PGY-2 ED Shift Evaluation

• Participates as observer in resuscitations • May not recognize when patient is unstable • Able to assess ABCs and perform basic interventions

• Recognize abnormal vital signs • Seeks immediate help for critically ill patients • Prioritizes patient care by time of arrival • Initiates advanced resuscitation procedures

• Recognizes subtle abnormalities in vital signs • Prioritizes patient by vital signs/acuity • Performs appropriate initial evaluation to form diagnostic plan on critically ill patient • Reassesses patient after stabilizing interventions

• Sometimes incomplete HPI gathered • History presentations may lack critical information • Physical exam is completed but findings are frequently missed

• Histories may be unfocused and give extraneous details, but are usually complete • Performs an adequate physical exam with few missed findings

• Gains most critical information on initial patient interview • Histories focused to patient complaint with detailed PMH/SH/FH etc. • Appropriately focused physical exam performed with infrequent missed findings

• Reports data gathered with attempt made to form plan • Differentials narrow and occasionally lacks emergent considerations • Relies on prebuilt/ordered pathways • Infrequently utilizes EBM or decision tools

• Reports focused HPI giving adequate differentials with emergent considerations • Orders appropriate diagnostics and performs bedside diagnostics as indicated • Has working knowledge of EBM and decision tools for key chief complaints

• Efficient HPI reported with thorough DDx ordered by most emergent considerations • Frequently and appropriately uses decision tools • Understands statistical limitations of diagnostic modalities • Adjusts differential when confronted with dynamic information

• Knows the different classifications of pharmacologic agents and their mechanism of action. • Consistently asks patients for drug allergies

• Applies medical knowledge for selection of appropriate agent for therapeutic intervention • Considers potential adverse effects of pharmacotherapy

• Considers array of drug therapy for treatment. • Selects appropriate agent based on mechanism of action, intended effect, and anticipates potential adverse side effects • Considers and recognizes potential drug to drug interactions

• Recognizes need for patient re-assessment • May not consider disposition until end of patient care • Describe basic discharge instructions • May be unaware of resources for safe disposition

• Monitors that interventions are accomplished • Gives appropriate updates and reports on patient status when instructed • Updates patients on results and anticipated next steps • Speaks early to likely disposition • Frequently identifies who requires admission

• Addresses likely disposition in initial presentation • Does NOT require prompting for patient reassessment • Provides patient education effectively • Involves appropriate resources (PCP, consultants, care coordination) • Appropriate disposition and level of care decisions

• Able to manage a single patient at a time • May not recognize when they are the limiting factor to patient care progression

• Able to manage 2-3 patients and task switch effectively • May have some inefficiencies present but generally they are not the limiting factor in patient care progression

• Able to manage multiple patients efficiently and in a timely manner • Able to recognize systems issues that need to be addressed to move patient care forward

• Understands indications and contraindications to procedures • Requires frequent guidance during basic procedures such as suturing • May need assistance collecting basic procedural supplies • May require multiple attempts for intubation • Limited knowledge of procedural sedation

• Effectively obtains informed consent and ensures appropriate supplies in place for procedure • Can identify key anatomical landmarks for procedures and techniques • May be noted to avoid more difficult procedures • Can perform RSI with basic medication knowledge • Often successful with intubation with multiple techniques to confirm placement

• Performs common procedures with low-moderate risk of complication • Able to delineate results of procedure (LP/Aspiration, Post procedural films, etc.) • Capable of assisting medical students with procedures • Multiple modes of preoxygenation and post-intubation management • Able to perform procedural sedation pre to post assessment

• Demonstrated scientific and bedside knowledge of common presentations and conditions • Identifies types of clinical reasoning errors with guidance

• Demonstrates scientific and bedside knowledge of complex conditions • Identifies types of clinical reasoning errors and biases within patient care

• Integrates knowledge of comorbid conditions within complex clinical conditions • Demonstrates knowledge of impact of patient factors on treatment options • Able to retrospectively identify cognitive errors