Adult Rheumatology — Core of Discipline

C2 Detecting rheumatologic disease abnormalities through physical examination

Key Features:
- The focus of this EPA is the application of knowledge of musculoskeletal (MSK) anatomy across all patient presentations, and the ability to describe findings and document them in a timely manner including synovitis, joint damage, peripheral and axial, enthesitis, and soft tissue abnormalities including small joint abnormalities, as well as extra-articular manifestations.
- This EPA includes MSK physical examination, standardized disease activity measures (e.g. disease activity score), documentation, and patient comfort and privacy/draping.
- Observation of this EPA may include using a STACER to assess the joint count.

Assessment Plan:
Direct observation of MSK physical exam, with particular focus on every joint and enthesis, and case discussion by supervisor
Use Form 1, and a STACER* or equivalent. Form collects information on:
- Joint: foot and ankle; elbow; hand and wrist; neck exam; back and SI joint exam
- Joint count: yes; no
- Extra-articular manifestations: not applicable; skin; eyes; GI; enthesitis; tenosynovitis; other (write in)
Collect 7 observations of achievement
- At least 1 of each joint
- At least 2 joint count STACER or equivalent
- At least 2 assessors
* STACER is not available as an observation form in ePortfolio

Form

F1: Observation

Milestones

• COM 1.2. Optimize the physical environment for patient comfort, dignity, privacy, and safety

• ME 1.3. Apply knowledge of MSK anatomy, including synovial membrane, joints, and soft tissue

• ME 1.3. Apply clinical knowledge of rheumatologic diseases and associated extra-articular manifestations

• ME 2.2. Apply physical examination maneuvers to assess and diagnose rheumatologic disease

• ME 2.2. Perform an MSK exam, identifying abnormal findings

• ME 2.2. Perform the MSK examination in a focused, time-effective manner without excluding key elements

• ME 2.2. Perform a comprehensive joint count for tender joints

• ME 2.2. Perform a comprehensive joint count for swollen joints

• ME 2.2. Apply and integrate evidence with respect to standard disease activity measures

• COM 5.1. Document clinical encounters in an accurate, complete, clear, and timely manner

Context Variables

• Joint (single-choice)
  • foot and ankle
  • elbow
  • hand and wrist
  • neck exam
  • back and SI joint exam
• Joint count (single-choice)
  • yes
  • no
• Extra-articular manifestations (multiple-choice)
  • not applicable
  • skin
  • eyes
  • GI
  • enthesitis
  • tenosynovitis
  • other

Requirements

• Collect 7 observations of achievement (minimum 7)
• At least 1 of each joint (minimum 1)
  • Only counts when Joint is foot and ankle
• At least 1 of each joint (minimum 1)
  • Only counts when Joint is elbow
• At least 1 of each joint (minimum 1)
  • Only counts when Joint is hand and wrist
• At least 1 of each joint (minimum 1)
  • Only counts when Joint is neck exam
• At least 1 of each joint (minimum 1)
  • Only counts when Joint is back and SI joint exam
• At least 2 joint count STACER or equivalent (minimum 2)
  • Only counts when Joint count is yes
• At least 2 assessors (minimum 2)
  • Counted once per distinct Assessor