document procedures accurately

• ME 3.4. Establish and implement a plan for post-procedure care

• ME 3.4. Recognize and manage complications

• COM 5.1. Document the encounter to convey the procedure and outcome

Context Variables

• Site (single-choice)
  • knee
  • femoral
  • subclavian
  • other joint
  • not applicable
  • internal jugular
• Setting (single-choice)
  • clinical
  • simulation
• Procedure (single-choice)
  • paracentesis
  • thoracentesis
  • lumbar puncture
  • joint arthrocentesis
  • central line placement
  • arterial line catheter insertion
  • airway management & endotracheal intubation
• Use of ultrasound guidance (single-choice)
  • no
  • yes

Requirements

• Collect 21 observations of achievement (minimum 21)
• At least 1 of each procedure in the clinical setting (minimum 7)
  • Only counts when Setting is clinical
  • Counted once per distinct Procedure
• At least 5 central line placements using ultrasound guidance (minimum 5)
  • Only counts when Procedure is central line placement
  • Only counts when Use of ultrasound guidance is yes
• Central line placements must include different sites (minimum 2)
  • Only counts when Procedure is central line placement
  • Only counts when Use of ultrasound guidance is yes
  • Counted once per distinct Site
• At least 3 thoracentesis (minimum 3)
  • Only counts when Procedure is thoracentesis
• At least 3 paracentesis (minimum 3)
  • Only counts when Procedure is paracentesis
• At least 3 lumbar puncture (minimum 3)
  • Only counts when Procedure is lumbar puncture
• At least 2 arthrocentesis (minimum 2)
  • Only counts when Procedure is joint arthrocentesis
• At least 1 knee (minimum 1)
  • Only counts when Site is knee
• At least 3 airway management (bag and mask ventilation) and endotracheal intubations (minimum 3)
  • Only counts when Procedure is airway management & endotracheal intubation
• At least 2 arterial line catheter insertions (minimum 2)
  • Only counts when Procedure is arterial line catheter insertion