Focused Assessment

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ME 2.4.1.1

Importance of accurate history taking as the major contributor to the diagnostic process.

ME 2.4.1.2

Impact of social and cultural factors on the patient's history.

ME 2.4.1.3

Use universal precautions when performing any assessment.

ME 2.4.1.4

Consistently use a patient-centred approach when performing patient assessment, taking into account gender, sexuality, cultural background and religious beliefs.

ME 2.4.1.5

Identify the presence or absence of relevant physical signs in an appropriate examination, taking into account how social and cultural differences impact upon physical examination findings.

ME 2.4.1.6

Perform a detailed subsequent systematic culturally sensitive assessment in patients with more complex presentations.

ME 2.4.1.7

Develop a problem list for a patient presentation, taking into consideration the patient's social and cultural background.

ME 2.4.1.8

Generate a differential diagnosis to match each problem by linking all the history, symptoms and signs found on assessment.

ME 2.4.1.9

Apply knowledge of basic sciences and natural progression of disease to the patient's presenting complaint.

ME 2.4.1.10

Act on time critical investigations results as they arise.

ME 2.4.1.11

Apply knowledge of basic sciences to the analysis of raw information from investigations.

ME 2.4.1.12(a)

Apply understanding of indications for the following investigations, their theoretical accuracy, principles underpinning their performance and interpretation of formal reports to patient care: Tests for inborn errors of metabolism (urine and serum)

ME 2.4.1.12(b)

Apply understanding of indications for the following investigations, their theoretical accuracy, principles underpinning their performance and interpretation of formal reports to patient care: Tumour markers

ME 2.4.1.12(c)

Apply understanding of indications for the following investigations, their theoretical accuracy, principles underpinning their performance and interpretation of formal reports to patient care: Histopathology

ME 2.4.1.12(d)

Apply understanding of indications for the following investigations, their theoretical accuracy, principles underpinning their performance and interpretation of formal reports to patient care: Cytology

ME 2.4.1.13

Under direct supervision, analyse results of fasting lipids investigations.

ME 2.4.1.14(a)

Independently analyse and interpret results of the following investigations 12-lead ECG patterns or patterns on ECG rhythm strip, including:

ME 2.4.1.14(b)

Spirometry/peak flow meter measurement

ME 2.4.1.14(c)

Plain radiology images, including chest x-ray (all views), cervical spine, pelvis, abdominal x-ray (all views)

ME 2.4.1.14(d)

Laboratory investigations, including:

ME 2.4.2.1

Complete a focused clinical assessment while simultaneously looking for evidence of time critical diagnoses.

ME 2.4.2.2

Recognise inconsistencies within elements of the focused assessment that require clarification.

ME 2.4.2.3

Recognise the contribution of social and cultural complexities in clinical assessment of history and examination.

ME 2.4.2.4

Seek collateral history to support clinical findings in a socially and culturally safe manner.

ME 2.4.2.5

Formulate a provisional diagnosis to match the immediate issues.

ME 2.4.2.6

Incorporate the concepts of likelihood and severity of disease into the differential diagnosis, inclusive of the social determinants of health.

ME 2.4.2.7

Incorporate investigation results into the diagnostic reasoning process.

ME 2.4.2.8

Perform rational investigation selection after completing a patient's clinical assessment.

ME 2.4.2.9(a)

Under direct supervision, analyse the results of the following investigations: Advanced inflammatory markers (Rh factor, ANA, ANCA)

ME 2.4.2.9(b)

Under direct supervision, analyse the results of the following investigations: Parathyroid hormones, cortisol/ACTH/Synacthen test

ME 2.4.2.10(a)

Independently analyse and interpret results of the following investigations: 12-lead ECG patterns or patterns on ECG rhythm strip, including:

ME 2.4.2.10(b)

pH testing of eye tears

ME 2.4.2.10(c)

plain radiology images, including long bones, clavicle, scapula, patella, OPG

ME 2.4.2.10(d)

CT images, including:

ME 2.4.2.10(e)

Laboratory investigations, including:

ME 2.4.3.1

Adapt the focused clinical assessment to situations with a paucity of clinical information.

ME 2.4.3.2

Complete an accurate focused clinical assessment of an undifferentiated patient within a limited timeframe.

ME 2.4.3.3

Tailor a socially and culturally safe assessment style to the patient and the situation.

ME 2.4.3.4

Complete a focused clinical assessment of a patient to clarify the findings of a junior clinician.

ME 2.4.3.5

Refine the provisional diagnosis as more information comes to hand.

ME 2.4.3.6

Create a focused investigation plan that concentrates on confirming or excluding time critical diagnoses.

ME 2.4.3.7(a)

Under direct supervision, analyse results from the following investigations: Cardiac exercise stress test

ME 2.4.3.7(b)

Under direct supervision, analyse results from the following investigations: Cardiotocography

ME 2.4.3.7(c)

Under direct supervision, analyse results from the following investigations: Nerve conduction studies

ME 2.4.3.7(d)

Under direct supervision, analyse results from the following investigations: Image from nuclear medicine or MRI, including:

ME 2.4.3.7(e)

Cholinesterase levels for toxicology monitoring

ME 2.4.3.8(a)

Independently analyse and interpret results of the following investigations: 12-lead ECG patterns or patterns on ECG rhythm strip, including:

ME 2.4.3.8(b)

Formal respiratory function test

ME 2.4.3.8(c)

Plain radiology images, e.g., paediatric CXR, AXR, cervical spine, pelvis, extremities; adult small bones; paediatric extremities; thoracolumbar spine; facial (all views); soft tissue neck

ME 2.4.3.8(d)

CT images including:

ME 2.4.3.9

Images obtained by a FACEM credentialled to perform ED sonography, including cardiac arrest ECG or FELS, to assess cardiac activity during resuscitation

ME 2.4.3.10

Laboratory investigations, including drug levels, urine osmolality, urinary sodium, and snake venom detection kit tests

ME 2.4.4.1

Conduct a fragmented focused assessment which becomes whole over time.

ME 2.4.4.2

Summarise and prioritise the key issues that must be addressed during and following the emergency encounter, considering health literacy, and the knowledge of and access to health services, as factors influencing community care.

ME 2.4.4.3

Adapt the technique of provision of information to the needs of the patient and/or their family/whānau.

ME 2.4.4.4

Justify investigation selection based on the patient's presentation, pre-test probability, risk-benefit ratio and resources of the local health service.

ME 2.4.4.5(a)

Under direct supervision, analyse the following investigations: Stress Thallium/Sestamibi scan

ME 2.4.4.5(b)

Under direct supervision, analyse the following investigations: MRI bones

ME 2.4.4.5(c)

Under direct supervision, analyse the following investigations: MRI soft tissues

ME 2.4.4.6

Independently analyse and interpret results of cholinesterase levels for toxicology monitoring.