Adult Rheumatology — Core of Discipline

C5 Managing patients with exacerbations, disease progression, and/or complications of chronic rheumatologic diseases and/or treatment

Key Features:
- The focus of this EPA is the identification, assessment and management of patients with a changing clinical course.
- This EPA includes ordering and interpreting rheumatologic investigations, including serologic and genetic testing, radiologic testing, tissue diagnostics, and interpretation of plain radiographs, managing complications resulting from the disease or from treatment, recognizing the need for change or escalation of therapy and implementing a therapeutic plan.
- This EPA may be observed in the inpatient or outpatient setting and must be observed in a range of rheumatologic diseases.

Assessment Plan:
Indirect observation (case review) by supervisor
Use Form 1. Form collects information on
- Diagnosis (select all that apply): chronic inflammatory MSK condition; SLE; vasculitis; PMR; gout; infection related; medication side effect; disease flares; other systemic rheumatic disease (write in)
- Anatomic site (select all that apply): axial; peripheral; non-articular
Collect 10 observations of achievement.
- At least 5 chronic inflammatory MSK conditions, at least 1 axial and 1 peripheral
- At least 5 systemic rheumatologic diseases, at least 1 SLE, 1 vasculitis, and 1 PMR
- At least 1 infection related
- At least 1 medication side effect
- At least 2 disease flares
- At least 1 non-articular disease flare
- At least 3 assessors

Form

F1: Observation

Milestones

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

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

• ME 1.6. Adapt care as the complexity and uncertainty of the patient’s clinical situation evolves

• ME 1.6. Seek assistance in situations that are new or complex

• ME 2.1. Prioritize which issues need to be addressed

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

• ME 2.2. Interpret the results of investigations identifying disease progression, activity, and complications

• ME 2.2. Interpret the results of investigations identifying complications from treatment

• ME 2.2. Synthesize and interpret information from the clinical assessment

• ME 2.2. Determine the severity and/or stage of the patient’s condition, activity of disease, and risk of progression

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

• ME 1.3. Apply knowledge of clinical pharmacology as it relates to therapeutic agents in rheumatologic disease

• ME 4.1. Prevent and/or manage complications of chronic rheumatologic diseases

• ME 3.1. Identify indications, timing and suitable non-pharmacologic and pharmacologic therapies

• ME 3.3. Triage procedures or therapies taking into account clinical urgency and potential for deterioration

• ME 1.3. Apply knowledge of the risks and benefits of therapeutic options in rheumatologic disease

• COM 3.1. Provide information on diagnosis and/or prognosis clearly and compassionately

• HA 1.1. Work with patients to identify and implement strategies for health promotion

• P 1.1. Respond punctually to requests from patients or other health care professionals

• P 1.1. Exhibit appropriate professional behaviours

Context Variables

• Diagnosis (multiple-choice)
  • chronic inflammatory MSK condition
  • SLE
  • vasculitis
  • PMR
  • gout
  • infection related
  • medication side effect
  • disease flares
  • other systemic rheumatic disease
• Anatomic site (multiple-choice)
  • axial
  • peripheral
  • non-articular

Requirements

• Collect 10 observations of achievement (minimum 10)
• At least 5 chronic inflammatory MSK conditions (minimum 5)
  • Only counts when Diagnosis is chronic inflammatory MSK condition
• At least 1 axial chronic inflammatory MSK condition (minimum 1)
  • Only counts when Diagnosis is chronic inflammatory MSK condition
  • Only counts when Anatomic site is axial
• At least 1 peripheral chronic inflammatory MSK condition (minimum 1)
  • Only counts when Diagnosis is chronic inflammatory MSK condition
  • Only counts when Anatomic site is peripheral
• At least 5 systemic rheumatologic diseases (minimum 5)
• At least 1 SLE (minimum 1)
  • Only counts when Diagnosis is SLE
• At least 1 vasculitis (minimum 1)
  • Only counts when Diagnosis is vasculitis
• At least 1 PMR (minimum 1)
  • Only counts when Diagnosis is PMR
• At least 1 infection related (minimum 1)
  • Only counts when Diagnosis is infection related
• At least 1 medication side effect (minimum 1)
  • Only counts when Diagnosis is medication side effect
• At least 2 disease flares (minimum 2)
  • Only counts when Diagnosis is disease flares
• At least 1 non-articular disease flare (minimum 1)
  • Only counts when Diagnosis is disease flares
  • Only counts when Anatomic site is non-articular
• At least 3 assessors (minimum 3)
  • Counted once per distinct Assessor