Download Resident Review Committee

THE UNIVERSITY OF TOLEDO
College of Medicine
Name of Policy:
OFFICIAL POLICY
Promotion Criteria
Policy Number(s): IM – ED 5
Issuing Office:
Effective Date: 03/26/007
Residency Office, Department of
Internal Medicine
Responsible Agent: Director, Residency
Program
Scope of Policy: Internal Medicine Residents
POLICY
Residents are promoted and graduated based on explicit criteria in accordance with
the Accreditation Council for Graduate Medical Education (ACGME) General
Competencies and the Residency Review Committee-Internal Medicine (RRC-IM)
Program Requirements. The residency program requires its residents to obtain
competencies in the six areas below to the level expected of a new practitioner.
a. Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health
b. Medical Knowledge about established and evolving biomedical, clinical, and cognate
(e.g. epidemiological and social-behavioral) sciences and the application of this
knowledge to patient care
c. Practice-Based Learning and Improvement that involves investigation and evaluation
of their own patient care, appraisal and assimilation of scientific evidence, and
improvements in patient care
d. Interpersonal and Communication Skills that result in effective information exchange
and teaming with patients, their families, and other health professionals
e. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population
f. Systems-Based Practice, as manifested by actions that demonstrate an awareness of
and responsiveness to the larger context and system of health care and the ability to
effectively call on system resources to provide care that is of optimal value
PURPOSE
To provide criteria for promotion of residents from PGY-1 to PGY-2 and PGY-2 to PGY-3 and for
graduation.
PROCEDURE
The following describes the roles and responsibilities of the Resident Review Committee, the
Faculty Advisor, and the Attending Physician.
Resident Review Committee
The Resident Review Committee is chaired by the Residency Program Director. It is composed of
the Chief Resident and all faculty members of the Department of Internal Medicine. It meets
weekly and reviews the clinical and academic performance and progress of each resident at least
biannually.
Faculty Advisor
The faculty advisor meets with the resident at least biannually to discuss performance evaluation.
If serious deficits are identified in the resident’s performance, meetings with the faculty advisor
will be more frequent.
Attending Physician
The resident will receive timely feedback and be advised of deficits in performance by each
attending with whom he/she works to allow an opportunity for remediation. A PDF mid month
feedback formative evaluation will be emailed to the residents by the residency coordinator.
Criteria for Promotion of Residents
Standards that apply to all residents
1.
Patient Care
a. Participation in patient care and management (but are not limited to history and
physical, procedures) on each rotation as documented by the faculty evaluation
forms. Major performance deficits will be grounds for probation. Attendance and
behavior are also considered in evaluating performance.
b. Completion of the required procedures and being proficient is a requirement for
graduation from the program and eligibility requirement to sit for the American Board of Internal
Medicine (ABIM). See policy IM 0012.
Medical Knowledge
a. A monthly test is administered by the residency program to evaluate residence
medical knowledge. A 65% correct answer score is required to satisfy this
COMPETENCY for third year residents, 55% for second year residents and 45% for
first year residents. At-risk residents are required to meet with the program
director/associates to develop and implement a plan to remediate deficits. The
frequency of these meetings will vary by resident and will be determined by the
faculty advisor in consultation with the Residency Program Director.
b. Attendance at departmental academic conferences. Failure to attend at least 60% of
these conferences will be grounds for probation.
c. Contribution to the academic and scholarly mission of the department. Student and
resident teaching, conference presentations and participation, as well as overall
faculty assessment of resident performance will evaluate this. Major performance
deficits will be grounds for probation.
d. Passing USMLE step three is a prerequisite for promotion from PGY2 to PGY3.
3.
Practice-Based Learning and Improvement
a. The resident need to successfully complete a practice based learning and
improvement plan-as a third year –elective research month, the resident is to choose his
project from a list of projects listed at the American Board of Internal Medicine web site.
b. Assistance in chart audits and recommendations for improving patient care.
4.
Interpersonal and Communication Skills
a. Will be evaluated by Mini-CEX, inpatient services and continuity clinic supervision in
addition to 360 evaluations.
5.
6.
Professionalism
a. Personal integrity, which includes strict avoidance of substance abuse, theft, lying,
cheating, and unexplained absences. Unauthorized use of UTMC equipment and
personnel for other than educational, professional, and patient care use is prohibited.
Failure to follow this standard will be grounds for probation.
Systems-Based Practice
a. Compliance with all hospital and departmental record keeping and documentation
requirements. A pattern of lateness and noncompliance will be grounds for probation.
1. Patient Care
FIRST YEAR RESIDENT
Prioritizes patient
problems
 Prioritize a day of work
 Monitors and follows up
patients appropriately
 Satisfactory
performance on Mini
CEX
 Demonstrates caring
and respectful behaviors
with patients and
families
 Gathers essential,
accurate information in
interviews and physical
exams, and reviews
other data
 Knows indications,
contraindications, &
some risks of some
invasive procedures
 Completely performs
some invasive
procedures.
 Provides services aimed
at prevention and/or
maintenance of health.
 Works with all health
care professionals to
provide patient –focused
care.
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
SECOND YEAR RESIDENT
Prioritizes patient problems

THIRD YEAR RESIDENT
Prioritizes patient problems
Prioritizes a day of work
Monitors and follows up patients
appropriately
Satisfactory performance on Mini CEX



Demonstrates caring and respectful
behaviors with patients and families

Demonstrates caring and
respectful behaviors with
patients and families

Gathers essential, accurate information in
interviews and physical exams, and reviews
other data

Gathers essential, accurate
information in interviews and
physical exams, and reviews
other data

Knows indications, contraindications, &
risks of an increasing number of invasive
procedures.


Completely performs a number of invasive
procedures.

Knows indications,
contraindications, & risks of all
ABIM required invasive
procedures
Completely performs ABIM
required invasive procedures.

Provides services aimed at prevention
and/or maintenance of health.


Works with all health care professionals to
provide patient –focused care.


Understands and weighs alternatives for
diagnosis and treatment


Uses diagnostic procedures and therapies
appropriately
Elicits subtle findings on physical
examination
Obtains a precise, logical and efficient
history







Prioritizes a day of work
Monitors and follows up patients
appropriately
Satisfactory performance on
Mini CEX
Provides services aimed at
prevention and/or maintenance
of health.
Works with all health care
professionals to provide patient
–focused care.
Understands and weighs
alternatives for diagnosis and
treatment
Uses diagnostic procedures and
therapies appropriately
Elicits subtle findings on
physical examination
Obtains a precise, logical and
efficient history


Interprets results of procedures properly


Able to simultaneously manage multiple
problems


Develops and carries out management plans


Considers patient preferences when making
medical decisions


Triages patients to appropriate location



Interprets results of procedures
properly
Able to simultaneously manage
multiple problems
Develops and carries out
management plans
Considers patient preferences
when making medical decisions
Triages patients to appropriate
location
Reasons well in ambiguous
situations
Spends time appropriate to the
complexity of the problem
2. Medical
Knowledge


INTERN
Demonstrates
knowledge of basic and
clinical sciences.
Applies knowledge to
therapy

SECOND YEAR RESIDENT
Demonstrates knowledge of basic and
clinical sciences.

THIRD YEAR RESIDENT
Demonstrates knowledge of
basic and clinical sciences.

Applies knowledge to therapy

Applies knowledge to therapy

Is aware of indications, contraindications
and risks of commonly used medications
and procedures.


Demonstrates knowledge of epidemiologic
and social behavioral sciences knowledge to
the care of the patient.


Applies basic, clinical, epidemiologic and
social behavioral science to the care of the
patient

Is aware of indications,
contraindications and risks of
commonly used medications and
procedures and commonly used
medications.
Demonstrates knowledge of
epidemiologic and social
behavioral sciences knowledge
to the care of the patient.
Applies basic, clinical,
epidemiologic and social
behavioral science to the care of
the patient
Demonstrates an investigatory
and analytic approach to clinical
situations.

3. Practice Based Learning &Improvement




INTERN
Understands his or her
limitations of
knowledge
Asks for help when
needed
Is self motivated to
acquire knowledge
Use of computerized

SECOMD YEAR RESIDENT
Understands his or her limitations of
knowledge

THIRD YEAR RESIDENT
Understands his or her
limitations of knowledge

Asks for help when needed
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Asks for help when needed

Is self motivated to acquire knowledge
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Use of computerized sources of results and


Is self motivated to acquire
knowledge
Use of computerized sources of

sources of results and
information to enhance
patient care.
Accepts feedback and
develops selfimprovement plans.
information to enhance patient care.
results and information to
enhance patient care.

Accepts feedback and develops selfimprovement plans.

Accepts feedback and develops
self-improvement plans.

Undertakes self evaluation with insight


Facilitates the learning of students and other
health care professionals.

Undertakes self evaluation with
insight
Facilitates the learning of
students and other health care
professionals.
Analyzes personal practice
patterns systematically and looks
to improve.
Compares personal practice
patterns to larger populations
Locates, appraises and
assimilates scientific literature
appropriate to specialty.
Applies knowledge of study
design and statistics.
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4. Interpersonal & Communication Skills

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
INTERN
Writes pertinent and
organized notes.
Documents timely and
legible medical records
Uses effective listening,
narrative and non-verbal
skills to elicit and
provide information.
Works effectively as a
member of the health
care team


SECOND YEAR RESIDENT
Writes pertinent and organized notes.

THIRD YEAR RESIDENT
Writes pertinent and organized
notes.
Documents timely and legible
medical records
Uses effective listening,
narrative and non-verbal skills to
elicit and provide information.
Documents timely and legible medical
records
Uses effective listening, narrative and nonverbal skills to elicit and provide
information.


Works effectively as a member of the health
care team

Works effectively as a leader of
the health care team

Creates and sustains therapeutic and
ethically sound relationships with patient
and families.
Provides education and counseling to
patients, families and colleagues.

Able to discuss end of life care with
patients/families.

Creates and sustains therapeutic
and ethically sound relationships
with patient and families.
Provides education and
counseling to patients, families
and colleagues.
Able to discuss end of life care
with patients/families.
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5. Professionalism




INTERN
Establishes trust with
patients and staff.
Does not refuse to treat
patients.
Is honest, reliable, and
cooperative and accepts
responsibility.
Shows regard for
opinions and skills of

SECOND YEAR RESIDENT
Establishes trust with patients and staff.

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Does not refuse to treat patients.


Is honest, reliable, and cooperative and
accepts responsibility.


Shows regard for opinions and skills of
colleagues.

THIRD YEAR RESIDENT
Establishes trust with patients
and staff.
Does not refuse to treat patients.
Is honest, reliable, and
cooperative and accepts
responsibility.
Shows regard for opinions and
skills of colleagues.


colleagues.
Demonstrates respect,
compassion and
integrity.
Is responsive to needs of
patients and society,
which supersedes self
interest.

Demonstrates respect, compassion and
integrity.

Demonstrates respect,
compassion and integrity.

Is responsive to needs of patients and
society, which supersedes self interest.

Is responsive to needs of patients
and society, which supersedes
self interest.

Displays initiative and leadership.

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Is able to delegate responsibility to others.

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Demonstrates commitment to on-going
professional development.

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Demonstrates commitment to ethical
principals pertaining to the provision or
withholding of care, patient confidentiality,
and informed consent and business
practices.


Demonstrates sensitivity to patient culture,
gender, age, preferences and disabilities.


Acknowledges errors and works to
minimize them.


Displays initiative and
leadership.
Is able to delegate responsibility
to others.
Demonstrates commitment to
on-going professional
development.
Demonstrates commitment to
ethical principals pertaining to
the provision or withholding of
care, patient confidentiality, and
informed consent and business
practices.
Demonstrates sensitivity to
patient culture, gender, age,
preferences and disabilities.
Acknowledges errors and works
to minimize them.
Is effective as a consultant.

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THIRD YEAR RESIDENT
Is a patient advocate
Has constructive skepticism.
6. Systems-Based Practice



INTERN
Is a patient advocate
Has constructive
skepticism.
Advocates for high
quality patient care and
assists patients in
dealing with system
complexity.
SECOND YEAR RESIDENT
Is a patient advocate
Has constructive skepticism.

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Advocates for high quality patient care and
assists patients in dealing with system
complexity.

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Advocates for high quality
patient care and assists patients
in dealing with system
complexity.

Applies knowledge of how to partner with
other health care providers to assess,
coordinate and improve patient care.


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Uses Systematic approaches to reduce
errors.
Participates in developing ways to improve
systems of practice and health management.

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
Applies knowledge of how to
partner with other health care
providers to assess, coordinate
and improve patient care.
Uses Systematic approaches to
reduce errors.
Participates in developing ways
to improve systems of practice
and health management.

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Demonstrates ability to adapt to
change
Provides cost effective care
Understands how individual


practices affect other health care
professionals, organizations and
society.
Demonstrates knowledge of
types of medical practice and
delivery systems.
Practices effective allocation of
health care resources that does
not compromise the quality of
care.
Graduation
It is the sole responsibility of the Residency Program Director with the advice of the
Committee to determine whether the resident has successfully completed the residency.
Criteria include, but are not limited to:
1.
Patient Care
a. Complete the tasks of the patient care session so that all necessary duties (including
telephone messages, charting, administrative tasks, patient care) are accomplished
in a timely, organized, and professional manner.
2.
Medical Knowledge
a. Engage in activities that will foster personal and professional growth as a physician.
b. Successful completion of 36 months of ABIM-approved Internal medicine residency
training. The resident must receive a passing evaluation in all rotations.
3.
Practice-Based Learning and Improvement
a. Engage in continuing medical education activities that are influenced by interest,
deficiency, and need.
b. Anticipate and recognize new curriculum necessary for future practice and advocate
for needed reform in medical education.
c. Routinely evaluates care provided to patients through chart audits and develops and
Implements strategies designed to improve care.
4.
Interpersonal and Communication Skills
a. Participation in Simulated Patient Examinations with review by the faculty advisor.
5.
Professionalism
a. Conducts self in a manner that portrays integrity.
b. Demonstrates behavior that espouses the values of internal medicine, e.g.
importance of family, teamwork, patient-centered care, etc.
Systems-Based Practice
b. Work together with clerical staff and nursing staff in a manner that fosters mutual
respect and facilitates an effectively run practice.
c. Work together with partners, fellow physicians, and sub-specialists in a manner that
fosters mutual respect and facilitates the effective handling of patient care issues.
d. Work together with other professionals on the health care team in a manner that
fosters mutual respect and facilitates the effective handling of patient care issues.
e. At each patient care encounter, present yourself and the practice in a manner that
will encourage the patient to select you, the practice, and internal medicine in the
future.
6.
Academic Warning
When a resident is placed on academic warning, a remedial program will be instituted in an
attempt to correct the particular deficit(s). Continued failure to meet departmental standards
despite attempted remediation will result in probationary status and adherence to the UTMC GME
Due Process Policy.
Appeal
If a resident is placed on probation, or recommended for expulsion from the program, he/she may
appeal to the Residency Program Director. The Residency Program Director will attempt to
resolve the grievance within 30 days. If the resident is not satisfied with the resolution proposed
by the Residency Program Director, he/she may submit an appeal to the Associate Dean for
Graduate Medical Education, in accord with the Due Process policies of the University of Toledo.
Approved by:
__________________________________
Chairman, Department of Internal Medicine
Chairman ,Department of Medicine
________________________
Program Director
_______________________________
3/28/2007
_________
Date