Adult Rheumatology — Transition to Discipline

TTD1a Performing histories and physical examinations in uncomplicated patients with rheumatologic disease, including documenting and presenting findings - Part A: History and Physical

Key Features:
- The focus of this EPA is the use of an organized approach and appropriate technique for musculoskeletal (MSK) history and physical examination.
- This EPA includes a review of systems as it relates to rheumatologic diseases, enquiring for symptoms of extra-articular manifestations, documenting the findings in an organized and well synthesized presentation, and structuring clinical notes for patients with rheumatologic disease.
- The EPA also includes demonstrating appropriate technique for joint examinations, including small joints, large joints, temporomandibular joints (TMJs), peripheral and axial joints, and differentiation of inflammatory from non-inflammatory pain.
- This EPA does not include interpretation of findings or accuracy of findings.
- Observation of this EPA is divided into two parts: history and physical; assessment and documentation.

Assessment Plan:
Direct observation by supervisor
Use Form 1. Form collects information on:
- Task (select all that apply): rheumatologic history; MSK exam (physical)
- Exam techniques (select all that apply): small joint (MCP, PIP, DIP, wrists, MTP); large joint (knees, hips, ankles, shoulders, elbows); peripheral and axial joint; not applicable
Collect 2 observations of achievement
- At least 1 history
- At least 1 MSK examination

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of uncomplicated rheumatologic diseases and symptoms of extra-articular manifestations

• COM 2.1. Use patient-centred interviewing skills to effectively gather all relevant information

• ME 2.2. Elicit a history relevant to the rheumatologic presentation

• ME 2.2. Perform a focused MSK physical exam using appropriate technique for joint examinations

• ME 2.2. Focus the clinical encounter, performing it in a time-effective manner without excluding key elements

• COM 2.2. Provide a clear structure for and manage the flow of the patient encounter

Context Variables

• Task (multiple-choice)
  • rheumatologic history
  • MSK exam (physical)
• Exam techniques (multiple-choice)
  • small joint (MCP, PIP, DIP, wrists, MTP)
  • large joint (knees, hips, ankles, shoulders, elbows)
  • peripheral and axial joint
  • not applicable

Requirements

• Collect 2 observations of achievement (minimum 2)
• At least 1 history (minimum 1)
  • Only counts when Task is rheumatologic history
• At least 1 MSK examination (minimum 1)
  • Only counts when Task is MSK exam (physical)