Internal Medicine — Transition to Practice

TTP3 Assessing and managing patients in whom there is uncertainty in diagnosis and/or treatment

Key Features:
- This EPA focuses on the treatment of patients for whom there is uncertainty in diagnosis despite appropriate clinical assessment, and/or uncertainty in determining optimal therapy.
- This EPA includes the clinical assessment and management as well as effective communication of uncertainty to the patient/family and primary care or referring physician.

Assessment Plan:

Direct or indirect observation (case discussion and/or review of clinical documentation) by supervisor

Use Form 1. Form collects information on:
- Setting: ambulatory; inpatient
- Condition: acute; chronic; both acute and chronic
- Type of undifferentiated issue: limited data; non-diagnostic data; conflicting data
- Type of observation: direct observation; case review; review of consult note/other documents

Collect 4 observations of achievement
- At least 1 review of consult note/written communication to other MD
- At least 1 direct observation of communication with patient

Milestones

• ME 2.1. Prioritize which issues need to be addressed

• ME 2.2. Synthesize patient information

• ME 2.2. Revise the differential diagnosis in response to new clinical information, or response to treatment

• ME 2.4. Demonstrate flexibility in clinical reasoning, in the setting of clinical uncertainty

• ME 2.4. Establish a patient-centered management plan despite limited, non-diagnostic, or conflicting clinical data

• ME 2.4. Develop a plan to deal with clinical uncertainty

• ME 3.1. Determine the most appropriate procedures or therapies for the purpose of assessment and/or management

• COM 3.1. Convey information related to the uncertainty in diagnosis and/or treatment in a clear, timely and transparent manner

• COM 4.1. Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

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

• P 1.1. Identify limits in their own expertise

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

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