Adult Rheumatology — Foundation of Discipline

F2 Triaging and proposing initial management of patients with emergency rheumatologic conditions

Key Features:
- The focus of this EPA is the recognition and initial management of emergent and urgent conditions.
- This includes clinical assessment, ordering of appropriate investigations in a timely manner, follow up, patient and family counselling as indicated, communication with attending physician and other health care providers, and appropriate documentation.
- This EPA may be observed in a variety of settings: telephone consult (3-way phone call with supervisor, resident and referring MD); inpatient consult (sharing plan with referring team); clinic visit; ER consult; case discussion; simulation.

Assessment Plan:
Direct or indirect observation by supervisor
Use Form 1. Form collects information on:
- Setting: inpatient; outpatient; emergency room; simulation
- Case mix (select all that apply): serious infections and conditions related to immune suppression; SLE/APL emergency; GCA and systemic vasculitis emergency; scleroderma emergency; suspected septic arthritis with synovial fluid interpretation; HLH/MAS
Collect 2 observations of achievement
- No more than 1 in simulation setting
- At least 2 examples of the case mix
- At least 2 assessors

Form

F1: Observation

Milestones

• ME 2.1. Identify clinical emergencies and prioritize response

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance

• ME 2.2. Perform focused clinical assessments in a time-effective manner, without excluding key elements

• COM 2.3. Seek and synthesize relevant information from other sources

• ME 2.2. Select and/or interpret appropriate investigations

• ME 2.4. Develop and implement plans for initial management

• ME 4.1. Ensure follow-up on results of investigation and response to treatment

• ME 4.1. Coordinate management plans with attending physicians and other health care professionals

• COL 1.3. Communicate effectively with physicians and other health care professionals

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

Context Variables

• Setting (single-choice)
  • inpatient
  • outpatient
  • emergency room
  • simulation
• Case mix (multiple-choice)
  • serious infections and conditions related to immune suppression
  • SLE/APL emergency
  • GCA and systemic vasculitis emergency
  • scleroderma emergency
  • suspected septic arthritis with synovial fluid interpretation
  • HLH/MAS

Requirements

• Collect 2 observations of achievement (minimum 2)
• No more than 1 in simulation setting
  • Only counts when Setting is simulation
• At least 2 examples of the case mix (minimum 2)
• At least 2 assessors (minimum 2)
  • Counted once per distinct Assessor