Adult Rheumatology — Core of Discipline

C4 Providing ongoing management for patients with stable, chronic and/or complex conditions

Key Features:
- This EPA focuses on the recognition of patients with a stable clinical course and their ongoing management that includes implementing screening, ordering and interpreting rheumatologic investigations including plain radiography, discussing findings with patients, surveillance or monitoring strategies, assessing medication adherence and effects, and addressing patient concerns, education and appropriate follow-up.
- This EPA must be observed in a range of rheumatologic diseases and may be completed in the inpatient or outpatient setting.

Assessment Plan:
Indirect observation (case review) by supervisor
Use Form 1. Form collects information on
- Case mix (select all that apply): chronic inflammatory axial MSK condition; chronic inflammatory peripheral MSK condition; systemic rheumatologic disease (SLE, vasculitis, myositis, Sjögren's, scleroderma/morphea)
- Comorbidities (select all that apply): none; anticoagulation issues; multiple comorbid diseases; extra-articular manifestations of rheumatologic disease; chronic liver disease; chronic kidney disease; childbearing age with preconception consideration; pregnancy; malignancy; significant social barriers to health care; cultural, language and/or religious barriers to communication and/or care; pre-op
Collect 7 observations of achievement
- At least 1 female patient with preconception consideration
- At least 1 pregnant patient
- At least 4 patients with comorbidities
- At least 1 pre-op
- At least 3 different assessors

Form

F1: Observation

Milestones

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

• ME 1.3. Apply knowledge of physiology and pathophysiology of chronic rheumatologic disease and its progression

• ME 2.1. Iteratively establish priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves

• ME 2.2. Select and interpret rheumatologic investigations, including plain radiography

• ME 2.2. Assess medication adherence, response to therapy and adverse effects

• ME 2.3. Establish goals of care, which may include slowing disease progression, improving function or palliation

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

• COM 1.6. Adapt communication to the unique needs and preferences of the patient

• HA 1.2. Recognize potential barriers such as illness, health literacy, cultural practice/beliefs and language skills

• COM 3.1. Share information and explanations that are clear and accurate while checking for understanding

• ME 4.1. Implement a plan for ongoing care, follow-up on investigations, response to treatment and monitoring for disease progression

• HA 1.2. Select patient education resources related to rheumatology

• HA 1.2. Work with patients to increase their understanding of their condition and associated comorbidities, supporting their active role in their disease management

Context Variables

• Case mix (multiple-choice)
  • chronic inflammatory axial MSK condition
  • chronic inflammatory peripheral MSK condition
  • systemic rheumatologic disease (SLE, vasculitis, myositis, Sjögren's, scleroderma/morphea)
• Comorbidities (multiple-choice)
  • none
  • anticoagulation issues
  • multiple comorbid diseases
  • extra-articular manifestations of rheumatologic disease
  • chronic liver disease
  • chronic kidney disease
  • childbearing age with preconception consideration
  • pregnancy
  • malignancy
  • significant social barriers to health care
  • cultural, language and/or religious barriers to communication and/or care
  • pre-op

Requirements

• Collect 7 observations of achievement (minimum 7)
• At least 1 female patient with preconception consideration (minimum 1)
  • Only counts when Comorbidities is childbearing age with preconception consideration
• At least 1 pregnant patient (minimum 1)
  • Only counts when Comorbidities is pregnancy
• At least 4 patients with comorbidities (minimum 4)
• At least 1 pre-op (minimum 1)
  • Only counts when Comorbidities is pre-op
• At least 3 different assessors (minimum 3)
  • Counted once per distinct Assessor