Adult Rheumatology — Core of Discipline

C1 Providing initial assessment, diagnosis, and management for patients with a range of acute and chronic rheumatologic presentations

Key Features:
- This EPA focuses on consultation for and management of a new patient.
- The clinical assessment includes history, comprehensive review of the medical record, physical exam (including extra-articular manifestations), interpretation of rheumatologic investigations, including the interpretation of plain radiographs, disease activity/ outcomes measures, and prognosis.
- The management aspects include pharmacologic and non-pharmacologic strategies, advocacy (e.g. access to care and services, psychosocial factors), and patient safety (e.g. counselling and monitoring medication side effects).
- This EPA may be observed across a range of rheumatologic diseases, settings and special situations including fertility peri-operative, and/or co-morbid conditions, and includes a variety of patient factors such as acute, chronic, complicated, uncomplicated, and/or vulnerable populations.

Assessment Plan:
Indirect observation by supervisor
Use Form 1. Form collects information on:
- Setting: inpatient; ICU; emergency room; ambulatory
- Case mix: chronic inflammatory MSK condition; acute arthritis; non-inflammatory MSK condition; systemic rheumatologic disease; widespread chronic pain syndrome
Collect 12 observations of achievement
- At least 5 chronic inflammatory MSK conditions, 2 acute arthritis, 2 non-inflammatory MSK conditions, 2 systemic rheumatologic diseases, 1 widespread chronic pain syndrome
- At least 1 from each setting
- At least 3 different assessors

Form

F1: Observation

Milestones

• ME 1.3. Apply clinical and biomedical knowledge to manage the breadth of rheumatologic presentations

• ME 1.4. Perform clinical assessments that address all relevant issues

• ME 2.2. Elicit a history and perform a physical exam, identifying extra-articular manifestations

• ME 2.2. Perform comprehensive medical record reviews

• COM 2.3. Seek and synthesize relevant information from other sources

• ME 2.2. Synthesize patient information to determine diagnosis

• ME 2.2. Select and/or interpret appropriate investigations

• ME 2.2. Interpret the results of plain radiographs in the context of the patient’s presentation

• S 3.4. Integrate best evidence and clinical expertise into decision-making

• ME 2.4. Develop and implement management plans including both non-pharmacologic and pharmacologic modalities, as appropriate

• ME 4.1. Establish plans for monitoring the patient’s condition and medication side effects

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

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

• L 2.2. Apply evidence and guidelines with respect to resource utilization

• HA 1.1. Facilitate timely patient access to services and resources

Context Variables

• Setting (single-choice)
  • inpatient
  • ICU
  • emergency room
  • ambulatory
• Case mix (single-choice)
  • chronic inflammatory MSK condition
  • acute arthritis
  • non-inflammatory MSK condition
  • systemic rheumatologic disease
  • widespread chronic pain syndrome

Requirements

• Collect 12 observations of achievement (minimum 12)
• At least 5 chronic inflammatory MSK conditions (minimum 5)
  • Only counts when Case mix is chronic inflammatory MSK condition
• At least 2 acute arthritis (minimum 2)
  • Only counts when Case mix is acute arthritis
• At least 2 non-inflammatory MSK conditions (minimum 2)
  • Only counts when Case mix is non-inflammatory MSK condition
• At least 2 systemic rheumatologic diseases (minimum 2)
  • Only counts when Case mix is systemic rheumatologic disease
• At least 1 widespread chronic pain syndrome (minimum 1)
  • Only counts when Case mix is widespread chronic pain syndrome
• At least 1 from each setting (minimum 1)
  • Only counts when Setting is inpatient
• At least 1 from each setting (minimum 1)
  • Only counts when Setting is ICU
• At least 1 from each setting (minimum 1)
  • Only counts when Setting is emergency room
• At least 1 from each setting (minimum 1)
  • Only counts when Setting is ambulatory
• At least 3 different assessors (minimum 3)
  • Counted once per distinct Assessor