Table 1

Ambulatory care objectives used to structure COCOS

Diagnosis


1. Identify pertinent features on history and physical examination

2. Describe diagnostic tests used to evaluate a patient, including their cost-effectiveness

3. List the differential diagnosis for a patient based on his/her clinical presentation


Natural history


1. Classify a patient's current state in the natural history of a chronic condition

2. Describe, to a patient, the expected course of their condition without treatment

3. Order tests, if necessary, to monitor the course of a chronic condition


Treatment


1. Describe, to a patient, and compare treatment options including: mechanism of action; benefits, including efficacy and time course; risks, including adverse effects

2. Order tests, if necessary, to monitor treatment efficacy and/or adverse effects

3. Analyze data to determine changes in treatment that is required

4. Discuss an appropriate duration of treatment for a chronic condition

5. Detect if treatment has failed, and select alternate treatment options


Special situations


1. Provide prepregnancy counseling to a woman with a chronic condition, including: how her condition will affect fertility; how or if her condition will change during pregnancy; how the condition will affect her during pregnancy; how the condition will affect the fetus during pregnancy; the likelihood her baby will develop the same condition, management or treatment that should take place prior to conception

2. Formulate a management plan for a pregnant woman with a chronic medical condition

3. Manage a patient with a chronic medical problem during the peripartum period

4. Formulate a management plan for a woman with a chronic medical condition during the immediate and later post-partum period


Practice management


1. Discuss the criteria by which requests for consultation should be prioritized as urgent

2. Discuss an appropriate time frame to arrange follow-up care in the case of: a patient in whom the diagnosis has not been made; a patient in whom you've initiated therapy; a patient on therapy who has not been stabilized; a patient on therapy who has been stabilized

3. Discuss factors that influence whether a patient can be followed his/her primary care physician for a medical condition

4. Describe key recommendations that should be made to a primary care physician who will be following a patient for a medical condition


Wong and Lochnan BMC Medical Education 2009 9:8   doi:10.1186/1472-6920-9-8

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