Queen's Family Medicine Objectives - Family Medicine Objectives

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					                                                              Queen's Family Medicine Objectives
Family Medicine Expert: Using a patient-centered approach the Family Medicine resident will, while considering racial, cultural and gender differences:
FME 1: Demonstrate appropriate assessment of patients with:
     FME 1.1 Acute minor illnesses
stroke, drug reaction, malignant neuroleptic syndrome).Investigate patients with fever of unknown origin appropriately. In the immune compromised patient with fever,
consider atypical presentations and the need for early intervention.
1.1.2 Assess hydration status in patients with hyperthermia and/or fluid loss (e.g. vomiting, diarrhea)
or during travel (e.g.. Malaria, parasitic disease, tuberculosis) and inquire about the use of alternative healers and/or medications (e.g. "natural" or herbal medicines,
spiritual healers, medications from different countries, moxibustion.)
congenital skin lesions)
1.1.5 Recognize the significance of dysmorphism or congenital anomalies and refer for genetic assessment.
1.1.6 Recognize the difference in the presentation of infectious disease in the elderly.
1.1.7 Recognize potential allergic symptoms (skin, ophthalmologic, ENT, systemic)
search for an underlying cause
symptoms).
1.1.10 Assess children presenting with strabismus, dacryocystitis, preorbital and orbital cellulitis determining need for referral.
1.1.11 Diagnose otitis media upon visualization of the TM and include pain referred from other sources in the differential diagnosis of an earache (e.g.. tooth abscess,
trigenminal neuralgia TMJ dysfunction pharyngitis etc)
1.1.12 Assess hearing in all children presenting with language delay
1.1.13 Have an approach to vertigo with knowledge of benign and serious causes (BPV, stroke, labyrinthitis).
1.1.14 Differentiate viral from bacterial sinusitis and bronchitis
1.1.15 Use the sore throat score and consider mononucleosis in investigating patients with a sore throat.
1.1.16 Obtain a history to determine the cause in patients with epistaxis. Obtain lab work when necessary.
1.1.17 Distinguish allergic, viral and bacterial conjunctivitis.
(e.g.. pupil size, and visual acuity, slit lamp, fluorescein). Do appropriate investigations (e.g., erythrocyte sedimentation rate measurement, tonometry). Consider
underlying systemic causes, when the diagnosis is iritis.
1.1.19 Diagnose and manage other common eye lesions such as hordeolum, chalazion, pterygium, pingueculum.
slit lamp and evert the eyelid to look for a foreign body
1.1.21 Include allergy (e.g.. Sick building syndrome, seasonal allergy) in the differentiated diagnosis of a patient with unexplained respiratory symptoms.
1.1.22 Include asthma and COPD as part of the differential diagnosis in a patient with respiratory symptoms
1.1.23 Objectively determine the severity of asthma or COPD (i.e.. pulmonary function testing)
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malformationsin children) in patients with an acute, persistent or recurrent cough
1.2.25 Recognize the need for further workup for secondary hypertension
1.1.26 Distinguish innocent and abnormal cardiac murmurs and evaluate appropriately for congenital heart disease.
1.1.27 Diagnose specific gastrointestinal pathology commonly seen in primary care (e.g.. gastroesophageal reflux disease, peptic ulcer disease, irritable bowel syndrome,
celiac disease)
1.1.28 Have an approach to diagnosis in a patient with abnormal liver enzymes differentiating hepatocellular and obstructive patterns
1.1.29 Establish a diagnosis (e.g.. infectious, malabsorption, immune, irritable bowel) in a patient with acute or chronic diarrhea.
1.1.30Recognize extra intestinal manifestations in a patient with a diagnosis of inflammatory bowel disease (IBD).
1.1.31 Identify patients at high risk of GI bleed and modify treatment appropriately.
1.1.32ppropriately investigate a patient presenting with upper or lower gastrointestinal bleeding (non-life threatening).
1.1.33 In women with abdominal pain, always rule out pregnancy in the reproductive age group and suspect gynecologic etiology for abdominal pain.
1.1.34 In any woman with vaginal bleeding, rule out pregnancy.
foreign body, STI's
1.1.36 Diagnose breast pain, breast lump, or breast discharge
prostatis, vaginitis etc.when appropriate

                                                                                  Page 1                                      Care of Adults Table Template Revised April 14 2010
and investigations.
spine rules, and knee rules) to guide the use of X-ray examinations and know which fractures you need to manage according to your clinical suspicion, even if X-rays are
normal (e.g.. scaphoid fractures in wrist injuries, elbow fracture, growth plate fracture in children, stress fractures)
 Evaluate and manage a child presenting with limp, intoeing, alignment abnormalities/scoliosis, joint instability, swelling or pain.
1.1.39 Recognize common skin conditions (ex. atopic dermatitis, acne, viral exanthems, candidiasis, impetigo, seborrheic dermatitis, cellulitis).
1.1.40 Recognize important rashes and investigate for possible serious underlying illness (petechiae, purpura, erythema nodosum, erythema migrans, café au lait spot)
1.1.41 Evaluate patients presenting with animal, insect, snake, and human bites assessing for nerve and tissue damage and infection
relief of symptoms with treatment excludes serious pathology
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lifestyle, other illnesses)
Learning Disorder,          Autism Spectrum Disorder, Fetal Alcohol Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Cerebral Palsy, Myelodysplastic and
Neuromuscular Disorders). .
1.1.44Evaluate children with disruptive behaviour (ODD, CD) or possible mood/psychotic disorder and refer appropriately.
and addiction.
FME 1.2 Acute serious illnesses
needed.
need for youth protrection.
1.2.3 Include recurrence or metastatic disease in the differential diagnosis in patients with a distant history of cancer who present with new symptoms.
1.2.4 With a patient with weakness, investigate appropriately and distinguish between non-neurological causes of weakness (e.g.infections, myocardial infarction,
endocrine, metabolic, and psychiatric disease states) and neurological causes (upper motor neuron from lower motor neuron, or neuromuscular disorders).
1.2.5 Have some knowledge of common hematological malignancy (leukemia, lymphoma, myeloma)including the presenting symptoms and investigations.

1.2.6 Be able to investigate a patient presenting with a bleeding disorder, or an acute coagulopathy (warfarin overdose, liver disease, sepsis etc.)
1.2.7 In patients with poisoning take a thorough history from many sources to guide toxicological diagnosis.
1.2.8 Make the diagnosis of and determine the underlying cause for, dehydration and electrolyte (sodium, potassium), acid base and calcium imbalances.
1.2.9 Recognize signs and symptoms of new onset Type 1 diabetes and complications (ketoacidosis, hyperosmolar coma, severe hypoglycemia)
1.2.10 Differentiate between causes, and provide appropriate management, of acute visual loss.
1.2.11 Recognize those eye conditions (visual loss, acute glaucoma, retinal detachment) which must be referred urgently for management with the ophthalmologist.
1.2.12 Consider serious causes in the differential diagnosis of an ongoing earache (e.g.. Tumors, temporal arteritis, mastoiditis).
1.2.13 Recognize and refer appropriately potentially life-threatening upper respiratory presentations such as epiglotitis and retropharyngeal abscess
hospitalization
1.2.15 Evaluate severity of respiratory distress and manage respiratory emergencies (ex. epliglottitis, retropharyngeal abscess, anaphylaxis, foreign body aspiration,
review medications, and investigate appropriately.
atypical presentations, pulmonary embolism, dissecting aneurysm)
1.2.18 In a patient presenting with symptoms suggestive of ischemic heart disease but in whom the diagnosis may not be obvious, do not eliminate the diagnosis solely
because of tests with limited specificity and sensitivity (e.g.. electrocardiography, normal enzyme results).
1.2.19 Recognize hypertensive crisis.
1.2.20 Assess a patient who presents with a painful or swollen leg in terms of his/her risk for ischemic vascular disease or DVT and investigate appropriately.
1.2.21 Assess cardiovascular function and determine the underlying cause in patients with heart failure (systolic and diastolic).
1.2.22 Given a suspected diagnosis of pulmonary embolism, do not rule out the diagnosis solely on the basis of a test with low sensitivity and specificity
1.2.23 Have an approach to arrhythmia
1.2.24 Include cardiac causes and other conditions as part of the differential diagnosis in patients presenting with dyspepsia and rule out serious conditions.
1.2.25 Differentiate causes of patients with hematemesis, hematochezia, or melena


                                                                                 Page 2                                      Care of Adults Table Template Revised April 14 2010
1.2.26 Generate a complete differential diagnosis including group-specific surgical cases of acute abdominal pain in specific patient groups such as children, pregnant
women and the elderly. In women with abdominal pain, always rule out pregnancy in the reproductive age group and suspect gynecologic etiology for abdominal pain
1.2.27 Diagnose diverticulitis, pancreatitis and inflammatory bowel disease.
1.2.28 Form comprehensive differential diagnoses and management plans for gastrointestinal complaints in children including less common but serious illnesses knowing
that these may present atypically (vomiting, acute/chronic abdominal pain, acute/chronic diarrhea, constipation, failure to thrive).
1.2.29 Differentiate vaginal infections from other vulvar conditions such as lichen sclerosis, other dermatologic conditions, vulvar dysplasia/cancer
1.2.30 Diagnose abnormal vaginal bleeding in the non-pregnant women including determination and management of hemodynamic instability
appropriate.
1.2.32 Use history and physical to rule out serious causes in a patient with low back or neck pain,
1.2.33 Look for and diagnose high-risk complications (e.g.. an open fracture, unstable cervical spine, compartment syndrome) in patients with fractures.
Ray)
1.2.25 Identify non-articular symptoms of rheumatic disease. (vasculitis, dermatologic, ocular)
investigations (e.g.. Biopsy or excision)
1.2.27 Understand the cutaneous manifestations of systemic disease and be able to diagnose using history, physical and appropriate investigations.
patient including stopping further injury, covering of burn area, protecting the airway, resuscitation and fluid replacement, providing monitoring, and ensuring pain control
and identify patients requiring transfer to a burn unit.
1.2.29 In patients with severe lacerations identify situations which require special skill for repair based on location, depth or complications.
fashion to determine eligibility for thrombolysis.
recognition of reversible conditions (shock, hypoxia, hypoglycemia, drug overdose).
1.2.32 Distinguish simple from complex febrile seizures in children and investigate appropriately.
1.2.33 Be able to recognize and appropriately investigate benign versus life-threatening causes of headaches (trauma, subarachnoid hemorrhage, meningitis).
investigations and neuroimaging.
1.2.35 When assessing patients anticipate possible violent or aggressive behavior and recognize the warning signs
FME 1.3 Chronic conditions
cause of the symptoms, while continuing to search for other organic pathology.
1.3.2 Given a patient with multiple defined medical conditions, periodically assess forg
             p             p yp          y        yp                      y q           g      secondary anxiety and/or depression, as they are particularly at risk for it.
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status, and include the diagnosis of medications as a cause of atypical presentations.
depression and adverse effects from medication in the differential diagnosis and avoid early, routine investigations in patients with fatigue unless specific indications for
such investigations are present.
pain and the use of the standard tools used in symptom assessment
1.3.6 Recognize the importance of serial weight measurement in cases of suspected malnutrition, failure to thrive and when monitoring treatment of conditions with
potential for fluid overload (e.g. congestive heart failure, renal failure, liver failure) and when abnormal investigate for cause when indicated.
1.3.7 Recognize the high prevalence of eating disorders in adolescents
1.3.8 Make a diagnosis of obesity with a clear definition, assess for treatable co-morbidities, inquire about the effect of obesity on the patient’s personal and social life,
establish the patient’s readiness to make changes to lose weight, and advise the obese patient seeking treatment.
1.3.9 Appropriately investigate patients suspected with thyroid disease and limit testing for thyroid disease to patients with a significant pre-test probability of abnormal
results
1.3.10 Diagnose patients with chronic urticaria and recurrent allergic upper respiratory seasonal allergies, etc.
resident consider sources of referred pain.
1.3.12 Use anp   evidence-based approach to the g
                                pp                 assessment and management of falls.g
                                                                    y                                           g                y          yp
(stress, urge, mixed) and the unique treatment approach requiredyfor each.
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assays, semen analysis, US, and knowledge of resources for referral in the community
components.
Recognize and evaluate precocious puberty and primary amenorrhea.
1.3.16 Diagnose the menopause/perimenopause understanding the pitfalls of hormone assays.

                                                                                    Page 3                                       Care of Adults Table Template Revised April 14 2010
1.3.17 Differentiate different types of tremors, i.e. resting tremor, intention tremor, investigating as indicated
1.3.18 Accurately distinguish between idiopathic and atypical Parkinson’s disease and look for, other coexistingp
                 p                           p                   g       y         ,                         p       , conditions.
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differential diagnoses for symptoms which also include medical causes and contibutors and rule out serious organic pathology. Identify suicide/homicide risk and
1.3.20 Recognize and effectively treat depression in the elderly by utilizing screening tools such as the Geriatric Depression Scale
1.3.21 Recognize that psychiatric disorders (depression, anxiety) may present differently in children
1.3.22 Recognize signs of declining cognitive function in elderly individuals, such as poor hygiene, memory complaints from patients of their family members and difficulty
with IADL’s such as banking and meal preparation and appropriately administer assessment g
                          y     g            yp                        yp                 ,        tools (mini-cog, MMSE, MOCA) understanding their limitations.
                                                                                                                         ,     y     y       ,             p
Vascular Dementia.
1.3.24 Be aware of the laws pertaining to competence (eg. POA, Public Guardian and Trusteeship, the Mental Health Act).
1.3.25 Understand the concepts of Basic Activities of Daily Living (BADL’s) and Instrumental Activities of Daily Living (IADL’s).
assessment.
1.3.27 Understand the relationship between laboratory values and aging and correctly interpret data in this context.
FME 1.4 Psychosocial conditions
1.4.1 Identify signs of abuse and neglect (child, elder) and understand the importance of reporting these findings to the appropriate authorities.
1.4.2 Know the available community resources and offer referral to all people affected by the assault
FME 2: Demonstrate appropriate management of patients with:
FME 2.1 Acute minor illnesses
2.1.1 Direct oral or parenteral fluid resuscitation in dehydrated patients
2.1.2 Manage potential allergic symptoms (skin, ophthalmologic, ENT, systemic) using avoidance, pharmacotherapy, and desensitization where appropriate.
2.1.3 Use a selective approach in ordering cultures and make rational antibiotic choices using specific knowledge of first-line therapies, local resistance patterns, patient’s
medical and drug history and patient’s context.. In a febrile patient with a viral infection, do NOT prescribe antibiotics.
2.1.4 Prescribe antibiotics for bacterial upper respiratory infections, delaying antibiotic treatment where appropriate.
2.1.5 Manage common eye conditions such as conjunctivitis, blocked lacrimal duct in the newborn, hordeolum, chalazion, pterygium, pingueculum.
2.1.6 Direct treatment or referral for patients presenting with decreased visual acuity, strabismus, preorbital and orbital cellulitis.
2.1.7 In patients presenting with DVT manage appropriately including outpatient treatment
2.1.8 Manage patients with acute diarrhea (diet, fluid replacement, need for antibiotics, jobs requiring time off until settled)
 2.1.9 Appropriately manage a patient presenting with upper or lower gastrointestinal bleeding (non-life threatening).
2.1.10 Manage patients presenting with dysuria
2.1.11 Manage vaginal discharge appropriately including not treating asymptomatic yeast and bacterial vaginosis
provide treatment before confirmation by laboratory results.
2.1.13 In a patient who has had unprotected sex or a failure of the chosen contraceptive method, counsel concerning post-coital contraception (time sensitivity,
contraindications pt preference)
2.1.14 Provide counseling or refer to a source of counseling for women with an unwanted pregnancy
2.1.15 Manage abdominal vaginal bleeding in a non-pregnant woman.
2.1.16 Manage breast pain, breast lump, or breast discharge.
2.1.17 Manage common symptoms of the menopause such as changes in libido, vaginal dryness, urinary tract symptoms, and hot flashes. Discuss individual risks and
benefits of estrogen and other pharmacologic agents for the treatment of hot flashes including herbal remedies
 2.1.18 Manage post-menopausal vaginal bleeding including appropriate use of endometrial biopsy
2.1.19 In patients presenting with animal, insect, snake and human bites culture where appropriate, provide rabies and antibiotic prophylaxis and tetanus immunization
when indicated and select patients whose HIV and hepatitis status needs investigation and treatment.
physical therapists as indicated
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parasitic), psoriasis, allergic/ contact conditions, skin ulcers (vascular, pressure)
FME 2.2 Acute serious illnesses


                                                                                    Page 4                                        Care of Adults Table Template Revised April 14 2010
an Epipen (for home and work) for patients with history of anaphylaxis and educate about proper use and warning signs of anaphylaxis. Consider medic alert bracelet and
referral for allergy testing
individual risk factors and a decision about hospital admission.
neutropenia, and infections.manage and refer appropriately oncological emergencies (tumour lysis syndrome, febrile neutropenia, acute cord compression, superior vena
cava syndrome)
2.2.4 Manage and refer as appropriate serious neonatal conditions (ex. jaundice, hypoglycemia, SGA/LGA, infant born to febrile/GBS positive mother, infant born to
Hepatitis B positive mother, respiratory distress, vomiting in newborn period, sepsis, hypotonia, failure to thrive/dehydration)
syndrome and terminal agitation.
 2.2.6 Manage and refer appropriately a patient presenting with a bleeding disorder, or an acute coagulopathy (warfarin overdose, liver disease, sepsis etc.)
2.2.7 Recognize the acutely ill, new or diagnosed diabetic patient and manage and refer appropriately.
2.2.8 Manage and refer appropriately the acute episode of epislaxis, and provide appropriate after care instruction to prevent recurrence
2.2.9 Appropriately treat patients with heart failure (systolic and diastolic).
2.2.10 Treat in a timely manner patients with life-threatening conditions of chest pain (i.e. ischemic heart disease, pulmonary embolism, dissecting aneurysm)
manage the condition in an appropriate and timely manner.
2.2.12 Treat hypertensive crisis in a timely fashion.
2.2.13 Manage acute exacerbations of asthma or COPD appropriately including assessment for hospitalization.
organism and underlying conditions of the patient.
2.2.15 Be able to manage and refer appropriately patients with diverticulitis, pancreatitis and inflammatory bowel disease.
treatment.
2.2.17 Have an approach to acute renal failure, including underlying cause, understand acute and chronic management and monitoring for complications.
rheumatoid condition
2.2.19 Refer appropriately patients with cord and/or cauda equina compression
2.2.20 Manage vaginal bleeding.Diagnose (and refer appropriately) hemodynamic instability. Manage hemodynamically stable but significant vaginal bleeding (e.g.. with
2.2.21 Manage various prenatal problems (e.g. IUGR, hypertension, maternal infections, gestational diabetes, APH, PROM, etc)
2.2.22 In the post-partum patient manage delayed hemorrhage, depression, infections
 2.2.23 Stabilize and investigate status epilepticus.
2.2.24 Manage treatable causes of delirium
for having patients involuntarily admitted.
FME 2.3 Chronic conditions
2.3.1 Periodically re-address and re-evaluate the management of patients with multiple medical problems in order to simplify their management (pharmacologic and
other),limit polypharmacy,minimize possible drug interactions,update therapeutic choices (e.g., because of changing guidelines or the patient’s situation).
2.3.2Assess all spheres of function in patients and offer a multifaceted approach (medication, rehabilitation, community support, lifestyle modification).
elderly, patients with renal or liver failure)
2.3.4 Have the ability to safely stop commonly used drugs and monitor for signs of withdrawal (eg; SSRI’s, benzodiazepines, beta blockers).
individual needs of the patient
2.3.6 In patients with chronic pain prescribe adjuvant modalities and medications for pain and symptom relief and be aware of and utilize non-pharmacologic strategies
2.3.7 When needed In patients with chronic pain prescribe opioids effectively including initiating dosage, titrating, breakthrough dosing, prevention of side effects,
monitoring, dose equivalency and opiod rotation. Manage side effects (e.g. neurotoxicity) when present.
2.3.8 Be aware of and actively inquire about side effects or expected complications of cancer treatment
2.3.9 In palliative care patients develop and implement management plans for symptoms including fatigue,anorexia and cachexia, constipation,dyspnea, nausea and
vomiting, delirium, skin and mouth care and anxiety and depression. Review and adjust management plans to accommodate the changes that may occur as the end of
2.3.10 ave sensitivity towards quality of life issues and an understanding that quality of life may be of more importance than quantity in some patients
in their fatigue
2.3.12 In patients whose fatigue has become chronic, manage supportively, while remaining vigilant for new diseases and illnesses.

                                                                                 Page 5                                     Care of Adults Table Template Revised April 14 2010
2.3.13 Manage patients with chronic urticaria and recurrent allergic upper respiratory seasonal allergies, etc.
2.3.14 Address obesity including age appropriate guidance on exercise and diet. Be aware of when to use medication and refer for bariatric surgery.
2.3.15 Manage diabetes appropriately using lifestyle, oral agents, and insulin and provide patient and family education. Monitor and manage complications
2.3.16 Manage patients with thyroid dysfunction with medication and check thyroid-stimulating hormone levels at appropriate times
2.3.17 Monitor for progression in ophthalmogic conditions referring when appropriate (e.g.macular degeneration, cataracts)
2.3.18 Effectively use pharmacotherapy to manage COPD and asthma, monitoring for progression.
2.3.19 Offer appropriate respiratory rehabilitation for COPD and emphysema.
2.3.20 Have knowledge of the impact of valvular heart disease on long-term management including prognosis, appropriate medication and follow-up.
2.3.21 Manage a patient with stable ischemic heart disease in a timely manner according to the severity of the disease, and coordinate appropriate follow-up
2.3.22 In patients post MI monitor for side effects of medication initiated in hospital, offer rehabilitation and monitor functional abilities.
2.3.23 Be able to treat hypertension with pharmacological means. For patients with the diagnosis of hypertension assess periodically for end-organ complications.
2.3.24 Initiate and follow anticoagulant treatment (using oral anticoagulants as well as SC Heparin/LMVH and perfusion drips) for venous thromboembolic disease
2.3.25 Manage chronic gastrointestinal conditions commonly seen in primary care (e.g.. gastroesophageal reflux disease, peptic ulcer disease, constipation, irritable
bowel syndrome, celiac disease, chronic diarrhea, lactose intolerance, chronic abdominal pain) referring judiciously
2.3.26 Assess infectivity and HIV status in patients with Hepatitis B and C, counsel regarding harm reduction, and monitor for complications
hypertrophy and sexual dysfunction in males.
2.3.28 Manage common gynecologic problems including dysfunctional uterine bleeding, amenorrhea, chronic pelvic pain, endometriosis,prolapse, and sexual dysfunction
2.3.29 Manage sexual dysfunction where a specific cause has been identified, and be aware of referral sources to assist with further assessment and management.
refer for dialysis management
tolerated.
syndrome).
2.3.33 Offer appropriate rehabilitation and occupational therapy for post-trauma and joint replacement p.atients
2.3.34 Use fall prevention, nutrition, exercise and medication appropriately to treat osteoporosis.
2.3.35 Appropriately treat chronic and recurrent skin conditions (eczema, acne, psoriasis, allergic/ contact conditions, skin ulcers {vascular, pressure})
multiple sclerosis)
prescribe, assess and anticipate side effects of medications
2.3.38 Manage the common causes of headaches (migraine, tension).
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treatment in a way that promotes full discussion of options and patient's own decision-making, use multifaceted approach to treatment, demonstrate knowledge of
indications, side effect profile, common interactions and monitoring requirements of psychopharmacological agents (e.g. antidepressants, antianxiety medications, mood
stabilizers, antipsychotics, and other commonly used agents), demonstrate knowledge of different forms of counselling therapy (including brief psychotherapy, couples
and family therapy, behavior therapy, long-term psychotherapy) and the selection of patients for each modality and monitor response to treatment using functional
FME 2.4 Psychosocial conditions
2.4.1 Understand the psychosocial issues facing patients with chronic disease and how they might be addressed.
2.4.2 Understand the developmental challenges faced by the older person (eg. dealing with loss, coping with chronic disease).
2.4.3 Demonstrate the role of the family physician in assessing and managing grief in patients and families
2.4.4 Identify and assess spiritual issues in end-of-life care.
2.4.5 Identify and address sexual concerns in a patient in a manner that is sensitive to their needs and comfort level, and promotes open discussion.
resources for domestic violence and be able to involve them as appropriate by developing an appropriate emergency plan to ensure the safety of the patient and other
household members.
in sexual assault patients to observations and other necessary medical information (i.e.. avoid recording hearsay information). Assess the need for human
immunodeficiency virus and hepatitis B prophylaxis in patients who have been sexually assaulted in addition to other prophylaxis.
FME 3: Manage multiple clinical issues simultaneously through prioritizing and being selective
consultation.

                                                                                Page 6                                     Care of Adults Table Template Revised April 14 2010
3.2 In all patients presenting with multiple medical concerns, prioritize problems appropriately to develop an agenda that both you and the patient can agree upon (i.e.,
determine common ground) and adapt management strategies and goals incorporating all conditions
frequency of visits).
FME 4: Implement health promotion and screening interventions
4.1 Understand the central role of the family physician in educating regarding health promotion and disease prevention.
patient’s specific circumstances. Use an evidence-based annual physical examination and keep up to date with new recommendations for the periodic health examination
which includes prevention and screening recommendations.
4.3 Learn to administrate an organized vaccination program within family practice including routine vaccinations and those for travel and special populations (e.g. those at
risk for hepatitis, patients with splenectomies, newly arrived immigrants) and be able to discuss benefits, safety and side effects of vaccinations with patients and/or
4.4 Offer post-exposure prophylaxis when indicated (e.g. Non-immune pregnant patients exposed to chickenpox)
diarrhea
4.6 Evaluate all patients for hearing loss risk, including prevention
4.7 Be opportunistic in giving cancer prevention advice
4.8 Stratify patient's risk for cancer (breast, colorectal) and screen appropriately.
smoking cessation.
4.10 Treat modifiable risk factors in patients at risk of stroke and other cardiovascular disease and offer antithrombotic treatment in appropriate populations.
4.11 Screen for hypertension, measure blood pressure correctly, and make a diagnosis on multiple visits, and investigate appropriately to rule out secondary causes.
advice, and periodically assess compliance.
4.13 Screen appropriately for diabetes for all patients
4.14 Screen high-risk patients (vascular disease, DM) for sexual dysfunction.
4.15 Ask about sexual activity and the need for contraception when opportunities arise for all patients. Demonstrate the ability to counsel patients on the use of
contraception. by screening for risk factors and contraindications and discussing side effects and risks of hormonal, barrier, intrauterine and non-pharmacologic methods
of contraception
4.16 Assess risk and counsel the patients at risk for STI's appropriately (HIV testing, prevention)
history.
vitamin D supplementation, sleep positioning)
4.19 In providing care to children employ case-finding as well as evidence based surveillance and screening tools to detect illness, deviation from normal growth and
development and prevent injury. Provide thorough and attentive evaluation of parent’s concerns cognizant that many developmental problems first present this way.
4.20 Understand and be able to counsel parents about normal nutritional needs at different ages. Effectively monitor growth and suggest intervention as necessary.
4.21 Provide education and advice on injury prevention and common behavioural and family issues. Provide suggestions to encourage motor, language and social
4.22 When caring for adolescents, review and counsel about substance abuse, peer issues, home environment, diet/eating disorders, academic performance, social
4.23 For children of all ages, evaluate home, school and recreational environments in terms of supports and stressors and intervene appropriately. Recognize the impact
addiction.
the household, generating an emergency plan if needed
FME 5: Demonstrate timely and proficient performance of relevant procedures
5.1 Be able to safely and effectively carry out core procedural skills as outlined in the CFPC document (add web page, link)
5.2 Demonstrate the knowledge base required to effectively evaluate the indications for procedural and surgical procedures
5.3 Demonstrate awareness of the indications and contraindications of each procedure and the ability to obtain informed consent from patients
first pelvic exam)
5.5 Provide appropriate analgesia for all procedures
5.6 Use techniques which achieve good cosmetic results, do not close wounds at high risk for infections and immunize for tetanus if needed.
required and indications for anesthesia consultation.
5.8 Be prepared to mentally rehearse the landmarks, technical steps and potential complications of each procedure
5.9 Demonstrate knowledge of normal postoperative healing and the ability to manage post- operative complications i.e.. infection, wound dehiscence, keloid formation


                                                                                   Page 7                                       Care of Adults Table Template Revised April 14 2010
5.10 Demonstrate the ability to act effectively as a surgical assistant for major surgical procedures.

Manager: Using a patient centered approach the family medicine resident will:
M 1: Effectively manage their time
1.1 Triage effectively patients presenting with multiple complaints
1.2 Manage difficult or emotionally intense situations or interactions, including setting clear boundaries with respect to appointment length, prescribing practices and
1.3 Manage competing demands (patient care, phone calls, office staff requests, external requests) effectively
M 2: Allocate diagnostic and therapeutic (medications/other health care professionals) resources appropriately
2.1 Have knowledge of community resources and how to best access them
2.2.Balance the individual patient’s concerns against the responsible use of public resources
M 3: Coordinate patient care effectively
3.1 Be aware of the local access issues including wait times for procedures, investigation and placementf
3.2 Understand the placement criteria for different levels of institutional care.
3.3 Determine, record, revise and implement goals of care through effective communication with patient, family and other caregivers.
3.4 Understand the steps needed to end the physician-patient relationship when it is patient's best interests and do so according to guidelines
M 4: Cope with uncertainty
treatment or referral.
Communicator: Using a patient centered approach the family medicine resident will effectively communicate, while considering racial, language, cultural and
COM 1: Develop rapport and trust in a therapeutic relationship
1.1 Communicate information about illness to a patient with compassion and respect.
trust
1.3 In the setting of delivering bad news, understand the value of maintaining hope in the face of reality.
COM 2: Demonstrate a common understanding and plan of care with patients and families
economic factors as well as biological ones.
2.2 Understand informed consent and capacity issues as well as substitute decision making.
stroke).
2.4 Demonstrate the ability to discuss advance care planning, including developing, revising and implementing advance directives with patients and families.
uncomfortable position with respect to his or her literacy
COM 3: Elicit information appropriately from other sources (family and professionals)
psychosis, children, stroke)
COM 4: Use effective written and oral communication for collaborative care (consulting skills, team based care)
4.1 Model principles of effective office organization to support a collaborative system of care including verbal communication and/or clinical note-keeping which facilitates
successful communication amongst team members regarding the ongoing care of complex patients.
COM 5: Effectively present verbal reports of clinical encounters and plans
COM 6: Maintain clear, accurate and appropriate written records
Collaborator: Using a patient centered approach the family medicine resident will:
COL 1: Participate collaboratively in a team-based model
1.1 Understand team function, dynamics and their role within the health care team.
1.2 Work effectively (through timely, respectful communication) with other physicians, allied health care professionals and community agencies to optimize patient care
1.3 Inquire about and maintain openness to the use of alternative healers, practices, and medications
1.4 Appropriately seek out inter-professional team contributions and incorporate these into a thorough functional assessment.
1.5 Participate in or Initiate and conduct as needed effective meetings (e.g. family meetings, discharge planning)
COL 2: Maintain a postive working environment


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COL 3: Involve patients and families as appropriate, to optimize patient care
3.1. Enlist patients and their families as participants in their healthcare while identifying tensions and role differences in the process, and while maintaining confidentiality
and comformt to families in need.
3.3 Learn to recognize signs of caregiver stress and fully assess caregiver needs.
Health Advocate: Using a patient centered approach the family medicine resident will, while considering racial, cultural, and gender differences, be able to:
HA1: Advocate in response to patient health needs and/or those of a community
1.1 Demonstrate appropriate use of OW, ODSP and CAS resources, including letters advocating for clients, appropriate completion of ODSP forms, access to dental care
coverage, drug coverage, and various forms allowing patients to access special coverage
1.2 Demonstrate an awareness of the mandate of CHCs, PHUs and midwifery clinics, for example, to provide healthcare services for patients with no OHIP coverage
HA2: Identify the determinants of health of the populations they serve
security net)
1.2. Ddemonstrate a knowledge of the epidemiology of health issues in specific populations (e.g. immigrants, aboriginals, inner-city populations)
1.3. Understand key differences between aboriginal communities on and off reserves, including issues of inadequate housing and unclean water supply
1.4 Demonstrate an understanding of global burden of disease, the concept of epidemiologic transition and its impact for health of populations in Canada and abroad
1.5 Demonstrate a basic understanding of the impact on health of individuals of migration, forced displacement, war, and armed conflict
Professional: Using a patient centered approach the family medicine resident will while considering racial, cultural and gender differences be able to:
P1: Demonstrate respect for patients
1.1 Ensure the privacy and dignity of patients
P2: Demonstrate respect for colleagues
P3: Demonstrate knowledge of his/her own strengths and limitations
3.1 Define her or his own background, culture, beliefs, values and biases and the impact these may have on interactions with patients
be contributing to the situation
3.3 Demonstrate self-awareness and self-care in managing difficult or emotionally intense situations.
P4: Balance personal and professional priorities
P5: Demonstrate a commitment to ethical practice
5.1 Demonstrate integrity and honesty in the care of patients and their families
Scholar: Using a patient centered approach the family medicine resident will:
S1: Demonstrate self-directed learning based on reflective practice
S2: Critically evaluate medical information and apply this to practice
S3: Facilitate the education of patients, families, and other team members




Dr. Jane Griffiths and Dr. Karen Schultz Queen's University Department of family Medicine Amay 6, 2010




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