What you must demonstrate
- Collateral history
- ADL/IADL assessment
- Cognition and delirium screening
- Medication reconciliation
- Capacity and substitute decision-making
11-minute performance map
1. Opening and immediate safety
Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.
2. Focused assessment
Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.
3. Targeted examination
Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.
4. Synthesize
Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.
5. Investigations
Choose tests that answer a specific diagnostic or safety question; state urgent tests first.
6. Immediate management
Treat instability, begin syndrome-specific care, consult early when needed and define disposition.
7. Communication and safety net
Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.
Focused history prompts
Define the presentation
- Onset, chronology, triggers and progression.
- Severity and effect on function.
- Associated symptoms that support the leading diagnosis.
- Relevant negatives that reduce dangerous alternatives.
Risk context
- Relevant past medical/surgical/obstetric/psychiatric history.
- Medications, allergies and adherence.
- Family, social, substance, travel/exposure or safeguarding factors as applicable.
- Patient ideas, concerns, expectations and goals.
Dangerous alternatives to prioritize
- Acute delirium
- Injury after fall
- Medication toxicity
- Abuse or neglect
- Unsafe discharge
- Rapid functional decline
Targeted investigations
Medication reconciliation and orthostatic vital signs when relevant
CBC, electrolytes/renal function, glucose, urinalysis and targeted tests for acute change
ECG and imaging based on falls, focal findings or acute illness
Functional, cognitive, sensory and social assessment
Immediate management and disposition
- Treat acute reversible illness while preventing delirium, falls and medication harm.
- Review medications and function, cognition, mobility and supports.
- Involve substitute decision-makers only when appropriate to capacity/consent.
- Plan a safe disposition with follow-up and caregiver supports.
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