Internal Medicine — Foundation of Discipline

F2a Managing patients admitted to acute care settings with common medical problems and advancing their care plans- Part A: Patient Assessment and Management

Key Features:
- This EPA includes treating common acute medical presentations under remote, indirect supervision. At this level, trainees would be expected to solicit assistance from more senior residents, junior attendings, fellows, or attendings for complex presentations.

- The observation of this EPA is divided into three parts: patient assessment and management; communication with the patient and/or family throughout the clinical course; handover of patient care.

- The observation of handover should emphasize the interactive nature of handover for a group of patients (i.e. a handover event).

Assessment Plan:

Part A: Patient Assessment and Management Direct or indirect observation by supervisor

Use Form 1. Form collects information on:
- Category of main condition: Cardio (arrhythmia, CHF, coronary artery disease/chest pain/acute coronary syndrome); Endocrine (diabetes mellitus); Geriatrics (falls); Haem (venous thromboembolic disease, anemia); GI (nausea/vomiting, abdominal pain, gastrointestinal bleeding, cirrhosis/jaundice); Infectious (fever, sepsis); Nephro (acute kidney injury); Neuro (delirium/altered level of consciousness, cerebrovascular accident); Respiratory (COPD/asthma, pneumonia, shortness of breath, hemoptysis); other (toxidromes)
- Diagnosis (write in):

Collect 8 observations of achievement
- At least 8 different categories
- At least 6 different assessors

Milestones

• ME 1.1. Demonstrate compassion for patients

• ME 1.3. Apply clinical and biomedical sciences to manage common patient presentations in Internal Medicine

• ME 1.4. Perform appropriate clinical assessments throughout the course of a patient illness

• ME 1.5. On the basis of patient-centred priorities, seek assistance to prioritize multiple competing tasks that need to be addressed

• ME 2.1. Iteratively establish priorities as the patient’s situation evolves

• ME 2.4. Develop and implement initial management plans for common problems in Internal Medicine

• ME 2.4. Adapt the management plans to the clinical course

• ME 3.4. Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered

• ME 4.1. Ensure follow-up on results of investigation and response to treatment

• ME 4.1. Monitor patients for complications, response to therapy, and evolution of the clinical course

• COM 1.2. Optimize the physical environment for patient comfort, privacy, engagement, and safety

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions