Core

The third stage is estimated to take approximately 12-14 months. There are 11 EPAs attached to this stage and a minimum of 51 required assessments for this stage.

1. Managing older adults with functional decline using comprehensive geriatric assessment (CGA)

This EPA builds on the competencies of the Foundations stage to focus on generating a feasible management plan using CGA, including communicating prognosis, care planning, and managing transitions of care
This EPA includes creating a prioritized problem list with a patient- and/or family-centred management plan that projects functional status trajectory of, and assesses for, rehabilitative potential
The observation of this EPA includes the completion of a CGA STACER∗ and is divided into three parts: management plan; communication with patient and family; communication with referring source

Assessment Requirements:

At least 8 total Assessments

Part A: Management plan. 3 Indirect observations by geriatrician

Setting: inpatient consult; geriatric unit; outpatient clinic; day hospital; outreach

Use Form 1
At least 3 different case presentations
At least 1 assessment of rehabilitative potential
At least 2 different settings
At least 2 different assessors

Part B: Communication with patient and family. 2 Direct observations by geriatrician, including discussion with the patient and their family.

Setting: inpatient consult; geriatric unit; outpatient clinic; day hospital; outreach

Use Form 1 and CGA STACER
At least 2 different assessors
At least 1 with CGA STACER

Part C: Communication with referring source. 3 Direct or indirect observations by geriatrician

Setting: inpatient consult; geriatric unit; outpatient clinic; day hospital; outreach

Use Form 1
At least 2 consultation letters
At least 2 assessors

2. Managing older adults with multiple co-morbidities across the spectrum of frailty

This EPA focuses on developing an individualized management plan, demonstrating knowledge of a wide variety of interacting medical conditions common in older adults, and projecting trajectory of illness and care needs
In addition to conducting a CGA, this EPA includes integrating the degree of frailty, performing advanced medication reviews, applying optimal prescribing and deprescribing practices, and recommending health promotion as applicable
This EPA may be observed across multiple clinical settings, including collaborative geriatric specialty services

Assessment Requirements:

At least 5 Case discussions with supervisor

Setting: inpatient consult; geriatric unit; outpatient clinic; day hospital; geriatric oncology service; trauma service; hip fracture service; transcatheter aortic valve implantation (TAVI) service; pre-operative assessment service

Use Form 1
A variety of case mix
At least 2 different settings

3. Determining patients’ capacity for decision-making

This EPA focuses on assessing frail older adults’ capacity to assign a substitute decision maker and to decide about personal care and healthcare in the context of provincial medico-legal legislation
This EPA includes conducting screens for financial capacity but does not involve any formal medico-legal opinion or declaration
Observation of this EPA can be done in a variety of settings and experiences, including simulation, and inpatient service and outpatient clinic in geriatric medicine and/or geriatric psychiatry

Assessment Requirements:

At least 3 Direct Observations or case reviews by supervisor

Setting: inpatient unit; day hospital; outpatient clinic; inpatient consult; simulation

Use Form 1
At least 1 personal care decision
At least 1 screen of financial capacity
At least 1 direct observation

4. Assessing and managing patients with complex and/or uncommon neuro-cognitive presentations

This EPA focuses on assessing and managing less common neuro-cognitive disorders, such as non-Alzheimer dementias and non-vascular dementias
- This EPA includes performing a comprehensive neurological exam to support atypical features, as well as managing other factors that can complicate the presentation
This EPA does not include the diagnosis of common and typical neuro-cognitive disorders, the use of basic cognitive screening tests, or counseling about basic safety issues (e.g. driving, home safety, etc.)
The observation of this EPA is divided into two parts: assessment and management of complex and/or uncommon neuro-cognitive disorders; and counseling and communication of diagnosis and prognostic issues specific to these less common disorders
This EPA may be observed in the simulation setting

Assessment Requirements:

At least 7 total Assessments

Part A: Assessment and managment. 5 Direct observations or case review by supervisor

Setting: outpatient clinic; memory disorders clinic; geriatric unit; inpatient consult; day hospital; simulation; other

Use Form 1
At least 3 different presentations from case mix
At least 2 different assessors

Part B: Counseling and communication. 2 Direct observations by supervisor

Setting: outpatient clinic; memory disorders clinic; geriatric unit; inpatient consult; day hospital; simulation; other

Use Form 1
At least 2 different presentations from case mix

5. Assessing and managing behavioural and psychological symptoms of dementia (BPSD)

This EPA focuses on the assessment and management of BPSD, including identifying possible contributing/precipitating factors across the spectrum of BPSD and establishing pharmacological and non-pharmacological management options
This EPA includes integrating input from the interprofessional team and caregivers, engaging caregivers and the interprofessional team in the implementation of non-pharmacological interventions, and referring patients to subspecialty care, as appropriate

Assessment Requirements:

At least 5 Direct Observations or case reviews by supervisor

Setting: outpatient clinic; specialized (memory disorders) clinic; geriatric unit; inpatient consult; geriatric psychiatry; behavioral neurology; long-term care; day hospital; other

Use Form 1
At least 3 different presentations
At least 3 different settings
At least 2 observations by a geriatrician

6. Preventing and managing delirium

This EPA focuses on identifying patients at risk for delirium, implementing prevention strategies at individual patient and institutional levels, and managing delirium
This EPA applies to simple and complicated delirium. Complicated delirium include factors that make the management of delirium more challenging and require a higher level of expertise. Examples include:
This EPA also includes identifying long-term outcomes, and advocacy and education for improved prevention, recognition, and management of delirium by other health care professionals
The observation of this EPA is divided into two parts: preventing delirium; and managing delirium

Assessment Requirements:

At least 5 total Assessments

Part A: Preventing Delirium. 2 Case discussions with Geriatrician

Setting: inpatient consult; geriatric unit; outpatient clinic; ;geriatric oncology; Transcatheter Heart Valve Program (TAVI) clinic; residential care; emergency department; other

Use Form 1
At least 2 different settings
At least 2 different assessors

Part B: Managing delirium. 3 Case discussions with Geriatrician

Setting: inpatient consult; geriatric unit; outpatient clinic; geriatric oncology; TAVI clinic; residential care; emergency department; other

Use Form 1
At least 1 from each case mix
At least 1 with one or more complicated delirium factors
At least 2 different settings
At least 2 different assessors

7. Assessing and managing older adults with uncomplicated mental health conditions

This EPA focuses on common uncomplicated mental health conditions in the presence or absence of medical comorbidities
This EPA includes assessing suicidal and homicidal risk, diagnosing common uncomplicated mental health conditions, recognizing potential medical conditions contributing to the disorder, and recognizing complex psychiatric conditions, knowing when to refer or participate in co-management with mental health care providers
This EPA does not include assessing and managing complex mental health conditions, such as psychotic depression, active suicidal or homicidal ideations, or exacerbation of chronic psychiatric conditions such as schizophrenia, bipolar affective disorder or personality disorder
The observation of this EPA is divided into two parts: patient interview; and management

Assessment Requirements:

At least 4 total Assessments

Part A: Patient Interview. 1 Direct observation by supervisor

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 1

Part B: Management. 3 Case discussions with supervisor

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 1
At least 1 depression and 1 anxiety condition
At least 1 observation by a geriatrician
At least 2 different assessors

8. Managing end-of-life care in older adults

This EPA focuses on providing end-of-life care for patients with a major neuro-cognitive disorder or non-cancer diagnosis
This EPA includes establishing goals of care, projecting trajectory of illness and care needs, managing patient, family and care provider expectations, and communicating prognosis
This EPA also includes medical management such as the use of non-pharmacological and pharmacological approaches to symptom control, optimal prescribing and deprescribing, awareness of the referral process for local community resources including palliative services and medical assistance in dying (MAID), and advance care planning (e.g. substitute-decision makers)
This EPA may be observed in any clinical setting, including residential care and palliative care rotations
The observation of this EPA is divided into two parts: medical management; and communication

Assessment Requirements:

At least 4 total Assessments

Part A: Medical managment. 2 Direct observation by supervisor

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 1
At least 1 patient with a non-cancer diagnosis or major neuro-cognitive disorder

Part B: Communication. 2 Direct observations by supervisor, incorporating feedback from other members of health care team

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 1

9. Assessing and managing complex psycho-social issues unique to vulnerable older adults

This EPA focuses on identifying, assessing, and managing complex psycho-social issues, including vulnerability, caregiver burden, conflictual family dynamics, elder abuse and neglect, safety issues and risks, legal and ethical issues in care planning, and high risk transitions of care
This EPA includes optimizing safety consistent with patient preferences, taking legal action when required and appropriate, demonstrating cultural competence, referring patients to appropriate resources, and counseling patients and/or caregivers
This EPA may be observed in any clinical setting, including family meetings, through direct observation of components of the CGA and discussions with other health professionals, family, and substitute decision makers
The observation of this EPA is divided into two parts: case discussion; and submission of case narratives
The submission of case narratives requires the resident to submit a portfolio with five narrative reflections (on different topics) for discussion with the faculty advisor/supervisor. A copy of the portfolio is then submitted to the Competence Committee

Assessment Requirements:

At least 2 total Assessments

Part A: Case discussion. 1 Case discussion with supervising geriatrician

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 1

Part B: Portfolio and supervisor discussion . 1 Supervisor review of 5 narrative cases submitted by resident on different topics

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; other

Use Form 4

10. Running family and team meetings

This EPA focuses on organizing and leading a meeting, including giving effective and constructive feedback to the interprofessional team and/or individual team members
This includes leading the discussion, attending to meeting flow and organization, encouraging participation of the team, and integrating information from the interprofessional team to complete the assessment and management of the patient, patient-centred goal-setting, and discharge planning
This EPA also includes managing conflicts, managing and communicating diagnosis, management plan, discharge planning and discussing adverse events with patient and family
Observation of this EPA must include use of a Team Meeting and Family Meeting STACER∗. Simulation of conflict situations may also be utilized

Assessment Requirements:

At least 4 Observations. Multiple observers may contribute provide feedback individually to the supervisor, which is then collated to one report

Setting: geriatric psychiatry; outpatient clinic; geriatric unit; inpatient consult; day hospital; simulation; other

Use Form 1
At least 1 STACER for each meeting type
At least 2 of each meeting type
At least 1 observation by a supervising geriatrician

11. Teaching other learners

This EPA focuses on teaching, giving constructive feedback to learners, and choosing appropriate learning methods
This EPA includes formal and informal teaching sessions delivered to peers, broad audiences, other trainees, faculty, other health professionals, and/or the public
This EPA does not include individual patient counselling
This EPA has two parts: giving feedback to junior learners; and formal scheduled teaching

Assessment Requirements:

At least 4 total Assessments

Part A: Feedback to junior learners . 2 Direct observations by supervisor

Setting: clinical setting with junior learners

Use Form 1

Part B: Formal scheduled teaching . 2 Direct observation by supervisor, incorporating feedback from learners

Setting: formal teaching setting

Use Form 1
At least 2 different settings/presentation types

Google Sites

Report abuse