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