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Table 2 Description of EPA 1.1. as an example of an undergraduate EPA for community medicine

From: Entrustable professional activities for Junior Brazilian Medical Students in community medicine

Title: First consultation to diagnose the health needs of the individual (EPA 1.1)

Short description. The student, in pairs of two, performs this activity during a home visit in the territory and alternates with student partner in the roles of the executor and the observer. He or she introduces himself/herself to the person (patient), identifies the person, and documents the history of the person’s life, creating a spontaneous account guided by the classical principles of anamnesis and performing a general physical examination of the person with dexterity. Based on the information found and using clinical-epidemiological reasoning, the student develops a diagnosis of the individual’s health needs

Specifications. To perform this EPA, the student:

• Communicates empathetically, respectfully, ethically and effectively with the patient and his or her family.

• Performs anamnesis and clinical examination with the patient’s informed consent and builds trust and develops a collaborative relationship. (Home visits must be prioritized to focus on persons diagnosed with diabetes; persons diagnosed with hypertension; pregnant women; children under five years of age; elderly people; and people who are mentally ill, bedridden, physically disabled or carriers of infectious disease).

• Uses biosafety standards and follows protocols and service guides.

• Evaluates the patient’s general appearance, mental state, vital signs, anthropometric data, mucosa, skin and skin attachments, head and neck, and cardiocirculatory and respiratory systems. Gathers basic diagnostics of abnormalities (e.g., general state, facies, gait, mental orientation, weight, blood pressure and pulse, breath and cardiac frequency, and aspects of nutrition and hydration).

• Uses the patient’s clinical history (interview) and the physical examination as aids to develop clinical-epidemiological reasoning and diagnose individual health needs.

• Perceives risk factors and the general health condition of the person. In cases of abnormal signs, the student must refer the person to the Family Health Strategy (FHS) unit. In cases of imminent risk, the student must take the patient to the FHS or request help.

• Identifies the most common pathologies in the locality/region, perceives their evolution, and ultimately recognizes their most frequent complications.

• Based on the literature, provides guidance regarding personal and environmental hygiene (vector control), nutrition (diets to control diabetes, hypertension, and weight reduction), ergonomics, physical activity, sexually transmitted diseases, smoking and alcohol control, adherence to treatment plans, self-medication, access to and use of FHS resources (the women’s health prevention programme; the men’s health prevention programme; and prenatal, puerperium, and child health services).

• Based on the literature, answers questions related to health promotion, disease prevention, complications, and risks of the main pathologies present in the locality/region (fever, hypertension, diabetes, dengue, cold, influenza, dehydration, tuberculosis, and the control and transmission of sexually transmitted diseases), smoking and adolescent pregnancy.

• Reports home visits to the FHS team, the student group, and the supervisor.

• Records relevant information in the patient’s medical record and in the e-SUS AB maintained by the Data Centre of the Brazilian Unified Health System (DATA-SUS) in a clear, organized, and problem-oriented way.

Limitations. This EPA does not apply to/a closer level of supervision is needed in case of the following:

a. Patients in a generally poor condition; terminal patients; haemodynamically unstable patients; and patients with a history of psychiatric illness, a history of violence or drug or alcohol addiction.

b. Patients who refuse care either before or during the care.

c. Physical examination of newborns, infants, adolescents and pregnant women (conducted alongside the supervisor).

d. Specific physical examination and collection of a pap smear (conducted only in the FHS unit).

e. In certain risky situations (in the presence of a dangerous animal, drug deal, or gang fight), the student pair must return to the FHS unit.

f. If a student is required to work alone, he or she must work only at the FHS

Conditions and implications of the entrustment decision.

The observations and information collected and compiled by the student form the basis for the expanded diagnosis of the health needs of the patient and the patient care plan without immediate detailed examination by the supervising physician.

The patient’s medical history, findings and records should be reviewed by the student during home visits and by the supervisor at the next regular patient home visit or at an appointment at the FHS unit. The supervisor must encourage the student to reflect on the patient’s reality and to share information with the team

Supervision level at the training stage. The student should be observed and accompanied over the two years and at the end of the second year:

the student is able to perform the EPA under reactive supervision, i.e., to perform the EPA autonomously and in an effective and safe manner with supervision readily available on request (supervision level 3).