Clinical Context
EPA 1 – Clinical assessment applies in admissions, reviewing a patient in response to a particular concern, ward-call tasks, ward rounds, lower acuity emergency department presentations, general practice consultations or outpatient clinical attendances.
Training Material
EPA 1 Task Descriptors
Each EPA 1 – Clinical assessment assessment form lists the tasks that may be observed, noting that there is no requirement to observe all components. Prevocational doctors will be asked to tick the relevant tasks, but this may be changed by the assessor.
Click to view task descriptors
- If the clinical assessment has been requested by a team member, clarify the concern(s) with them
- Identify relevant information in the patient record
- Obtain consent from the patient
- Obtain history
- Examine the patient
- Consider and integrate information from the patient record, clinical assessment and relevant ward protocols, guidelines or literature
- Develop provisional and differential diagnoses and/or problem list
- Produce a management plan, confirm as appropriate with a senior colleague, and communicate with relevant team members and patient
- Implement the management plan, initiate or perform appropriate investigations and procedures, and document the assessment and next steps, including indications for follow-up
It is recommended that the prevocational doctor aim to cover most of these areas across the year as they complete multiple EPAs (i.e., They should not all focus on the same areas).
How to put EPA 1 into practice
EPA 1 – Clinical assessment would ideally not be undertaken until at least Week 3, so that the prevocational doctor has had an opportunity to become familiar with the unit and typical cases.
Use this as an opportunity to get the prevocational doctor to undertake a routine assessment while being observed:
Ward Round Patient:
Some units will rotate roles between scribe/notes, assess and discuss. When it is the prevocational doctors turn to assess the patient and consider the management, the assessor should actively note and consider a few feedback points. This is the EPA.
Outpatients:
Allocate the prevocational doctor to a patient and sit in to observe some of the consultation. Then take a few minutes to discuss at the end – you may also consider the management plan.
General Practice:
Sit in to observe some of the consultation and discussion with a patient and take a few minutes to discuss at the end.
Emergency Department:
Early in the day, watch the prevocational doctor as they assess a patient and consider their management plan.
While observing the consultation, consider the following points which may then be used as feedback:
Considerations:
- Does the patient appear comfortable/at ease?
- Does the patient appear confused or uncertain?
- As the prevocational doctor asks questions, is there a flow of conversation or does it seem unstructured?
- As the assessor, is there a lot more information you find yourself wanting to ask (and why)?
- Does the patient have lots of questions and does the prevocational doctor have an approach to these?
- Is the management plan you considered in your mind similar to that developed by the prevocational doctor? If there are differences, consider why and the importance of these?
Extension:
Although the prevocational doctor did well, are there extra considerations that you may consider for variation:
- The anxious patient (what would you do if the patient refused?)
- The non-English speaking patient (how would you explain this is the patient did not speak English?)
- The patient requiring attention to cultural safety (if this patient was from a different background, are these changes you might make?)
- The patient with lots of questions (do you have strategies to make sure you answer questions, but also keep you work flowing?)
- The patient who does not agree with the medical plan