Internal Medicine — Core of Discipline

C9a Caring for patients at the end of life - Part A: Symptom Management in End of Life

Key Features:
- This EPA focuses on symptom management at the end of life, up to and including referral to palliative care services. It includes the discussions with patients and families about progression of illness and evolution of the goals of care.

- The observation of this EPA is divided into two parts: symptom management in end of life care and the communication with patients/families regarding the transition away from disease modifying treatment.

Assessment Plan:

Part A: Symptom Management in End of Life Care Direct and/or indirect observation by supervisor

Use Form 1. Form collects information about:
- Scenario: cancer; organ failure; neurodegenerative diseases

Collect 3 observations of achievement

Milestones

• ME 1.6. Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves

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

• ME 2.2. Identify symptoms influencing patient comfort at the end of life

• ME 2.2. Synthesize patient information to determine symptom management priorities

• ME 2.4. Develop and implement management plans

• ME 4.1. Establish plans for ongoing care, taking into consideration the patient’s clinical state, circumstances, preferences, and actions, as well as available resources, best practices, and research evidence

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

• COM 2.1. Actively listen and respond to patient cues

• COL 1.2. Consult as needed with other health care professionals, including other physicians

• HA 1.1. Facilitate timely patient access to services and resources

• P 4.1. Maintain capacity for professional clinical performance in stressful situations