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.
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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
