Internal Medicine — R5 Academic Day

Consultation workshop

Teaching

Competencies covered in this activity

2. Perform a patient-centred clinical assessment and establish a management plan
2.1. Prioritize issues to be addressed in a patient encounter
2.1.1. Recognize medical instability and address the priorities of resuscitation
2.1.2. Identify relevant clinical issues in a consultation request
2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion
2.2.1. Elicit information relevant to the risk profile for disease
2.2.2. Assess risk factors for disease progression, as well as a patient’s need for health promotion and/or health surveillance
2.2.3. Obtain relevant information from the family history
2.2.4. Elicit an accurate occupational history, as appropriate, with documentation of the patient’s exposure to occupational health hazards, safety risks, and job demands
2.2.5. Perform a complete and appropriate assessment of complex medical presentations, including consideration of competing treatment needs
2.2.6. Assess the patient’s capacity to make decisions about his/her medical care
2.2.7. Perform a functional assessment of basic and instrumental activities of daily living, mental status examination, and assessment of gait and balance
2.2.8. Perform a quantitative measure of performance status for patients with malignancy
2.2.9. Select investigation strategies, demonstrating awareness of the availability and access to resources in various clinical settings
2.2.10. Apply criteria for use of diagnostic imaging and nuclear medicine examinations, including their risks and contraindications
2.2.11. Interpret cardio-pulmonary diagnostic testing, including electrocardiograms, and related reports
2.2.12. Interpret reports of medical imaging and pathology in the context of the patient
2.2.13. Integrate, synthesize and summarize information gathered through the clinical assessment and investigations
2.3. Establish goals of care in collaboration with patients and their families1, which may include slowing disease progression, treating symptoms, achieving cure, improving function, and palliation
2.3.1. Recognize and respond to changes in patient status that indicate a need to reassess goals of care
2.3.2. Identify and respond to symptoms affecting patient comfort
2.3.3. Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued
2.4. Establish a patient-centred management plan
2.4.1. Develop and implement plans for
2.4.1.1. Critically ill patients, including provision of hemodynamic support, non-invasive ventilation and monitoring
2.4.1.2. Hospitalized patients with acute illness, or acute exacerbations of chronic illness
2.4.1.3. Ambulatory patients with common acute presentations and/or chronic medical conditions
2.4.1.4. Patients with multiple medical conditions, including consideration of competing priorities, conditions or treatments as well as drug interactions
2.4.1.5. Safe discharge of patients with acute and chronic conditions, including medication reconciliation
2.4.1.6. Safe transition to another health care setting, including anticipation, prevention, and management of changes in health status during transition
2.4.1.7. Referral to comprehensive or interprofessional care
2.4.2. Identify and address interactions between different diseases and different treatments
2.4.3. Implement primary and secondary prevention strategies as part of the overall management plan
2.4.4. Incorporate consultant recommendations into diagnostic and treatment plans
2.4.5. Integrate recommendations from other health care professionals
2.4.6. Monitor clinical status and adapt management plans during the evolution of the patient’s clinical course