Milestones

Patient Care 1: History

Elicits and concisely reports a hypothesis driven patient history for common patient presentations    
Independently obtain data from secondary sources
Elicit and concisely reports a hypothesis-driven patient history this complex patient presentation
Reconcile current data with secondary sources
Efficiently elicit and    concisely report a patient history, incorporating pertinent psychosocial and other determinants of health
Use history and secondary data to guide the need for further diagnostic testing
speech input
Efficiently and effectively tailor the history taking, including relevant historical subtleties, based on patient, family, and system needs
Model effective use of history to guide the need for further diagnostic testing

Patient Care 2: Physical Examination

Perform a general physical examination while attending to patient comfort and safety
Identify common abnormal findings
Document a hypothesis-driven physical examination for a common patient presentation
Interpret common abnormal findings
Document a hypothesisdriven physical examination for a complex patient presentation
Identify and interpret uncommon and complex abnormal findings
Reference use of advanced maneuvers to elicit subtle findings
Integrate subtle physical examination findings to guide diagnosis and management
Model effective evidence-based physical examination technique
Teach the predictive value of the examination findings to guide
diagnosis and management

Patient Care 3: Clinical Reasoning

Organize and accurately summarize information obtained from the patient evaluation to develop a clinical impression
Integrate information from all sources to develop a basic differential diagnosis for this patient's presentation
Identify clinical reasoning errors within patient care, with guidance
Develop a thorough and prioritized differential diagnosis for this patient's presentation
Retrospectively apply clinical reasoning principles to identify
errors
Develop prioritized differential diagnoses in this patient presentation and incorporate subtle, unusual, or conflicting findings
Continually re-appraise the clinical reasoning to improve patient care in real time
Develop prioritized differential diagnoses in this complex patient presentation
Model how to recognize error and reflect upon one’s own clinical
reasoning

Patient Care 4: Patient Management – Inpatient

Formulate management plan for each condition, with guidance
Identify opportunities to maintain and promote health
Develop and implement management plans for each condition, recognizing acuity, and modify based on the clinical course
Develop and implement management plans to maintain and promote health, with guidance
Develops and implements value-based (high value) management plans for patients with multisystem disease and comorbid conditions; modify based on the clinical course
Independently develop and implement plan to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
Use shared decision making to develop and implement value-based (high value) comprehensive management plans for this patient's comorbid and multisystem disease, including those conditions requiring critical care
speech input
Independently develop and implements comprehensive plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
Develop and implement comprehensive
management plans for rare or ambiguous presentations or unusual comorbid conditions