Foundations

The second stage is estimated to take approximately 6-8 months. There are 7 EPAs attached to this stage and a minimum of 49 required assessments for this stage.

1. Performing comprehensive geriatric assessments (CGA)

This EPA focuses on all components of the CGA, including analyzing and synthesizing diagnoses for common geriatric syndromes
This EPA also includes incorporating medical and interprofessional team input, comprehensive care planning, awareness of community services, living environments and programs, and managing transitions of care, managing goals of care, discharge planning, and rehabilitation potential

Assessment Requirements :

At least 5 Direct Observations or case review by supervisor

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

Use Form 1 and STACER
At least 3 different case presentations
At least 1 direct observation using a CGA STACER
At least 3 different settings
At least 2 assessors

2. Diagnosing and managing older patients with common medical conditions

This EPA focuses on demonstrating a comprehensive history and physical examination, and collaborating with other specialties or other treating physicians in the management of common medical conditions
This EPA also includes identifying normal aging vs disease states, interpreting labs and imaging results in context of age, and identifying the effects of multicomplexity and frailty
This EPA includes patients with typical and atypical presentations of acute and chronic conditions

Assessment Requirements:

At least 5 Direct and/or indirect observations by supervisor

Setting: inpatient consult; geriatric unit; outpatient clinic; day hospital; collaborative geriatric specialty services

Use Form 1
At least 4 different case mixes
At least 2 direct observations
At least 2 settings
At least 3 by a geriatrician

3. Assessing, diagnosing and managing common neuro-cognitive disorders with typical presentations

This EPA focuses on the initial assessment and diagnosis of patients with common neuro-cognitive disorders but does not include patients with delirium or behavioural and psychological symptoms of dementia (BPSD)
This EPA includes performing and interpreting cognitive assessment, physical examination and investigations, communicating diagnosis and prognosis, identifying potentially modifiable conditions, and recognizing the need for neuropsychological testing
This EPA also includes managing patients with pharmacologic and non-pharmacologic treatment options, utilizing community support programs, and demonstrating awareness of medicolegal aspects, and future planning
The observation of this EPA is divided into three parts: cognitive assessment; communication with patient and/or caregiver; and management
Parts A and C may be observed in simulation

Assessment Requirements:

At least 16 total Assessments

Part A: Cognitive Assessment. 6 Direct observations or case review by supervisor

Setting: clinical; simulation

Use Form 1
At least 1 of each from the case mix
No more than 2 observed in simulation
At least 3 by a geriatrician

Part B: Communication with patient/caregiver. 5 Direct observations by supervisor

Setting: clinical; outpatient

Use Form 1
At least 2 of any of the following types of communication: home safety, management of finances, or other safety issues
At least 1 communication of driving risk
At least 2 observations by a geriatrician

Part C: Management. 5 Direct or indirect observations by supervisor

Setting: inpatient; outpatient; simulation

Use Form 1
At least 1 each of the case mix
At least 4 in clinical setting
At least 2 observations by a geriatrician

4. Diagnosing and initiating management of patients in delirium

This EPA focuses on the diagnosis and initial management of delirium through the use of validated delirium screening tools, and the communication of diagnosis
This EPA does not include prevention or pharmacologic management
The observation of this EPA is divided into three parts: diagnosis; communication; and initiating management

Assessment Requirements:

At least 8 total Assessments

Part A: Diagnosis. 3 Direct or indirect observations by supervisor

Setting: geriatric unit; inpatient consult; pre- and/or post-operative setting; emergency room; day hospital; residential care; other

Use Form 1
At least 1 of each from case mix
At least 2 settings
At least 2 by a geriatrician

Part B: Communication with communication with family/care provider. 2 Direct observations by supervisor

Setting: geriatric unit; inpatient consult; pre- and/or post-operative setting; emergency room; day hospital; residential care; other

Use Form 1
At least 1 of each from case mix
At least 2 settings
At least 2 different assessors

Part C: Initiate Management. 3 Case Review with supervisor

Setting: geriatric unit; inpatient consult; pre- and/or post-operative setting; emergency room; day hospital; residential care; other

Use Form 1
At least 1 each of the case mix
At least 2 settings
At least 2 observations by a geriatrician

5. Identifying issues with medication use and making suggestions for optimal prescribing

This EPA focuses on obtaining an accurate medication history, medication review and reconciliation, including recommendations for optimal prescribing and feasible management suggestions (e.g. deprescribing, drug, dose, formulation alternatives)
This EPA includes awareness of the factors and limitations of the best possible medication history generated by other professionals, as well as limitations of the extrapolation of clinical trial data and clinical practice guidelines to the frail elderly
This EPA also includes understanding and incorporating patient goals and values in medication management decisions

Assessment Requirements:

At least 5 Case presentations and reviews with supervisor

Setting: inpatient; outpatient

Use Form 1
At least 2 inpatient
At least 1 outpatient
At least 2 observations by a geriatrician
At least 2 different assessors

6. Assessing and managing patients with a fall risk

This EPA focuses on managing fall risk by performing appropriate neurologic and musculoskeletal examinations and gait analysis, and prescribing simple gait aids
This EPA includes using and interpreting appropriate fall risk and balance assessments such as gait speed, Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. It also includes a comprehensive assessment of modifiable and non-modifiable extrinsic and intrinsic risk factors to guide fall risk management, and integrating the assessments of interprofessional team members
The observation of this EPA is divided into two parts: gait analysis and balance assessment; fall risk assessment and management
Gait analysis and balance may be observed in a simulation setting

Assessment Requirements:

At least 8 total Assessments

Part A: Gait analysis and balance assessment. 3 Direct observations by supervisor, which may include input from physiotherapist or occupational therapist

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

Use Form 1
At least 1 movement disorder
At least 2 in clinical setting
At least 1 by a geriatrician

Part B: Falls risk assessment and managment. 5 Direct and/or indirect observations by supervisor, which may include input from physiotherapist or occupational therapist

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

Use Form 1
At least 1 movement disorder
At least 1 orthostatic hypotension
At least 1 by a geriatrician

7. Teaching and supervising junior learners

This EPA focuses on evidence-informed practice and teaching skills
This EPA includes topics such as the components of a CGA and common geriatric syndromes, and can be assessed in any setting involving junior learners
This EPA also includes workplace based supervision and educational activities, bedside teaching and small group formal teaching
This EPA does not include formal presentations (e.g. journal clubs, academic half day, grand rounds)

Assessment Requirements:

At least 2 Direct observations by supervisor, incorporating junior learner feedback

Setting: geriatric unit; inpatient consult; outpatient clinic; day hospital; geriatric rehabilitation unit; after-hours coverage; other

Use Form 1

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