Internal Medicine — Core of Discipline

C6 Assessing capacity for medical decision-making

Key Features:
- This EPA builds on the abilities entrusted in the Foundations stage in the task related to establishing goals of care.
- This EPA focuses on the determination of capacity, and the laws and guidelines that direct the care of patients who lack decision-making capacity.

Assessment Plan:

Direct or indirect observation by supervisor

Use Form 1. Form collects information on

- Type of observation: direct; indirect
- Observer type: faculty/staff; senior resident
- Category: patient leaving hospital against medical advice; patient refusing recommended treatment; patient or substitute decision maker refusing recommended home supports or nursing home placement; other

Collect 3 observations of achievement
- At least 1 direct observation
- At least 1 faculty/staff observer
- At least 2 categories

Milestones

• ME 2.3. Determine the patient’s understanding of their condition, risks associated with treatment options and alternatives to proposed treatments

• ME 2.2. Assess the patient’s capacity to make decisions about his/her medical care

• ME 4.1. Determine the necessity and appropriate timing of consultation with mental health and/or other professionals

• COM 1.6. Tailor approaches to decision-making to patient capacity, values, and preferences

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

• COM 1.3. Recognize when one’s own values, biases, or perspectives may have an impact on the quality of care, and modify the approach to the patient accordingly

• COM 2.1. Actively listen and respond to patient cues

• COM 3.1. Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

• COM 4.1. Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

• P 3.1. Adhere to institutional policies and procedures relevant to advance directives and goals of care

• P 3.1. Apply professional standards, and laws governing capacity and competence for medical decision making