Internal Medicine — Transition to Discipline

TTD2 Identifying and assessing unstable patients, providing initial management, and obtaining help

Key Features:

- This EPA includes recognizing critical illness, implementing initial emergent care, and obtaining assistance.
- This EPA does not include leading a resuscitation team beyond initial care (i.e. not entrusted with diagnosing etiologies or on-going critical care management).
- Examples of presentations include acute respiratory distress, hemodynamic instability, and altered level of consciousness.

Assessment Plan:

Direct or indirect observation by supervisor (staff or senior resident), with input from other health professionals

Use Form 1. Form collects information on:
- Type of observation: direct; indirect
- Presentation: acute respiratory distress; hemodynamic instability; altered level of consciousness; other
- Setting: clinical; simulation
- Observer role: staff; senior resident; fellow

Collect 3 observations of achievement

- At least 1 direct observation
- A variety of presentations
- At least 1 observation in the clinical setting
- At least 2 different assessors; at least 1 faculty

Milestones

• ME 1.1. Demonstrate compassion for patients

• ME 1.4. Perform a focused history and physical exam

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced physicians and seek their assistance

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

• ME 2.4. Develop and implement initial management plans for common acute unstable presentations in Internal Medicine

• ME 3.4. Perform the skills of Advanced Cardiac Life Support (ACLS)

• COM 3.1. Provide explanations and updates to the patient and family

• COL 3.2. Provide specific information required for safe and effective handover to senior colleagues

• P 1.1. Consistently prioritize the needs of patients and others to ensure a patient’s legitimate needs are met