Internal Medicine — Core of Discipline

C7 Discussing serious and/or complex aspects of care with patients, families, and caregivers

Key Features:
- This EPA focuses on communication, including conveying complex and/or emotionally distressing information, guiding discussions involving multiple members of the health care team and recognizing and mitigating conflict.

Assessment Plan:

Direct observation by supervisor or other health professional

Use Form 1. Form collects information on:
- Complexity: low; medium; high
- Substitute decision maker: yes; no
- Issue: futility of care; breaking bad news; discharge related discussion; conflicting recommendations of consultants

- Observer: staff; senior resident; other health care professional

Collect 3 observations of achievement

Milestones

• COM 3.1. Provide information on diagnosis and/or prognosis clearly and compassionately

• COL 1.2. Determine the necessity of involving other health care professionals, and incorporate their perspectives as appropriate

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

• COM 2.2. Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

• COM 4.1. Communicate with cultural awareness and sensitivity

• COM 4.3. Use communication skills and strategies that help the patient make informed decisions

• ME 4.1. Establish plans for ongoing care