Internal Medicine — Foundation of Discipline

F5 Assessing unstable patients, providing targeted treatment and consulting as needed

Key Features:
- This EPA focuses on the primary priorities of resuscitation of patients with unstable medical conditions – airway, breathing, circulation – and the general survey that provides a preliminary diagnosis and management.
- At this stage of training, this EPA does not include definitive management but rather timely consultation and handover of care, as appropriate, to other physicians.
- Examples of presentations include acute respiratory distress, hemodynamic instability, and altered level of consciousness.

Assessment Plan:

Direct and/or indirect observation by supervisor (MRP, other consulting staff, senior resident)

Use Form 1. Form collects information on:
- Type of observation: direct; indirect
- Presentation: acute respiratory distress; hemodynamic instability; altered level of consciousness; other
- Setting: emergency department; step-down unit; critical care unit; ward; simulation

Collect 7 observations of achievement

- A variety of presentations
- No more than 3 in simulation setting
- At least 3 observations by most responsible physician

Milestones

• ME 2.1. Recognize medical instability in patients with acute medical conditions

• ME 2.1. Address primary priorities of resuscitation (Airway, Breathing, Circulation)

• ME 2.2. Perform a focused clinical assessment of a patient with an unstable medical condition

• ME 2.2. Develop a specific differential diagnosis relevant to the patient’s presentation

• ME 2.4. Develop and implement preliminary treatment strategies for patients with unstable medical conditions

• ME 4.1. Identify the necessity and urgency of referral for advanced care

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

• COL 3.2. Communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues as needed