Adult Rheumatology — Core of Discipline

C7b Counselling patients/families regarding diagnosis and treatment plans for a broad range of rheumatologic diseases - Part B: Counselling on the Treatment Plan

Key Features:
- The focus of this EPA is the application of communication skills to convey diagnosis and counsel patients regarding treatment; this includes being sensitive to patient specific factors (e.g., age, gender, religion, culture, preferences) applying a patient/family-centred approach, explaining clearly (lack of jargon) and compassionately, discussing alternatives, engaging in shared decision making, respecting patient autonomy, and assessing the patient's understanding.
- This EPA includes discussing indications, adverse events, monitoring requirements, immunizations, reproduction, reimbursement for non-biologic and biologic disease-modifying antirheumatic drugs (DMARDs) and other immunosuppressive medications, non-pharmacologic therapies and appropriate immunization counselling.
- This EPA also includes counselling regarding biologics/DMARDS medications.
- This EPA may be observed in the simulation setting.
- The observation of this EPA is divided into two parts: diagnosis and counselling on disease state; and counselling on the treatment plan.

Assessment Plan:
Direct observation by supervisor
Use Form 1. Form collects information on:
- Medication: MTX; biologic /targeted synthetic DMARD; cyclophosphamide; other (write in)
Collect 3 observations of achievement
- At least 1 of each of the following medications: MTX; biologic /targeted synthetic DMARD; cyclophosphamide
- At least 2 assessors

Form

F1: Observation

Milestones

• ME 3.2. Apply knowledge of the indications and contraindications, and positive and adverse effects of biologics or DMARD medications

• ME 4.1. Implement a plan for monitoring and adjusting biologics or DMARD medication prescriptions and treatment plans

• ME 4.1. Establish plans for ongoing care

• COM 1.1. Communicate using a patient-centred approach that encourages patient trust and autonomy

• COM 1.5. Recognize when strong emotions are affecting an interaction and respond appropriately

• COM 1.6. Tailor approaches to decision-making to patient capacity, values, and preferences

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

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

• HA 1.1. Identify barriers to access in the health care and social service system for individual patients

• L 1.2. Contribute to a culture that promotes patient safety

• HA 1.3. Incorporate prevention, health promotion and health surveillance into patient interactions

Context Variables

• Medication (single-choice)
  • MTX
  • biologic /targeted synthetic DMARD
  • cyclophosphamide
  • other

Requirements

• Collect 3 observations of achievement (minimum 3)
• At least 1 MTX (minimum 1)
  • Only counts when Medication is MTX
• At least 1 biologic /targeted synthetic DMARD (minimum 1)
  • Only counts when Medication is biologic /targeted synthetic DMARD
• At least 1 cyclophosphamide (minimum 1)
  • Only counts when Medication is cyclophosphamide
• At least 2 assessors (minimum 2)
  • Counted once per distinct Assessor