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Core Competencies

The Core Competencies document is an invaluable resource that is the culmination of the hard work of the CSHM and your peers. This was assembled to bring consistency and create a set of standards among those practicing hospital medicine. We also aim to highlight all of the work that hospital practitioners do! With this document, we are in a better position to work towards a certification program and bring awareness to the practice. 

Many programs would benefit from having these guidelines outlined and available. Copies are reasonabaly priced at $100.

Although the document is robust, it is ever-evolving and needs to be updated regularly as circumstances dictate. We need your feedback to move forward and create Phase 2! 

Members are highly encouraged to comment and provide feedback by using the "Contact Us' button or from the email below.

If you are interested in having an active role in the next phase of this important document, please email canadianhospitalmedicine@gmail.com to find out what opportunities are available.  

 

 


TABLE OF CONTENTS

LETTER FROM THE CANADIAN SOCIETY OF HOSPITAL MEDICINE ............................................................................................................................................................... 5

ACKNOWLEDGEMENTS ......................................................................................................................................................................................................................................6

CORE COMPETENCIES IN HOSPITAL MEDICINE (CCHM 2015) EXECUTIVE COMMITTEE ........................................................................................................................... 6

CORE COMPETENCIES IN HOSPITAL MEDICINE (CCHM) EXPERT COMMITTEE........................................................................................................................................... 7

INTRODUCTION ..................................................................................................................................................................................................................................................12

PREFACE ...............................................................................................................................................................................................................................................................12

CSHM CORE COMPETENCIES IN HOSPITAL MEDICINE: DEFINITIONS AND FUTURE DIRECTIONS............................................................................................................13

A BRIEF HISTORY OF HOSPITAL MEDICINE PROGRAMS IN CANADA............................................................................................................................................................18

CURRENT CLIMATE OF HOSPITAL MEDICINE IN CANADA .............................................................................................................................................................................25

CANADIAN HOSPITALISTS: WORKING IN TEAMS TO PROVIDE QUALITY INPATIENT CARE .......................................................................................................................33

GENERAL CLINICAL SKILLS, COMMON CLINICAL CONDITIONS, AND PROCEDURES FRAMEWORKS........................................................................................................44

HOW DOES THE CCHM DOCUMENT NUMBERING SYSTEM WORK? ............................................................................................................................................................44

1. GENERAL CLINICAL SKILLS: MANAGEMENT OF A STANDARD MEDICAL ADMISSION.............................................................................................................................45

2. GENERAL CLINICAL SKILLS: ANTIMICROBIALS – PREVENTING RESISTANCE............................................................................................................................................47

3. GENERAL CLINICAL SKILLS: ANTIMICROBIALS – STEWARDSHIP................................................................................................................................................................49

4. GENERAL CLINICAL SKILLS: COMPLEX AND FRAIL ELDERLY .....................................................................................................................................................................52

5. GENERAL CLINICAL SKILLS: DIAGNOSTIC DECISION MAKING ..................................................................................................................................................................55

6. GENERAL CLINICAL SKILLS: DRUG SAFETY AND MEDICATION RECONCILIATION...................................................................................................................................58

7. GENERAL CLINICAL SKILLS: INFORMATION MANAGEMENT......................................................................................................................................................................61

8. GENERAL CLINICAL SKILLS: NUTRITION AND THE HOSPITALIZED PATIENT............................................................................................................................................64

9. GENERAL CLINICAL SKILLS: HOSPICE PALLIATIVE CARE.............................................................................................................................................................................66

10. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: ACUTE CORONARY SYNDROME (ACS)..........................................68

11. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: ACUTE SPINAL CORD COMPRESSION (ASCC)..............................71

12. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: ACUTE STROKE/TIA.........................................................................74

13. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: SEVERE DRUG ADVERSE OR ALLERGIC REACTIONS....................76

14. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: SEPSIS AND SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

(SIRS).....................................................................................................................................................................................................................................................................78

15. CLINICAL CONDITIONS: ACUTE LIFE OR LIMB THREATENING EMERGENCIES ON THE WARD: SHOCK..............................................................................................80

16. COMMON CLINICAL CONDITIONS: ASSESSMENT OF ACUTE ABDOMINAL PAIN..................................................................................................................................82

17. COMMON CLINICAL CONDITIONS: ANEMIA AND TRANSFUSION MEDICINE........................................................................................................................................84

18. COMMON CLINICAL CONDITIONS: ASTHMA ............................................................................................................................................................................................86

19. COMMON CLINICAL CONDITIONS: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD).............................................................................................................89

20. COMMON CLINICAL CONDITIONS: CONGESTIVE HEART FAILURE (CHF)...............................................................................................................................................91

21. COMMON CLINICAL CONDITIONS: DELIRIUM...........................................................................................................................................................................................94

22. COMMON CLINICAL CONDITIONS: DIABETES MELLITUS ........................................................................................................................................................................96

23. COMMON CLINICAL CONDITIONS: INTOXICATION, OVERDOSE AND WITHDRAWAL...........................................................................................................................98

24. COMMON CLINICAL CONDITIONS: GASTROINTESTINAL (GI) BLEEDING................................................................................................................................................101

25. COMMON CLINICAL CONDITIONS: LIVER DISEASE – ACUTE....................................................................................................................................................................103

26. COMMON CLINICAL CONDITIONS: LIVER DISEASE – CHRONIC...............................................................................................................................................................105

27. COMMON CLINICAL CONDITIONS: ONCOLOGY MANAGEMENT INCLUDING EMERGENCIES .............................................................................................................107

28. COMMON CLINICAL CONDITIONS: PAIN MANAGEMENT – ACUTE AND CHRONIC................................................................................................................................109

29. COMMON CLINICAL CONDITIONS: PNEUMONIA – COMMUNITY-ACQUIRED (CAP)...............................................................................................................................112

30. COMMON CLINICAL CONDITIONS: PNEUMONIA – HOSPITAL-ACQUIRED (HAP)....................................................................................................................................115

31. COMMON CLINICAL CONDITIONS: RENAL FAILURE – ACUTE...................................................................................................................................................................117

32. COMMON CLINICAL CONDITIONS: RENAL FAILURE – CHRONIC..............................................................................................................................................................119

33. COMMON CLINICAL CONDITIONS: SEIZURES.............................................................................................................................................................................................120

34. COMMON CLINICAL CONDITIONS: SKIN AND SOFT TISSUES INFECTIONS ............................................................................................................................................123

35. COMMON CLINICAL CONDITIONS: URINARY TRACT INFECTION (UTI).....................................................................................................................................................125

36. COMMON CLINICAL CONDITIONS: VENOUS THROMBOEMBOLIC (VTE) DISEASE...................................................................................................................................127

37. PROCEDURES: ARTHROCENTESIS..................................................................................................................................................................................................................129

38. PROCEDURES: LUMBAR PUNCTURE (LP).......................................................................................................................................................................................................131

39. PROCEDURES: PARACENTESIS .......................................................................................................................................................................................................................133

40. PROCEDURES: THORACENTESIS ....................................................................................................................................................................................................................135