COD 3: Assessing patients with medical and/or psychosocial complexity

Key Features

• This EPA builds on the skills achieved in the Foundations stage to focus on obtaining a history and completing a physical exam for patients with undifferentiated, complex single system or multiple active competing conditions at varying levels of chronicity.
• This includes patients with medical and/or psychosocial issues who may be unstable and/or uncooperative.
• It includes developing a prioritized problem list with a differential diagnosis.
• This EPA does not include ongoing management of the patient.

Assessment Plan

Direct observation or case review by supervisor

Use Form 1. Form collects information on:

• Observation: direct; case review
• Setting: inpatient; outpatient; emergency department; community; on call/after hours; NICU; PICU
• Age: neonate; infant; preschool; school age; adolescent
• Type of condition (check all that apply): respiratory; gastrointestinal; ID; cardiac; rheumatic/musculoskeletal; hematology/oncology; endocrine; neurology; renal/genitourinary; otolaryngology/ophthalmology; dermatology; genetic; mental health; developmental/behavioural/psychosocial; allergy/immunology
• Complexity: low; medium; high
• Acuity: emergent; urgent; non-urgent

Collect 4 observations of achievement.

• At least 2 direct observations
• No more than 1 in a neonate
• At least 3 different types of conditions
• No more than 2 assessments with the same type of condition
• At least 2 different assessors

CanMEDS milestones

1. ME 2.2 Gather a history, including all pertinent medical and psychosocial issues
2. COM 2.2 Manage the flow of complex patient encounters
3. ME 2.2 Perform the physical exam in a manner that minimizes discomfort or distress, without excluding key elements
4. ME 2.2 Perform a physical examination relevant to the presentation
5. ME 2.2 Adapt the clinical assessment to the child’s age and development
6. COM 2.3 Seek and synthesize relevant information from other sources (e.g., family, medical record)