Adult Rheumatology — Core of Discipline

C6 Assessing and managing patients in whom there is uncertainty in rheumatologic diagnosis and/or treatment

Key Features:
- The focus of this EPA is recognizing uncertainty, developing a plan to care for the patient, and recognizing when patients may benefit from referral to a specialty clinic or investigational protocol.
- This EPA includes the clinical assessment and management as well as effective communication of uncertainty to the patient/family and primary care or referring physician.
- This EPA also include evidence-informed decision-making, and critical appraisal and synthesis of literature, thus modeling lifelong learning.

Assessment Plan:
Case discussion and/or review of clinical documentation by supervisor
Use Form 1. Form collects information on:
- Type of observation: consult note/written communication; case discussion
Collect 2 observations of achievement
- At least 1 review of consult note/written communication to other MD
- At least 1 case discussion of management plan following literature review and decision-making

Form

F1: Observation

Milestones

• ME 1.6. Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice

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

• ME 2.2. Revise the differential diagnosis in response to new clinical information, or response to treatment

• ME 2.4. Demonstrate flexibility in clinical reasoning in the setting of clinical uncertainty

• P 1.1. Identify limits in their own expertise

• S 3.3. Critically evaluate the integrity, reliability, and applicability of health-related research and literature

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

• ME 2.4. Establish a patient-centred management plan despite limited, non-diagnostic, or conflicting clinical data

• COM 3.1. Convey information related to the uncertainty in diagnosis and/or treatment in a clear, timely, and transparent manner

• COM 4.1. Use communication skills and strategies that help the patient make informed decisions

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

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

Context Variables

• Type of observation (single-choice)
  • consult note/written communication
  • case discussion

Requirements

• Collect 2 observations of achievement (minimum 2)
• At least 1 review of consult note/written communication to other MD (minimum 1)
  • Only counts when Type of observation is consult note/written communication
• At least 1 case discussion of management plan following literature review and decision-making (minimum 1)
  • Only counts when Type of observation is case discussion