1 Intro to Clinical Practice 2 COLLABORATOR Key competencies - - PowerPoint PPT Presentation

Intro to Clinical Practice

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COLLABORATOR

Key competencies

PHYSICIANS ARE ABLE TO:

• 1. Work effectively with physicians

and other colleagues in the health care professions

• 2. Work with physicians and other

colleagues in the health care professions to promote understanding, manage differences, and resolve conflicts

• 3. Hand over the care of a patient to

another health care professional to facilitate continuity of safe patient care

Enabling competencies

1.1 Establish and maintain positive relationships with physicians and other colleagues in the health care professions to support relationship-centred collaborative care 1.2 Negotiate overlapping and shared responsibilities with physicians and

• ther colleagues in the health care professions in episodic and ongoing

care 1.3 Engage in respectful shared decision-making with physicians and other colleagues in the health care professions 2.1 Show respect toward collaborators 2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture 3.1 Determine when care should be transferred to another physician or health care professional 3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care

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§ Case Presentations

§ Concise vs. Detailed

§ Consultations

§ Direct (face-to-face, telephone) vs. Indirect (written)

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1.

Practice a structured process for presenting clinical cases to a preceptor (F-SOAP)

2.

Identify tools that support a clinical consultation request (e.g. RAAPID, ROCA)

3.

Practice a structured process for communicating with consultants (5Cs)

4.

List elements to include in written clinical consultation

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FRAME

• Stable/unstable
• Identifying data (age, gender)
• Chief complaint
• Pertinent PMHx for chief complaint

STORY

• Chronological HPI
• Pertinent positives and negatives

OBJECTIVE DATA

• Start with vital signs
• Relevant physical exam and

investigations

ASSESSMENT

• DDX: most likely dx and top 3 others

(include dangerous ddx and common ddx in list of alternatives)

PLAN

• Symptomatic treatment
• Investigations and management
• Disposition
• Patient education

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Groups of 2-3

1 Learner (presents case) 1 Preceptor (listens to case and can ask clarifying questions) 1 Observer Rotate roles so that everyone gets to present as a learner

Read & Make Notes Practice & Peer Feedback Group Debrief

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10 min 25 min 10 min

§ She is here for chest discomfort. It started 3 hours ago while she was sitting

watching Wheel of Fortune. It doesn’t get worse when she takes a deep breath in

• r radiate anywhere, but she has been feeling a little nauseous over the past 3

hours with it. She describes it as more of a pressure sensation and rates it 6/10

• presently. She’s never had this before. She doesn’t have any infectious symptoms

and she hasn’t felt light-headed or fainted. She denies any palpitations, sweats, positional, or exertional change to the chest pressure sensation. She also hasn’t travelled, had surgery, or suffered any recent injuries.

§ She tells you that she smokes, but doesn’t take any recreational drugs or alcohol. § Her father had a heart attack at age 70 and her mother had asthma. § She is on metformin for DM, Ramipril for HTN, and atorvastatin for dyslipidemia.

She has no allergies. She’s never had a heart attack before.

§ On exam: § Vitals: Temp 37.3, HR 90, RR 22, Sats 94% RA, BP 110/77 § CVS: JVP normal, S1/S2 normal, no murmurs or extra heart sounds, strong and

regular pulse

§ Resp: lungs are clear, no increased work of breathing, her chest pain is not

reproducible on palpation. When asked to point to the location of her chest discomfort, she presses on her sternum.

§ Abdo: Soft, non-tender, non-distended, she has old scars for previous

appendectomy

§ Extremities: no calf swelling or tenderness

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FRAME STORY OBJECTIVE DATA ASSESSMENT PLAN

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Verbal vs. Written

Based on urgency

5Cs Model

How to effectively ask for clinical guidance

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§ RAAPID:

§ Referral, Access, Advice, Placement, Information, and

Destination service

§ Call centre that coordinates consultations and transfers (esp

from rural sites)

§ ROCA:

§ Regional On Call Application § Updated contact registry for on-call services in Calgary

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Contact

• Identify name, rank, service

(including self, staff, and consultant)

Core Question

• Question for consultant or reason

for consultation

• Include urgency/timeline

Communicate

• Communicate case (F-SOAP)
• Include what has already been

done (investigations/management)

Collaborate

• Work with consultant to

determine next steps

Close the Loop

• Repeat plan
• Confirm roles and responsibilities

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Groups of 2-3

1 Learner (presents case) 1 Preceptor (listens to case and can ask clarifying questions) 1 Observer Rotate roles so that everyone gets to present as a learner

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Read & Make Notes Practice & Peer Feedback Group Debrief

10 min 25 min 5 min

§ ID: Stable condition 52yo M admitted to MTU for mild pancreatitis § CC: Newly developed melena stools x 2 episodes § HPI: Admitted to MTU 3 days ago for confirmed mild pancreatitis. 2 episodes

• f melena stools today, but otherwise no nausea, vomiting, diarrhea, or

fever/chills.

§ PMHx/SHx: ETOH abuse (no liver disease or varices), peptic ulcer disease § FHx: Non-contributory § Meds: None § Relevant Exam Features: § Vitals: Temp 37.3, HR 90, RR 22, Sats 94% RA, BP 110/77 § Mild epigastric discomfort, but non-peritonitic abdomen and rectal exam

significant for small amount of melena stool only.

§ Treatment started:

§ NPO, IV PPI, bloodwork (CBC, INR/PTT)

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Contact Core Question Communicate Collaborate Close the Loop

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To: Consultant CC: Patient’s GP. Re: Patient XY, ID# Date: MM-DD-YYYY Reason for Referral: <The Core Question for the consultant> Patient contact info: working phone number (double check this with the patient) Dear Dr. X Patient XY is a __yo M/F evaluated at ______ on MM-DD-YYYY for <Chief Complaint or suspected/confirmed diagnosis if available>. PMHx includes _________. She is currently on the following medications: ____. <Brief HPI and relevant physical exam/investigation synopsis>. <Management and investigations initiated thus far>. <Close the loop on next steps for the consultant to manage>. Thank you for your assistance. Signed, XX

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§ Clear question § Identifying information and patient contact information § Clarify treatment and management plans in the interim § Write legibly if writing by hand

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§ Whenever possible, take a moment to organize your

presentation before speaking

§ Consider your Ddx early on to help guide relevant details

to include in your presentation

§ Take a stab at the A & P, even if you’re not sure – it’s a

great way to learn!

§ For consults, remember to have a clear question in mind

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YOUR FEEDBACK IS IMPORTANT ! Feedback helps improve

This session Your facilitators The MED SCHOOL EXPERIENCE

1. Haber R. and Lingard L. Learning Oral Presentation Skills: A Rhetorical Analysis with Pedagogical and Professional Implications. JGIM. 2001;16:308-314. 2. Rosenfield D., Smaggus A, and Detsky A. The Art of Presenting. CMAJ. 2011;183(18):E1356-1358. 3. Davenport C., Honigman B., and Druck J. The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme. SAEM. 2008;15(7):683-687. 4. Wiese J., Saint S., and Tierney L. Using Clinical Reasoning to Improve Skills in Oral Case

• Presentation. Sem in Med Prac. 2002;5(3):29-36.

5. Go S, Richards DM, Watson WA. Enhancing medical student consultation request skills in an academic emergency department. The Journal of Emergency Medicine. 1998;16(4):659-662. 6. Kessler C, Afshar Y, Sardar G, Yudkowsky R, Ankel F, Schwartz A. A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5Cs of Consultation. Academic Emergency Medicine. 2012;19(8)968-974. 7. Kessler C, Kalapurayil PS, Yudkowsky R, Schwartz A. Validity Evidence for a New Checklist Evaluating Consultations, The 5Cs Model. Acad Med. 2012;87:1408-1412. Workshop designed by Katie Lin and Anthony Seto. Workshop piloted April 2017 by Katie Lin, Anthony Seto, and Steven Liu. Piloted again December 2017 by Anthony Seto.

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