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AHEC SOUTHWEST FAMILY MEDICINE RESIDENCY RESIDENCY PROGRAM GOALS AND OBJECTIVES GOAL 1: THE OVERARCHING GOAL IS PREPARING FAMILY MEDICINE RESIDENTS TO BECOME COMPETENT, INDEPENDENT FAMILY PHYSICIANS WHO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT AND THE PROMOTION OF HEALTH. OBJECTIVES 1. RECRUIT EXCELLENT STUDENTS TO THE PROGRAM 2. ENGAGE AREA HIGH SCHOOL STUDENTS TO BECOME INTERESTED AND INVOLVED IN THE WORLD OF HEALTHCARE AS A CAREER AND IN FAMILY MEDICINE, IN PARTICULAR. 3. THE PROGRAM WILL TRACK THE ACHIEVEMENTS AND BOARD CERTIFICATIONS OF ALL GRADUATING RESIDENTS. 4. THE PROGRAM WILL ROUTINELY SURVEY GRADUATES IN ORDER TO IMPROVE THE EDUCATIONAL ASPECT OF THE PROGRAM. GOAL 2: OUR PROGRAM WILL PROVIDE A SAFE, EXCELLENT ENVIRONMENT FOR THE TEACHING OF FAMILY MEDICINE. OBJECTIVES 1. FACULTY WILL NOT TEACH BY INTIMIDATION OR HUMILIATION OF STUDENTS OR RESIDENTS (UAMS POLICY). 2. FACULTY AND STAFF WILL NOT TOLERATE HARASSMENT BASED ON SEX, AGE, GENDER, RELIGION OR SEXUAL PREFERENCE. 3. THE PROGRAM WILL PROVIDE ADEQUATE SALARY, WORK SPACE, ENCOURAGEMENT, AND STRICT ADHERENCE TO DUTY HOURS FOR ALL RESIDENTS. 4. THE PROGRAM WILL PROVIDE EXCELLENT OPPORTUNITIES FOR EDUCATION IN ALL AREAS OF MEDICINE THAT PERTAINS TO FAMILY MEDICINE. GOAL 3: OUR PROGRAM WILL PROVIDE EXCELLENT EDUCATIONAL OPPORTUNITIES FOR STUDENTS, RESIDENTS, AND ALL LEARNERS INVOLVED IN THE PROGRAM. OBJECTIVES 1. THE PROGRAM WILL PROVIDE NECESSARY IT EQUIPMENT (COMPUTER, PDA, PRINTERS, INTERNET ACCESS, AND PAGERS) FOR RESIDENTS, STUDENTS, AND FACULTY. 2. THE PROGRAM WILL PROVIDE LIBRARIES (CLINIC AND COMPREHENSIVE) WITH PERTINENT BOOKS, JOURNALS AND EDUCATIONAL MATERIALS. IT WILL HAVE A FULL TIME LIBRARIAN AND HAVE THE ABILITY TO GET ARTICLES, PROVIDE SEARCHES, AND OBTAIN OTHER EDUCATIONAL LITERATURE (MONOGRAPHS, CDS, BOOKS) FOR ALL LEARNERS. 3. THE PROGRAM WILL STRIVE TO HAVE A COMFORTABLE “FAMILY” RELATIONSHIP INCLUDING RESIDENTS, FACULTY, ADMINISTRATION, NURSING STAFF, AND BUSINESS OFFICE. THIS WILL BE ENCOURAGED BY DAILY CONTACT AT NOON CONFERENCES AND MORNING REPORT. GOAL 4: OUR PROGRAM WILL PROVIDE EXCELLENT FACULTY WITH A VARIETY OF SKILLS AND EXPERTISE TO TRAIN OUR RESIDENTS. 1 OBJECTIVES 1. THE PROGRAM WILL PROVIDE SALARY, VACATION, CME, AND ENCOURAGEMENT FOR OUR FULL AND PART TIME FACULTY. 2. THE FACULTY WILL INCLUDE DIVERSE SKILLS AND TRAINING (MD, PHARM D, SOCIAL WORKERS, AND EDUCATORS). 3. THE PROGRAM WILL PROVIDE OPPORTUNITIES BOTH TIME AND FINANCIAL RESOURCES TO ENSURE FACULTY DEVELOPMENT ON FOUR LEVELS. a. INDIVIDUAL ACTIVITY b. GROUP (LOCAL) ACTIVITY c. STATE WIDE d. NATIONAL (AAFP, STFM, PDW, RPS). 4. THE PROGRAM WILL PROVIDE OPPORTUNITY AND FACILITATE RESEARCH AND SCHOLARLY ACTIVITY FOR ALL FULL-TIME FACULTY MEMBERS. TRAINING GOALS: UPON COMPLETION OF THIS RESIDENCY, A FAMILY MEDICINE RESIDENT WILL (AS DETERMINED BY THE SIX COMPETENCIES): 1. DEMONSTRATE CLINICAL EXCELLENCE, UTILIZING CURRENT BIOMEDICAL KNOWLEDGE IN IDENTIFYING AND MANAGING THE MEDICAL PROBLEMS PRESENTED BY HIS/HER PATIENTS. 2. PROVIDE CONTINUING AND COMPREHENSIVE CARE TO INDIVIDUALS AND FAMILIES. 3. DEMONSTRATE THE ABILITY TO INTEGRATE THE BEHAVIORAL, EMOTIONAL, AND SOCIAL ENVIRONMENT FACTORS OF FAMILIES IN PROMOTING HEALTH AND MANAGING DISEASE. 4. RECOGNIZE THE IMPORTANCE OF MAINTAINING AND DEVELOPING KNOWLEDGE, SKILLS, AND ATTITUDES REQUIRED FOR THE BEST IN MODERN MEDICAL KNOWLEDGE IN A RAPIDLY-CHANGING WORLD AND PURSUE A REGULAR AND SYSTEMATIC PROGRAM OF LIFE-LONG LEARNING. 5. RECOGNIZE THE NEED AND DEMONSTRATE THE ABILITY TO UTILIZE CONSULTATION WITH OTHER MEDICAL SPECIALISTS WHILE MAINTAINING CONTINUITY OF CARE. 6. BE AWARE OF THE FINDINGS OF RELEVANT RESEARCH; UNDERSTAND AND CRITICALLY EVALUATE THIS BODY OF RESEARCH; AND APPLY THE RESULTS OF THE RESEARCH TO MEDICAL PRACTICE. 7. MANAGE HIS/HER PRACTICE IN A BUSINESSLIKE, COST-EFFECTIVE MANNER WHICH WILL PROVIDE PROFESSIONAL SATISFACTION AND TIME FOR A REWARDING PERSONAL LIFE. 8. SERVE AS AN ADVOCATE FOR THE PATIENT WITHIN THE HEALTH CARE SYSTEM. ACCESS THE QUALITY OF CARE THAT IS PROVIDED AND ACTIVELY PURSUE MEASURES TO CORRECT DEFICIENCIES. 9. RECOGNIZE COMMUNITY RESOURCES AS AN INTEGRAL PART OF THE HEALTH CARE SYSTEM; PARTICIPATE IN IMPROVING THE HEALTH OF THE COMMUNITY. 10. INFORM AND COUNSEL PATIENTS CONCERNING THEIR HEALTH PROBLEMS, RECOGNIZING PATIENT AND PHYSICIAN BACKGROUNDS, BELIEFS, AND EXPECTATIONS MAY BE DIFFERENT. 11. DEVELOP MUTUALLY SATISFYING PHYSICIAN-PATIENT RELATIONSHIPS TO PROMOTE COMPREHENSIVE PROBLEMIDENTIFICATION AND PROBLEM-SOLVING. 12. USE CURRENT MEDICAL KNOWLEDGE TO IDENTIFY, EVALUATE AND MINIMIZE RISKS FOR PATIENT AND FAMILY WHILE BALANCING POTENTIAL BENEFITS, COSTS, AND RESOURCES IN DETERMINING APPROPRIATE INTERVENTIONS. 13. ACTIVELY PARTICIPATE IN PROFESSIONAL ORGANIZATIONS THAT PROMOTE THE INTEGRITY OF MEDICINE AND COMPETITIVE ACCESS TO AFFORDABLE HEALTH CARE FOR ALL CITIZENS. 2 GOALS THAT SHOULD BE ACCOMPLISHED BY GRADUATES INCLUDE: SCOPE OF TRAINING 1. THE GRADUATE SHOULD BE A FAMILY PHYSICIAN WHO WILL BE ABLE TO PROVIDE PRIMARY, CONTINUING, COMPREHENSIVE HEALTH CARE TO ALL MEMBERS OF FAMILIES, REGARDLESS OF AGE OR PROBLEMS, BY GATHERING ESSENTIAL AND ACCURATE INFORMATION AND COMBINING IT WITH UP-TODATE SCIENTIFIC EVIDENCE TO MAKE DECISIONS ABOUT DIAGNOSTIC AND THERAPEUTIC INTERVENTIONS. 2. THE GRADUATE SHOULD BE ABLE TO FUNCTION AS THE PHYSICIAN OF FIRST CONTACT, TO BE AN EXPERT IN DEALING WITH UNDIFFERENTIATED PROBLEMS, TO BE PROFICIENT IN SENSING MEDICAL PROBLEMS, AND SKILLFUL IN INDUCTIVE MEDICAL PROBLEM SOLVING, AND FRUGAL IN THE USED OF RESOURCES FOR DIAGNOSIS AND TREATMENT. 3. THE GRADUATE WILL DEMONSTRATE COMPETENCY IN THE DIAGNOSIS AND MANAGEMENT OF COMMON TYPES OF MEDICAL PROBLEMS AND ILLNESSES SUCH AS PRESENT IN THE AMBULATORY SETTING. 4. THE GRADUATE WILL BE EXPECTED TO DEMONSTRATE KNOWLEDGE AND ABILITY TO RECOGNIZE CASUAL RELATIONSHIPS OF ILLNESSES AND THE INFLUENCE OF LIFESTYLE AS WELL AND THE INTERACTION OF LIFESTYLE AND GENETICS. 5. THE GRADUATE WILL BE ABLE TO COMFORTABLY MANAGE THE NON-BIOMEDICAL CARE OF THE PATIENT WITH CHRONIC ILLNESS. CLINICAL CARE 1. THE GRADUATE WILL MAKE INFORMED DECISIONS ABOUT DIAGNOSTIC AND THERAPEUTIC INTERVENTIONS BASED ON PATIENT INFORMATION AND PREFERENCES, UP-TO-DATE SCIENTIFIC EVIDENCE, AND CLINICAL JUDGMENT AND DEVELOP AND CARRY OUT PATIENT MANAGEMENT PLANS APPROPRIATE TO THE PATIENTS DISEASE PROCESS, NEED FOR PREVENTIVE SERVICES, AND HIGH RISK BEHAVIOR. 2. GRADUATES SHOULD UNDERSTAND THE NEED FOR EPIDEMIOLOGICAL, CLINICAL, AND OPERATIONAL RESEARCH. 3. GRADUATES SHOULD BE ABLE TO RECOGNIZE AND DEFINE INFORMATIONAL NEEDS AND IMPLEMENT CHANGE BASED ON BEST AVAILABLE EVIDENCE INTO THEIR PRACTICE. 4. THE GRADUATES FROM THE PROGRAM WILL DEMONSTRATE THE FUNDAMENTAL QUALITIES OF PROFESSIONALISM, RESPECT FOR THE PATIENT, REGARD TO THE PATIENT’S WISHES, INTEGRITY, AND RESPONSIVENESS TO THE NEEDS OF THE PATIENT THAT SUPERSEDES SELF-INTEREST. THIS IS TO BE DONE IN A MANNER THAT REFLECTS SENSITIVITY TO THE PATIENT’S CULTURAL BACKGROUND AND DESIRES. 5. GRADUATES WILL BE COMPETENT IN THE USE OF THE COMPUTER TO MANAGE INFORMATION, ACCESS ONLINE INFORMATION, AND SUPPORT CLINICAL CARE. 6. GRADUATES ARE EXPECTED TO DEVELOP AND MAINTAIN THAT PARTICULAR TYPE OF DOCTOR-PATIENT RELATIONSHIP THAT IS CHARACTERIZED BY A CONTINUING, PERSONAL INTENSE RELATIONSHIP IN WHICH THE PHYSICIAN CARE FOR THE PATIENT AS A PERSON, AND MANAGES A BROAD RANGE OF PROBLEMS OF 3 CONCERN TO THE PATIENT WHETHER BIOMEDICAL, INSOLUBLE PROBLEMS, AND ONE IN WHICH THE FAMILY PHYSICIAN ACTS AS A THERAPEUTIC AGENT. 7. THE GRADUATE WILL DEMONSTRATE A FAMILIARITY WITH FAMILY SYSTEMS THEORY INCLUDING SKILLS PERTINENT TO HIS OR HER INDIVIDUAL PRACTICE. 8. THE GRADUATE WILL DEMONSTRATE KNOWLEDGE OF THE INFLUENCES OF HEREDITY AND GENETICS ON HEALTH AND MEDICALS PROBLEMS, AND TO DEMONSTRATE SKILLS IN COLLECTING AND UTILIZING DATA ON THE FAMILY PEDIGREE IN MANAGING THE PATIENT, FAMILY, AND COMMUNITY. 9. THE GRADUATE WILL DEMONSTRATE THE ABILITY TO FUNCTION WITH THE LARGER HEALTH SYSTEM BUT USE OF COST EFFECTIVENESS AND CASE MANAGEMENT TECHNIQUES, APPROPRIATE UTILIZATION OF DIAGNOSTIC STUDIES AND THERAPEUTIC PROCEDURES, AND ORDERING WITHIN THE CONSTRAINTS OF THE INDIVIDUAL PATIENTS’ AND SOCIETY’S RESOURCES. 10.UPON GRADUATION, THE LEARNER WILL HAVE AN UNDERSTANDING OF THE VARIETY OF PRACTICE SITUATIONS AVAILABLE AND THE RISKS AND BENEFITS INVOLVED IN EACH AND WILL BE ABLE TO FUNCTION AS A FAMILY PHYSICIAN IN THE SETTING OF HIS OR HER CHOICE. 11.THE GRADUATE WILL UNDERSTAND THE ISSUES INVOLVED IN PROPER DOCUMENTATION OF CARE. THIS INCLUDES PROPER CHARTING FOR MEDICAL, REIMBURSEMENT, AND LEGAL PURPOSES. THIS REQUIRES THEIR KNOWLEDGE IN THE MANAGEMENT OF PATIENT SPECIFIC INFORMATION, PATIENT PRIVACY AND CONFIDENTIALITY, AND MAINTENANCE OF QUALITY THROUGH CHART REVIEW AND QUALITY IMPROVEMENT METHODS. 12.THE GRADUATE WILL FUNCTION IN THE BROADER PRACTICE COMMUNITY BY DEALING WITH FAMILY AND WORK RELATED CONCERNS, MAINTAINING A DOCTOR-PATIENT RELATIONSHIP WHILE NOT BEING CONSTANTLY AVAILABLE, WORKING WITH PHYSICIANS OF OUR SPECIALTY AS WELL AS OTHER SPECIALTIES, AND MAINTENANCE OF THE CLINICAL DATABASE AND RECERTIFICATION. RESIDENT ADMINISTRATIVE RESPONSIBILITIES BY YEAR PGY-I 4 SUCCESSFULLY COMPLETE ACLS, PALS, & NALS COMPLETE HEALTH WORK AND PROVIDE PAPERWORK NECESSARY FIND OUT ABOUT ALL SCHEDULES, CLINIC, ROTATION, CAN CALL PRIOR TO SCHEDULED ROTATIONS APPEAR FOR DUTIES PROMPTLY AND DRESSED APPROPRIATELY REQUEST VACATION TIME FROM APPROPRIATE ROTATIONS IN TIMELY MANNER UPKEEP OF CHARTS IN OUR EMR, AND HOSPITALS TAKE FIRST CALL FOR RESIDENCY AS SCHEDULED BY RESIDENTS ASSIST IN RECRUITING ORIENTATE TO CLINIC EMR AND EPOCRATES SOFTWARE MEET WITH PROGRAM DIRECTOR TWO TIMES DURING PGY I YEAR PREPARE FOR IN-TRAINING EXAM DOCUMENT DELIVERIES, ICU CARE, & PROCEDURES ON NEW INNOVATIONS PROVIDE ANY AND ALL NECESSARY DUTIES TO INSURE SMOOTH OPERATION OF PROGRAM, CLINIC, CALL AND HOSPITAL SERVICE PGY-II PROVIDE COPIES OF ALL LICENSURE INFORMATION TO RESIDENCY OFFICE SUCCESSFULLY COMPLETE ATLS REQUEST VACATION TIME FROM APPROPRIATE ROTATIONS UPKEEP OF CHARTS IN OUR EMR AND HOSPITALS FIND OUT ABOUT ALL SCHEDULES, CLINIC, ROTATION AND CALL APPEAR FOR DUTIES PROMPTLY AND DRESSED APPROPRIATELY BACK UP CALL AND ASSIST PGY 1 AS SCHEDULED BY RESIDENTS ASSIST IN RECRUITING DOCUMENT DELIVERIES, ICU CARE, & PROCEDURES ON NEW INNOVATIONS PREPARE FOR IN-TRAINING EXAM SET UP AND EXECUTE PERFORMANCE IMPROVEMENT PROJECT MEET WITH PROGRAM DIRECTOR TWO TIMES DURING PGY II YEAR PROVIDE ANY AND ALL NECESSARY DUTIES TO INSURE SMOOTH OPERATION OF PROGRAM, CLINIC, CALL, AND HOSPITAL SERVICE SUCCESSFULLY COMPLETE STEP III PGY-III REQUEST VACATION TIME FROM APPROPRIATE ROTATIONS UPKEEP OF PAPERWORK AND CHARTS SECURE ROTATIONS FOR ELECTIVE MONTHS FIND ABOUT ALL SCHEDULES, CLINIC, ROTATION AND CALL APPEAR FOR DUTIES PROMPTLY AND DRESSED APPROPRIATELY ASSIST IN RECRUITING WORK WITH CLINIC SOCIAL WORKER IN FINISHING HOME VISITS PRESENT PERFORMANCE IMPROVEMENT PROJECT AT JOURNAL CLUB BACK UP CALL AND ASSIST PGY 1 AS SCHEDULED BY RESIDENTS DOCUMENT DELIVERIES, ICU CARE, & PROCEDURES ON NEW INNOVATIONS MEET WITH THE PROGRAM DIRECTOR TWO TIMES DURING PGY III YEAR INCLUDING EXIT INTERVIEW 5 PREPARE FOR IN-TRAINING EXAM OBTAIN A STATE MEDICAL LICENSE PREPARE AND PASS BOARD CERTIFICATION EXAM IN APRIL PROVIDE ANY AND ALL NECESSARY DUTIES TO INSURE SMOOTH OPERATION OF PROGRAM, CLINIC. CALL, AND HOSPITAL SERVICE GENERAL COMPETENCY CURRICULUM ALL RESIDENT EVALUATIONS ARE TO BE DONE WITHIN THE 6 COMPETENCIES LISTED: MEDICAL KNOWLEDGE, PATIENT CARE, PRACTICEDBASED LEARNING AND IMPROVEMENT, INTERPERSONAL COMMUNICATION SKILLS, PROFESSIONALISM, AND PRACTICEBASED SYSTEM. THIS IS A GENERAL FRAMEWORK BY WHICH THESE COMPETENCIES WILL BE EVALUATED. FOLLOWING WILL BE A DETAILED CURRICULUM WRITTEN IN THE COMPETENCY FORMAT. LEARNING OBJECTIVES COMPETENCY MEDICAL KNOWLEDGE RESIDENTS MUST DEMONSTRATE KNOWLEDGE ABOUT ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE SCIENCES AND THE APPLICATION OF THE KNOWLEDGE TO PATIENT CARE. THE RESIDENT MUST: 1. DEMONSTRATE AN 2. INVESTIGATORY AND ANALYTIC THINKING APPROACH TO CLINICAL SITUATIONS. KNOW AND APPLY THE BASIC AND CLINICALLY SUPPORTIVE SCIENCES, WHICH ARE APPROPRIATE TO THEIR DISCIPLINE. IMPLEMENTATION 1. JOURNAL CLUB PRESENTATIONS AND PARTICIPATION. 2. RESEARCH PROJECT 3. NOON CONFERENCES 4. HIPPA TRAINING 5. HUMAN SUBJECT PROTECTION TRAINING FOR INSTITUTIONAL REVIEW BOARD (RESEARCH PROJECTS) 6. ONLINE RESEARCH METHODS COURSE 7. ORAL PRESENTATIONS AT 8. 9. 10. 11. 12. LEARNING OBJECTIVES COMPETENCY PATIENT CARE THE RESIDENT MUST: 1. COMMUNICATE THE RESIDENT MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT AND THE PROMOTION OF HEALTH. 2. 3. 4. 6 EFFECTIVELY AND DEMONSTRATE CARING BEHAVIOR WHEN INTERACTING WITH PATIENTS AND THEIR FAMILIES. GATHER ESSENTIAL AND ACCURATE INFORMATION ABOUT THEIR PATIENTS. MAKE INFORMED DECISIONS ABOUT DIAGNOSTIC AND THERAPEUTIC INTERVENTIONS BASED ON PATIENT INFORMATION AND PREFERENCES, UP-TO-DATE SCIENTIFIC EVIDENCE, AND CLINICAL JUDGMENT. DEVELOP AND CARRY OUT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. EVALUATION METHOD 1. IN-SERVICE EXAMINATION 2. MONTHLY CHART REVIEW BY A FACULTY MEMBER 3. CONFERENCE ATTENDANCE AND PARTICIPATION 4. JOURNAL CLUB ATTENDANCE AND PARTICIPATION 5. HOSPITAL AND CLINIC PRESENTATIONS 6. VERIFICATION OF CHALLENGER SERIES QUESTIONS BEDSIDE OR IN THE CLINIC MORNING REPORT PRESENTATIONS ASSIGNED ROTATIONAL READING ASSIGNMENTS. MONTHLY QUIZZES REMEDIATION FOR <10TH PERCENTILE ITE SCORES CLINIC PRECEPTOR ENCOUNTER 7. CLINIC PATIENT PRESENTATION TO PRECEPTOR 8. PASSAGE OF USMLE STEP III BY END OF PGY2 IMPLEMENTATION HOSPITAL TEACHING ROUNDS MORNING REPORT ROTATIONAL EXPERIENCE NOON CONFERENCE CURRICULUM VIDEOTAPE MONITORING ON A SEMI-ANNUAL BASIS CLINIC PRESENTATION TEACHING QUALITY IMPROVEMENT PROJECT FPIN MEDICAL INQUIRY PREPARATION FOR USLME STEP III PERFORMANCE IMPROVEMENT PROJECTS EVALUATION METHOD 1. HOSPITALIZED PATIENT CARE EVALUATIONS 2. ROTATIONAL EVALUATIONS MONTHLY 3. VIDEOTAPE REVIEW SEMIANNUALLY 4. ADVISOR CLINIC CHART REVIEW 5. QUALITY IMPROVEMENT PROJECT 6. PROCEDURE PORTFOLIO EVALUATION MONTHLY IN ADVISOR MEETINGS 7. MONTHLY CLINIC PRECEPTOR EVALUATIONS 8. 360 DEGREE EVALUATIONS QUARTERLY 9. FPIN MEDICAL INQUIRY POSTER PRESENTATION 10. PASSAGE OF USLME STEP III BY END OF PGY 2 5. 6. 7. 8. 9. LEARNING OBJECTIVES COMPETENCY PRACTICE BASED LEARNING & IMPROVEMENT THE RESIDENT MUST: 1. ANALYZE PRACTICE RESIDENTS MUST BE ABLE TO INVESTIGATE AND EVALUATE THEIR PATIENT CARE PRACTICES, APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND IMPROVE THEIR PATIENT CARE PRACTICES. 2. 3. 4. 7 PATIENT MANAGEMENT PLANS. COUNSEL AND EDUCATE PATIENTS AND THEIR FAMILIES. USE INFORMATION TECHNOLOGY TO SUPPORT PATIENT CARE DECISIONS AND PATIENT EDUCATION. PERFORM COMPETENTLY ALL MEDICAL AND INVASIVE PROCEDURES CONSIDERED ESSENTIAL FOR THE AREA OF PRACTICE. PROVIDE HEALTH CARE SERVICES AIMED AT PREVENTING HEALTH PROBLEMS OR MAINTAINING HEALTH. WORK WITH HEALTH CARE PROFESSIONALS, INCLUDING THOSE FROM OTHER DISCIPLINES, TO PROVIDE PATIENT FOCUSED CARE. EXPERIENCE AND PERFORM PRACTICE-BASED IMPROVEMENT ACTIVITIES USING A SYSTEMATIC METHODOLOGY. LOCATE, APPRAISE, AND ASSIMILATE EVIDENCE FROM SCIENTIFIC STUDIES RELATED TO THEIR PATIENTS’ HEALTH PROBLEMS. OBTAIN AND USE INFORMATION ABOUT THEIR OWN POPULATION OF PATIENTS AND THE LARGER POPULATION FROM WHICH THEIR PATIENTS ARE DRAWN. APPLY KNOWLEDGE OF STUDY DESIGNS AND STATISTICAL METHODS TO THE APPRAISAL OF CLINICAL STUDIES AND OTHER INFORMATION ON DIAGNOSTIC AND IMPLEMENTATION EVALUATION METHOD 1. CQI QUARTERLY CONFERENCE BY 1. ADVISORY MONTHLY CLINIC HOSPITAL ANALYZING THE CHART REVIEW OF Q/A RESIDENCY’S HOSPITAL ISSUES PRACTICES. 2. JOURNAL CLUB ATTENDANCE 2. CLINIC Q/A COMMITTEE & PARTICIPATION PROJECTS 3. CONFERENCE ATTENDANCE & 3. JOURNAL CLUB ATTENDANCE & PARTICIPATION PARTICIPATION 4. RESEARCH PROJECT 4. NOON CONFERENCE PARTICIPATION THROUGH ATTENDANCE & PARTICIPATION. FPIN 5. USE OF EMEDICINE WEBSITE 5. HOSPITAL QUARTERLY 6. RESEARCH PROJECT REPORTS OF UR/QM PARTICIPATION IN FPIN PROJECTS 7. UR/QM COMMITTEE 6. ADVISOR REVIEW ASSIGNMENTS AT HOSPITALS PROCEDURE PORTFOLIO 8. PERFORMANCE IMPROVEMENT QUARTERLY PROJECT 7. PERFORMANCE 9. MONTHLY CHART REVIEW BY IMPROVEMENT PROJECT FACULTY POSTER PRESENTATION 10. COMPLIANCE WITH CORE 8. FEEDBACK ON MONTHLY MEASURES FOR INPATIENTS WITH CHART REVIEW ACUTE MI, PNEUMONIA, & CHF 9. 100% COMPLIANCE OF 11. REVIEW OF DICTATED HOSPITAL INPATIENT CORE MEASURES H&PS AND DISCHARGE 10. REVIEW OF HOSPITAL SUMMARIES DICTATED H&PS AND 12. PERFORMANCE IMPROVEMENT DISCHARGE SUMMARIES PROJECTS 5. 6. COMPETENCY THERAPEUTIC EFFECTIVENESS. USE INFORMATION TECHNOLOGY TO MANAGE INFORMATION, ACCESS ONLINE MEDICAL INFORMATION, AND SUPPORT THEIR EDUCATION. FACILITATE THE LEARNING OF STUDENTS AND OTHER HEALTH CARE PROFESSIONALS. LEARNING OBJECTIVES IMPLEMENTATION 1. VIDEOTAPE PATIENT ENCOUNTERS ON A SEMITHERAPEUTIC AND ANNUAL BASIS. ETHICALLY SOUND 2. ORIENTATION CONFERENCES RESIDENTS MUST BE ABLE TO RELATIONSHIP WITH REGARDING INTERPERSONAL & DEMONSTRATE PATIENTS. COMMUNICATION SKILLS. INTERPERSONAL AND 2. USE EFFECTIVE LISTENING 3. ATTENDANCE AND COMMUNICATION SKILLS SKILLS AND ELICIT AND PARTICIPATION IN THE MONTHLY THAT RESULT IN EFFECTIVE PROVIDE INFORMATION ETHICS NOON CONFERENCES. INFORMATION EXCHANGE USING EFFECTIVE 4. MONTHLY BEHAVIOR MEDICINE AND LEARNING WITH NONVERBAL, EXPLANATORY CONFERENCE ATTENDANCE AND PATIENTS, FAMILIES, AND QUESTIONING, AND PARTICIPATION. PROFESSIONAL ASSOCIATES. WRITING SKILLS. 5. IN/OUTPATIENT BEDSIDE 3. WORK EFFECTIVELY WITH TEACHING OTHERS AS A MEMBER OR 6. MODELING BY FAMILY PRACTICE LEADER OF A HEALTH CARE FACULTY MEMBERS. TEAM OR OTHER 7. INVOLVEMENT IN ACTIVITIES AT PROFESSIONAL GROUP. OPPORTUNITIES, INC. DURING COPC ROTATION 8. PARTICIPATION IN REQUIRED COMMUNITY PROJECTS 9. REVIEW OF ASSIGNED READINGS BY BEHAVIOR SCIENCE FACULTY INTER-PERSONAL & COMMUNI-CATION SKILLS THE RESIDENT MUST: 1. CREATE AND SUSTAIN A 10. 11. MEMBER QUARTERLY ETHICAL DILEMMA PRESENTATIONS SEE ORIENTATION EVALUATION METHOD 1. VIDEOTAPE PATIENT ENCOUNTER REVIEWS. 2. FACULTY DIRECT OBSERVATION OF RESIDENT IN CLINIC AND HOSPITAL. 3. BEHAVIOR SCIENCE CONFERENCE ATTENDANCE & PARTICIPATION. 4. ETHICS CONFERENCE ATTENDANCE AND PARTICIPATION. 5. ROTATIONAL EVALUATIONS MONTHLY 6. CLINIC PRECEPTOR EVALUATIONS MONTHLY 7. ORIENTATION INTERPERSONAL & COMMUNICATION SKILLS CONFERENCE PARTICIPATION. 8. COPC ROTATIONAL EVALUATION. 9. 360 DEGREE EVALUATION INCLUDING INPUT FROM SELF, OTHER RESIDENTS, NURSING STAFF, OFFICE STAFF AND PATIENTS. 10. PARTICIPATION IN QUARTERLY DILEMMA DISCUSSIONS 11. ASSIGNED READINGS BY BEHAVIOR SCIENCE FACULTY MEMBER COMPETENCY LEARNING OBJECTIVES PROFESSIONALISM THE RESIDENT MUST: RESIDENTS MUST 1. DEMONSTRATE RESPECT, COMPASSION, AND DEMONSTRATE A 8 IMPLEMENTATION EVALUATION METHOD 1. VOLUNTEERISM IN COMMUNITY 1. 360 DEGREE EVALUATION PROJECTS. WITH INPUT FROM PATIENTS, 2. FACULTY OBSERVATION OF NURSING STAFF, OFFICE RESIDENT INTERACTING WITH STAFF, FELLOW-RESIDENTS, COMMITMENT TO CARRYING PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION. 2. 3. LEARNING OBJECTIVES COMPETENCY SYSTEMS-BASED PRACTICE RESIDENT MUST THE RESIDENT MUST: 1. UNDERSTAND HOW THEIR 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. 2. 3. 9 INTEGRITY; A RESPONSIVENESS TO THE NEEDS OF PATIENTS AND SOCIETY THAT SUPERCEDES SELF-INTEREST; ACCOUNTABILITY TO PATIENTS, SOCIETY, AND THE PROFESSION; AND A COMMITMENT TO EXCELLENCE AND ON-GOING PROFESSIONAL DEVELOPMENT. DEMONSTRATE A COMMITMENT TO ETHICAL PRINCIPLES PERTAINING TO PROVISION OR WITHHOLDING THE CLINICAL CARE, CONFIDENTIALITY OF PATIENT INFORMATION, INFORMED CONSENT, AND BUSINESS PRACTICES. DEMONSTRATE SENSITIVITY AND RESPONSIVENESS TO PATIENTS’ CULTURE, AGE, GENDER, AND DISABILITIES. PATIENT CARE AND OTHER PROFESSIONAL PRACTICES AFFECT OTHER HEALTH CARE PROFESSIONALS, THE HEALTH CARE ORGANIZATION, AND THE LARGER SOCIETY AND HOW THESE ELEMENTS OF THE SYSTEM AFFECT THEIR OWN PRACTICE. KNOW HOW TYPES OF MEDICAL PRACTICE AND DELIVERY SYSTEMS DIFFER FROM ONE ANOTHER, INCLUDING METHODS OF CONTROLLING HEALTH CARE COSTS AND ALLOCATING RESOURCES. PRACTICE COST-EFFECTIVE HEALTH CARE AND RESOURCE ALLOCATION THAT DOES NOT COMPROMISE QUALITY OF CARE. 3. 4. 5. 6. 7. 8. 9. 10. 11. PATIENTS AND PROFESSIONAL HEALTH CARE WORKERS. BEHAVIOR MEDICINE CONFERENCE AND PARTICIPATION. ROLE MODELING BY FAMILY PRACTICE RESIDENCY FACULTY. ETHICS NOON CONFERENCE MONTHLY VIDEOTAPED RESIDENT-PATIENT ENCOUNTERS. ORIENTATION CONFERENCES ON PROFESSIONALISM. HOSPITAL ETHICS COMMITTEE ASSIGNMENT INTERNATIONAL MEDICAL MISSIONS QUARTERLY SCHEDULED ETHICAL DILEMMA PRESENTATION ASSIGNED READINGS BY BEHAVIOR SCIENCE FACULTY MEMBER IMPLEMENTATION 1. ASSIGNED READINGS BY BEHAVIOR SCIENCE FACULTY 2. 3. 4. 5. 6. 7. 8. MEMBER Q/A CLINIC COMMITTEE OF RESIDENT UTILIZATION OF RESOURCES. PRACTICE MANAGEMENT MONTHLY NOON CONFERENCE. DEVELOPMENT & IMPLEMENTATION OF PRACTICE MANAGEMENT ROTATION FACULTY MODELING IN AHEC CLINIC PRACTICE AND AS CLINIC PRECEPTORS. LONGITUDINAL SUPERVISION OF CLINIC AND HOSPITAL ENCOUNTERS. UTILIZATION OF CASE MANAGER IN HOSPITAL DURING INPATIENT MEDICINE ROTATION. APPROPRIATE UTILIZATION OF CLINIC SOCIAL WORKER AND HEALTH EDUCATOR. COMMUNITY ORIENTED PRIMARY CARE ROTATION WITH EXPOSURE TO MIGRANT WORKER FACULTY, AND SELF. 2. VIDEOTAPED PATIENT ENCOUNTER REVIEWS ON A SEMI-ANNUAL BASIS 3. BEHAVIOR MEDICINE CONFERENCE ATTENDANCE AND PARTICIPATION. 4. ETHICS NOON CONFERENCE MONTHLY ATTENDANCE 5. ON HOSPITAL ETHICS COMMITTEE. 6. DOCUMENTED PARTICIPATION IN AN ANNUAL COMMUNITY PROJECT. 7. PARTICIPATION IN QUARTERLY ETHICAL DILEMMA PRESENTATIONS EVALUATION METHOD 1. 360 DEGREE EVALUATION 2. 3. 4. 5. 6. 7. 8. WITH INPUT FROM PATIENTS, NURSING STAFF, OFFICE STAFF, FELLOW-RESIDENTS, FACULTY, AND SELF. ADVISORY MONTHLY CHART REVIEW. INPATIENT MEDICINE EVALUATION. COMMUNITY ORIENTED PRIMARY CARE ROTATION EVALUATION. “HANDS ON” PRACTICE MANAGEMENT EVALUATION. PRACTICE MANAGEMENT NOON CONFERENCE ATTENDANCE AND PARTICIPATION. REPORT CARD FROM QUARTERLY UR/QM COMMITTEE CONFERENCE ON RESIDENCY’S HOSPITAL PRACTICE CLINIC Q/A COMMITTEE EVALUATION OF CLINIC PRACTICE. 4. ADVOCATE FOR QUALITY 5. 10 PATIENT CARE AND ASSIST PATIENTS IN DEALING WITH SYSTEM COMPLEXITIES. KNOW HOW TO PARTNER WITH HEALTH CARE MANAGERS AND HEALTH CARE PROVIDERS TO ASSESS, COORDINATE, AND IMPROVE HEALTH CARE AND KNOW HOW THESE ACTIVITIES CAN AFFECT SYSTEM PERFORMANCE. CLINIC, HOSPICE AND HOME 9. PARTICIPATION IN PHYSICIAN HEALTH ORGANIZATIONS, DEVELOPMENT MONTH. COUNTY HEALTH DEPARTMENT, 10. LONGITUDINAL AND OCCUPATIONAL MEDICINE OBSERVATIONS OF CLINIC SPECIALIST. PRECEPTORS, SOCIAL 9. INTRODUCTION TO COMMUNITY WORKER, AND HEALTH RESOURCES DURING THE EDUCATOR. ORIENTATION MONTH OF PHYSICIAN DEVELOPMENT. AHEC SOUTHWEST CURRICULUM (REVISED JUNE 2008) PGY 1 ORIENTATION & PROFESSIONAL DEVELOPMENT FAMILY MEDICINE INPATIENT SERVICE CARE OF THE CHILD MATERNITY CARE GENERAL SURGERY I CARDIOLOGY NIGHT FLOAT/FM CLINICS 1 MONTH 3 MONTHS 1 MONTH 2 MONTHS 1 MONTH 1 MONTH 3 MONTHS FAMILY MEDICINE INPATIENT SERVICE CARE OF THE CHILD NEONATOLOGY PULMONOLOGY/CRITICAL CARE ORTHOPEDICS PSYCHIATRY DIAGNOSTIC IMAGING EMERGENCY ROOM NIGHT FLOAT/FM CLINICS 3 MONTHS 1 MONTH 1 MONTH 1 MONTH 1 MONTH 1 MONTH 1 MONTH 1 MONTH 2 MONTHS FAMILY MEDICINE INPATIENT SERVICE NEUROLOGY CARE OF THE CHILD ENT/OPHTHALMOLOGY UROLOGY/COMMUNITY ORIENTED PRIMARY CARE MHS/SCHOLARLY ACTIVITY EMERGENCY MEDICINE ELECTIVE NIGHT FLOAT/FM CLINICS 2 MONTHS 1 MONTH 1 MONTH 1 MONTH 1 MONTH 1 MONTH 1 MONTH 3 MONTHS 1 MONTH PGY 2 PGY 3 ELECTIVES: ANESTHESIA PROCEDURES, RURAL FAMILY MEDICINE, RHEUMATOLOGY, EMERGENCY MEDICINE, HOSPITAL MEDICINE, MATERNITY CARE, REHABILITATIVE MEDICINE, CARE OF THE ELDERLY, MEDICAL MISSIONS, GASTROENTEROLOGY, PEDIATRIC EMERGENCY MEDICINE, FAMILY MEDICINE PRACTICE SITE EVALUATION, HEMATOLOGY/ONCOLOGY, RADIATION THERAPY, & OTHERS 11 PGY 1 ROTATIONS ORIENTATION & PROFESSIONAL DEVELOPMENT FAMILY MEDICINE INPATIENT SERVICE CARE OF THE CHILD MATERNITY CARE GENERAL SURGERY CARDIOLOGY EMERGENCY MEDICINE NIGHT FLOAT/FAMILY MEDICINE CLINICS ORIENTATION & PROFESSIONAL DEVELOPMENT FIRST YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCES THE FIRST YEAR RESIDENTS START THE LAST FULL WEEK IN JUNE. DURING THAT TIME THAT HAVE NO CLINICAL RESPONSIBILITIES. AFTER THE RESIDENTS WILL COMPLETE THE NECESSARY EMPLOYMENT PAPERWORK, THEY WILL BE ORIENTED TO THE CLINIC, HOSPITALS, AND OTHER MEDICAL INSTITUTIONS/FACILITIES IN THE COMMUNITY THAT WILL PLAY A ROLE IN THE CARE OF THEIR PATIENTS. DURING THIS WEEK AND DURING SOME CONFERENCES AND SELECTED AFTERNOONS IN JULY (SEE FIRST YEAR FAMILY MEDICINE INPATIENT SERVICE) THE RESIDENTS RECEIVE CONFERENCES ON PATIENT CARE, ON-CALL RESPONSIBILITIES, ETHICAL RESEARCH, PHYSICIAN-PATIENT COMMUNICATION, PATIENT CARE, HOW FATIGUE AFFECTS PERFORMANCE AND THE ACGME DUTY HOUR REGULATIONS, “HANDS ON” PROCEDURAL TRAINING, AND DISCUSSION ON SELECTED READINGS REGARDING PROFESSIONALISM. THE FIRST YEAR RESIDENTS WILL BE INSTRUCTED IN CRITICALLY APPRAISING MEDICAL LITERATURE AND REQUIRED TO PRESENT AN ANSWER TO A CLINICAL QUESTIONS WITH INFORMATION DERIVED FROM A MEDICAL LITERATURE SEARCH. THE LAST WEEK IN JUNE AND THROUGHOUT THE MONTH OF JULY THERE WILL BE OPPORTUNITIES FOR THE RESIDENT S TO DEVELOP RAPPORT AND CAMARADERIE AWAY FROM THE WORK PLACE. GOAL THE RESIDENT WILL OBTAIN SKILLS IN PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH 12 OBJECTIVES 1. THE ORIENTATING RESIDENT WILL OBTAIN “HANDS ON” EXPERIENCE DURING TEACHING DEMONSTRATIONS FOR THE FOLLOWING PROCEDURES: ENDOTRACHIAL INTUBATION CULPOSCOPY SUTURING PULMONARY FUNCTION TEST INTERPRETATION ABG INTERPRETATION EKG INTERPRETATION LUMBAR PUNCTURE CENTRAL LINE PLACEMENT 2. THE ORIENTATING RESIDENT WILL OBTAIN TRAINING AND BECOME PROFICIENT IN DOCUMENTING PATIENT VISITS UTILIZING THE CLINIC’S AND THE HOSPITALS’ ELECTRONIC MEDICAL RECORD SOFTWARE. 3. THE ORIENTATING RESIDENT WILL LEARN THE LOGISTICS OF INPATIENT CARE WORKING ON THE FAMILY MEDICINE INPATIENT MEDICAL SERVICE DURING THE MONTH OF JULY. 4. THE RESIDENT WILL WORK WITH THE CHIEF RESIDENT REVIEWING THE RESIDENT GENERATED “INTERN SURVIVAL GUIDE” AND LEARN ON-CALL AND ON-SERVICE RESPONSIBILITIES. GOAL THE RESIDENT WILL OBTAIN 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 OBJECTIVES 1. THE ORIENTATING RESIDENT WILL ATTEND THE DIDACTIVE NOON CONFERENCE SERIES THAT WILL COVER DVT PROPHYLAXIS, PRE-OP EVALUATIONS, AND WRITING ORDERS FOR COMMON INPATIENT DIAGNOSES AS CONGESTIVE HEART FAILURE, PNEUMONIA, ACUTE MYOCARDIAL, INFARCTION, CHEST PAIN, AND OTHERS. 2. THE ORIENTATING RESIDENT WILL OBTAIN CERTIFICATION IN THE NALS COURSE. ARRANGEMENTS WILL BE MADE FOR THOSE RESIDENTS WHO ARE NOT CERTIFIED IN BLS AND ACLS TO TAKE THE COURSE TO BECOME CERTIFIED. 3. THE ORIENTATING RESIDENT WILL ATTEND CONFERENCES THAT COVER NUTRITION EDUCATION REGARDING DIETARY INSTRUCTION FOR PATIENTS WHO SUFFER FROM DIABETES, HYPERTENSION, HYPERLIPIDEMIAS, CORONARY ARTERY DISEASE, AND OBESITY. 4. THE ORIENTATING RESIDENT WILL TAKE THE HIPPA ONLINE COURSE AND HUMAN SUBJECT PROTECTION TRAINING COURSE COORDINATED BY THE SPONSORING INSTITUTION. 5. THE ORIENTATING RESIDENT WILL DERIVE A CLINICAL QUESTION, RESEARCH THE MEDICAL LITERATURE FOR THE ANSWER, AND PRESENT THE QUESTION AND THE FINDINGS AT THE JULY JOURNAL CLUB CONFERENCE. GOAL THE RESIDENT WILL BE INTRODUCED TO 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 OBJECTIVES 1. THE ORIENTATING RESIDENT WILL LEARN HOW TO UTILIZE THE ELECTRONIC MEDICAL RECORD SYSTEM TO GENERATE A PERFORMANCE IMPROVEMENT PROJECT. 2. THE ORIENTATING RESIDENT WILL LEARN FROM A LECTURE THE BASIC PRINCIPLES OF EVIDENCE BASED MEDICINE. 3. THE ORIENTATING RESIDENT WILL SELECT A CLINICAL QUESTION THAT IS APPROVED BY THE FACULTY ADVISOR AND PRESENT IT WITH THE EVIDENCED BASED ANSWERS IN JULY’S JOURNAL CLUB CONFERENCE. 13 4. THE ORIENTATING RESIDENT WILL HAVE 16 HOURS OF DIDACTIC INSTRUCTION OF A CRITICAL REVIEW OF MEDICAL LITERATURE COURSE THAT WILL ALSO INCLUDE HIPPA ONLINE TRAINING COURSE AND HUMAN SUBJECT PROTECTION TRAINING REQUIRED OF ALL RESIDENTS IN THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES SYSTEM. GOAL THE RESIDENT WILL BE INTRODUCED TO THE PRINCIPLES OF 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. OBJECTIVES 1. THE ORIENTATING RESIDENT WILL WORK IN THE BUSINESS OFFICE OF THE CLINIC DURING THE LAST WEEK IN JUNE TO LEARN PRACTICE MANAGEMENT ISSUES AND HOW A CLINIC OPERATES. 2. THE ORIENTATING RESIDENT WILL LEARN BY TOURING THE FOLLOWING SITES WHAT RESOURCES ARE AVAILABLE FOR THEIR PATIENTS LOCALLY: CHRISTUS ST. MICHAEL HEALTH CARE CENTER WADLEY REGIONAL MEDICAL CENTER CHRISTUS ST. MICHAEL REHABILITATION HOSPITAL MILLER COUNTY HEALTH DEPARTMENT BOWIE COUNTY HEALTH DEPARTMENT MIGRANT HEALTH CARE CLINIC ARKANSAS PUBLIC SCHOOLS ARKANSAS NURSING AND REHABILITATION CENTER 3. THE ORIENTATING RESIDENT WILL HAVE EXTENSIVE TUTORING IN THE UTILIZATION OF THE AHEC SOUTHWEST FAMILY MEDICINE RESIDENCY CLINIC’S ELECTRONIC MEDICAL RECORDS SYSTEM. GOAL THE RESIDENT WILL HAVE AN EXTENSIVE INTRODUCTION TO PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION. OBJECTIVES 1. THE ORIENTATING RESIDENT WILL SIGN OFF THAT HE/SHE HAS RECEIVED AND WILL READ THE POLICES AND PROCEDURES OF UAMS AND THE ACGME PROGRAM REQUIREMENT. 2. THE RESIDENCY DIRECTOR WILL REVIEW WITH THE ORIENTATING RESIDENT THE RULES AND REGULATIONS OF THE AHEC SW FAMILY MEDICINE RESIDENCY WITH EXTENSIVE ATTENTION PAID TO THE DUTY HOUR RULES. 3. THE ORIENTATING RESIDENT WILL SIGN OFF THAT HE/SHE HAS RECEIVED AND WILL REVIEW WITH THE RESIDENCY DIRECTOR THE PROGRAM’S CURRICULUM MANUAL. 4. THE ORIENTATING RESIDENT WILL START THE PROCESS OF BUILDING RAPPORT AND CAMARADERIE WITH FELLOW PEER AND UPPER LEVEL RESIDENTS BY ATTENDING NUMEROUS RESIDENT INFORMAL AFTER-HOUR “GET-TOGETHERS.” 5. THE ORIENTATING RESIDENT WILL PARTICIPATE IN ALTRUISM BY BEING INVOLVED IN LOCAL COMMUNITY PROJECTS, SUCH AS THE WILD ABOUT WELLNESS HEALTH FAIR. GOAL THE FIRST YEAR RESIDENT WILL START DEVELOPING INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS. 14 OBJECTIVES 1. THE ORIENTATING RESIDENT WILL BE OBSERVED DURING JULY DIRECTLY BY A FAMILY MEDICINE PHYSICIAN FACULTY MEMBER AND THE BEHAVIOR SCIENCE FACULTY MEMBER ENGAGING IN A PATIENT ENCOUNTER THAT WILL BE USED FOR INSTRUCTION. 2. THE ORIENTATING RESIDENT WILL BE A PARTICIPANT IN A GROUP DISCUSSION WITH AN EXPERT FROM UAMS IN LITTLE ROCK REGARDING THE FORMING OF EFFECTIVE RELATIONSHIPS WITH PATIENTS THAT IMPROVE PATIENT COMPLIANCE WITH TREATMENT. TEACHING METHODS ROUNDS, ONE ON ONE WITH MENTORING, LECTURES, WORKSHOPS, INTERACTIVE GROUP DISCUSSIONS, ONLINE COURSES, AND TOURS ASSESSMENT METHODS OBSERVATIONS BY FACULTY, NURSING STAFF OF CLINIC AND HOSPITALS, PARTICIPATION FAMILY MEDICINE INPATIENT SERVICE FIRST YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE FIRST YEAR RESIDENT WILL SPEND FOUR MONTHS OF THE FIRST YEAR ON THE INPATIENT FAMILY MEDICINE SERVICE. THE FIRST MONTH WILL BE IN JULY AND SERVES AS AN ORIENTATION TO THE INPATIENT MEDICINE CURRICULUM. ALL EIGHT FIRST YEAR RESIDENTS WILL BE DIVIDED AMONG THE TWO HOSPITAL INPATIENT SERVICES IN JULY. THEY WILL LEARN THE FRAMEWORK AND DYNAMICS OF THE INPATIENT FAMILY MEDICINE SERVICE THAT WILL ENABLE THEM TO MANAGE PATIENTS FROM ADMISSION THROUGH DISCHARGE. EACH HOSPITAL TEAM WILL CONSIST OF AN ATTENDING PHYSICIAN AND AN UPPER LEVEL RESIDENT A CLINICAL PHARMACIST AND HOSPITAL CASE MANAGER WILL HELPING DIRECT PATIENT CARE WITH 3-4 FIRST YEAR RESIDENTS. ALWAYS ACCOMPANY EACH TEAM DURING ROUNDS AND BE AVAILABLE TO ASSIST THE RESIDENTS IN THE INPATIENT MANAGEMENT AND DISCHARGE PLANNING OF THEIR PATIENTS THAT MONTH AND THROUGHOUT THE YEAR. AFTER JULY, EACH HOSPITAL TEAM WILL BE COMPRISED OF AN UPPER LEVEL RESIDENT INVOLVED MORE DIRECTLY IN PATIENT CARE AND ONE FIRST YEAR RESIDENT. THE DAY WILL START EACH MORNING AT 7 AM MEETING DURING WHICH THE ON CALL TEAM REPORTS TO THE MEDICINE TEAMS ABOUT THE PREVIOUS NIGHT’S ADMISSIONS AND DEVELOPMENTS. THE TWO ATTENDING PHYSICIANS WILL DIRECT THIS MORNING REPORT. GOALS 1. PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH 2. 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 3. 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 4. 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 5. PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION 6. INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS 15 OBJECTIVES ADMISSION SKILLS PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DEMONSTRATE KNOWLEDGE OF THE COMPONENTS OF AN H&P 2. OBTAIN A COMPLETE HISTORY OR PRESENT ILLNESS 3. GATHER A COLLECTION OF PERTINENT PSYCHOSOCIAL INFORMATION 4. RECORD THE REQUIRED ELEMENTS OF THE PMH, SH, AND FH 5. SYSTEMATICALLY INCLUDE A 13 ORGAN REVIEW OF SYSTEMS 6. DETAIL AN ACCURATE HOME MEDICATION LIST WITH DOSAGES AND INSTRUCTIONS 7. DOCUMENT A COMPREHENSIVE EXAMINATION COMPLETE WITH VITAL SIGNS AND RECTAL EXAM 8. DOCUMENT ALL LABORATORY AND IMAGING STUDIES 9. STATE RATIONALE FOR PRINCIPLE DIAGNOSIS AND THE REASON FOR ADMISSION 10. RECORD ALL PATIENT PROBLEMS IN THE ASSESSMENT 11. RECORD TREATMENT PLAN 12. DOCUMENT H&P WITH A LEGIBLE ADMISSION NOTE 13. DEVELOP PROFICIENCY IN DICTATING A COMPLETE H&P AT THE TIME OF ADMISSION 14. COMPLETE APPROPRIATE ORDERS IN A REASONABLE TIME MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SELECT APPROPRIATE ORDER SET FOR ADMISSION DIAGNOSIS 2. REVIEW MEDICAL DIAGNOSTIC WORK UP AND TREATMENT PLAN ON EACH PATIENT BEFORE MORNING REPORT PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW 2. REVIEW COMPONENTS OF H&P TO MAKE SURE THAT ALL COMPONENTS ARE PRESENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK WITH THE EMERGENCY ROOM STAFF AND PHYSICIANS TO INSURE THAT THE PATIENT IS ASSIGNED TO THE HOSPITAL WARD WHOSE NURSING STAFF CAN DELIVERY THE MOST APPROPRIATE LEVEL OF CARE 2. 3. REVIEW ALL HOME MEDICATIONS AND RENEW AS APPROPRIATE FOR PATIENT’S ADMISSION NEEDS WRITE ADMISSION ORDERS IN CORPORATION WITH THE CASE MANAGER WITH THE GOAL OF GETTING THE PATIENT THE MOST TIME-EFFICIENT, COST-EFFICIENT, AND SAFEST CARE FOR THE PROBLEMS THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL FOR PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. ATTEND TO THE PATIENT IN THE EMERGENCY ROOM FOR ADMISSION AS SOON AS POSSIBLE 2. BE APPROPRIATELY AND PROFESSIONALLY ATTIRED 3. COMMUNICATE IN A PROFESSIONAL MANNER WITH THE ER PHYSICIANS, NURSES, AND STAFF 4. FOLLOW ALL HIPPA REGULATIONS IN REGARD TO THE CARE OF THE PATIENT 5. INTRODUCE YOURSELF TO THE PATIENT AND FAMILY SHOWING RESPECT AND COMPASSION 6. CALL ALL CONSULTANTS AND EXPLAIN EITHER VIA PHONE OR IN PERSON PATIENT’S CLINICAL COURSE AND WHY THE REFERRAL IS BEING MADE 16 INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DICTATE AND WRITE A LENGTHY AND ACCURATE ADMISSION NOTE 2. WRITE ORDERS THAT ARE LEGIBLE BY ALL OTHER WORKERS OF THE HEALTH CARE TEAM 3. COMMUNICATE WITH THE FAMILY AND PATIENT THE DIAGNOSES, THE NEED FOR ADMISSION, AND THE TREATMENT PLAN 4. PRESENT THE PATIENT SUCCINCTLY AND ACCURATELY TO THE UPPER LEVEL RESIDENT ON CALL AND THE ATTENDING AHEC PHYSICIAN DAILY ROUNDING SKILLS PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. INTERVIEW AND EXAMINE THE PATIENT DAILY 2. KNOW ALL THE PERTINENT INFORMATION REGARDING THE CARE OF THE ASSIGNED PATIENT 3. CREATE SOAP NOTE WITH COMPLETE AND ACCURATE ASSESSMENT AND PLAN 4. ANTICIPATE AND DISCUSS POTENTIAL COMPLICATIONS OF A PATIENT’S TREATMENT PLAN MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. READ DAILY ON THE DISEASE PROCESSES AND TREATMENT OPTIONS ON THE INPATIENTS THAT THE RESIDENT IS FOLLOWING 2. 3. PREPARE FOR ASSIGNED PRESENTATIONS IN MORNING REPORT PARTICIPATE IN DISCUSSIONS IN MORNING REPORT WITH THE ATTENDING AND OTHER RESIDENTS AND STUDENTS ON THE HEALTHCARE TEAM 4. BE PREPARED TO EXPLAIN AND DEFEND THE RATIONALE BEHIND YOUR ASSESSMENT AND TREATMENT PLAN TO THE ATTENDING FACULTY MEMBER DURING ROUNDS PRACTICE-BASED LEARNING AND IMPROVEMENT: THE FIRST YEAR RESIDENT WILL 1. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 2. ASSIST OR COORDINATE EFFORTS TO PERFORM “ROOT CAUSE ANALYSIS” STUDIES ON EVENTS THAT OCCUR THAT ARE UNEXPECTED OR CAUSE ADDITIONAL MORBIDITY/MORTALITY TO THE INPATIENT DURING THEIR HOSPITALIZATION 3. DISCUSS QUALITY IMPROVEMENT CASES WITH THE VICE-PRESIDENT OF PATIENT AFFAIRS DURING THE MORNING REPORT EACH FRIDAY SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. ROUND DAILY WITH THE CASE MANAGER AND DISCUSS THE CLINICAL HOSPITAL COURSE OF THE PATIENT PLANS FOR DISCHARGE & PLACEMENT, DURABLE MEDICAL EQUIPMENT NEEDED AT DISCHARGE, AND PLAN OF HOW THE PATIENT WILL OBTAIN MEDICATIONS UPON DISCHARGE 2. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 3. 4. DEMONSTRATE HOW TO FIND MEDICAL ANSWERS IN LESS THAN TWO MINUTES USING HANDHELD PDA ANTICIPATE AND AVOID POTENTIAL COMPLICATIONS OF HOSPITALIZATION SUCH AS DELIRIUM, NOSOCOMIAL INFECTION, OR DEEP VEIN THROMBOSIS/PULMONARY EMBOLUS 5. 6. 7. CREATE AND UPDATE ACCURATELY THE INPATIENT LIST FOR MORNING REPORT PERFORM TIME MANAGEMENT SKILLS PROFICIENTLY IN ORDER THAT THE RESIDENT IS READY FOR ROUNDS WORK WITH THE CLINICAL PHARMACIST ON ROUNDS TO MAKE SURE THAT THE MOST APPROPRIATE AND COST EFFICIENT MEDICATIONS ARE USED AND ADVERSE DRUG REACTIONS OR DRUG-DRUG INTERACTIONS ARE AVOIDED 17 PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. TREAT THE PATIENT WITH THE UTMOST RESPECT AND COURTESY 2. WORK WITH THE NURSES ON THE FLOOR TO DELIVER THE BEST AND MOST EFFICIENT PATIENT CARE POSSIBLE 3. COMMUNICATE IN PERSON AND IN CHART THE CURRENT ASSESSMENT AND TREATMENT PLAN GOALS FOR ALL OTHER HEALTHCARE TEAM MEMBERS 4. 5. BE AT MORNING REPORT AND ROUNDS PREPARED AND ON TIME DAILY SIGN OUT TO ON CALL TEAM IN THE EVENING INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. CALL AND ACCURATELY DESCRIBE THE PATIENT’S CLINICAL COURSE AND THE REASON FOR CONSULTATION TO CONSULTANT PHYSICIAN 2. 3. 4. 5. 6. WRITE LEGIBLY SO ALL CARETAKERS CAN EASILY READ WRITE ORDERS THAT ARE CLEAR AND EASILY UNDERSTOOD KEEP PATIENT AND FAMILY INFORMED OF THE LATEST DEVELOPMENTS AS THEY UNFOLD EXPLAIN TO THE PATIENT AND FAMILY THE GOALS OF THE DAY’S TREATMENT PRESENT THE PATIENT’S ASSESSMENT AND PLAN ON ROUNDS TO THE ATTENDING FACULTY MEMBER DISCHARGE SKILLS PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. RECOGNIZE AT WHAT POINT IN THE PATIENT’S HOSPITAL COURSE WHEN THE INPATIENT CAN BE SAFELY DISCHARGED 2. DISCUSS WITH THE ATTENDING FACULTY MEMBER THE RATIONALE FOR DISCHARGE, ASSESSMENT, AND POST-DISCHARGE PLAN 3. WRITE DISCHARGE ORDERS THAT ARE COMPLETE AND LEGIBLE NO LATER THAN EARLY AFTERNOON ON THE DAY OF DISCHARGE 4. DICTATE A DISCHARGE SUMMARY WITH ALL OF THE REQUIRED COMPONENTS INCLUDED AND THAT CAN BE USED AS A VALUABLE REFERENCE FOR ANY SUBSEQUENT TREATING PHYSICIANS 5. COMPLETE DISCHARGE MEDICATION LIST MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SUMMARIZE THE HOSPITAL COURSE, WHAT DIAGNOSES WERE PRESENT, WHAT TREATMENT PLANS WERE FOLLOWED, ALTERNATIVE TREATMENT PLANS THAT COULD HAVE BEEN UTILIZED, AND APPROPRIATE HOSPITAL FOLLOW UP REQUIRED 2. DISCUSS THE RATIONALE FOR THE TREATMENT RENDERED AND WHAT ISSUES NEED TO BE ADDRESSED AT FOLLOW UP OUTPATIENT VISITS PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK WITH THE CASE MANAGER TO INSURE AT DISCHARGE THAT THE PATIENT HAS APPROPRIATE PLACEMENT, NEEDED DURABLE MEDICAL EQUIPMENT, ACCESS TO PRESCRIBED MEDICATIONS, AND FOLLOW UP WITH PRIMARY CARE PROVIDER 2. 18 NOTIFY PRIMARY CARE PROVIDER OF PATIENT NEEDS AT THE NEXT POST-HOSPITALIZATION FOLLOW UP VISIT PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. BE PRESENT AT DISCHARGE TO BE ABLE TO CLEARLY COMMUNICATE TO PATIENT AND FAMILY THE SUMMARY OF THE HOSPITALIZATION, DISCHARGE PLANS, AND FOLLOW UP 2. COMMUNICATE TO NURSES THE DISCHARGE ORDERS 3. BE SENSITIVE TO POSSIBLE PATIENT, FAMILY, AND NURSING HOME TIME CONSTRAINTS REGARDING A PROMPT AND EARLY DISCHARGE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. INFORM NURSING STAFF OF DISCHARGE 2. CLEARLY COMMUNICATE TO PATIENT AND FAMILY DISCHARGE INSTRUCTIONS 3. DISCUSS WITH THE ATTENDING PHYSICIAN THE DISCHARGE PLANS 4. EXPLAIN TO THE PATIENT AND FAMILY THE DIAGNOSES, MEANING OF TESTS UP TO DATE, NEEDS FOR FURTHER TESTING, RATIONALE BEHIND CURRENT TREATMENT PLAN THE FIRST YEAR RESIDENT WILL BECOME COMPETENT IN THE DIAGNOSIS AND HOSPITAL TREATMENT OF THE FOUR “CORE MEASURE” ADMITTING DIAGNOSES, AS DENOTED BY MEDICARE. THESE ARE 1) PNEUMONIA, INCLUDING COMMUNITY ACQUIRED, HEALTH FACILITY ACQUIRED, AND ASPIRATION PNEUMONIAS, 2) CONGESTIVE HEART FAILURE, 3) ACUTE MYOCARDIAL INFARCTION, AND 4) CHEST PAIN. THE FIRST YEAR RESIDENT WILL LEARN ABOUT THE PATHOPHYSIOLOGY, DIAGNOSTIC SKILLS, AND TREATMENT MODALITIES FOR THESE COMMON ADMITTING DIAGNOSES. PNEUMONIA PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN THE SKILLS TO MAKE THE DIAGNOSIS OF PNEUMONIA 2. LICIT A FOCUSED HISTORY TO IDENTIFY SYMPTOMS CONSISTENT WITH PNEUMONIA AND DEMOGRAPHIC FACTORS THAT MAY PREDISPOSE PATIENTS TO CERTAIN TYPES OF PNEUMONIA 3. 4. PERFORM TARGETED PHYSICAL EXAM TO DISCOVER SIGNS CONSISTENT WITH PNEUMONIA SELECT AND INTERPRET INDICATED LAB, MICROBIOLOGIC, AND RADIOLOGICAL STUDIES TO CONFIRM DIAGNOSES OF PNEUMONIA AND RISK STRATIFYING CONDITIONS 5. 6. 7. DIFFERENTIATE BETWEEN COMMUNITY ACQUIRED, HEALTH FACILITY ACQUIRED, AND ASPIRATION PNEUMONIA WRITE THE ORDER SETS FOR EACH OF THE THREE TYPES OF PNEUMONIAS IDENTIFY PATIENTS WITH CO-MORBIDITIES THAT PREDISPOSE PATIENTS TO INCREASED MORBIDITY AND MORTALITY FROM PNEUMONIA 8. INITIATE EMPIRIC ANTIBIOTIC SELECTION BASED ON EXPOSURE TO LONG TERM OR GROUP CARE, SEVERITY OF ILLNESS, AND EVIDENCE-BASED GUIDELINES 9. FORMULATE SUBSEQUENT TREATMENT PLAN THAT INCLUDES NARROWING ANTIBIOTIC THERAPIES BASED ON AVAILABLE CULTURAL EVIDENCE AND PATIENT RESPONSE TO TREATMENT 10. DISCUSS THE NON-PHARMACOLOGICAL TREATMENT MODALITIES FOR PNEUMONIA WITH PARTICULAR ATTENTION TO RESPIRATORY THERAPY MODALITIES 11. PREDICT PATIENT RISK FOR MORBIDITY AND MORTALITY FROM PNEUMONIA USING EVIDENCE BASED TOOLS AS THE PNEUMONIA OUTCOME RESEARCH TEAM AND PNEUMONIA SEVERITY INDEX VALIDATED RISK SCORE 12. RECOGNIZE AND ADDRESS COMPLICATIONS TO PNEUMONIA AND/OR INADEQUATE RESPONSE TO TREATMENT INCLUDING RESPIRATORY FAILURE OR EMERGING PARAPNUEMONIC EFFUSIONS 13. OUTLINE INDICATIONS FOR SUBSPECIALTY CONSULTATION 14. DOCUMENT TREATMENT PLAN AND DISCHARGE INSTRUCTIONS, AND IDENTIFY OUTPATIENT PRIMARY CARE PHYSICIAN FOR FOLLOW UP OF PENDING STUDIES 19 MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DEFINE THE DIFFERENT TYPES OF PNEUMONIAS, LIST ETIOLOGIES, AND SIGNS & SYMPTOMS 2. LIST INDICATED DIAGNOSTIC TESTS 3. EXPLAIN INDICATIONS FOR RESPIRATORY ISOLATION 4. SPECIFY THE PATHOGENS THAT PREDISPOSE PATIENTS TO A COMPLICATED COURSE OF PNEUMONIA 5. DESCRIBE INDICATED MODALITIES FOR PNEUMONIA, INCLUDING OXYGEN THERAPY, RESPIRATORY THERAPY, AND ANTIBIOTIC SELECTION 6. EXPLAIN THE GOALS FOR DISCHARGE, INCLUDING EVIDENCE BASED MEASURES OF CLINICAL STABILITY PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW OR UNDERSTAND 2. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 3. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 2. 3. PROMOTE PREVENTATIVE STRATEGIES SUCH AS CESSATION OF SMOKING AND INDICATED VACCINATIONS RECOGNIZE AND ADDRESS BARRIERS TO FOLLOW UP CARE AND ANTICIPATED POST DISCHARGE REQUIREMENTS PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR THE PATIENTS AND ALL OTHER HEALTHCARE WORKERS INVOLVED IN THE CARE OF THE PATIENT 2. BE RESPONSIVE TO THE NEEDS OF THE PATIENT BY ALWAYS BEING IMMEDIATELY AVAILABLE WHEN ON THE WARDS OR ON CALL 3. RESPECT THE NEED AND THE RIGHT FOR PATIENT PRIVACY AND AUTONOMY BY OBSERVING HIPPA REGULATIONS AND HOSPITAL BY LAWS 4. BE ALWAYS PROMPT AND PROFESSIONALLY ATTIRED IN ATTENDING TO THE PATIENT’S NEEDS INTERPERSONAL COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. COMMUNICATE TO THE PATIENT AND FAMILY TO EXPLAIN THE HISTORY AND PROGNOSIS OF PNEUMONIA 2. RELATE TO THE PATIENT AND FAMILY THE TREATMENT GOALS, INDICATIONS OF STABILITY, IMPORTANCE OF PREVENTATIVE MEASURES SUCH AS SMOKING CESSATION, AND FOLLOW UP CARE 3. EXPLAIN TO THE PATIENT AND FAMILY THE NEED FOR THE TESTS AND PROCEDURES ORDERED AND THE POTENTIAL SIDE EFFECTS OF THEM AND THE PHARMACOLOGIC AGENTS UTILIZED 4. COLLABORATE WITH SENIOR RESIDENTS, ATTENDING PHYSICIANS, AND EMERGENCY PHYSICIANS IN MAKING CLINICAL DECISIONS 5. INTERACT ON A DAILY BASIS IN A POSITIVE WAY TO ENHANCE THE PATIENT’S CARE WITH THE NURSING STAFF, CASE MANAGERS, CLINIC PHARMACISTS, RESPIRATORY THERAPISTS, AND OTHER HEALTH CARE WORKERS 20 CONGESTIVE HEART FAILURE PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN THE SKILLS TO MAKE THE DIAGNOSIS OF CONGESTIVE HEART FAILURE (CHF) 2. LICIT A FOCUSED HISTORY TO IDENTIFY SYMPTOMS CONSISTENT WITH CHF AND FACTORS THAT MAY PREDISPOSE PATIENTS TO CHF 3. PERFORM TARGETED PHYSICAL EXAM TO DISCOVER SIGNS CONSISTENT WITH CHF 4. SELECT AND INTERPRET INDICATED LAB, EKGS, AND RADIOLOGICAL STUDIES TO CONFIRM DIAGNOSES OF CHF AND RISK STRATIFYING CONDITIONS 5. 6. 7. DIFFERENTIATE BETWEEN DIASTOLIC AND SYSTOLIC CHF WRITE THE ORDER SET FOR CHF IDENTIFY PATIENTS WITH CO-MORBIDITIES THAT PREDISPOSE PATIENTS TO INCREASED MORBIDITY AND MORTALITY FROM CHF 8. INITIATE APPROPRIATE PHARMACOLOGICAL TREATMENT FOR CHF 9. FORMULATE SUBSEQUENT TREATMENT PLAN BASED ON PATIENT’S INITIAL RESPONSE TO TREATMENT 10. DISCUSS THE NON-PHARMACOLOGICAL TREATMENT MODALITIES FOR CHF 11. DOCUMENT LEFT VENTRICULAR FUNCTION DURING PATIENT’S HOSPITALIZATION 12. RECOGNIZE AND ADDRESS COMPLICATIONS OF CHF AND/OR INADEQUATE RESPONSE TO TREATMENT INCLUDING RESPIRATORY FAILURE 13. OUTLINE INDICATIONS FOR SUBSPECIALTY CONSULTATION 14. DOCUMENT TREATMENT PLAN AND DISCHARGE INSTRUCTIONS, INCLUDING DISCHARGING PATIENT ON ACEI/ARB, BETA BLOCKER, AND 81 MG OF ASPIRIN, LOW SALT DIET, AND DAILY WEIGHTS 15. IDENTIFY OUTPATIENT PRIMARY CARE PHYSICIAN FOR FOLLOW UP OF PENDING STUDIES MEDICAL KNOWLEDGE OBJECTIVES: 1. DEFINE THE DIFFERENCES BETWEEN DIASTOLIC AND SYSTOLIC CHF 2. LIST INDICATED DIAGNOSTIC TESTS 3. EXPLAIN RATIONALE BEHIND THE USE OF ACEI/ARB, BETA BLOCKERS, AND LOW DOSE ASPIRIN 4. DISCUSS THE GOALS FOR DISCHARGE, INCLUDING EVIDENCE BASED MEASURES OF CLINICAL STABILITY PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW OR UNDERSTAND 2. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 3. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 2. PROMOTE PREVENTATIVE STRATEGIES SUCH AS CESSATION OF SMOKING, SALT RESTRICTIVE DIET, AND DAILY WEIGHTS AT HOME 3. 21 RECOGNIZE AND ADDRESS BARRIERS TO FOLLOW UP CARE AND ANTICIPATED POST DISCHARGE REQUIREMENTS PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR THE PATIENTS AND ALL OTHER HEALTHCARE WORKERS INVOLVED IN THE CARE OF THE PATIENT 2. BE RESPONSIVE TO THE NEEDS OF THE PATIENT BY ALWAYS BEING IMMEDIATELY AVAILABLE WHEN ON THE WARDS OR ON CALL 3. RESPECT THE NEED AND THE RIGHT FOR PATIENT PRIVACY AND AUTONOMY BY OBSERVING HIPPA REGULATIONS AND HOSPITAL BY LAWS 4. BE ALWAYS PROMPT AND PROFESSIONALLY ATTIRED IN ATTENDING TO THE PATIENT’S NEEDS INTERPERSONAL COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. COMMUNICATE TO THE PATIENT AND FAMILY TO EXPLAIN THE HISTORY AND PROGNOSIS OF CHF 2. RELATE TO THE PATIENT AND FAMILY THE TREATMENT GOALS, INDICATIONS OF STABILITY, IMPORTANCE OF PREVENTATIVE MEASURES SUCH AS SMOKING CESSATION, SALT RESTRICTED DIET, DAILY WEIGHTS, AND FOLLOW UP CARE 3. EXPLAIN TO THE PATIENT AND FAMILY THE NEED FOR THE TESTS AND PROCEDURES ORDERED AND THE POTENTIAL SIDE EFFECTS OF THEM AND THE PHARMACOLOGIC AGENTS UTILIZED 4. COLLABORATE WITH SENIOR RESIDENTS, ATTENDING PHYSICIANS, AND EMERGENCY PHYSICIANS IN MAKING CLINICAL DECISIONS 5. INTERACT ON A DAILY BASIS IN A POSITIVE WAY TO ENHANCE THE PATIENT’S CARE WITH THE NURSING STAFF, CASE MANAGERS, CLINIC PHARMACISTS, DIETICIANS, AND OTHER HEALTH CARE WORKERS ACUTE MYOCARDIAL INFARCTION PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN THE SKILLS TO MAKE THE DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION (AMI) 2. LICIT A FOCUSED HISTORY TO IDENTIFY SYMPTOMS CONSISTENT WITH AMI 3. PERFORM TARGETED PHYSICAL EXAM TO DISCOVER SIGNS CONSISTENT WITH AMI 4. SELECT AND INTERPRET INDICATED LAB, EKG, AND RADIOLOGICAL STUDIES TO CONFIRM THE DIAGNOSIS OF AMI 5. DIFFERENTIATE BETWEEN AMI AND OTHER CAUSES OF CHEST PAIN 6. WRITE THE ORDER SET FOR AMI INCLUDING MEDICATIONS USED URGENTLY IN ER 7. IDENTIFY PATIENTS WHO HAVE RISK FACTORS THAT PUT THEM AT ADDED RISK FOR SUFFERING AN AMI 8. IDENTIFY PATIENTS UPON DIAGNOSING AMI WITH CO-MORBIDITIES THAT PREDISPOSE THEM TO INCREASED MORBIDITY AND MORTALITY FROM AMI 9. OUTLINE INDICATIONS FOR SUBSPECIALTY CONSULTATION 10. DOCUMENT TREATMENT PLAN AN DISCHARGE INSTRUCTIONS 11. DISCHARGE PATIENTS ON APPROPRIATE MEDICATIONS INCLUDING BETA BLOCKERS AND ASPIRIN 12. IDENTIFY OUTPATIENT PRIMARY CARE PHYSICIAN FOR FOLLOW UP OF PENDING STUDIES MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DESCRIBE THE PATHOPHYSIOLOGY OF AN AMI 2. LIST INDICATED DIAGNOSTIC TESTS 3. EXPLAIN INDICATIONS AND CONTRAINDICATIONS FOR IMMEDIATE THROMBOLYTIC THERAPY FOR AMI 4. SPECIFY THE RISK FACTORS AND MODIFICATION OF RISK FACTORS FOR AMI 5. LIST THE TREATMENT FOR THE KNOWN COMPLICATIONS OF AMI INCLUDING RESPIRATORY FAILURE, SHOCK, DYSRHYTHMIAS, HEART BLOCK, AND OTHERS 6. EXPLAIN THE GOALS FOR DISCHARGE 7. DISCUSS DISCHARGE MEDICATIONS UTILIZED AT DISCHARGE INCLUDING ASPIRIN AND BETA BLOCKERS 22 PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW OR UNDERSTAND 2. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 3. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 2. PROMOTE PREVENTATIVE STRATEGIES SUCH AS CESSATION OF SMOKING, SALT RESTRICTIVE DIET, BLOOD PRESSURE CONTROL, LOW LIPID DIET, SERUM GLUCOSE CONTROL IN DIABETICS, AND EXERCISE PLAN POST DISCHARGE 3. RECOGNIZE AND ADDRESS BARRIERS TO FOLLOW UP CARE AND ANTICIPATED POST DISCHARGE REQUIREMENTS PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR THE PATIENTS AND ALL OTHER HEALTHCARE WORKERS INVOLVED IN THE CARE OF THE PATIENT 2. BE RESPONSIVE TO THE NEEDS OF THE PATIENT BY ALWAYS BEING IMMEDIATELY AVAILABLE WHEN ON THE WARDS OR ON CALL 3. RESPECT THE NEED AND THE RIGHT FOR PATIENT PRIVACY AND AUTONOMY BY OBSERVING HIPPA REGULATIONS AND HOSPITAL BY LAWS 4. BE ALWAYS PROMPT AND PROFESSIONALLY ATTIRED IN ATTENDING TO THE PATIENT’S NEEDS INTERPERSONAL COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. COMMUNICATE TO THE PATIENT AND FAMILY TO EXPLAIN THE HISTORY AND PROGNOSIS OF AMI 2. RELATE TO THE PATIENT AND FAMILY THE TREATMENT GOALS, INDICATIONS OF STABILITY, IMPORTANCE OF PREVENTATIVE MEASURES SUCH AS SMOKING CESSATION, SALT RESTRICTED DIET, LIPID, GLUCOSE, AND BLOOD PRESSURE CONTROL, AND A PLAN FOR INCREASED ACTIVITY 3. EXPLAIN TO THE PATIENT AND FAMILY THE NEED FOR THE TESTS AND PROCEDURES ORDERED AND THE POTENTIAL SIDE EFFECTS OF THEM AND THE PHARMACOLOGIC AGENTS UTILIZED 4. COLLABORATE WITH SENIOR RESIDENTS, ATTENDING PHYSICIANS, AND EMERGENCY PHYSICIANS IN MAKING CLINICAL DECISIONS 5. INTERACT ON A DAILY BASIS IN A POSITIVE WAY TO ENHANCE THE PATIENT’S CARE WITH THE NURSING STAFF, CASE MANAGERS, CLINIC PHARMACISTS, DIETICIANS, AND OTHER HEALTH CARE WORKERS CHEST PAIN PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. LICIT A FOCUSED AND DETAILED HISTORY OF THE CHEST PAIN INCLUDING QUALITY, INTENSITY, RADIATION, PRECIPITATING AND RELIEVING FACTORS, AND ASSOCIATED SYMPTOMS 2. PERFORM TARGETED PHYSICAL EXAM TO DISCOVER SIGNS THAT COULD LEAD TO A DIAGNOSIS OF CHEST PAIN 3. SELECT AND INTERPRET INDICATED LAB, EKGS, AND RADIOLOGICAL STUDIES TO CONFIRM DIAGNOSES OF CHEST PAIN 4. DISCUSS THE RISK FACTORS THAT WOULD PREDISPOSE THE PATIENT TO HAVE CHEST PAIN SECONDARY TO SUCH DIAGNOSIS AS UNSTABLE ANGINA, ACUTE MYOCARDIAL INFARCTION, PERICARDITIS, VASCULAR DISORDERS, PULMONARY EMBOLUS, PNEUMONIA, GASTROINTESTINAL DISORDERS, OR MUSCULOSKELETAL PAIN 5. LIST A DIFFERENTIAL DIAGNOSIS OF CHEST PAIN 23 6. 7. WRITE THE ORDER SET FOR CHEST PAIN IDENTIFY PATIENTS WITH CO-MORBIDITIES THAT PREDISPOSE PATIENTS TO INCREASED MORBIDITY AND MORTALITY FROM CHEST PAIN 8. INITIATE APPROPRIATE PHARMACOLOGICAL TREATMENT FOR CHEST PAIN 9. FORMULATE SUBSEQUENT TREATMENT PLAN BASED ON PATIENT’S INITIAL RESPONSE TO TREATMENT 10. DISCUSS THE NON-PHARMACOLOGICAL TREATMENT MODALITIES FOR CHEST PAIN 11. OUTLINE INDICATIONS FOR SUBSPECIALTY CONSULTATION 12. DOCUMENT TREATMENT PLAN AND DISCHARGE INSTRUCTIONS, INCLUDING DISCHARGING PATIENT WITH DIAGNOSIS OF CHEST PAIN BASED ON THE ETIOLOGY OF THE CHEST PAIN 13. IDENTIFY OUTPATIENT PRIMARY CARE PHYSICIAN FOR FOLLOW UP OF PENDING STUDIES MEDICAL KNOWLEDGE OBJECTIVES: 1. DISCUSS WORK UP FOR DIFFERENTIAL DIAGNOSIS OF CHEST PAIN 2. LIST INDICATED DIAGNOSTIC TESTS 3. EXPLAIN RATIONALE BEHIND THE PHARMACOLOGICAL STRATEGIES FOR CHEST PAIN 4. EXPLAIN THE GOALS FOR DISCHARGE, INCLUDING EVIDENCE BASED MEASURES OF CLINICAL STABILITY PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW OR UNDERSTAND 2. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 3. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 2. PROMOTE PREVENTATIVE STRATEGIES SUCH AS CESSATION OF SMOKING, WEIGHT REDUCTION, LIPID AND BLOOD PRESSURE CONTROL, AND ANY OTHER APPROPRIATE STRATEGIES ASSOCIATED WITH THE PARTICULAR CAUSE OF CHEST PAIN 3. RECOGNIZE AND ADDRESS BARRIERS TO FOLLOW UP CARE AND ANTICIPATED POST DISCHARGE REQUIREMENTS PROFESSIONALISM OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR THE PATIENTS AND ALL OTHER HEALTHCARE WORKERS INVOLVED IN THE CARE OF THE PATIENT 2. BE RESPONSIVE TO THE NEEDS OF THE PATIENT BY ALWAYS BEING IMMEDIATELY AVAILABLE WHEN ON THE WARDS OR ON CALL 3. RESPECT THE NEED AND THE RIGHT FOR PATIENT PRIVACY AND AUTONOMY BY OBSERVING HIPPA REGULATIONS AND HOSPITAL BY LAWS 4. BE ALWAYS PROMPT AND PROFESSIONALLY ATTIRED IN ATTENDING TO THE PATIENT’S NEEDS INTERPERSONAL COMMUNICATION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. COMMUNICATE TO THE PATIENT AND FAMILY TO EXPLAIN THE HISTORY AND PROGNOSIS OF CHEST PAIN 2. RELATE TO THE PATIENT AND FAMILY THE TREATMENT GOALS, INDICATIONS OF STABILITY, IMPORTANCE OF PREVENTATIVE MEASURES SUCH AS SMOKING CESSATION, LIPID AND BLOOD PRESSURE CONTROL, GLYCEMIC CONTROL IF A DIABETIC, HEALTHY DIET, AND FOLLOW UP CARE 24 3. EXPLAIN TO THE PATIENT AND FAMILY THE NEED FOR THE TESTS AND PROCEDURES ORDERED AND THE POTENTIAL SIDE EFFECTS OF THEM AND THE PHARMACOLOGIC AGENTS UTILIZED 4. COLLABORATE WITH SENIOR RESIDENTS, ATTENDING PHYSICIANS, AND EMERGENCY PHYSICIANS IN MAKING CLINICAL DECISIONS 5. INTERACT ON A DAILY BASIS IN A POSITIVE WAY TO ENHANCE THE PATIENT’S CARE WITH THE NURSING STAFF, CASE MANAGERS, CLINIC PHARMACISTS, DIETICIANS, AND OTHER HEALTH CARE WORKERS TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES CECIL’S TEXTBOOK OF INTERNAL MEDICINE WASHINGTON’S MANUAL TARASCON POCKET PHARMACOPOEIA AND POCKET CRITICAL CARE SANFORD’S GUIDE TO ANTIMICROBIAL THERAPY, LATEST EDITION UAMS LIBRARY ONLINE ELECTRONIC DATA BASE WITH UP TO DATE AND OTHERS ACLS EDUCATIONAL MATERIAL • ASSIGNED CHALLENGER SERIES QUESTIONS CARE OF THE CHILD AND ADOLESCENT FIRST YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF ROTATIONAL EXPERIENCE THE FIRST YEAR RESIDENT WILL ROTATE WITH A LOCAL PEDIATRICIAN. THE PEDIATRICIAN WILL MEET THE RESIDENT IN THE HOSPITAL AND ROUNDS ON 5-7 PATIENTS WILL OCCUR. THIS WILL INCLUDE A NURSERY EXPERIENCE. ALSO, THE RESIDENTS WILL ROTATE THROUGH THE ALL FOR KIDS CLINIC WITH A PEDIATRICIAN. THE RESIDENTS WILL ENJOY A WEALTH OF INPATIENT AND OUTPATIENT EXPERIENCES. ALSO, THE ARKANSAS CHILDREN’S HOSPITAL WILL, THROUGH INTERACTIVE VIDEO, PRESENT A MONTHLY DIDACTIC PEDIATRIC NOON CONFERENCE. THIS IS DONE BY THE FACULTY OF ONE OF THE TOP PEDIATRIC TRAINING CENTERS IN THE COUNTRY. THE FIRST YEAR RESIDENT WILL ALSO BECOME CERTIFIED IN NEONATAL ADVANCED LIFE SUPPORT AND PEDIATRIC ADVANCED LIFE SUPPORT. 25 PATIENT CARE GOAL THE FIRST YEAR RESIDENT WILL DELIVER PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH FOR THE CHILD AND ADOLESCENT. OBJECTIVES 1. THE RESIDENT WILL RECOGNIZE AND TREAT COMMON PEDIATRIC BEHAVIORAL, MEDICAL, AND SURGICAL DISEASES AND DISORDERS IN THE ABOVE SETTINGS AND IN THE HOME, KEEPING THE ROLE OF THE FAMILY PHYSICIAN CLEARLY IN FOCUS. 2. THE RESIDENT WILL USE THE PROBLEM-ORIENTED APPROACH TO PEDIATRICS IN BOTH THE IN-PATIENT AND OUTPATIENT SETTING WITH EMPHASIS ON THE ESTABLISHMENT OF AN APPROPRIATE AND COMPREHENSIVE DATA BASE AND TREATMENT PLAN UTILIZING INDICATED RESOURCES AND CONSULTATIONS. 3. THE RESIDENTS UTILIZE PREVENTIVE MEDICINE TECHNIQUES IN THE PEDIATRIC POPULATION INCLUDING APPROPRIATE WELL-CHILD VISITS AND IMMUNIZATIONS SCHEDULES. 4. THE RESIDENT WILL UNDERSTAND THE PRE-NATAL PERIOD, THE GROWTH AND DEVELOPMENT OF THE NEWBORN THROUGH ADOLESCENCE, AND EMOTIONAL PROBLEMS OF CHILDREN AND THEIR MANAGEMENT. 5. THE RESIDENT WILL BECOME PROFICIENT IN NEONATAL RESUSCITATION, STABILIZATION, AND PREPARATION FOR TRANSPORT OF THE DISTRESSED NEONATE. MEDICAL KNOWLEDGE GOAL THE FIRST YEAR RESIDENT WILL WORK TO OBTAIN MEDICAL KNOWLEDGE OF CHILDREN ABOUT ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. OBJECTIVES 1. THE FIRST YEAR RESIDENT WILL MAKE PRESENTATIONS AT NOON CONFERENCES. EVALUATION WILL BE IMMEDIATE BY FACULTY AND PEERS. 2. THE FIRST YEAR RESIDENT WILL PARTICIPATE IN ATTENDING/RESIDENT SESSIONS BY DOING CHART REVIEW, X-RAY INTERPRETATIONS, AND SUGGEST OPPORTUNITIES FOR IMPROVEMENT AND SAFETY. EVALUATION WILL BE IMMEDIATE BY FACULTY, PEERS, AND PEDIATRICIANS. 3. THE RESIDENT WILL LEARN LIMITATIONS AND WHEN CONSULTATION IS NECESSARY AND HOW TO OBTAIN A CONSULT. 4. THE RESIDENTS OVER THREE YEARS WILL BECOME COMPETENT TO DIAGNOSE AND TREAT THE BELOW LISTED MEDICAL CONDITIONS. MEDICAL CONDITIONS 1. DIARRHEA/DEHYDRATION 2. FEVER IN A CHILD <3 MOS. 3. BRONCHIOLITIS/CROUP 4. SEIZURES 5. CHILD ABUSE [LAW] 6. EPIGLOTTIS 7. POISONING 8. ASTHMA 9. CONGENITAL HEART DISEASE 10. SEPTIC ARTHRITIS 11. THE DYING CHILD & THE FAMILY 26 22. COMMON FRACTURES 23. URI/PHARYNGITIS 24. OTITIS MEDIA 25. VIRAL GASTROENTERITIS 26. IMPETIGO 27. INTESTINAL PARASITOSIS 28. RASHES 29. VAGINAL DISCHARGE 30. FAILURE TO THRIVE 31. RECTAL BLEEDING 32. ANEMIA 12. EFFECTS OF HOSPITALIZATION ON A CHILD 13. DIABETES MELLITUS 14. CARDIAC MURMURS 15. HYPERBILIRUBINEMIA 16. ACCIDENTS 17. SEXUAL ABUSE 18. ALLERGY WORK-UP 19. FEEDING PROBLEMS 20. IMMUNIZATIONS 21. URINARY TRACT INFECTIONS 33. ENURESIS/ENCOPRESIS 34. ABDOMINAL PAIN 35. HYPERACTIVITY 36. SCHOOL PROBLEMS 37. GASTRIC LAVAGE 38. GYN EXAM OF A CHILD 39. CIRCUMCISION 40. NEONATAL RESUSCITATION 41. PEDIATRIC RESUSCITATION 42. GROWTH & DEVELOPMENT OF THE CHILD PRACTICE-BASED AND LEARNING IMPROVEMENT GOAL THE FIRST YEAR RESIDENT WILL BE INTRODUCED TO THE PRINCIPLE OF 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. COMPETENCY IDENTIFY AND PERFORM APPROPRIATE LEARNING ACTIVITIES. OBJECTIVES 1. THE RESIDENT WILL BEGIN WITH ORIENTATION CONTINUE WITH INCREASING RESPONSIBILITY WITH BOTH IN AND OUT PATIENT CARE IN THE FMC AND HOSPITAL. THE STRUCTURAL PEDIATRIC ROTATIONS WILL CONTINUE THE PROCESS. ADDITIONAL ELECTIVE WILL PROVIDE RESIDENTS WITH SPECIFIC INTEREST OPPORTUNITY TO ACHIEVE INDIVIDUAL GOALS. COMPETENCY USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING. OBJECTIVES 1. THE RESIDENT BECOMES COMPETENT IN THE USE OF E-MED, UP-TO-DATE, DYNAMED, AND JOURNAL SEARCHES. THE RESIDENT WILL LEARN TO UTILIZE OF AVAILABILITY OF A VARIETY OF KNOWLEDGE SOURCES. 2. THE RESIDENT WILL BECOME COMPETENT IN THE USE OF PDA TECHNOLOGY TO TRACK PATIENTS, RECOVER LAB DATA AND MEDICAL REPORTS. THE RESIDENT WILL BECOME COMPETENT TO USE THE PDA WITH EPOCRATES AND 5-MINUTE MEDICAL CONSULT. SYSTEM BASED PRACTICE GOAL THE FIRST YEAR RESIDENT WILL START UNDERSTANDING AND PRACTICING THE CONCEPT OF 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. COMPETENCY WORK IN INTER-PROFESSIONAL TEAMS TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY. OBJECTIVES THE RESIDENT WILL LEARN THE DIFFERENT HEALTHCARE SETTINGS AND SYSTEMS (OPPORTUNITIES, INC, JUVENILE DETENTION CENTER, CHILD PROTECTIVE SERVICES) AND HOW TO MOVE THEIR PATIENTS EASILY TO THE BEST SETTING FOR THE PATIENT. 27 PROFESSIONALISM GOAL THE FIRST YEAR RESIDENT WILL EXHIBIT PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION. COMPETENCY COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS. OBJECTIVES 1. THE RESIDENT WILL BE MENTORED BY THE FACULTY TO TEACH THE UNDERSTANDING OF COMPASSION, INTEGRITY, AND RESPECT IN CARE OF THE CHILD WITH ACUTE AND CHRONIC PROBLEMS. 2. THE RESIDENT WILL BE PROMPT FOR ALL APPOINTMENTS AND WORK PERIODS. THE RESIDENT WILL DRESS AND BEHAVE ACCORDING TO THE SIGNED STANDARDS FOR PROFESSIONAL RELATIONS CONTRACT. INTERPERSONAL AND COMMUNICATION SKILLS GOAL THE RESIDENT WILL START PRACTICING INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS. COMPETENCY COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH OBJECTIVES THE RESIDENT WILL LEARN APPROPRIATE CONSULTATION, TIMELY TRANSFERS, AND OTHER OPTIONS OF CARE FOR ACUTE AND CHRONIC PROBLEMS. THIS WILL BE MONITORED AT DAILY REPORT AND ON ROUNDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND DISTANT LEARNING VIA INTERACTIVE VIDEO FROM CHILDREN’S HOSPITAL ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES THE HARRIET LANE HANDBOOK, 14TH ED., DISEASES OF THE NEWBORN, AVERY. NELSON'S TEXTBOOK OF PEDIATRICS, 15TH ED. NRP & PALS EDUCATIONAL MATERIAL 28 UAMS LIBRARY ONLINE ELECTRONIC DATA BASE WITH UP TO DATE AND OTHERS ASSIGNED CHALLENGER SERIES QUESTIONS MATERNITY CARE FIRST YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE FIRST YEAR RESIDENT WILL SPEND TWO MONTHS IN OBSTETRICS. THIS SHALL CONSIST OF NO LESS THAN 48 HOURS ON THE ROTATION WEEKLY IN THE HOSPITAL. THE RESIDENT WILL ALSO BE RESPONSIBLE FOR THEIR ½ DAY PER WEEK CONTINUITY OF CARE CLINIC AND POSSIBLY ½ DAY PER WEEK OF COLPOSCOPY CLINIC AT THE AHEC. ON THE LABOR AND DELIVERY UNIT THE RESIDENTS ARE TO BE ON DUTY NO LATER THAN 8 AM ON THE ASSIGNED DAY AND STAY UNTIL AFTER ROUNDS ARE COMPLETED NO SOONER THAN 8 AM ON THE FOLLOWING DAY. THEY ARE UNDER THE COMPLETE SUPERVISION OF THE OBSTETRICIAN ON CALL AND ARE TO FOLLOW THE INSTRUCTION AND RULES AS PUT FORTH BY THE ATTENDING PHYSICIAN. THEIR DUTIES MAY ALSO INCLUDE TIME IN THE WRMC PRENATAL CARE CLINIC. THE RESIDENT IS EXEMPT FROM AHEC CALL DURING THIS MONTH. THEY ARE TO PARTICIPATE OR PERFORM PROCEDURES OR PATIENT CARE RESPONSIBILITIES AS DIRECTED BY THE ATTENDING PHYSICIAN. THE RESIDENT IS TO HAVE NO FEWER THAN 30 VAGINAL DELIVERIES DURING THEIR TWO MONTHS ON THIS ROTATION. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PRENATAL CARE OBJECTIVES: THE RESIDENT WILL 1. DETERMINE AN ACCURATE EDC EARLY IN PRENATAL CARE 2. IDENTIFY THE PROPER DIAGNOSTIC TESTS TO ORDER IN ROUTINE PRENATAL CARE 3. OBTAIN AN ACCURATE AND COMPLETE HISTORY IN THE PRENATAL VISIT 4. PERFORM A THOROUGH AND EXTENSIVE EXAMINATION DURING THE PRENATAL VISIT 5. RECOGNIZE COMMON ABNORMALITIES IN THE PRENATAL EXAM 6. IDENTIFY HIGH RISK PATIENTS 7. DEMONSTRATE THE ABILITY TO DELIVER COMPETENT PRENATAL CARE. BLEEDING IN PREGNANCY OBJECTIONS: THE RESIDENT WILL 1. LIST A DIFFERENTIAL DIAGNOSIS FOR BLEEDING IN PREGNANCY 2. ORDER THE PROPER DIAGNOSTIC TESTS FOR BLEEDING IN PREGNANCY 3. DEFINE A TREATMENT PLAN FOR BLEEDING IN PREGNANCY. ECTOPIC PREGNANCY OBJECTIONS: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF ECTOPIC PREGNANCY 2. DEVELOP A DIFFERENTIAL DIAGNOSIS FOR ECTOPIC PREGNANCY 3. IDENTIFY THE PROPER DIAGNOSTIC TESTS IN THE WORK UP OF ECTOPIC PREGNANCY 4. APPROPRIATELY TREAT OR REFER THE ECTOPIC PREGNANT PATIENT IN A TIMELY MANNER. SMOKING DURING PREGNANCY OBJECTIVES: THE RESIDENT WILL 1. DISCUSS ALL OF THE COMPLICATIONS OF SMOKING DURING PREGNANCY 2. DEVELOP A PLAN FOR SMOKING CESSATION WITH PRENATAL PATIENTS 29 3. IDENTIFY THE SCREENING TESTS THAT CAN BE UTILIZED FOR COMPLICATIONS OF SMOKING WHILE PREGNANT. PRETERM LABOR OBJECTIONS: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF PRETERM LABOR 2. DEFINE A DIFFERENTIAL DIAGNOSIS FOR PRETERM LABOR 3. IDENTIFY THE PROPER WORK UP FOR SUSPECTED PRETERM LABOR 4. KNOW THE TREATMENT PLAN FOR PRETERM LABOR 5. DESCRIBE HOW TO PREVENT PRETERM LABOR. PREMATURE RUPTURE OF MEMBRANES OBJECTIONS: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF PREMATURE RUPTURE OF MEMBRANES 2. LIST THE DIFFERENTIAL DIAGNOSIS OF PREMATURE RUPTURE OF MEMBRANES 3. PERFORM AN APPROPRIATE EXAM TO DIAGNOSE PREMATURE RUPTURE OF MEMBRANES 4. ORDER THE CORRECT WORK UP FOR PREMATURE RUPTURE OF MEMBRANES 5. DESCRIBE THE TREATMENT PLAN FOR PREMATURE RUPTURE OF MEMBRANES 6. KNOW HOW TO PREVENT THE PREMATURE RUPTURE OF MEMBRANES. UTI IN PREGNANCY OBJECTIONS: THE RESIDENT WILL 1. UNDERSTAND THE SIGNIFICANCE OF ASYMPTOMATIC BACTURIA OR UTI IN PREGNANCY 2. BE ABLE TO DIAGNOSE BACTURIA OR UTI IN PREGNANCY 3. KNOW THE APPROPRIATE ANTIMICROBIALS TO TREAT UTI OR ASYMPTOMATIC BACTURIA IN PREGNANCY AND WHEN OR WHEN NOT TO USE THEM. PRE-ECLAMPSIA/PREGNANCY INDUCED HYPERTENSION OBJECTIONS: THE RESIDENT WILL 1. KNOW THE RISK FACTORS FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 2. BE ABLE TO DETAIL THE SIGNS AND SYMPTOMS OF PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 3. LIST THE DIFFERENTIAL DIAGNOSIS FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 4. IDENTIFY THE PROPER DIAGNOSTIC WORK UP AND TESTS TO DIAGNOSE PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 5. 6. DEFINE THE TREATMENT PLAN FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA DEMONSTRATE WHAT CAN BE DONE TO PREVENT PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA. GESTATIONAL DIABETES OBJECTIONS: THE RESIDENT WILL 1. RECOGNIZE THE RISK FACTORS FOR A PATIENT DEVELOPING GESTATIONAL DIABETES 2. KNOW THE SIGNS AND SYMPTOMS OF GESTATIONAL DIABETES 3. BE ABLE TO DIAGNOSE GESTATIONAL DIABETES AT ITS ONSET 4. IDENTIFY THE TREATMENT PLAN, INCLUDING MEDICATIONS AND FOLLOW UP FOR PATIENT WITH GESTATIONAL DIABETES 5. BE AWARE OF THE COMPLICATIONS OF A PREGNANCY MARKED BY GESTATIONAL DIABETES 6. LEARN WHAT CAN BE DONE TO PREVENT GESTATIONAL DIABETES 7. DETAIL POST-PARTUM FOLLOW UP FOR PATIENT WITH GESTATIONAL DIABETES POST DATES OBJECTIVES: THE RESIDENT WILL 1. ASSIGN AN ACCURATE EDC TO EACH PREGNANCY AS EARLY AS POSSIBLE IN PRENATAL CARE 2. CONTINUALLY CONFIRM THE EDC WITH EACH PRENATAL VISIT 3. DEVELOP A PLAN FOR POST DATES PREGNANCY 4. KNOW WHEN TO ORDER FETAL ASSESSMENT FOR POST DATES PATIENT 5. DESCRIBE THE APPROPRIATE FETAL ASSESSMENT FOR POST DATES PATIENTS 6. BE ABLE TO INTERPRET FETAL ASSESSMENT TESTS FOR POST DATES PATIENTS 30 7. FORMULATE A TREATMENT PLAN FOR POST DATES PATIENTS BASED ON FETAL ASSESSMENT NORMAL LABOR AND SPONTANEOUS VAGINAL DELIVERY OBJECTIVES: THE RESIDENT WILL 1. DESCRIBE THE SIGNS, SYMPTOMS, AND STAGES OF NORMAL LABOR 2. PERFORM AT LEAST 30 VAGINAL DELIVERIES 3. DEFINE A DIFFERENTIAL DIAGNOSIS FOR SIGNS AND SYMPTOMS OF LABOR 4. IDENTIFY PROPER DIAGNOSTIC TESTS TO ORDER IN THE DIAGNOSIS OF LABOR 5. OUTLINE A TREATMENT PLAN FOR NORMAL LABOR, INCLUDING ANALGESIA OPTIONS 6. KNOW THE ANALGESIC AGENTS USED, THEIR ADVERSE EFFECTS, AND THE CLINICAL SITUATION BEST FOR EACH ANALGESIC AGENT TO BE UTILIZED ABNORMAL LABOR OBJECTIVES: THE RESIDENT WILL 1. KNOW THE SIGNS AND SYMPTOMS OF ABNORMAL LABOR 2. DEFINE A DIFFERENTIAL DIAGNOSIS FOR ABNORMAL LABOR 3. IDENTIFY THE PROPER DIAGNOSTIC WORK UP AND LABORATORY TESTS FOR ABNORMAL LABOR 4. DESCRIBE A TREATMENT PLAN FOR ABNORMAL LABOR 5. LIST THE STRATEGIES THAT CAN BE DONE TO PREVENT ABNORMAL LABOR ROUTINE POSTPARTUM CARE OBJECTIVES: THE RESIDENT WILL 1. DESCRIBE THE MANAGEMENT OF A NORMAL POSTPARTUM PATIENT 2. KNOW THE PROPER TESTS TO FOLLOW A NORMAL POSTPARTUM PATIENT 3. PERFORM EXAMINATIONS REQUIRED FOR A NORMAL POSTPARTUM PATIENT 4. BE ABLE TO APPROPRIATELY DISCHARGE A NORMAL POSTPARTUM PATIENT POSTPARTUM COMPLICATION OBJECTIVES: THE RESIDENT WILL 1. KNOW THE SIGNS AND SYMPTOMS OF POSTPARTUM COMPLICATIONS 2. PERFORM ROUNDS ON PATIENTS THAT HAVE BEEN DELIVERED 3. DIAGNOSE POSTPARTUM COMPLICATIONS AS THEY ARISE 4. ORDER THE APPROPRIATE WORK UP FOR POSTPARTUM COMPLICATIONS 5. DEVISE A TREATMENT PLAN FOR POSTPARTUM COMPLICATIONS 6. KNOW WHAT THINGS CAN BE DONE TO PREVENT SOME POSTPARTUM COMPLICATIONS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE RESIDENT WILL 1. READ THE ASSIGNED MATERIAL ASSIGNED FOR THE COURSE (SEE EDUCATIONAL RESOURCES BELOW) 2. READ UP ON THE PROBLEMS THAT PATIENTS HAVE AS THEY PRESENT TO THE LABOR AND DELIVERY UNIT 3. BE READY TO DISCUSS THE ASSESSMENT AND PLAN FOR PATIENTS WHO PRESENT TO THE LABOR AND DELIVERY UNIT WITH THE ATTENDING PHYSICIAN 31 PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. PARTICIPATE IN THE EDUCATION OF PATIENTS AND THEIR FAMILIES ABOUT THEIR CLINICAL COURSE IN THE PRENATAL CLINIC AND IN THE L&D UNIT IN ORDER THAT PATIENTS WILL BE ABLE TO MAKE INFORMED DECISIONS REGARDING THEIR CARE AND BE MORE COMPLIANT WITH TREATMENT PLANS 2. IDENTIFY WEAKNESSES WITH FEEDBACK FROM ATTENDING PHYSICIAN AND THEN UTILIZE THIS INFORMATION TO IMPROVE THEIR CARE OF PATIENTS 3. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING BY BEING ABLE TO MASTER THE ELECTRONIC MEDICAL RECORD OF THE HOSPITAL IN OBTAINING INFORMATION ON PATIENTS AND LOOKING UP AND LEARNING INFORMATION ABOUT OBSTETRICS ON THE UAMS LIBRARY DATABASE WEB SITE SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 1. WORK IN INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY a. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE L&D UNIT AND PRENATAL CARE CLINIC CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE AND b. 2. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY PARTICIPATE IN IDENTIFYING SYSTEM ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEM SOLUTIONS BY a. b. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE L&D TEAM FOR PATIENT SAFETY AND UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM PROCEDURES SUCH AS DELIVERIES IN A WAY THAT IS SAFE FOR THE PATIENT AND NEWBORN. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN ON THE L&D UNIT BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER DELIVERING OBSTETRICAL CARE ON THE L&D UNIT, AND 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE ON THE L&D UNIT 32 PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE OBSTETRICAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER OBSTETRICAL CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES THE RESIDENT WILL READ AND BE PREPARED TO DISCUSS MATERIAL FROM ESSENTIALS OF OBSTETRICS AND GYNECOLOGY BY NEVILLE HACKER (AUTHOR), J. GEORGE MOORE (AUTHOR), JOSEPH GAMBONE (AUTHOR) THE RESIDENTS WILL BE ASSIGNED THE FOLLOWING READ: ASSIGNED CHALLENGER OB SERIES QUESTIONS AMONG THE MANY SOURCES AVAILABLE FOR THE RESIDENTS FOR ANSWERING CLINICAL QUESTIONS, THE UP-TO-DATE RESOURCE FOUND ON THE UAMS LIBRARY DATABASE RESOURCE PAGE WILL BE EXTENSIVELY UTILIZED. HTTP://WWW.UTDOL.COM/UTD/CONTENT/SEARCH.DO GENERAL SURGERY I FIRST YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE SURGICAL ROTATION WILL BE A REQUIRED ONE MONTH ROTATION IN THE PGY I YEAR. THE RESIDENT WILL BE ASSIGNED TO AN ATTENDING SURGEON. THE RESIDENT WILL BE EXPECTED TO MAKE PRELIMINARY ROUNDS ON EACH TEACHING CASE PRIOR TO ATTENDING ROUNDS FOR FORMAL PRESENTATION OF EACH TEACHING CASE. THE RESIDENT WILL PROVIDE IMMEDIATE CONSULTATION SERVICES WHEN REQUESTED BY THE EMERGENCY ROOM AND WILL BE THE INITIAL PHYSICIAN TO EVALUATE THE MAJORITY OF CONSULTATION REQUESTS FOR INPATIENT SERVICES. THE RESIDENT WILL BE REQUIRED TO WRITE A HISTORY AND PHYSICAL TREATMENT PLAN IN MANAGEMENT RECOMMENDATION ON EACH PATIENT SEEN FOR PRESENTATION TO THE ATTENDING SURGEON FOR CRITIQUE. 33 AT THE ATTENDING SURGEON’S DISCRETION, THE RESIDENT MAY RECEIVE INSTRUCTION IN THE OUTPATIENT SETTING. THIS WILL BE DONE IN A CLINICAL SETTING WITH SPECIFIC GOALS OF EVALUATION, MANAGEMENT PLAN AND POST-OPERATIVE CARE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. PERFORM SURGICAL EVALUATIONS OF DIAGNOSTIC PROCEDURES AND CLINICAL EXAMINATION ON PATIENTS PRESENTING TO THE EMERGENCY ROOM 2. 3. 4. 5. 6. 7. DEVELOP A ASSESSMENT AND PLAN FOR THE PATIENT DEMONSTRATE COMPETENCE IN THE MANAGEMENT OF THE ACUTE SURGICAL PATIENT PERFORM A STERILE SCRUB PRIOR TO THE PROCEDURE AND NOT BREAK STERILE TECHNIQUE DURING THE PROCEDURE BECOME COMPETENT IN THE PLACEMENT OF INTERNAL JUGULAR CENTRAL LINES EXHIBIT THE ABILITY TO REPAIR SIMPLE SKIN LACERATIONS PROFICIENTLY DO A COMPLETE EXAMINATION OF THE FEMALE BREAST MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. LEARN THE WORKUP OF AN ACUTE ABDOMEN 2. BE ABLE TO MAKE A CARDIO-PULMONARY RISK ASSESSMENT PRE-OPERATIVELY 3. BE ABLE TO ANTICIPATE THE MOST COMMON COMPLICATIONS FOR PARTICULAR SURGICAL PROCEDURES 4. BECOME COMPETENT IN THE ASSESSMENT AND TREATMENT OF DECUBITUS ULCERS AND WOUND CARE 5. DESCRIBE THE TYPES OF SUTURE REPAIR TECHNIQUES FOR PARTICULAR LACERATIONS 6. RECOGNIZE SKIN LESIONS THAT NEED TO BE BIOPSY AND THE MOST APPROPRIATE BIOPSY PROCEDURE 7. UNDERSTAND HOW TO PERFORM FLUID RESUSCITATION IN THE HYPOVOLEMIC PATIENT, INCLUDING MOST APPROPRIATE BLOOD AND BLOOD PRODUCTS THAT SHOULD BE ADMINISTERED IN ANY GIVEN CLINICAL SITUATION 8. CERTIFY IN ADVANCE TRAUMA LIFE SUPPORT (ATLS) PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. 1. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 2. LEARN THE SAFETY CHECKS THAT OCCUR IN THE OR TO INSURE PATIENT SAFETY 3. UNDERSTAND THE REVIEW PROCESS OF COMPLICATIONS OR UNWANTED SURGICAL OUTCOMES 4. ASK THE ATTENDING ANYTHING THAT IS NOT UNDERSTOOD BY THE RESIDENT 5. BECOME FAMILIAR WITH THE CORE MEASURES IN SURGERY 6. OBTAIN FOLLOW UP IN THE CLINIC OF PATIENTS IN WHICH THE RESIDENT WAS INVOLVED IN THE HOSPITAL DIAGNOSIS AND TREATMENT OF THE SURGICAL PATIENT 34 SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. SYSTEM-BASED OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK IN INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY a. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE OPERATING ROOM AND THE SURGICAL WARDS CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE AND b. 2. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY PARTICIPATE IN IDENTIFYING SYSTEM ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEM SOLUTIONS BY a. b. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE OR TEAM FOR PATIENT SAFETY AND UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM PROCEDURES IN THE OPERATING ROOM AND IN THE CLINIC IN A WAY THAT IS SAFE FOR THE PATIENT. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE SURGERY ROTATION 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER OBSTETRICAL CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE SURGICAL TEAM MEMBER 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE 35 TEACHING METHODS ONE ON ONE WITH THE SURGEON THAT WILL INCLUDE BEDSIDE INSTRUCTION, LECTURE, AND SELECTED READINGS. ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES SPECIFIC READINGS AS ASSIGNED BY SURGERY ATTENDING ASSIGNED CHALLENGER SERIES QUESTIONS CARDIOLOGY FIRST YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF THE EDUCATIONAL EXPERIENCE THE FIRST YEAR RESIDENT IS ASSIGNED TO A PRIVATE PRACTICING CARDIOLOGIST. THE FIRST YEAR RESIDENT IS EXPECTED TO ATTEND ALL ROUNDS, PERFORM CONSULTATION AND SELECTED PROCEDURES, HISTORY AND PHYSICALS, AND DISCHARGES UNDER THE DIRECTION OF THE PRECEPTING CARDIOLOGIST. THE RESIDENT WILL BE RESPONSIBLE FOR ALL CONFERENCES, CALL RESPONSIBILITIES AND SCHEDULED CLINICS. DURING THIS ROTATION THE RESIDENT WILL BECOME PROFICIENT IN THE WORK UP OF CHEST PAIN, BE ABLE TO SELECT THE MOST APPROPRIATE DIAGNOSTIC WORK UP FOR A PARTICULAR CLINICAL SITUATION, TREAT COMPETENTLY AN ACUTE MYOCARDIAL INFARCTION REMOTE FROM A CARDIOLOGIST, WORK TO FAVORABLY ADJUST A PATIENT’S RISK FACTORS FOR CORONARY ARTERY DISEASE, AND GIVE APPROPRIATE CARE TO THE PATIENT WITH A HISTORY OF HEART DISEASE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. LEARN THROUGH OBSERVATION, DISCUSSION AND PERFORMANCE TO PERFORM A COMPLETE HISTORY AND PHYSICAL EXAM RELATED TO CARDIOLOGY SPECIFICALLY AND ALSO BE ABLE TO PRESENT A WELL THOUGHT OUT PRESENTATION. 2. APPROPRIATELY IDENTIFY MURMURS SPECIFICALLY THOSE NEEDING FURTHER TESTING OR REFERRAL. 3. ACCURATELY INTERPRET A 12 LEAD EKG AND RHYTHM STRIP 4. DESCRIBE INITIAL EVALUATION AND UNDERSTANDING OF THE SPECIFIC TESTING MODALITY, THE APPROPRIATE DIAGNOSTIC TEST TO ORDER TO HELP IN THE DIFFERENTIAL DIAGNOSIS AND CARE OF THE PATIENT INCLUDING 36 UNDERSTANDING HOW THE TEST ITSELF IS PERFORMED AND BEING ABLE TO EXPLAIN IT TO THE PATIENT IN A SATISFACTORY MANNER. 5. DEMONSTRATE THE ABILITY TO ORDER APPROPRIATE PHARMACOLOGIC THERAPY AND BE ABLE TO DISCUSS THE REASONS FOR THE SPECIFIC THERAPY WITH THE CARDIOLOGY ATTENDING. 6. THE RESIDENT WILL BE ABLE TO APPROPRIATELY RECOGNIZE PATIENTS THAT REQUIRE CARDIOLOGY CONSULTATION, INCLUDING THOSE WHO REQUIRE IMMEDIATE CARDIOLOGY INTERVENTION 7. 8. BE CERTIFIED IN AND BE ABLE TO PERFORM ADVANCED CARDIAC LIFE SUPPORT (ACLS) RECOGNIZE AND BE ABLE TO EMERGENTLY/URGENTLY TREAT: a. ACUTE MYOCARDIAL INFARCTION b. UNSTABLE CARDIAC DYSRHYMIAS c. HYPERTENSIVE CRISIS d. HYPOVOLEMIA AND FLUID RESUSCITATION e. CONGESTIVE HEART FAILURE WITH PULMONARY EDEMA f. PULMONARY EMBOLUS g. CHEST PAIN h. UNSTABLE ANGINA i. AV BLOCK j. CARDIOGENIC SYNCOPE k. OTHER LIFE-THREATENING CARDIAC PATHOLOGY MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. LEARN THROUGH OBSERVATION, DISCUSSION AND PERFORMANCE TO PERFORM A COMPLETE HISTORY AND PHYSICAL EXAM RELATED TO CARDIOLOGY SPECIFICALLY AND ALSO BE ABLE TO PRESENT A WELL THOUGHT OUT PRESENTATION. 2. APPROPRIATELY IDENTIFY MURMURS SPECIFICALLY THOSE NEEDING FURTHER TESTING OR REFERRAL. 3. ACCURATELY INTERPRET A 12 LEAD EKG AND RHYTHM STRIP 4. DESCRIBE INITIAL EVALUATION AND UNDERSTANDING OF THE SPECIFIC TESTING MODALITY, THE APPROPRIATE DIAGNOSTIC TEST TO ORDER TO HELP IN THE DIFFERENTIAL DIAGNOSIS AND CARE OF THE PATIENT INCLUDING UNDERSTANDING HOW THE TEST ITSELF IS PERFORMED AND BEING ABLE TO EXPLAIN IT TO THE PATIENT IN A SATISFACTORY MANNER. 5. DEMONSTRATE THE ABILITY TO ORDER APPROPRIATE PHARMACOLOGIC THERAPY AND BE ABLE TO DISCUSS THE REASONS FOR THE SPECIFIC THERAPY WITH THE CARDIOLOGY ATTENDING. 6. THE RESIDENT WILL BE ABLE TO APPROPRIATELY RECOGNIZE PATIENTS THAT REQUIRE CARDIOLOGY CONSULTATION, INCLUDING THOSE WHO REQUIRE IMMEDIATE CARDIOLOGY INTERVENTION 7. BECOME CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT (ACLS) PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 37 1. 2. 3. 4. 5. LEARN THE SAFETY CHECKS THAT OCCUR IN THE CATH LAB AND CARDIAC ICU TO INSURE PATIENT SAFETY UNDERSTAND THE REVIEW PROCESS OF COMPLICATIONS OR UNDESIRED OUTCOMES ASK THE ATTENDING ANYTHING THAT IS NOT UNDERSTOOD BY THE RESIDENT BECOME FAMILIAR WITH THE CORE MEASURES IN CARDIOLOGY OBTAIN FOLLOW UP IN THE CLINIC OF PATIENTS IN WHICH THE RESIDENT WAS INVOLVED IN THE HOSPITAL DIAGNOSIS AND TREATMENT OF THE CARDIAC PATIENT SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK IN INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY a. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE CARDIAC UNIT CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE AND b. 2. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY PARTICIPATE IN IDENTIFYING SYSTEM ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEM SOLUTIONS BY a. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE CARDIAC ICU TEAM FOR PATIENT SAFETY AND b. UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM PROCEDURES SUCH AS DELIVERIES IN A WAY THAT IS SAFE FOR THE PATIENT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL 2. 3. 4. 5. 6. 7. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE CARDIOLOGY ROTATION TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 38 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY 3. 4. 5. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, PATIENT CARE, BE CONSIDERED A VALUABLE AND INFORMATIVE HEALTHCARE TEAM MEMBER MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE TEACHING METHODS ONE ON ONE WITH THE SURGEON THAT WILL INCLUDE BEDSIDE INSTRUCTION, LECTURE, AND SELECTED READINGS. ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES 12-LEAD ECGS: A POCKET BRAIN FOR EASY INTERPRETATION BY KEN GRAUER HTTP://WWW.ACC.ORG/QUALITYANDSCIENCE/CLINICAL/STATEMENTS.HTM CLINICAL STATEMENTS/GUIDELINES ATRIAL FIBRILLATION: ACC/AHA/PHYSICIAN CONSORTIUM 2008 PERFORMANCE MEASURES FOR MANAGEMENT OF PATIENTS W ITH NONVALVULAR ATRIAL FIBRILLATION OR ATRIAL FLUTTER (J AM COLL CARDIOL 2008;51:865-906) ST-ELEVATION MYOCARDIAL INFARCTION: 2007 FOCUSED UPDATE OF THE ACC/AHA 2004 GUIDELINES FOR THE MANAGEMENT OF PATIENTS W ITH CHRONIC ANGINA: 2007 CHRONIC ANGINA FOCUSED UPDATE OF THE ACC/AHA 2002 GUIDELINES FOR THE MANAGEMENT OF PATIENTS W ITH CHRONIC STABLE ANGINA PERIOPERATIVE CARDIOVASCULAR EVALUATION AND CARE FOR NONCARDIAC SURGERY: ACC/AHA 2007 GUIDELINES ON UNSTABLE ANGINA/NON–ST-ELEVATION MYOCARDIAL INFARCTION: ACC/AHA 2007 GUIDELINES FOR THE MANAGEMENT OF PATIENTS W ITH PRIMARY CARDIOLOGY BY EUGENE BRAUNWALD, LEE GOLDMAN, AND CHRISTOPHER MENZ (HARDCOVER - APRIL 9, 2003) ASSIGNED CHALLENGER SERIES QUESTIONS 39 CLINIC BASED TREADMILL STRESS TESTING DESCRIPTION OF EDUCATIONAL EXPERIENCE AFTER RECEIVING A SERIES OF FOUR ONE HOUR CONFERENCES ON THE INDICATIONS, CONTRA-INDICATIONS, INTERPRETATION OF RESULTS, AND ACTUAL PERFORMING THE TEST DURING THE ORIENTATION PERIOD, THE FIRST YEAR RESIDENT WILL BE ASSIGNED TO PERFORM CARDIAC TREADMILL STRESS TESTS EVERY THURSDAY MORNING IN THE AHEC SOUTHWEST FAMILY MEDICINE CLINIC UNDER THE DIRECT SUPERVISION OF THE PRECEPTING FACULTY MEMBER. THE PATIENTS WOULD HAVE BEEN APPROPRIATELY SELECTED BY RESIDENTS IN THE CLINIC AND APPROVED BY A FACULTY MEMBER AS BEING APPROPRIATE FOR TREADMILL STRESS TESTING IN THE CLINIC. THE RESIDENT AND FACULTY MEMBER WILL FIRST REVIEW THE CASE AND MAKE SURE THAT THE PATIENT IS APPROPRIATELY SCHEDULED FOR A STRESS TEST. WRITTEN CONSENT IS OBTAINED FROM THE PATIENT AFTER THE BENEFITS AND RISKS OF THE PROCEDURE ARE MADE CLEAR TO THE PATIENT. PRE-TEST PROBABILITY IS OBTAINED BY THE RESIDENT AND TARGET HEART RATE IS DETERMINED PRIOR TO THE PROCEDURE. THE TEST IS PERFORMED WITH THE FACULTY MEMBER PRESENT. AT THE COMPLETION OF THE TEST THE POST-TEST LIKELIHOOD OF SIGNIFICANT CORONARY ARTERY DISEASE IS DETERMINED. THE TEST IS RECORDED BY THE RESIDENT IN THE ELECTRONIC MEDICAL RECORD TEMPLATE DESIGNED SPECIFICALLY TO RECORD THE TREADMILL STRESS TEST. DISPOSITION OF THE PATIENT IS DISCUSSED WITH THE FACULTY MEMBER. THE RESIDENT CONVEYS THIS TO THE PATIENT IN A WAY THAT CAN BE CLEARLY UNDERSTOOD. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DEMONSTRATE THE COMPETENCY OF PERFORMING A COMPREHENSIVE CARDIOVASCULAR EXAM 2. BECOME PROFICIENT IN THE INTERPRETATION OF EKGS 3. KNOW WHEN AN OFFICE BASED TREADMILL STRESS TEST IS THE APPROPRIATE STUDY TO ORDER 4. CAN INTERPRET AN EKG 5. PERFORMS THE STRESS TEST 6. IS ABLE TO INTERPRET THE RESULTS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. BE ABLE TO DETERMINE THE DIFFERENCE BETWEEN TYPICAL, NON-TYPICAL, AND NON-ANGINAL CHEST PAIN 2. KNOW THE DIAGNOSTIC AND PROGNOSTIC INDICATIONS OF A TREADMILL STRESS TEST 3. DESCRIBE BASED ON AGE, RISK FACTORS, AND CHEST PAIN DESCRIPTION WHICH PATIENTS ARE MOST APPROPRIATELY STUDIED BY A TREADMILL STRESS TEST 4. 5. 6. 7. 8. 40 GIVE INSTRUCTIONS TO THE PATIENT ABOUT HOW TO TAKE THEIR MEDICATIONS ON THE DAY OF THE TEST KNOW THE RISK FACTORS OF PERFORMING A OFFICE BASED STRESS TEST LIST THE CONDITIONS BY WHICH AN OFFICE BASED TREADMILL STRESS TEST MUST BE IMMEDIATELY STOPPED INTERPRET AN TREADMILL STRESS TEST EKG MAKE A DISPOSITION AND TREATMENT PLAN BASED ON THE FINDINGS OF A TREADMILL STRESS TEST PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. EVALUATE THEIR PERFORMANCE TO THE FACULTY PRECEPTOR AT THE END OF EACH SESSION WITH SUGGESTIONS FOR IMPROVEMENT 2. 3. REVIEW THE OUTCOME OF TREATMENT PLAN FOLLOWED AS A RESULT OF A TREADMILL STRESS TEST CLEARLY STATE TO THE ATTENDING WHAT ONE DOES NOT KNOW OR UNDERSTAND SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. 1. WORK AS A TEAM WITH THE STRESS TEST NURSE TO DELIVER CARE BASED ON SAFETY AND THE BEST MEDICAL EVIDENCE AVAILABLE 2. IDENTIFY THE POTENTIAL ERRORS THAT OCCUR IN THE MEDICAL SYSTEMS THAT COULD JEOPARDIZE THE CARE OF THE PATIENT INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE NURSE AND THE FACULTY PHYSICIAN SO THAT THE HEALTH CARE TEAM CAN OPERATE AT IT MAXIMAL EFFECTIVENESS 2. IN AN COMPASSIONATE AND COMPREHENSIBLE WAY COMMUNICATE TO THE PATIENT EVERYTHING ABOUT THERE CONDITION AND THE TREATMENT THAT WILL BE REQUIRED 3. IN A TIMELY, COMPLETE, ACCURATE, AND LEGIBLE FASHION DOCUMENT THE PATIENT VISIT INTO THE ELECTRONIC MEDICAL RECORD PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO THE STRESS TESTING AREA PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE TREADMILL STRESS TESTING SESSIONS, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 41 5. 6. 7. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, ABIDE BY HIPAA AND AHEC SOUTHWEST BYLAWS, AND DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. TEACHING METHODS ONE ON ONE WITH THE FACULTY PHYSICIAN, DR. MAYO WITH OPEN DISCUSSION, ONLINE TEACHING RESOURCES, AND 4 ONE HOUR POWERPOINT PRESENTATIONS ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES ETT POCKET BRAIN BY KEN GRAUER SERIES OF FOUR CONFERENCES BY DR. MAYO ON: INDICATIONS AND CONTRAINDICATIONS OF ETT PERFORMING ETT INTERPRETING ETT ETT CASE STUDIES EMERGENCY MEDICINE FIRST YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE FIRST YEAR RESIDENTS WILL SPEND ONE MONTH ON THE EMERGENCY MEDICINE SERVICE. THIS WILL BE DONE AT ONE OF THE TWO EMERGENCY DEPARTMENTS IN THE HOSPITALS IN TEXARKANA. THE RESIDENT WILL SPEND TWELVE (12) TWELVE HOUR SHIFTS WORKING UNDER THE SUPERVISION OF THE EMERGENCY ROOM PHYSICIAN ON DUTY DURING THE MONTH. THE RESIDENT IS TO STAY IN COMPLIANCE WITH DUTY HOUR RULES DURING THIS ROTATION. THE FIRST YEAR RESIDENT IS ENCOURAGED TO DO DAYTIME AND NIGHTTIME SHIFTS, ALSO. THE FIRST YEAR RESIDENT WILL BE EXPECTED TO SEE PATIENTS INDEPENDENTLY AND PRESENT THE ASSESSMENT AND PLAN TO THE EMERGENCY ROOM PHYSICIAN. THE CASE WILL BE DISCUSSED THROUGHOUT THE PATIENT’S COURSE IN THE DEPARTMENT, INCLUDING THE DISPOSITION AND PLAN. THE EMERGENCY ROOM PHYSICIAN WILL ALSO INTERVIEW AND EXAM THE PATIENT, AS IT RELATES TO THE CHIEF COMPLAINT. THE FIRST YEAR RESIDENT IS TO ATTEND AND PARTICIPATE IN ALL CARDIAC CODES, RESPIRATORY FAILURES REQUIRING INTUBATION, AND TRAUMA CODES THAT OCCUR IN THE DEPARTMENT DURING DUTY HOURS. 42 PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. CARDIOVASCULAR EMERGENCY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE CARDIOVASCULAR SYSTEM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE CARDIOVASCULAR WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN, WHETHER THE PATIENT BE TREATED AS AN OUTPATIENT OR ADMITTED TO THE ACUTE CARE HOSPITAL 7. BE COMPETENT AT ADVANCED CARDIAC LIFE SUPPORT , ABLE TO CONDUCT A CARDIOVASCULAR CODE, AND OBTAIN CENTRAL LINE AND CHEST TUBE PLACEMENT EXPERIENCE TRAUMA EMERGENCY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION FOR A TRAUMA VICTIM, AS OUTLINED BY THE AMERICAN COLLEGE OF SURGEONS’ PUBLICATIONS ADVANCE TRAUMA LIFE SUPPORT 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE TRAUMA WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING 5. 6. 7. AND LABORATORY TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WORKING WITH CONSULTANTS INCLUDING APPROPRIATE LEVEL OF CARE IN HOSPITAL BE COMPETENT AT ADVANCED TRAUMA LIFE SUPPORT AND ABLE TO CONDUCT A TRAUMA CODE CEREBRAL ARTERIAL INSUFFICIENCY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE NEUROLOGICAL 3. 4. 5. 6. 7. EXAMINATION DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY, INCLUDING POSSIBILITY OF THE USE OF THROMBLYTIC AGENTS COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES BE COMPETENT AT NEUROLOGICAL PROCEDURES INCLUDING LUMBAR PUNCTURE RESPIRATORY FAILURE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE PULMONARY SYSTEM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE PULMONARY WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN INCLUDING APPROPRIATE LEVEL OF CARE IN HOSPITAL 7. BE COMPETENT AT PULMONARY EMERGENT PROCEDURES SUCH AS ENDOTRACHEAL OR CHEST TUBE PLACEMENT 43 SPINAL CORD INJURY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE POSSIBILITY OF A SPINAL CORD INJURY 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS 7. BE COMPETENT AT SPINAL CORD STABILIZATION AND IMMOBILIZATION PROCEDURES ABDOMINAL PAIN OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE ABDOMINAL EXAM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT ABDOMINAL PROCEDURES INCLUDING ABDOMINAL PARACENTESIS, PELVIC EXAM, AND ANOSCOPY GASTROINTESTINAL HEMORRHAGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE ABDOMINAL EXAM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT FLUID RESUSCITATION AND CARDIOVASCULAR STABILIZATION OF THE HYPOVOLEMIC PATIENT OBSTETRICAL/GYNECOLOGICAL OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE GYNECOLOGICAL EXAMINATION 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT OBSTETRICAL/GYNECOLOGICAL PROCEDURES SUCH AS PELVIC EXAM, OBTAINING FETAL HEART TONES, STABILIZATION OF MASSIVE ENDOMETRIAL HEMORRHAGE OPHTHALMOLOGICAL/OTOLARYNGOLOGICAL OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE OPHTHALMOLOGICAL AND 3. 44 OTOLARYNGOLOGICAL EXAMINATION DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND 5. 6. 7. LABORATORY TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES BE COMPETENT AT OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL PROCEDURES SUCH AS SLIT LAMP EXAMINATIONS, LARYNGOSCOPY, ANTERIOR NASAL PACKING, AND EXAMINATION FOR CORNEAL ABRASIONS ENVIRONMENTAL/TOXICOLOGY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE ENVIRONMENTAL AND TOXICOLOGY CAUSES OF SYMPTOMATOLOGY 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT DIAGNOSING AND TREATMENT OF COMMON TOXICOLOGY SYNDROMES PEDIATRIC EMERGENCY OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT PEDIATRIC PROCEDURES SUCH AS IV ACCESS, LUMBAR PUNCTURE, AND PASSED PEDIATRIC ADVANCED LIFE SUPPORT COURSE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. READ THE ASSIGNED MATERIAL DESIGNATED FOR THE COURSE (SEE EDUCATIONAL RESOURCES BELOW) 2. READ UP ON THE PROBLEMS THAT PATIENTS HAVE AS THEY PRESENT TO THE EMERGENCY DEPARTMENT 3. BE READ TO DISCUSS THE ASSESSMENT AND PLAN FOR PATIENTS WHO PRESENT TO THE EMERGENCY DEPARTMENT TO THE ATTENDING PHYSICIAN PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. 45 PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. PARTICIPATE IN THE EDUCATION OF PATIENTS AND THEIR FAMILIES ABOUT THEIR CLINICAL COURSE IN THE PRENATAL CLINIC AND IN THE EMERGENCY DEPARTMENT IN ORDER THAT PATIENTS WILL BE ABLE TO MAKE INFORMED DECISIONS REGARDING THEIR CARE AND BE MORE COMPLIANT WITH TREATMENT PLANS 2. IDENTIFY WEAKNESSES WITH FEEDBACK FROM ATTENDING PHYSICIAN AND THEN UTILIZE THIS INFORMATION TO IMPROVE THEIR CARE OF PATIENTS 3. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING BY BEING ABLE TO MASTER THE ELECTRONIC MEDICAL RECORD OF THE HOSPITAL IN OBTAINING INFORMATION ON PATIENTS AND LOOKING UP AND LEARNING INFORMATION ABOUT OBSTETRICS ON THE UAMS LIBRARY DATABASE WEB SITE SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK IN INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY a. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE EMERGENCY DEPARTMENT CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE b. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY 2. PARTICIPATE IN IDENTIFYING SYSTEM ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEM SOLUTIONS BY a. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE EMERGENCY DEPARTMENT TEAM FOR PATIENT SAFETY AND b. UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM EMERGENCY DEPARTMENT PROCEDURES INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN ON THE EMERGENCY DEPARTMENT BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER DELIVERING OBSTETRICAL CARE ON THE EMERGENCY DEPARTMENT UNIT 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE ON THE EMERGENCY DEPARTMENT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 46 2. 3. 4. 5. 6. 7. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE OBSTETRICAL ROTATION, TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES EMERGENCY MEDICINE: A COMPREHENSIVE STUDY GUIDE, 5TH EDITION CLINI, DAVID; MA, JOHN; TINTINALLI, JUDITH; KELEN, GABOR; STAPCZYNSKI, STEPHAN. AMONG THE MANY SOURCES AVAILABLE FOR THE RESIDENTS FOR ANSWERING CLINICAL QUESTIONS, THE UP-TO-DATE RESOURCE FOUND ON THE UAMS LIBRARY DATABASE RESOURCE PAGE WILL BE EXTENSIVELY UTILIZED. HTTP://WWW.UTDOL.COM/UTD/CONTENT/SEARCH.DO ASSIGNED CHALLENGER SERIES QUESTIONS NIGHT FLOAT FIRST YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE FIRST YEAR RESIDENTS WITH AN IN-HOUSE BACK UP UPPER LEVEL RESIDENT MEET THE MEMBERS OF THE MEDICINE TEAM AT, OR AROUND, 5 PM. AT THAT TIME, THE RESIDENTS FROM THE INPATIENT MEDICINE TEAM REVIEW EACH PATIENT ON THE INPATIENT LIST WITH THE NIGHT FLOAT TEAM. AT THE CONCLUSION OF THE MEETING, THE NIGHT FLOAT TEAM TAKES ALL CALLS FROM THE NURSE CARE TEAMS IN THE HOSPITAL REGARDING THE RESIDENCY’S PATIENTS AND ANY NEW ADMISSIONS. THE UPPER LEVEL RESIDENT CALLS ALL ADMISSIONS AND CHANGES IN STATUS OF THE INPATIENTS TO THE ATTENDING FACULTY MEMBER ON CALL. FOR ANY ICU ADMISSIONS, THE FACULTY MEMBER COMES OUT TO SEE THE PATIENT. THE FIRST YEAR RESIDENT SEES THE THE UPPER LEVEL RESIDENT THEN CALLS THE ATTENDING FACULTY MEMBER ON CALL TO REPORT THE ADMISSION ON ALL PATIENTS. AT 7 AM, THE FIRST YEAR RESIDENT IS TO HAVE THE LIST OF INPATIENTS UPDATED FOR MORNING REPORT. THE FIRST YEAR RESIDENT THEN PRESENTS ALL ADMISSIONS AND CHANGES IN STATUS OF INPATIENTS TO THE INPATIENT MEDICINE TEAM. THE FIRST YEAR RESIDENT AND THE UPPER LEVEL RESIDENT STAY TOGETHER AS A TEAM THROUGHOUT THE MONTH. FOR TWO WEEKS, THE TEAM WILL WORK THE NIGHT FLOAT SUNDAY THROUGH THURSDAY AND THEN FOR TWO WEEKS, THE TEAM WILL WORK ONLY FRIDAY NIGHTS. THERE ARE NO CONTINUITY CLINICS DURING THE TWO WEEKS ON NIGHT FLOAT. DURING THE TWO WEEKS THAT THE TEAM WORKS ONLY FRIDAY NIGHT, THOSE TWO RESIDENTS ARE IN CLINIC MONDAY THROUGH THURSDAY. NEW ADMISSIONS AND WRITES ORDERS WITH THE GUIDANCE OF THE UPPER LEVEL RESIDENT. 47 PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. OBJECTIVES: THE RESIDENT WILL: 1. DEMONSTRATE THE ABILITY TO INTERVIEW A PATIENT, GAINING PERTINENT FACTS IN AN EFFICIENT AN COMPLETE MANNER. 2. PERFORM A COMPLETE AND ACCURATE PHYSICAL EXAM. 3. EVALUATE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 4. PRIORITIZE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 5. EFFICIENTLY EVALUATE AND STABILIZE PATIENTS NEWLY FROM THE EMERGENCY DEPARTMENT. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. OBJECTIVES: THE RESIDENT WILL: 1. ARTICULATE THE PATHOPHYSIOLOGY, EVALUATION, DIAGNOSTIC WORK UP AND TREATMENT OF COMMON MEDICAL PROBLEMS 2. LEARN APPROPRIATE MANAGEMENT STRATEGIES FOR PROBLEMS COMMONLY OCCURRING IN HOSPITALIZED PATIENTS, SUCH AS FEVER, SHORTNESS OF BREATH, CHEST PAIN, ALTERED CONSCIOUSNESS, HYPOTENSION, AND OTHERS. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. OBJECTIVES: THE RESIDENT WILL: 1. COMMUNICATE EFFECTIVELY, VERBALLY AT MORNING REPORT AND THROUGH APPROPRIATE WRITTEN SIGN-OUT, WITH COLLEAGUES WHOSE PATIENTS ARE BEING COVERED. 2. COMMUNICATE EFFECTIVELY WITH NURSING STAFF REGARDING ACUTE PATIENT PROBLEMS. 3. COMMUNICATE EFFECTIVELY AND CONCISELY WITH ATTENDING PHYSICIANS WHOSE PATIENTS ARE ADMITTED AND EVALUATED DURING THE NIGHT. 4. COMMUNICATE WITH CONSULTING PHYSICIANS EFFECTIVELY, PROFESSIONALLY, AND IN A TIMELY MANNER TO INSURE GOOD PATIENT CARE. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. OBJECTIVES: THE RESIDENT WILL: 1. BEHAVE PROFESSIONALLY TOWARD PATIENTS, FAMILIES, COLLEAGUES, AND ALL MEMBERS OF THE HEALTH CARE TEAM. 2. BE PROMPT TO MORNING REPORT AND THE AFTERNOON CHECK OUT WITH THE INPATIENT MEDICINE TEAM. 48 3. PREPARED FOR MORNING REPORT WITH ASSIGNMENTS PER THE ATTENDING PHYSICIANS. 4. ANSWER ALL PAGES WITHIN 15 MINUTES. 5. PROMPTLY ATTEND PATIENTS IN THE ER THAT ARE DEEMED TO BE ADMITTED OR INPATIENTS WHO ARE HAVING DIFFICULTY AND NEED THE BEDSIDE PRESENCE OF A PHYSICIAN. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATEINTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. OBJECTIVES: THE RESIDENT WILL: 1. ACKNOWLEDGE THE “GAPS” IN MEDICAL KNOWLEDGE 2. IDENTIFY ERRORS IN MEDICAL CARE AND UTILIZE MEDICAL LITERATURE, INFORMATION SYSTEMS AND TEACHERS TO ADDRESS THOSE ERRORS. 3. USE AN EVIDENCED-BASED APPROACH IN THE CARE OF PATIENTS. 4. UNDERSTAND AND UTILIZE THE INFORMATION TECHNOLOGY AVAILABLE TO YOU AT EACH SITE. SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEST AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. OBJECTIVES: THE RESIDENT WILL: 1. EFFECTIVELY UTILIZE THE RELATIVE LIMITED RESOURCES AVAILABLE DURING THE NIGHT TO ASSURE HIGH QUALITY PATIENT CARE AND PATIENT SAFETY. 2. WORK WITH THE CASE MANAGERS IN THE ER TO INSURE APPROPRIATE ADMISSION STATUS FOR THOSE PATIENTS ADMITTED AFTER 5 PM. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES ONLINE RESOURCES: UP TO DATE, DYNAMED WASHINGTON’S MANUAL, LATEST EDITION ASSIGNED CHALLENGER SERIES QUESTIONS 49 NIGHT FLOAT HOW IT WORKS TWO NIGHT FLOAT TEAMS WILL COVER EACH MONTH. EACH TEAM WILL BE COMPOSED OF A FIRST YEAR RESIDENT AND AN UPPER LEVEL. THEY WILL PICK UP THE BEEPER AND BOTH WILL BE “IN HOUSE CALL” UNTIL THE CONCLUSION OF MORNING REPORT EACH MORNING. THEY WILL PICK UP THE BEEPER AT 5 PM ON SUNDAY, MONDAY, TUESDAY, WEDNESDAY, THURSDAY, & FRIDAY EVENINGS, ANSWER ALL CALLS, AND ADMIT PATIENTS TO THE INPATIENT SERVICE UNTIL THE CONCLUSION OF MORNING REPORT. AT THE CONCLUSION OF MORNING REPORT, THEY WILL GO HOME IMMEDIATELY, BOTH FIRST YEAR AND UPPER LEVEL RESIDENTS. TEAM A WILL DO THE FIRST TWO WEEKS SUNDAY THROUGH THURSDAY AND TEAM B WILL DO THE SECOND TWO WEEKS SUNDAY THROUGH THURSDAY. ON THE TWO WEEKS THAT THE NIGHT FLOAT TEAM DOES NOT WORK MONDAY THROUGH THURSDAY, THEY WORK FRIDAY NIGHT 5 PM UNTIL 8 AM SATURDAY MORNING. ANY DAYS LEFT, THEY WILL EVENLY SPLIT MAKING SURE THAT ALL DUTY HOUR REGULATIONS ARE NOT COMPROMISED. DURING THE TWO OFF WEEKS DURING WHICH THEY ARE NOT ON CALL, THE UPPER LEVEL RESIDENT WILL SERVE IN CLINIC FULL TIME, EXCEPT FOR THURSDAY AFTERNOONS AND FRIDAYS. THE FIRST YEAR ON THE TWO WEEKS OF NIGHT FLOAT MONTH WILL, WHILE NOT IN THE 2 WEEK PERIOD OF NIGHT FLOAT, WORK CLINIC EVERY MORNING, EXCEPT FRIDAY MORNING AND COMPLETE DIDACTIC CURRICULUM VIA CHALLENGER ASSIGNMENT FOR THE MONTH. WHILE RESIDENTS ARE ON THEIR TWO WEEK NIGHT FLOAT, THEY WILL NOT SERVE IN THE CLINIC. 50 PGY 2 ROTATIONS FAMILY MEDICINE INPATIENT SERVICE CARE OF THE CHILD NEONATOLOGY PULMONOLOGY/CRITICAL CARE MUSCULOSKELETAL AND SPORTS MEDICINE HUMAN BEHAVIOR AND MENTAL HEALTH DIAGNOSTIC IMAGING EMERGENCY ROOM NIGHT FLOAT/FAMILY MEDICINE CLINICS INPATIENT FAMILY MEDICINE UPPER LEVEL RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL SPEND TWO MONTHS OF THE EACH YEAR ON THE INPATIENT FAMILY MEDICINE SERVICE. EACH HOSPITAL TEAM WILL CONSIST OF AN ATTENDING PHYSICIAN, AN UPPER LEVEL RESIDENT HELPING DIRECT PATIENT CARE WITH A FIRST YEAR RESIDENT, A CLINICAL PHARMACIST AND A HOSPITAL CASE MANAGER THE DAY WILL START EACH MORNING AT 7 AM MEETING DURING WHICH THE ON CALL TEAM REPORTS TO THE MEDICINE TEAMS ABOUT THE PREVIOUS NIGHT’S ADMISSIONS AND DEVELOPMENTS. THE TWO ATTENDING PHYSICIANS WILL DIRECT THIS MORNING REPORT. GOALS 1. PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH 2. 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 3. 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 51 4. 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 5. PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION 6. INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS OBJECTIVES ADMISSION SKILLS PATIENT CARE OBJECTIVES: THE UPPER RESIDENT WILL 1. REVIEW THE COMPONENTS OF AN H&P AS DONE BY THE FIRST YEAR RESIDENT 2. ASSIST THE FIRST YEAR RESIDENT IN OBTAINING A COMPLETE HISTORY OR PRESENT ILLNESS 3. OVERSEE THE COLLECTION OF PERTINENT PSYCHOSOCIAL INFORMATION 4. REVIEW THE RECORDED ELEMENTS OF THE PMH, SH, AND FH AS DONE BY THE FIRST YEAR RESIDENT 5. SYSTEMATICALLY REVIEW THE 13 ORGAN REVIEW OF SYSTEMS AS DONE BY THE FIRST YEAR RESIDENT 6. MAKE SURE A DETAILED MEDICATION LIST IS IN THE CHART 7. DOCUMENT A COMPREHENSIVE EXAMINATION COMPLETE WITH VITAL SIGNS AND RECTAL EXAM 8. DOCUMENT ALL LABORATORY AND IMAGING STUDIES 9. MAKE SURE THE FIRST YEAR RESIDENT UNDERSTANDS THE PRINCIPLE DIAGNOSIS AND THE REASON FOR ADMISSION 10. SUBSTANTIATE ALL PATIENT PROBLEMS IN THE ASSESSMENT 11. RECORD TREATMENT PLAN AS REVIEWED AND PUT FORTH BY THE FIRST YEAR RESIDENT 12. DOCUMENT PERTINENT HISTORY AND PHYSICAL FINDINGS WITH A LEGIBLE ADMISSION NOTE 13. HELP FIRST YEAR RESIDENT DICTATE COMPLETE H&P AT THE TIME OF ADMISSION 14. OVERSEE THE COMPLETION OF APPROPRIATE ORDERS IN A REASONABLE TIME BY THE FIRST YEAR RESIDENT MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SUPERVISE FIRST YEAR RESIDENT IN SELECTING CORRECT ORDER SET FOR ADMISSION DIAGNOSIS 2. REVIEW MEDICAL DIAGNOSTIC WORK UP AND TREATMENT PLAN ON EACH PATIENT BEFORE MORNING REPORT PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW 2. REVIEW FIRST YEAR RESIDENT’S H&P TO MAKE SURE THAT ALL COMPONENTS ARE PRESENT SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CHECK TO MAKE SURE PATIENT IS ASSIGNED TO THE HOSPITAL WARD WHOSE NURSING STAFF CAN DELIVERY THE MOST APPROPRIATE LEVEL OF CARE 2. 3. REVIEW ALL HOME MEDICATIONS AND RENEW AS APPROPRIATE FOR PATIENT’S ADMISSION NEEDS SUPERVISE FIRST YEAR RESIDENT IN WRITING ADMISSION ORDERS IN CORPORATION WITH THE CASE MANAGER WITH THE GOAL OF GETTING THE PATIENT THE MOST TIME-EFFICIENT, COST-EFFICIENT, AND SAFEST CARE FOR THE PROBLEMS THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL FOR PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. ATTEND TO THE PATIENT IN THE EMERGENCY ROOM FOR ADMISSION AS SOON AS POSSIBLE AFTER CALLED BY THE FIRST YEAR RESIDENT 52 2. 3. 4. 5. 6. BE APPROPRIATELY AND PROFESSIONALLY ATTIRED COMMUNICATE IN A PROFESSIONAL MANNER WITH THE ER PHYSICIANS, NURSES, AND STAFF FOLLOW ALL HIPPA REGULATIONS IN REGARD TO THE CARE OF THE PATIENT INTRODUCE YOURSELF TO THE PATIENT AND FAMILY SHOWING RESPECT AND COMPASSION CALL ALL CONSULTANTS AND EXPLAIN EITHER VIA PHONE OR IN PERSON PATIENT’S CLINICAL COURSE AND WHY THE REFERRAL IS BEING MADE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WRITE AN ACCURATE ADMISSION NOTE 2. REVIEW ORDERS WRITTEN BY FIRST YEAR 3. COMMUNICATE WITH THE FAMILY AND PATIENT THE DIAGNOSES, THE NEED FOR ADMISSION, AND THE TREATMENT PLAN WITH THE FIRST YEAR RESIDENT 4. BE PRESENT DURING MORNING REPORT TO INSURE THE PATIENT IS PRESENTED ACCURATELY BY FIRST YEAR RESIDENTS AND BE READY TO DEFEND CARE ADMINISTERED DAILY ROUNDING SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INTERVIEW AND EXAMINE THE PATIENT DAILY 2. KNOW ALL THE PERTINENT INFORMATION REGARDING THE CARE OF THE ASSIGNED PATIENT 3. CREATE SOAP NOTE WITH COMPLETE AND ACCURATE ASSESSMENT AND PLAN 4. ANTICIPATE AND DISCUSS POTENTIAL COMPLICATIONS OF A PATIENT’S TREATMENT PLAN 5. REVIEW PATIENT LIST OF FIRST YEAR RESIDENT AND DISCUSS CLINICAL DECISIONS MADE ON A DAILY BASIS MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. READ DAILY ON THE DISEASE PROCESSES AND TREATMENT OPTIONS ON THE INPATIENTS THAT THE RESIDENT IS FOLLOWING 2. BE ABLE TO DISCUSS THE PATHOPHYSIOLOGY, RISK FACTORS, SIGNS, SYMPTOMS, DIFFERENTIAL DIAGNOSIS, APPROPRIATE DIAGNOSTIC WORK UP, TREATMENT PLAN, AND PREVENTATIVE STRATEGIES FOR THE TOP TEN DIAGNOSES: I. II. III. IV. V. VI. VII. VIII. IX. X. 3. 4. COPD CHEST PAIN PNEUMONIA CONGESTIVE HEART FAILURE ATRIAL FIBRILLATION STROKE TIA SYNCOPE PANCREATITIS GASTROENTESTINAL HEMORRHAGE PREPARE FOR ASSIGNED PRESENTATIONS IN MORNING REPORT PARTICIPATE IN DISCUSSIONS IN MORNING REPORT WITH THE ATTENDING AND OTHER RESIDENTS AND STUDENTS ON THE HEALTHCARE TEAM 5. BE PREPARED TO EXPLAIN AND DEFEND THE RATIONALE BEHIND YOUR ASSESSMENT AND TREATMENT PLAN TO THE ATTENDING FACULTY MEMBER DURING ROUNDS 53 PRACTICE-BASED LEARNING AND IMPROVEMENT: THE UPPER LEVEL RESIDENT WILL 1. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 2. ASSIST OR COORDINATE EFFORTS TO PERFORM “ROOT CAUSE ANALYSIS” STUDIES ON EVENTS THAT OCCUR THAT ARE UNEXPECTED OR CAUSE ADDITIONAL MORBIDITY/MORTALITY TO THE INPATIENT DURING THEIR HOSPITALIZATION 3. DISCUSS QUALITY IMPROVEMENT CASES WITH THE VICE-PRESIDENT OF PATIENT AFFAIRS DURING THE MORNING REPORT EACH FRIDAY SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. ROUND DAILY WITH THE CASE MANAGER AND DISCUSS THE CLINICAL HOSPITAL COURSE OF THE PATIENT PLANS FOR DISCHARGE & PLACEMENT, DURABLE MEDICAL EQUIPMENT NEEDED AT DISCHARGE, AND PLAN OF HOW THE PATIENT WILL OBTAIN MEDICATIONS UPON DISCHARGE 2. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 3. 4. DEMONSTRATE HOW TO FIND MEDICAL ANSWERS IN LESS THAN TWO MINUTES USING HANDHELD PDA ANTICIPATE AND AVOID POTENTIAL COMPLICATIONS OF HOSPITALIZATION SUCH AS DELIRIUM, NOSOCOMIAL INFECTION, OR DEEP VEIN THROMBOSIS/PULMONARY EMBOLUS 5. 6. 7. ASSIST FIRST YEAR RESIDENT IN UPDATING ACCURATELY THE INPATIENT LIST FOR MORNING REPORT PERFORM TIME MANAGEMENT SKILLS PROFICIENTLY IN ORDER THAT THE RESIDENT IS READY FOR ROUNDS WORK WITH THE CLINICAL PHARMACIST ON ROUNDS TO MAKE SURE THAT THE MOST APPROPRIATE AND COST EFFICIENT MEDICATIONS ARE USED AND ADVERSE DRUG REACTIONS OR DRUG-DRUG INTERACTIONS ARE AVOIDED PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. TREAT THE PATIENT WITH THE UTMOST RESPECT AND COURTESY 2. WORK WITH THE NURSES ON THE FLOOR TO DELIVER THE BEST AND MOST EFFICIENT PATIENT CARE POSSIBLE 3. COMMUNICATE IN PERSON AND IN CHART THE CURRENT ASSESSMENT AND TREATMENT PLAN GOALS FOR ALL OTHER HEALTHCARE TEAM MEMBERS 4. 5. BE AT MORNING REPORT AND ROUNDS PREPARED AND ON TIME DAILY SIGN OUT TO ON CALL TEAM IN THE EVENING INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CALL AND ACCURATELY DESCRIBE THE PATIENT’S CLINICAL COURSE AND THE REASON FOR CONSULTATION TO CONSULTANT PHYSICIAN 2. 3. 4. 5. 6. 7. ASSIST THE FIRST YEAR RESIDENT IN COMMUNICATING WITH CONSULTANT ON REFERRALS WRITE LEGIBLY SO ALL CARETAKERS CAN EASILY READ WRITE ORDERS THAT ARE CLEAR AND EASILY UNDERSTOOD KEEP PATIENT AND FAMILY INFORMED OF THE LATEST DEVELOPMENTS AS THEY UNFOLD EXPLAIN TO THE PATIENT AND FAMILY THE GOALS OF THE DAY’S TREATMENT PRESENT THE PATIENT’S ASSESSMENT AND PLAN ON ROUNDS TO THE ATTENDING FACULTY MEMBER DISCHARGE SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RECOGNIZE AND ASSIST FIRST YEAR RESIDENT IN RECOGNIZING AT WHAT POINT IN THE PATIENT’S HOSPITAL COURSE WHEN THE INPATIENT CAN BE SAFELY DISCHARGED 2. DISCUSS WITH THE ATTENDING FACULTY MEMBER THE RATIONALE FOR DISCHARGE, ASSESSMENT, AND POST-DISCHARGE PLAN 54 3. WRITE DISCHARGE ORDERS THAT ARE COMPLETE AND LEGIBLE NO LATER THAN EARLY AFTERNOON ON THE DAY OF DISCHARGE 4. 5. OVERVIEW DISCHARGE ORDERS WRITTEN BY FIRST YEAR RESIDENT DICTATE A DISCHARGE SUMMARY WITH ALL OF THE REQUIRED COMPONENTS INCLUDED AND THAT CAN BE USED AS A VALUABLE REFERENCE FOR ANY SUBSEQUENT TREATING PHYSICIANS 6. COMPLETE DISCHARGE MEDICATION LIST MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SUMMARIZE THE HOSPITAL COURSE, WHAT DIAGNOSES WERE PRESENT, WHAT TREATMENT PLANS WERE FOLLOWED, ALTERNATIVE TREATMENT PLANS THAT COULD HAVE BEEN UTILIZED, AND APPROPRIATE HOSPITAL FOLLOW UP REQUIRED 2. DISCUSS THE RATIONALE FOR THE TREATMENT RENDERED AND WHAT ISSUES NEED TO BE ADDRESSED AT FOLLOW UP OUTPATIENT VISITS PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WORK WITH THE CASE MANAGER TO INSURE AT DISCHARGE THAT THE PATIENT HAS APPROPRIATE PLACEMENT, NEEDED DURABLE MEDICAL EQUIPMENT, ACCESS TO PRESCRIBED MEDICATIONS, AND FOLLOW UP WITH PRIMARY CARE PROVIDER 2. NOTIFY PRIMARY CARE PROVIDER OF PATIENT NEEDS AT THE NEXT POST-HOSPITALIZATION FOLLOW UP VISIT PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE PRESENT AT DISCHARGE TO BE ABLE TO CLEARLY COMMUNICATE TO PATIENT AND FAMILY THE SUMMARY OF THE HOSPITALIZATION, DISCHARGE PLANS, AND FOLLOW UP 2. SUPERVISE FIRST YEAR RESIDENT IN COMMUNICATION WITH THE FAMILY AND PATIENT AT DISCHARGE 3. COMMUNICATE TO NURSES THE DISCHARGE ORDERS 4. BE SENSITIVE TO POSSIBLE PATIENT, FAMILY, AND NURSING HOME TIME CONSTRAINTS REGARDING A PROMPT AND EARLY DISCHARGE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INFORM NURSING STAFF OF DISCHARGE 2. CLEARLY COMMUNICATE TO PATIENT AND FAMILY DISCHARGE INSTRUCTIONS 3. DISCUSS WITH THE ATTENDING PHYSICIAN THE DISCHARGE PLANS 4. EXPLAIN TO THE PATIENT AND FAMILY THE DIAGNOSES, MEANING OF TESTS UP TO DATE, NEEDS FOR FURTHER TESTING, RATIONALE BEHIND CURRENT TREATMENT PLAN TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. 55 ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES CECIL’S TEXTBOOK OF INTERNAL MEDICINE WASHINGTON’S MANUAL TARASCON POCKET PHARMACOPOEIA AND POCKET CRITICAL CARE SANFORD’S GUIDE TO ANTIMICROBIAL THERAPY, LATEST EDITION UAMS LIBRARY ONLINE ELECTRONIC DATA BASE WITH UP TO DATE AND OTHERS ACLS EDUCATIONAL MATERIAL ASSIGNED CHALLENGER SERIES QUESTIONS CARE OF NEONATES, CHILDREN, AND ADOLESCENTS 2ND YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF ROTATIONAL EXPERIENCE THE SECOND YEAR RESIDENT WILL ROTATE WITH A LOCAL PEDIATRICIAN. THE PEDIATRICIAN WILL MEET THE RESIDENT IN THE HOSPITAL AND ROUNDS ON 5-7 PATIENTS WILL OCCUR. THIS WILL INCLUDE A NURSERY EXPERIENCE. ALSO, THE RESIDENTS WILL ROTATE THROUGH THE ALL FOR KIDS CLINIC WITH A PEDIATRICIAN. THE RESIDENTS WILL ENJOY A WEALTH OF INPATIENT AND OUTPATIENT EXPERIENCES. THIS IS DONE BY THE FACULTY OF ONE OF THE TOP PEDIATRIC TRAINING CENTERS IN THE COUNTRY. THE 2ND YEAR RESIDENT WILL FOLLOW PATIENTS WITH MUCH MORE INDEPENDENCE IN DEVELOPING ASSESSMENTS AND TREATMENT PLANS. PATIENT CARE GOAL THE SECOND YEAR RESIDENT WILL DELIVER PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH FOR THE CHILD AND ADOLESCENT. OBJECTIVES 2. THE RESIDENT WILL TREAT COMMON PEDIATRIC BEHAVIORAL, MEDICAL, AND SURGICAL DISEASES AND DISORDERS IN THE ABOVE SETTINGS AND IN THE HOME, KEEPING THE ROLE OF THE FAMILY PHYSICIAN CLEARLY IN FOCUS. 3. THE RESIDENT WILL USE THE PROBLEM-ORIENTED APPROACH TO PEDIATRICS IN BOTH THE IN-PATIENT AND OUTPATIENT SETTING WITH EMPHASIS ON THE ESTABLISHMENT OF AN APPROPRIATE AND COMPREHENSIVE DATA BASE AND TREATMENT PLAN UTILIZING INDICATED RESOURCES AND CONSULTATIONS. 4. THE RESIDENTS UTILIZE PREVENTIVE MEDICINE TECHNIQUES IN THE PEDIATRIC POPULATION INCLUDING APPROPRIATE WELL-CHILD VISITS AND IMMUNIZATIONS SCHEDULES. 5. THE RESIDENT WILL UNDERSTAND THE PRE-NATAL PERIOD, THE GROWTH AND DEVELOPMENT OF THE NEWBORN THROUGH ADOLESCENCE, AND EMOTIONAL PROBLEMS OF CHILDREN AND THEIR MANAGEMENT. 56 6. THE RESIDENT WILL DIRECT ANY NEONATAL RESUSCITATION, STABILIZATION, AND PREPARATION FOR TRANSPORT OF THE DISTRESSED NEONATE. MEDICAL KNOWLEDGE GOAL THE SECOND YEAR RESIDENT WILL WORK TO OBTAIN MEDICAL KNOWLEDGE OF CHILDREN ABOUT ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. OBJECTIVES 1. THE SECOND YEAR RESIDENT WILL PARTICIPATE IN ATTENDING/RESIDENT SESSIONS BY DOING CHART REVIEW, X-RAY INTERPRETATIONS, AND SUGGEST OPPORTUNITIES FOR IMPROVEMENT AND SAFETY. EVALUATION WILL BE IMMEDIATE BY FACULTY, PEERS, AND PEDIATRICIANS. 2. THE RESIDENT WILL OBTAIN CONSULTATION WHEN NECESSARY. 3. THE RESIDENTS OVER THREE YEARS WILL BECOME COMPETENT TO DIAGNOSE AND TREAT THE BELOW LISTED MEDICAL CONDITIONS. MEDICAL CONDITIONS 1. DIARRHEA/DEHYDRATION 2. FEVER IN A CHILD <3 MOS. 3. BRONCHIOLITIS/CROUP 4. SEIZURES 5. CHILD ABUSE [LAW] 6. EPIGLOTTIS 7. POISONING 8. ASTHMA 29. VAGINAL DISCHARGE 9. CONGENITAL HEART DISEASE 10. SEPTIC ARTHRITIS 11. THE DYING CHILD & THE FAMILY 12. EFFECTS OF HOSPITALIZATION ON A CHILD 13. DIABETES MELLITUS 14. CARDIAC MURMURS 15. HYPERBILIRUBINEMIA 16. ACCIDENTS 17. SEXUAL ABUSE 18. ALLERGY WORK-UP 19. FEEDING PROBLEMS 20. IMMUNIZATIONS 21. URINARY TRACT INFECTIONS 22. COMMON FRACTURES 23. URI/PHARYNGITIS 24. OTITIS MEDIA 25. VIRAL GASTROENTERITIS 26. IMPETIGO 27. INTESTINAL PARASITOSIS 28. RASHES 30. FAILURE TO THRIVE 31. RECTAL BLEEDING 32. ANEMIA 33. ENURESIS/ENCOPRESIS 34. ABDOMINAL PAIN 35. HYPERACTIVITY 36. SCHOOL PROBLEMS 37. GASTRIC LAVAGE 38. GYN EXAM OF A CHILD 39. CIRCUMCISION 40. NEONATAL RESUSCITATION 41. PEDIATRIC RESUSCITATION 42. COMMON FRACTURES 43. GROWTH & DEVELOPMENT OF THE CHILD . PRACTICE-BASED AND LEARNING IMPROVEMENT GOAL THE SECOND YEAR RESIDENT WILL BE INTRODUCED TO THE PRINCIPLE OF 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. 57 COMPETENCY IDENTIFY AND PERFORM APPROPRIATE LEARNING ACTIVITIES. OBJECTIVES 1. THE RESIDENT WILL CONTINUE WITH INCREASING RESPONSIBILITY WITH BOTH IN AND OUT PATIENT CARE IN THE FMC AND HOSPITAL. THE STRUCTURAL PEDIATRIC ROTATIONS WILL CONTINUE THE PROCESS. COMPETENCY USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING. OBJECTIVES 1. THE RESIDENT BECOMES COMPETENT IN THE USE OF E-MED, UP-TO-DATE, DYNAMED, AND JOURNAL SEARCHES. THE RESIDENT WILL LEARN TO UTILIZE OF AVAILABILITY OF A VARIETY OF KNOWLEDGE SOURCES. 2. THE RESIDENT WILL BECOME COMPETENT IN THE USE OF PDA TECHNOLOGY TO TRACK PATIENTS, RECOVER LAB DATA AND MEDICAL REPORTS. THE RESIDENT WILL BECOME COMPETENT TO USE THE PDA WITH EPOCRATES AND 5-MINUTE MEDICAL CONSULT. SYSTEM BASED PRACTICE GOAL THE SECOND YEAR RESIDENT WILL CONTINUE TO PRACTICE THE CONCEPT OF 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. COMPETENCY WORK IN INTER-PROFESSIONAL TEAMS TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY. OBJECTIVES 1. THE RESIDENT WILL LEARN THE DIFFERENT HEALTHCARE SETTINGS AND SYSTEMS (OPPORTUNITIES, INC, JUVENILE DETENTION CENTER, CHILD PROTECTIVE SERVICES) AND HOW TO MOVE THEIR PATIENTS EASILY TO THE BEST SETTING FOR THE PATIENT. PROFESSIONALISM GOAL THE SECOND YEAR RESIDENT WILL EXHIBIT PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION. COMPETENCY COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS. OBJECTIVES 1. THE RESIDENT WILL BE MENTORED BY THE FACULTY TO TEACH THE UNDERSTANDING OF COMPASSION, INTEGRITY, AND RESPECT IN CARE OF THE CHILD WITH ACUTE AND CHRONIC PROBLEMS. 2. THE RESIDENT WILL BE PROMPT FOR ALL APPOINTMENTS AND WORK PERIODS. THE RESIDENT WILL DRESS AND BEHAVE ACCORDING TO THE SIGNED STANDARDS FOR PROFESSIONAL RELATIONS CONTRACT. 58 INTERPERSONAL AND COMMUNICATION SKILLS GOAL THE SECOND RESIDENT WILL CONTINUE TO DEVELOP THEIR APPROPRIATE STYLE OF INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS. COMPETENCY COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH OBJECTIVES THE RESIDENT WILL EXHIBIT APPROPRIATE CONSULTATION, TIMELY TRANSFERS, AND OTHER OPTIONS OF CARE FOR ACUTE AND CHRONIC PROBLEMS. THIS WILL BE MONITORED AT DAILY REPORT AND ON ROUNDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND DISTANT LEARNING VIA INTERACTIVE VIDEO FROM CHILDREN’S HOSPITAL ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES THE HARRIET LANE HANDBOOK, 14TH ED., DISEASES OF THE NEWBORN, AVERY. NELSON'S TEXTBOOK OF PEDIATRICS, 15TH ED. NALS & PALS EDUCATIONAL MATERIAL UAMS LIBRARY ONLINE ELECTRONIC DATA BASE WITH UP TO DATE AND OTHER ASSIGNED CHALLENGER QUESTIONS CRITICAL CARE/PULMONARY 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE PULMONARY/MICU EXPERIENCE IS CONDUCTED IN THE PGY2 YEAR AND IS COMPRISED OF A 1 MONTH ROTATIONAL BLOCK WITH A PULMONOLOGIST/CRITICAL CARE SPECIALIST. THIS ROTATION IS PRIMARILY AN INPATIENT EXPERIENCE WITH SOME OUTPATIENT EXPERIENCE IN A PRIVATE OFFICE SETTING. RESIDENTS ACQUIRE LONGITUDINAL EXPERIENCE IN MANAGING BOTH 59 PULMONARY AND CRITICALLY ILL PATIENTS WHILE ON THE FAMILY PRACTICE SERVICE IN ALL THREE YEARS OF POST-GRADUATE TRAINING. RESIDENTS ARE EXPECTED TO BE THE PRIMARY PROVIDER AND DIRECT THE MANAGEMENT OF AT LEAST 15 CRITICALLY ILL PATIENTS DURING THEIR THREE YEARS OF TRAINING. OUR EXPERIENCE IS THAT THE RESIDENT IN THIS PROGRAM SHOULD HAVE AN OPPORTUNITY TO DIRECT THE CARE OF 40 – 50 INTENSIVE CARE PATIENTS IN THEIR 3 YEARS. THE ROTATIONAL GOAL IS FOR THE RESIDENT PHYSICIAN TO GAIN EXPERIENCE IN THE DIAGNOSIS AND MANAGEMENT OF PULMONARY DISEASE PROCESSES AS WELL AS TO GAIN EXPERIENCE IN MANAGING THE INPATIENT MANAGEMENT OF THE CRITICALLY ILL PATIENT. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL 1. BECOME FAMILIAR WITH THE ACUTE CARE NEEDS OF THE CRITICALLY ILL PATIENT IN THE ICU AND TO BECOME PROFICIENT IN COORDINATING SUCH CARE IN THE CONTEXT OF A MULTIDISCIPLINARY TEAM. 2. LEARN PROCEDURAL SKILLS UTILIZED IN THE MANAGEMENT OF THE PULMONARY AND CRITICALLY ILL PATIENT. 3. LEARN TO PERFORM A COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION OF THE PULMONARY PATIENT; WITH PARTICULAR FOCUS ON BECOMING PROFICIENT AT LUNG AUSCULTATION 4. 5. PERFORM A COMPREHENSIVE HISTORY AND PHYSICAL EXAM ON THE CRITICALLY ILL PATIENT. BECOME PROFICIENT AT INTERPRETING A CXR AND KNOW WHEN ORDERING A LUNG SCAN OR CT OF CHEST IS MOST APPROPRIATE. 6. BE COMPETENT AT INTERPRETING PULMONARY FUNCTION TEST AND WHAT SPECIFICALLY NEEDS TO BE DONE TO TREAT MALADY. 7. BECOME COMPETENT IN THE MANAGEMENT OF A VENTILATOR ON A PATIENT WITH RESPIRATORY FAILURE AND THE USE OF OTHER RESPIRATORY INTERVENTIONS SUCH AS BIPAP AND CPAP. 8. ABLE TO REVIEW AND IMPLEMENT DRUG THERAPY REGIMENS FOR PRIMARY CONDITIONS OF PULMONARY ORIGIN. 9. KNOW OF THE APPROPRIATE USE OF OXYGEN THERAPY AND PULMONARY REHABILITATION. 10. ADVOCATE STRATEGIES TO PREVENT THE DEVELOPMENT OF PULMONARY DISEASE IN THEIR PATIENTS (I.E. SMOKING CESSATION STRATEGIES, ADMINISTRATION OF PNEUMOVAX AND FLU VACCINES). 11. HAVE OPPORTUNITIES TO LEARN THE FOLLOWING PROCEDURAL SKILLS: INTUBATION, CENTRAL VENOUS LINE PLACEMENT, OBTAINING A CENTRAL VENOUS PRESSURE, THORACENTESIS, AND ARTERIAL LINE PLACEMENT. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. DISTINGUISH BETWEEN THE VARIOUS TYPES OF PNEUMONIA AND TO INSTITUTE THE PROPER TREATMENT REGIMEN 2. RECOGNIZE, DIAGNOSE, AND TREAT COPD; AND WILL ADVOCATE PREVENTIVE MEASURES WITH THEIR PATIENTS 3. LEARN THE PRINCIPLES OF DIAGNOSING AND TREATING ARDS 4. KNOW MEASURES IN PREVENTING PE, AND LEARN THE PRINCIPLES OF DIAGNOSIS AND TREATMENT OF PE 5. RECITE THE CRITERIA FOR RESPIRATORY FAILURE AND LEARN THE PRINCIPLES OF VENTILATORY SUPPORT. 6. BECOME FAMILIAR WITH THE PRINCIPLES OF THE DIAGNOSIS AND TREATMENT OF INTERSTITIAL LUNG DISEASE 7. PICK UP THE WARNING SIGNS OF PULMONARY MALIGNANCY AND LEARN THE WORK UP OF SUCH PATIENTS. 60 8. DELIVER APPROPRIATE MANAGEMENT OF THE PATIENT WITH SEPSIS INCLUDING MEASURES TO REDUCE MORBIDITY AND MORALITY FROM THIS CONDITION 9. DISPLAY KNOWLEDGE OF NUTRITIONAL SUPPORT INCLUDING THE VARIOUS MEANS OF ENTERAL AND PARENTERAL NUTRITIONAL SUPPORT 10. INTERPRET ABGS AND HOW IT APPLIES TO PATIENT MANAGEMENT 11. LEARN LIMITATIONS WHEN CONSULTANT IS NECESSARY AND HOW TO OBTAIN A CONSULT. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ASKED TO IDENTIFY STRENGTHS, DEFICIENCIES, AND LIMITS TO THEIR KNOWLEDGE 2. DEFINE LEARNING GOALS ON ROTATION SUCH AS VENTILATOR MANAGEMENT OR IMPROVING PROCEDURAL SKILLS 3. REVIEW DIFFICULT CASES WITH ATTENDING AT COMPLETION OF PATIENT’S HOSPITALIZATION 4. INCORPORATE FORMATIVE EVALUATION FEEDBACK INTO DAILY PRACTICE 5. UTILIZE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING 6. PARTICIPATE IN THE EDUCATION OF PATIENTS, FAMILIES, STUDENTS, RESIDENTS, AND OTHER HEALTH PROFESSIONALS SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS 61 INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES PRINCIPLES OF CRITICAL CARE, 3RD EDITION JESSE B. HALL, GREGORY A. SCHMIDT, LAWRENCE D.H. WOOD THE ICU BOOK, 3RD EDITION (ICU BOOK, 3E (MARINO/ LIPPINCOTT)) (PAPERBACK) BY PAUL L MARINO (AUTHOR), KENNETH M SUTIN (CONTRIBUTOR) TARASCON INTERNAL MEDICINE & CRITICAL CARE POCKETBOOK, FOURTH EDITION (PAPERBACK) BY JAMES S., M.D. WINSHALL (AUTHOR), ROBERT J. LEDERMAN (AUTHOR) ASSIGNED CHALLENGER QUESTIONS MUSCULOSKELETAL AND SPORTS MEDICINE 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE DURING THIS ROTATION THE RESIDENT WILL RECOGNIZE, ASSIMILATE, AND MASTER THOSE ASPECTS OF ORTHOPEDIC PROBLEMS/DISEASES THAT ARE NECESSARY FOR DAILY PATIENT CARE. AT THE CONCLUSION OF THIS TRAINING, THE RESIDENT WILL HAVE THE KNOWLEDGE AND SKILL TO MANAGE THE MAJORITY OF THE ORTHOPEDIC PROBLEMS THAT ARE COMMONLY SEEN BY FAMILY PRACTITIONERS AND ALSO RECOGNIZE THE NEED FOR PROPER REFERRAL AND CONSULTATION BY A SPECIALIST FOR THOSE THAT ARE BEYOND HIS/HER CAPABILITIES. 62 THE NEEDED SKILLS WILL BE OBTAINED THROUGH SEVERAL RESOURCES, INCLUDING THE ATTENDING ORTHOPEDIST’S IN-PATIENT AND OUT-PATIENT PRIVATE PATIENTS, THE RESIDENT’S PANEL OF PATIENTS AT THE AHEC FAMILY MEDICINE CLINIC, THE ANNUAL SPORTS MEDICINE SEMINAR, DIDACTIC LECTURES, ON-LINE RESOURCES (EMEDICINE, UPTODATE), AND CONFERENCES. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL 1. OBSERVE, DISCUSS, AND LEARN THE PROPER APPLICATION OF AN APPROPRIATE BRACE, SPLINT, OR CAST 2. BE ABLE TO DO A COMPLETE AND DETAILED ORTHOPEDIC EXAMINATION 3. INTERPRET XRAYS FOR BONEY OR SOFT TISSUE INJURY OR DISEASE PROCESS 4. SURGICALLY ASSIST IN ORTHOPEDIC SURGERY 5. PROPERLY PERFORM JOINT INJECTIONS AND ASPIRATION WITH STERILE TECHNIQUE 6. APPRECIATE ROLE OF PHYSICAL THERAPY IN THE REHABILITATION OF INJURY OR REGAINING FUNCTION FROM CHRONIC MUSCULOSKELETAL PROCESS 7. GROW A DIFFERENTIAL DIAGNOSES LIST AND DESCRIBE APPROPRIATE WORK UP FOR JOINT PAIN MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. DISCUSS THE PROPER APPROACH TO THE PATIENT WITH JOINT PAIN WITH THE ORTHOPEDIC PRECEPTOR AND DEVELOP THE DIFFERENTIAL DIAGNOSES AND TREATMENTS 2. DESCRIBE THE WORK UP FOR A PATIENT WITH EXTREMITY PAIN WITH THE ORTHOPEDIC PRECEPTOR AND DEVELOP THE DIFFERENTIAL DIAGNOSES AND TREATMENTS 3. POINT OUT THE HIGHLIGHTS OF THE WORK UP FOR A PATIENT WITH ACUTE MUSCULOSKELETAL INJURY WITH THE ORTHOPEDIC PRECEPTOR AND DEVELOP THE DIFFERENTIAL DIAGNOSES AND TREATMENTS 4. KNOW THE WORK UP FOR THE PATIENT WITH CHRONIC MUSCULOSKELETAL INJURY THROUGH SYSTEMIC DISEASE PROCESS AND FORMULATE THE DIFFERENTIAL DIAGNOSES AND TREATMENT PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. LEARN WHICH PATIENTS THAT A FAMILY PHYSICIAN CAN FOLLOW AND WHICH PATIENTS SHOULD BE REFERRED TO AN ORTHOPEDIC SPECIALIST 2. UTILIZE UP TO DATE MEDICAL LITERATURE TO HELP IN THE EVALUATION AND DEVELOPMENT OF TREATMENT PLANS FOR THE PATIENTS THAT HAS A MUSCULOSKELETAL PROBLEM 63 SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. GAIN AN UNDERSTANDING OF THE DELIVERY OF CARE TO THE ORTHOPEDIC PATIENT REGARDLESS OF IN-PATIENT OR OUT-PATIENT SETTING 2. LEARN THE LONGITUDINAL APPROACH TO DELIVERY OF CARE TO THE ORTHOPEDIC PATIENT IN PRIVATE VS. GOVERNMENT SECTORS OF HEALTHCARE 3. COORDINATE IN-PATIENT AND OUT-PATIENT CARE OF THE ORTHOPEDIC PATIENT INCLUDING BUT NOT LIMITED TO PT, OT, REHABILITATIVE MEDICINE, WOULD CARE, ETC… PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS DIRECT PRECEPTOR/RESIDENT INTERACTION, IN-PATIENT ROUNDS, OUT-PATIENT PRIVATE CLINIC, OUT-PATIENT AHEC PROCEDURE CLINIC AND ANNUAL SPORTS MEDICINE SEMINAR ASSESSMENT METHOD (RESIDENTS) THE RESIDENT’S PERFORMANCE IS MEASURED BY THE PRECEPTOR THROUGH A SPECIFIC EVALUATION FORM THAT OUTLINES THE GOALS AND EXPECTATIONS OF THE RESIDENT DURING THAT ROTATION. THE PRECEPTOR HAS THE OPTION OF GOING OVER THE EVALUATION PERSONALLY OR THE RESIDENT WILL RECEIVE THE EVALUATION ONCE IT HAS BEEN REVIEWED. REGARDLESS, ALL RESIDENT ROTATION EVALUATIONS ARE REVIEWED BY THE AHEC PROGRAM DIRECTOR, AHEC RESIDENCY DIRECTOR, AND THE RESIDENT’S ASSIGNED FACULTY MENTOR. IN ADDITION, THE RESIDENT MUST SIGN EACH ROTATION EVALUATION FORM HE/SHE 64 RECEIVES THROUGHOUT THREE YEARS OF THE RESIDENCY AND ANY RESIDENT DEFICITS THAT ARE NOTED THROUGH THE EVALUATION FORM ARE ADDRESSED ON AN INDIVIDUAL BASIS. THIS EVALUATION FORM IS GIVEN TO EACH PRECEPTOR ONE OR TWO MONTHS BEFORE THE SCHEDULED ROTATION SO THAT HE/SHE MAY PREPARE FOR AND BE ABLE TO ADDRESS THE EXPECTATIONS OF THE ROTATION. ASSESSMENT METHOD (PROGRAM EVALUATION) THE PERFORMANCE OF THE PRECEPTOR AND THE OVERALL EDUCATIONAL EXPERIENCE OF THE ROTATION IS EVALUATED BY THE RESIDENT AFTER THE COMPLETION OF EACH ROTATION. THIS EVALUATION OUTLINES THE GOALS AND OBJECTIVES THAT SHOULD HAVE BEEN ADDRESSED DURING THE ROTATION AND ALLOWS THE RESIDENT THE OPPORTUNITY TO RATE THE PRECEPTOR AND THE EXPERIENCE RECEIVED. THIS EVALUATION FORM IS GIVEN TO EACH RESIDENT AT THE BEGINNING OF THE ROTATION SO THAT HE/SHE MAY LOOK AHEAD AT THE EXPECTATIONS OF THE ROTATION. AFTER COMPLETION BY THE RESIDENT, EACH FORM IS REVIEWED BY THE AHEC PROGRAM DIRECTOR AND THE AHEC RESIDENCY DIRECTOR WHERE QUALITY IMPROVEMENT ISSUES ARE ADDRESSED. LEVEL OF SUPERVISION THE RESIDENT IS UNDER THE DIRECT SUPERVISION OF THE ASSIGNED PRECEPTOR. EDUCATIONAL RESOURCES THE EDUCATIONAL RESOURCES FOR THIS ROTATION INCLUDE, BUT ARE NOT LIMITED TO: DIRECT PATIENT CONTACT, DIRECT INTERACTION FROM THE PRECEPTOR, CAMPBELL’S ORTHOPEDICS TEXT, NETTER’S ATLAS OF HUMAN ANATOMY, ON-LINE RESOURCES (EMEDICINE, UPTODATE, OVID, ON-LINE UAMS JOURNALS) AHEC SOUTHWEST SEMI-ANNUAL SPORTS MEDICINE SEMINAR ASSIGNED CHALLENGER QUESTIONS HUMAN BEHAVIOR AND MENTAL HEALTH 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE SECOND YEAR RESIDENT WILL SPEND ONE MONTH WITH A LOCAL PSYCHIATRIST. IN-PATIENTS AND OUT-PATIENTS WILL BE FOLLOWED WITH EMPHASIS ON CARE IN THE OUT PATIENTS SETTING. COMMON PSYCHIATRIC DIAGNOSES WILL BE EXAMINED. ALSO, THE RESIDENT WILL HAVE AN EXTENSIVE STUDY OF PSYCHOTROPIC MEDICATIONS, THEIR INDICATIONS AND ADVERSE EFFECTS. THERE WILL ALSO BE A MONTHLY BEHAVIOR MEDICINE SEMINAR ON THE LAST FRIDAY NOON CONFERENCE EACH MONTH. DISCUSSION WILL CENTER ON ALL ASPECTS OF BEHAVIOR MEDICINE WITH GUEST SPEAKERS, MANY FROM UAMS IN LITTLE ROCK. THERE CONFERENCES WILL NORMALLY LAST ONE-AND-A-HALF HOURS. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL 1. DO THE INTAKE INTERVIEW NEW OUT-PATIENTS TO THE SOUTHWEST ARKANSAS REGIONAL MENTAL HEALTH CENTER (SARMHC) 65 2. 3. ARRIVE AT A DIAGNOSIS AND TREATMENT RECOMMENDATION FOR NEW OUT-PATIENT CATEGORIZE THE PSYCHOTROPIC MEDICATIONS BY INDICATIONS, CONTRAINDICATIONS, ADVERSE EFFECTS, AND SIGNIFICANT DRUG-DRUG INTERACTIONS 4. 5. 6. BE COMPETENT IN CARING FOR THE ACUTE AGITATED PATIENT RECOGNIZE THE SUICIDE AT-RISK PATIENT OUTLINE A TREATMENT PLAN UTILIZING PHARMACOLOGIC AND NON-PHARMACOLOGIC MODALITIES FOR THE ATTENTION DEFICIT/HYPERACTIVE CHILD AND ADULT 7. DESCRIBE DIAGNOSTIC CRITERIA FOR MOST COMMON PSYCHOLOGICAL DISEASE STATES SEEN BY FAMILY PHYSICIANS, INCLUDING DEPRESSION, PANIC DISORDERS, ACUTE PSYCHOSES, BI-POLAR DISORDER, DEMENTIA, DELIRIUM, AND OTHERS 8. 9. APPRECIATE THE OVERALL TREATMENT PLAN FOR DRUG, ALCOHOL, AND BEHAVIORAL ADDICTIVE DISORDERS KNOW WHEN PSYCHIATRIC CONSULTATION IS APPROPRIATE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. 2. 3. BE FAMILIAR WITH THE DIAGNOSTIC CRITERIA FOR MOST PSYCHIATRIC DISORDERS BE ABLE TO UTILIZE A VAST ARRAY OF MEDICATIONS FOR PARTICULAR PSYCHIATRIC DISORDERS SAFELY BECOME COMFORTABLE IN DEALING WITH THE ADVERSE EFFECTS OF THOSE PSYCHOTROPIC MEDICATIONS USED MOST OFTEN BY FAMILY PHYSICIANS PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ASKED TO IDENTIFY STRENGTHS, DEFICIENCIES, AND LIMITS TO THEIR KNOWLEDGE 2. REVIEW DIFFICULT CASES WITH ATTENDING AT COMPLETION OF PATIENT’S HOSPITALIZATION 3. INCORPORATE FORMATIVE EVALUATION FEEDBACK INTO DAILY PRACTICE 4. UTILIZE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING 5. PARTICIPATE IN THE EDUCATION OF PATIENTS, FAMILIES, STUDENTS, RESIDENTS, AND OTHER HEALTH PROFESSIONALS SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 66 2. 3. 4. 5. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, MONTHLY BEHAVIOR SCIENCE SEMINAR, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY POCKET HANDBOOK OF CLINICAL PSYCHIATRY, JAMES SADOCK, MD ASSIGNED CHALLENGER QUESTIONS 67 DIAGNOSTIC IMAGING 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE SECOND YEAR RESIDENT WILL SPEND 5 MORNINGS AND 2 AFTERNOONS A WEEK IN THE RADIOLOGY DEPARTMENT IN THE HOSPITAL. THEY WILL WORK ONE ON ONE WITH A BOARD CERTIFIED RADIOLOGIST. THE RESIDENT WILL BECOME COMPETENT AT READING A CXR AND OTHER PLAIN RADIOGRAPHS. THE RESIDENT WILL ALSO GAIN AN UNDERSTANDING TO THE INDICATIONS FOR OTHER IMAGING STUDIES SUCH AS CT SCANS, MRIS, VASCULAR STUDIES, AND OTHER TYPES OF IMAGING. THE RESIDENT WILL BECOME COMPETENT IN READING PLAIN FILMS WELL ENOUGH THAT THE RESIDENT COULD WORK IN A SMALL EMERGENCY ROOM WITHOUT RADIOLOGICAL ASSISTANCE FOR PLAIN FILMS. THE ROTATION IS SUPPLEMENTED BY A MONTHLY NOON CONFERENCE AS PUT ON BY A LOCAL RADIOLOGIST ON THE FIRST WEDNESDAY OF EACH MONTH. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL 1. BECOME FAMILIAR WITH THE VARIOUS MODALITIES OF PATIENT IMAGING AND BE ABLE TO APPLY THIS IN THE DIAGNOSTIC EVALUATION OF PATIENTS 2. BE ABLE TO INTERPRET A CXR AND CORRELATE IT WITH A PATIENT’S CLINICAL PICTURE, PARTICULARLY IN THE SETTING OF CHF, COPD, PNEUMONIA, PULMONARY EDEMA, AND PULMONARY MALIGNANCY 3. KNOW THE INDICATIONS FOR SPECIAL DIAGNOSTIC RADIOLOGICAL PROCEDURES INCLUDING ADVANCES IN INTERVENTIONAL RADIOLOGY 4. ACCESS PATIENTS’ IMAGING STUDIES ON THE PACS NETWORK AND BE ABLE TO MANIPULATE THE IMAGES FOR INTERPRETATION PURPOSES 5. RECOGNIZE CONTRAINDICATIONS TO CONTRAST IMAGING STUDIES AS IT PERTAINS TO RENAL FUNCTION OF A PATIENT MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. BE AWARE OF THE PHYSIOLOGIC PRINCIPLES OF RADIOLOGICAL IMAGING 2. ASSESS WHETHER A PLAIN RADIOGRAPH (PARTICULARLY A CSR) IS ADEQUATE FOR INTERPRETATION 3. BECOME WELL VERSED WITH THE INDICATIONS FOR DIAGNOSTIC STUDIES AND PROCEDURES IN THE RADIOLOGY DEPARTMENT PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. 68 PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. LEARN LIMITATIONS IN ORDERING AND INTERPRETING CERTAIN IMAGING STUDIES 2. KNOW WHEN TO SEEK CONSULTATION FROM A RADIOLOGIST FOR PATIENT CARE ISSUES SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. BECOME FAMILIAR WITH THE RELATIVE COST OF THE MOST COMMON RADIOLOGICAL PROCEDURES 2. BE ABLE TO DISCUSS POTENTIAL ADVERSE HEALTH RISKS OF CERTAIN DIAGNOSTIC PROCEDURES PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. ARRIVE PROMPTLY TO THE RADIOLOGY DEPARTMENT AS REQUESTED BY THE RADIOLOGIST AND BE PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, PATIENTS, AND RADIOLOGICAL TECHNICAL STAFF TEACHING METHODS ONE ON ONE TEACHING BY THE ATTENDING RADIOLOGIST IN THE RADIOLOGY DEPARTMENT AND MONTHLY NOON CONFERENCE ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. 69 LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES PRINCIPLES OF RADIOLOGY, ROBERT A. NOVELLINE, ASSIGNED CHALLENGER QUESTIONS DO ALL CATEGORIES ON VIRGINIA.EDU (WWW.MED-ED.VIRGINIA.EDU/COURSES/RAD) PERFORMANCE IMPROVEMENT PROJECT 2ND YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE ROTATION IS PATTERNED FROM THE ABFM REQUIREMENT FOR RECERTIFICATION USING THE 10 YEAR PLAN. THIS IS A LONGITUDINAL ROTATION WITH THE COMPLETION OF THE WORK DUE AT THE COMPLETION OF THE RESEARCH & SCHOLARLY ACTIVITY ROTATION THAT THE RESIDENT WILL HAVE IN HIS/HER THIRD YEAR. ATTACHED IS THE FLOW SHEET THAT THE RESIDENT WILL USED DURING THIS ROTATION. THE FIRST FIVE STEPS ARE TO BE ACCOMPLISHED DURING THIS MONTH AND THE LAST 2 ARE TO BE DONE DURING THEIR THIRD YEAR RESEARCH & SCHOLARLY ACTIVITY ROTATION. THE RESIDENT WILL SPEND ONE DAY WITH THE QUALITY ASSURANCE OFFICER AT THE HOSPITAL DISCUSSING THE PHILOSOPHY OF QUALITY IMPROVEMENT, WHAT PERFORMANCES THE HOSPITAL MEASURES, AND WHAT STEPS ARE TAKEN BY THE HOSPITAL IN THE PROCESS OF QUALITY IMPROVEMENT. IN STEP ONE, DUE BY THE 5TH OF THE MONTH, THE RESIDENT WILL SELECT A PUBLISHED AND WELL ESTABLISH PRACTICE GUIDELINE OR BENCHMARK RECOGNIZED FOR THE CARE OF OUT-PATIENTS OR IN-PATIENTS. THIS HAS TO BE APPROVED BY THE RESIDENT’S FACULTY ADVISOR. PART OF THE CRITERIA FOR THE SELECTION IS THAT IT MUST BE A TREATMENT GUIDELINE OR CLINICAL BENCHMARK IN WHICH WE AS A RESIDENCY CLINIC OR HOSPITAL HEALTHCARE TEAM FALL SHORT OF GOAL. THIS IS REVEALED IN STEP 3 AS THE RESIDENT MUST TAKE AN ADEQUATE SAMPLING (NO LESS THAN 100 CHARTS FOR A CLINIC PROJECT) AND MEASURE THE COMPLIANCE OF THE PHYSICIANS TO THAT BENCHMARK OR TREATMENT GUIDELINE. THIS CAN BE DONE UTILIZING THE ELECTRONIC MEDICAL RECORD SYSTEM. THIS IS TO BE DONE BY THE 15TH OF THE MONTH. STEP 4, WHICH IS DUE BY THE 20TH OF THE MONTH, IS TO DESIGN AN INTERVENTION TO IMPROVE OUR COMPLIANCE TO THE BENCHMARK OR TREATMENT GUIDELINE. THIS IS AN INTERVENTION THAT CAN BE WORKED INTO THE SYSTEM THAT IS HOPED WILL LEAD TO COMPLIANCE TO THESE BENCHMARKS. IN STEP 5 IMPLEMENTATION OF THE INTERVENTION IS TO OCCUR. OFTEN THIS WILL BE WHEN THE RESIDENT WORKS WITH THE IT DEPARTMENT OF THE CLINIC TO DESIGN A NEW POP-UP SCREEN IN THE OFFICE VISIT MODULE OR WORK WITH THE HOSPITAL TO INSERT SOMETHING IN THE SYSTEM THAT WILL HELP THOSE PHYSICIAN-RESIDENTS WORKING IN THE HOSPITAL REACH THE GOAL AND IMPROVE PREVIOUS PERFORMANCE. STEP 6 & 7 ARE TO BE CARRIED OUT DURING THE RESIDENT’S RESEARCH & SCHOLARLY ACTIVITY ROTATION IN THE THIRD YEAR. THIS WILL BE SCHEDULED APPROXIMATELY ONE YEAR AFTER THE PERFORMANCE IMPROVEMENT ROTATION IN THE 2ND YEAR. STEP 6 CONSISTS OF THE RESIDENT RE-MEASURING THE COMPLIANCE OR SUCCESS RATE TO THE TREATMENT GUIDELINE OR BENCH MARK. IN STEP 7 THE RESIDENT WILL SUBMIT THE FINDINGS ON A WRITTEN PAPER AND PRESENT THE PROJECT IN A POSTER SESSION AT THAT MONTH’S JOURNAL CLUB. THOUGH THERE HAS NOT BEEN A COMPLETED PROJECT, SINCE THIS ROTATION IS IN INAUGURAL YEAR, THERE HAS ALREADY BEEN A SUBSTANTIAL AND NOTICEABLE IMPROVEMENT IN COMPLIANCE IN SOME OF THE DIABETIC TREATMENT GUIDELINES WITHIN THE CLINIC. 70 PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. REVIEW TREATMENT PLANS THAT ARE A STANDARD IN PATIENT CARE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. BECOME FAMILIAR WITH TREATMENT GUIDELINES AND THE IMPACT OF COMPLIANCE OF THEM ON PATIENT OUTCOMES PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE NEED FOR BENCH MARKS AND TREATMENT GUIDELINES 2. APPRECIATE THE PHILOSOPHY OF CONTINUED QUALITY IMPROVEMENT IN MEDICINE 3. LEARN THE PROCESS OF OBTAINING A QUALITY SAMPLE FOR MEASUREMENT 4. MEASURE A PERFORMANCE THAT IS BOTH MEASURABLE AND MEANINGFUL 5. DESIGN AN INTERVENTION THAT WILL IMPROVE QUALITY OF CARE 6. IMPLEMENT THE INTERVENTION INTO THE SYSTEM 7. RE-MEASURE PERFORMANCE IN ONE YEAR 8. DRAW CONCLUSIONS FROM FINDINGS AND PRESENT THEM TO JOURNAL CLUB SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. UNDERSTAND THE SYSTEMS BY WHICH WE OPERATE IN DELIVERING MEDICAL CARE IN BOTH THE HOSPITAL AND THE CLINIC 2. BE COMPETENT IN TECHNOLOGY TO UTILIZE IT TO HELP DETERMINE PERFORMANCE TO BE MEASURED, MEASURING THE PERFORMANCE, AND DETERMINING IF THE CHANGE IN PERFORMANCE AFTER INTERVENTION IS SIGNIFICANT 3. KNOW THE SYSTEM WELL ENOUGH TO DETERMINE IN AN EFFECTIVE WAY HOW THE INTERVENTION CAN EASILY BE IMPLEMENTED WITHIN THE SYSTEM 71 4. FORESEE ALL THE CONSEQUENCES TO PATIENT CARE THAT THE IMPLEMENTATION OF THE INTERVENTION INTO THE SYSTEM MAY BRING, BOTH INTENDED AND UN-INTENDED PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. ARRIVE PROMPTLY TO APPOINTMENTS AND DRESS ACCORDING TO RESIDENCY RULES 5. WORK AS A TEAM PLAYER RESPECTING ALL OF THE HEALTHCARE TEAM WHO ARE IN THE SYSTEM (IT PERSONNEL, PHYSICIANS, NURSES, ADMINISTRATORS, AND OTHERS) THAT IS BEING ALTERED TO IMPROVE PATIENT OUTCOMES 6. RESPECT AND FOLLOW ALL RULES AND REGULATIONS ABOUT PATIENT CONFIDENTIALITY, INCLUDING FEDERAL HIPPA REGULATIONS, HOSPITAL PATIENT SAFETY RULES, OSHA STANDARDS, AND THE UAMS POLICIES AND PROCEDURE MANUEL INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH IT PERSONNEL, PHYSICIANS, NURSES, ADMINISTRATORS, AND ALL OTHER HEALTHCARE RELATED PERSONNEL WHO ARE INVOLVED IN THE RESEARCH, SET UP AND IMPLEMENTATION OF THE PERFORMANCE IMPROVEMENT PROJECT 2. PRESENT FINDINGS TO FACULTY AND STAFF OF AHEC SW IN A CLEAR AND CONCISE MANNER AT A JOURNAL CLUB CONFERENCE TEACHING METHODS ONE ON ONE TEACHING QUALITY ASSURANCE OFFICER OF THE HOSPITAL AND WITH THE ATTENDING FACULTY ADVISOR ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING 72 PERFORMANCE IMPROVEMENT ROTATION STEP 1 SELECT A PRACTICE GUIDELINE OR A HOSPITAL BENCHMARK THAT YOU WANT TO MEASURE. THIS IS DUE BY THE 5TH OF THE MONTH AND MUST BE SIGNED BY YOUR ADVISOR. THIS COULD BE A PROJECT ON WHETHER WE ARE COMPLIANT WITH THE DIABETIC GUIDELINES, IF YOUR PEDIATRIC PATIENTS ALL HAVE A BMI RECORDED, OR ANY NUMBER OF THINGS. YOU WILL SPEND ONE DAY WITH THE QUALITY ASSURANCE OFFICER AT CSM REVIEWING WHAT THE HOSPITAL MEASURES AND WHAT QUALITY IMPROVEMENT STEMS THAT THEY HAVE TAKEN. STEP 2 CHART REVIEW – IF IT IS A CLINIC QUESTION, GO TO ”REPORTS” TAB IN THE EMR AND FIND 100 CHARTS THAT HAVE THE DIAGNOSES ICD 9 CODE THAT FITS YOUR QUESTION. STEP 3 ASSESS PERFORMANCE – MEASURE YOUR COMPLIANCE. STEP 4 DESIGN AN INTERVENTION PLAN – THIS IS WHERE YOU DECIDE WHAT ACTION YOU ARE GOING TO TAKE TO IMPROVE YOUR COMPLIANCE. IT MIGHT BE SOMETHING THAT YOU CAN DESIGN IN THE EMR CLINIC VISIT THAT WOULD FORCE PROVIDERS TO FILL IN WHETHER A DIABETIC IS ON AN ACEI OR A BMI HAS BEEN DONE ON A CHILD. STEP 5 IMPLEMENT THE PLAN – PUT THE PLAN INTO ACTION. STEP 6 REASSESS PERFORMANCE – RE-MEASURE 100 CHARTS OF OURS AND THE FACULTY MEMBER THAT YOU MEASURED EARLIER. THIS WILL BE DONE DURING YOUR RESEARCH AND SCHOLARLY ACTIVITY ROTATION IN YOUR THIRD YEAR. STEP 7 WRITE UP AND PRESENT YOUR FINDINGS – YOU WILL SUBMIT A PAPER WITH YOUR FINDINGS ARE PRESENT AN ORAL ARGUMENT FOR OR AGAINST YOUR INTERVENTION AT THE NEXT JOURNAL CLUB. TIMETABLE STEP 1 IS DUE BY THE 5TH OF THE MONTH STEP 2 IS DUE BY THE 10TH OF THE MONTH STEP 3 IS DUE BY THE 15TH OF THE MONTH STEP 4 IS DUE BY THE 20TH OF THE MONTH STEP 5 IS DUE BY THE 30TH OF THE MONTH 73 PERFORMANCE IMPROVEMENT WORK SHEET RESIDENT MONTH/YEAR OF ROTATION STEP 1 RESULTS SIGNED STEP 2 RESULTS SIGNED STEP 3 RESULTS SIGNED STEP 4 RESULTS SIGNED STEP 5 RESULTS SIGNED 74 COMMUNITY ORIENTED PRIMARY CARE 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF THE EDUCATIONAL EXPERIENCE THIS MONTH LONG ROTATION WITH A NOON CONFERENCE SERIES IS DESIGNED TO MEET ALL OF THE ITEMS IN THE COMMUNITY MEDICINE SECTION OF THE PROGRAM REQUIREMENTS. THE RESIDENT WILL LEARN THE PRINCIPLES OF COMMUNITY MEDICINE BY SPENDING TIME AT THE FOLLOWING LOCATIONS: PEACHTREE HOSPICE ARKLATEX HOME HEALTH AGENCY MIGRANT HEALTH CENTER AHEC COMMUNITY EDUCATION AND OUTREACH ARKANSAS REHABILITATION SERVICES TEXARKANA REGIONAL CENTER ON AGING ALL FOR KIDS CLINIC BOWIE COUNTY HEALTH DEPARTMENT REPRODUCTION HEALTH CLINIC CSM CASE MANAGEMENT TEAM GABBIE INDUSTRIAL MEDICAL CLINIC ATHLETIC PHYSICALS FOR ENTIRE REGION (2000+ EXAMS) OPPORTUNITES, INC. (HOME & SCHOOL FOR MENTALLY HANDICAP CHILDREN AND ADULTS) AHEC CLINIC PATIENT EDUCATION DEPARTMENT WILD ABOUT WELLNESS HEALTH FAIR (AND OTHER REGIONAL FAIRS) THE RESIDENT WILL ALSO RECEIVED NOON CONFERENCES OVER THE THREE YEARS COVERING THE FOLLOWING TOPICS: COMMUNITY VIOLENCE ADULT AND CHILD ABUSE & NEGLECT COMMUNICABLE ILLNESS AND REPORTING REQUIREMENTS POPULATION EPIDEMIOLOGY ADOLESCENT MEDICINE AND SCHOOL HEALTH DISEASE PREVENTION THROUGH IMMUNIZATION YALE DISASTER PREPAREDNESS TABLE TOP DRILL DIFFERENTIAL HEALTH STATUS AMONG SUB-POPULATIONS PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. THERE ARE NO PATIENT CARE OBJECTIVES FOR THIS ROTATION. 75 MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. LEARN THE PARTICULAR MEDICAL KNOWLEDGE POINT REGARDING: SCHOOL HEALTH ADOLESCENT HEALTH COMMUNICABLE ILLNESSES ENVIRONMENTAL ILLNESS AND INJURY DISEASE PREVENTION THROUGH IMMUNIZATION DISASTER RESPONSIVENESS COMMUNITY PREVENTION AND HEALTH PROMOTION PUBLIC HEALTH EMPLOYEE HEALTH & INDUSTRIAL MEDICINE COMMUNITY HEALTH ASSESSMENT COMMUNITY BASED HEALTH EDUCATION PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ASKED TO IDENTIFY STRENGTHS, DEFICIENCIES, AND LIMITS TO THEIR KNOWLEDGE 2. REVIEW DIFFICULT CASES DEALING WITH COMMUNITY HEALTH AND THE GAPS THAT OCCUR IN THE CARE OF THE GENERAL POPULATION 3. INCORPORATE FORMATIVE EVALUATION FEEDBACK INTO DAILY PRACTICE 4. UTILIZE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING 5. PARTICIPATE IN THE EDUCATION OF PATIENTS, FAMILIES, STUDENTS, RESIDENTS, AND OTHER HEALTH PROFESSIONALS SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. 76 COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS ONE ON ONE TEACHING AT EACH LOCATION WITH HEALTHCARE PROFESSIONAL PERSONNEL, NOON CONFERENCES, SPECIAL TABLE TOP DRILL EXERCISE, HEALTH FAIRS ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT WITH FEEDBACK FROM SEVERAL SOURCES LOCATED IN AGENCIES WHERE RESIDENT VISITED AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION OVERALL BY PROGRAM DIRECTOR, INDIVIDUALLY BY RESPECTIVE HEALTH CARE PROFESSIONAL 77 MANAGEMENT OF HEALTH SYSTEMS 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE MANAGEMENT OF HEALTH SYSTEMS CURRICULUM HAS BEEN COMPLETELY REVAMPED BASED ON RESPONSES FROM GRADUATE SURVEYS. IN ADDITION TO THE 100 HOUR ROTATION DURING THE SECOND YEAR, THE FIRST YEAR ORIENTATING RESIDENT WILL BE INTRODUCED TO THE RECEPTION AND BUSINESS OFFICE OF THE CLINIC BY WORKING WITH THE BUSINESS OFFICE ONE AFTERNOON A WEEK DURING THE MONTH OF JULY. THE RESIDENTS WILL RECEIVE A TOTAL OF 18 NOON CONFERENCES DEALING WITH THE PRACTICE MANAGEMENT ASPECT OF RUNNING A PRIVATE PRACTICE CLINIC. DURING THE THIRD YEAR, RESIDENTS WILL ATTEND THE CLINIC’S MONTHLY FINANCE COMMITTEE MEETING. IN THESE MEETINGS THE OFFICE MANAGER, AHEC FINANCIAL OFFICER, ONE FACULTY MEMBER REPRESENTATIVE, HR DEPARTMENT REPRESENTATIVE, THE CLINIC NURSING SUPERVISOR, AHEC DIRECTOR, AND PROGRAM DIRECTOR. QUARTERLY THE THIRD YEAR RESIDENTS WILL ATTEND A FOUR HOUR MANAGEMENT OF HEALTH SYSTEMS SEMINAR. THESE SEMINARS WILL COVER CODING, CLINIC PERSONNEL ISSUES FACED IN PRIVATE PRACTICE, FACTORS IN DECIDING PRACTICE LOCATION/SITUATION, LEGAL MEDICINE, SELECTING AND IMPLEMENTING AN ELECTRONIC HEALTH RECORD SYSTEM, AND OTHERS. INCLUDED IN THIS CURRICULUM WITH BE THE RESIDENT AT SOME POINT SITTING IN ON A STATE BOARD MEETING FOR ONE HALF DAY AND WITNESSING HEARINGS OF PHYSICIANS WHO HAVE ETHICAL AND BEHAVIORAL ISSUES THAT REQUIRED STATE MEDICAL BOARD ATTENTION AND INTERVENTION. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. THERE ARE NO PATIENT CARE OBJECTIVES FOR THIS ROTATION. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. GAIN MEDICAL KNOWLEDGE JUST AS IT PERTAINS TO DOCUMENTATION OF SUCH FOR THE ENHANCEMENT OF CODING, ELECTRONIC RECORDS, BILLING, AND COLLECTIONS. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. HAVE THE OPPORTUNITY TO LEARN FROM EACH PERSON IN THE CLINIC WHO WORKS IN RECEPTION, CODING, BILLING, AND COLLECTIONS. 78 SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. WORK EFFECTIVELY IN VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY BY EXPERIENCING FAMILY MEDICINE FROM THE MANAGEMENT PROSPECTIVE. 2. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM RELEVANT TO THEIR CLINICAL SPECIALTY. 3. DISCUSS THE DYNAMICS OF PATIENT FLOW WITHIN A CLINIC 4. FOLLOW A CLAIM THROUGH CODING, BILLING, AND COLLECTIONS 5. START UNDERSTANDING THE CONSIDERATIONS OF COST AWARENESS AND RISK-BENEFIT ANALYSIS IN PATIENT CARE 6. BE ABLE TO EVALUATE OVERHEAD AND DETERMINE METHODS FOR COST CONTAINMENT IN THE PRIVATE PRACTICE CLINIC SETTING 7. UNDERSTAND THE CHARGE OF STATE MEDICAL BOARDS AND THEIR AUTHORITY PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. ARRIVE PROMPTLY TO APPOINTMENTS AND DRESS ACCORDING TO RESIDENCY RULES 5. WITNESS THE ARKANSAS STATE MEDICAL BOARD WRESTLE WITH ISSUES REGARDING ETHICS AND THE BEHAVIOR OF OTHER PHYSICIANS THAT IS OFTEN TIMES CAN BE CAREER ALTERING INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. BE AWARE OF RESOURCES THAT HELP THE COMMUNITY 2. BECOME AN EXPERT AT ELECTRONIC DEVICES SUCH AS EMR AND RETRIEVING INFORMATION FROM A PDA 3. WORK AS A VALUED TEAM MEMBER OF THE BUSINESS OFFICE OF THE RESIDENCY CLINIC TEACHING METHODS ONE ON ONE TEACHING WITH BUSINESS OFFICE PERSONNEL IN THE CLINIC, OBSERVATION OF A STATE MEDICAL BOARD PROCEEDING, NOON CONFERENCES ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. 79 ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION FAMILY MEDICINE FACULTY MEMBER RESPONSIBLE FOR MANAGEMENT OF HEALTH SYSTEMS ROTATION EDUCATIONAL RESOURCES FAMILY MEDICINE MANAGEMENT, MONTHLY PERIODICAL, AHEC STAFF AND FACULTY NIGHT FLOAT 2ND YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE UPPER LEVEL RESIDENTS WITH THE FIRST YEAR RESIDENT MEET THE MEMBERS OF THE MEDICINE TEAM AT, OR AROUND, 5 PM. AT THAT TIME, THE RESIDENTS FROM THE INPATIENT MEDICINE TEAM REVIEW EACH PATIENT ON THE INPATIENT LIST WITH THE NIGHT FLOAT TEAM. AT THE CONCLUSION OF THE MEETING, THE NIGHT FLOAT TEAM TAKES ALL CALLS FROM THE NURSE CARE TEAMS IN THE HOSPITAL REGARDING THE RESIDENCY’S PATIENTS AND ANY NEW ADMISSIONS. THE UPPER LEVEL RESIDENT CALLS ALL ADMISSIONS AND CHANGES IN STATUS OF THE INPATIENTS TO THE ATTENDING FACULTY MEMBER ON CALL. FOR ANY ICU ADMISSIONS, THE FACULTY MEMBER COMES OUT TO SEE THE PATIENT. THE FIRST YEAR RESIDENT SEES THE NEW ADMISSIONS AND WRITES ORDERS WITH THE GUIDANCE OF THE UPPER LEVEL RESIDENT. THE UPPER LEVEL RESIDENT THEN CALLS THE ATTENDING FACULTY MEMBER ON CALL TO REPORT THE ADMISSION ON ALL PATIENTS. AT 7 AM, THE FIRST YEAR RESIDENT IS TO HAVE THE LIST OF INPATIENTS UPDATED FOR MORNING REPORT. THE FIRST YEAR RESIDENT THEN PRESENTS ALL ADMISSIONS AND CHANGES IN STATUS OF INPATIENTS TO THE INPATIENT MEDICINE TEAM WITH DIRECTION OF THE UPPER LEVEL RESIDENT. THE FIRST YEAR RESIDENT AND THE UPPER LEVEL RESIDENT STAY TOGETHER AS A TEAM THROUGHOUT THE MONTH. FOR TWO WEEKS, THE TEAM WILL WORK THE NIGHT FLOAT SUNDAY THROUGH THURSDAY AND THEN FOR TWO WEEKS, THE TEAM WILL WORK ONLY FRIDAY NIGHTS. THERE ARE NO CONTINUITY CLINICS DURING THE TWO WEEKS ON NIGHT FLOAT. DURING THE TWO WEEKS THAT THE TEAM WORKS ONLY FRIDAY NIGHT, THOSE TWO RESIDENTS ARE IN CLINIC MONDAY THROUGH THURSDAY. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. OBJECTIVES THE RESIDENT WILL: 1. DEMONSTRATE THE ABILITY TO INTERVIEW A PATIENT, GAINING PERTINENT FACTS IN AN EFFICIENT AN COMPLETE MANNER. 2. PERFORM A COMPLETE AND ACCURATE PHYSICAL EXAM. 3. EVALUATE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 4. PRIORITIZE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 5. EFFICIENTLY EVALUATE AND STABILIZE PATIENTS NEWLY FROM THE EMERGENCY DEPARTMENT. 80 MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. OBJECTIVES THE RESIDENT WILL: 1. ARTICULATE THE PATHOPHYSIOLOGY, EVALUATION, DIAGNOSTIC WORK UP AND TREATMENT OF COMMON MEDICAL PROBLEMS 2. LEARN APPROPRIATE MANAGEMENT STRATEGIES FOR PROBLEMS COMMONLY OCCURRING IN HOSPITALIZED PATIENTS, SUCH AS FEVER, SHORTNESS OF BREATH, CHEST PAIN, ALTERED CONSCIOUSNESS, HYPOTENSION, AND OTHERS. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE PERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. OBJECTIVES THE RESIDENT WILL: 1. COMMUNICATE EFFECTIVELY, VERBALLY AT MORNING REPORT AND THROUGH APPROPRIATE WRITTEN SIGN-OUT, WITH COLLEAGUES WHOSE PATIENTS ARE BEING COVERED. 2. COMMUNICATE EFFECTIVELY WITH NURSING STAFF REGARDING ACUTE PATIENT PROBLEMS. 3. COMMUNICATE EFFECTIVELY AND CONCISELY WITH ATTENDING PHYSICIANS WHOSE PATIENTS ARE ADMITTED AND EVALUATED DURING THE NIGHT. 4. COMMUNICATE WITH CONSULTING PHYSICIANS EFFECTIVELY, PROFESSIONALLY, AND IN A TIMELY MANNER TO INSURE GOOD PATIENT CARE. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDNETS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. OBJECTIVES THE RESIDENT WILL: 1. 2. 3. 4. 5. BEHAVE PROFESSIONALLY TOWARD PATIENTS, FAMILIES, COLLEAGUES, AND ALL MEMBERS OF THE HEALTH CARE TEAM. BE PROMPT TO MORNING REPORT AND THE AFTERNOON CHECK OUT WITH THE INPATIENT MEDICINE TEAM. PREPARED FOR MORNING REPORT WITH ASSIGNMENTS PER THE ATTENDING PHYSICIANS. ANSWER ALL PAGES WITHIN 15 MINUTES. PROMPTLY ATTEND PATIENTS IN THE ER THAT ARE DEEMED TO BE ADMITTED OR INPATIENTS WHO ARE HAVING DIFFICULTY AND NEED THE BEDSIDE PRESENCE OF A PHYSICIAN. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. OBJECTIVES THE RESIDENT WILL: 1. ACKNOWLEDGE THE “GAPS” IN MEDICAL KNOWLEDGE 81 2. IDENTIFY ERRORS IN MEDICAL CARE AND UTILIZE MEDICAL LITERATURE, INFORMATION SYSTEMS AND TEACHERS TO ADDRESS THOSE ERRORS. 3. USE AN EVIDENCED-BASED APPROACH IN THE CARE OF PATIENTS. 4. UNDERSTAND AND UTILIZE THE INFORMATION TECHNOLOGY AVAILABLE TO YOU AT EACH SITE. SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEST AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. OBJECTIVES THE RESIDENT WILL: 1. EFFECTIVELY UTILIZE THE RELATIVE LIMITED RESOURCES AVAILABLE DURING THE NIGHT TO ASSURE HIGH QUALITY PATIENT CARE AND PATIENT SAFETY. 2. WORK WITH THE CASE MANAGERS IN THE ER TO INSURE APPROPRIATE ADMISSION STATUS FOR THOSE PATIENTS ADMITTED AFTER 5 PM. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES ONLINE RESOURCES: UP TO DATE, DYNAMED WASHINGTON’S MANUAL, LATEST EDITION BASIC NIGHT FLOAT COVERAGE (HOW IT WORKS) TWO NIGHT FLOAT TEAMS WILL COVER EACH MONTH. EACH TEAM WILL BE COMPOSED OF A FIRST YEAR RESIDENT AND AN UPPER LEVEL. THEY WILL PICK UP THE BEEPER AND BOTH WILL BE “IN HOUSE CALL” UNTIL THE CONCLUSION OF MORNING REPORT EACH MORNING. THEY WILL PICK UP THE BEEPER AT 5 PM ON SUNDAY, MONDAY, TUESDAY, WEDNESDAY, THURSDAY, & FRIDAY EVENINGS, ANSWER ALL CALLS, AND ADMIT PATIENTS TO THE INPATIENT SERVICE UNTIL THE CONCLUSION OF MORNING REPORT. AT THE CONCLUSION OF MORNING REPORT, THEY WILL GO HOME IMMEDIATELY, BOTH FIRST YEAR AND UPPER LEVEL RESIDENTS. TEAM A WILL DO THE FIRST TWO WEEKS SUNDAY THROUGH THURSDAY AND TEAM B WILL DO THE SECOND TWO WEEKS SUNDAY THROUGH THURSDAY. ON THE TWO WEEKS THAT THE NIGHT FLOAT TEAM DOES NOT WORK MONDAY THROUGH THURSDAY, THEY WORK FRIDAY NIGHT 5 PM UNTIL 8 AM SATURDAY MORNING. ANY DAYS LEFT, THEY WILL EVENLY SPLIT MAKING SURE THAT ALL DUTY HOUR REGULATIONS ARE NOT COMPROMISED. DURING THE TWO OFF WEEKS DURING WHICH THEY ARE NOT ON CALL, THE UPPER LEVEL RESIDENT WILL SERVE IN CLINIC FULL TIME, EXCEPT FOR THURSDAY AFTERNOONS AND FRIDAYS. THE FIRST YEAR ON THE TWO WEEKS OF NIGHT FLOAT MONTH WILL, WHILE NOT IN THE 2 WEEK PERIOD OF NIGHT FLOAT, WORK CLINIC EVERY MORNING, EXCEPT FRIDAY MORNING AND COMPLETE DIDACTIC CURRICULUM VIA CHALLENGER ASSIGNMENT FOR THE MONTH. WHILE RESIDENTS ARE ON THEIR TWO WEEK NIGHT FLOAT, THEY WILL NOT SERVE IN THE CLINIC. 82 PGY 3 ROTATIONS FAMILY MEDICINE INPATIENT SERVICE PEDIATRICS – OUT-PATIENT NEUROLOGY OTOLARYNGOLOGY/OPHTHALMOLOGY UROLOGY/COPC SCHOLARLY ACTIVITY/MHS EMERGENCY MEDICINE NIGHT FLOAT/FM CLINICS ELECTIVES 83 INPATIENT FAMILY MEDICINE UPPER LEVEL RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL SPEND TWO MONTHS OF THE EACH YEAR ON THE INPATIENT FAMILY MEDICINE SERVICE. EACH HOSPITAL TEAM WILL CONSIST OF AN ATTENDING PHYSICIAN, AN UPPER LEVEL RESIDENT HELPING DIRECT PATIENT CARE WITH A FIRST YEAR RESIDENT, A CLINICAL PHARMACIST AND A HOSPITAL CASE MANAGER. THE DAY WILL START EACH MORNING AT 7 AM MEETING DURING WHICH THE ON CALL TEAM REPORTS TO THE MEDICINE TEAMS ABOUT THE PREVIOUS NIGHT’S ADMISSIONS AND DEVELOPMENTS. THE TWO ATTENDING PHYSICIANS WILL DIRECT THIS MORNING REPORT. GOALS 1. PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH 2. 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 3. 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 4. 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 5. PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION 6. INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS OBJECTIVES ADMISSION SKILLS PATIENT CARE OBJECTIVES: THE UPPER RESIDENT WILL 1. REVIEW THE COMPONENTS OF AN H&P AS DONE BY THE FIRST YEAR RESIDENT 2. ASSIST THE FIRST YEAR RESIDENT IN OBTAINING A COMPLETE HISTORY OR PRESENT ILLNESS 3. OVERSEE THE COLLECTION OF PERTINENT PSYCHOSOCIAL INFORMATION 4. REVIEW THE RECORDED ELEMENTS OF THE PMH, SH, AND FH AS DONE BY THE FIRST YEAR RESIDENT 5. SYSTEMATICALLY REVIEW THE 13 ORGAN REVIEW OF SYSTEMS AS DONE BY THE FIRST YEAR RESIDENT 6. MAKE SURE A DETAILED MEDICATION LIST IS IN THE CHART 7. DOCUMENT A COMPREHENSIVE EXAMINATION COMPLETE WITH VITAL SIGNS AND RECTAL EXAM 8. DOCUMENT ALL LABORATORY AND IMAGING STUDIES 9. MAKE SURE THE FIRST YEAR RESIDENT UNDERSTANDS THE PRINCIPLE DIAGNOSIS AND THE REASON FOR ADMISSION 10. SUBSTANTIATE ALL PATIENT PROBLEMS IN THE ASSESSMENT 11. RECORD TREATMENT PLAN AS REVIEWED AND PUT FORTH BY THE FIRST YEAR RESIDENT 12. DOCUMENT PERTINENT HISTORY AND PHYSICAL FINDINGS WITH A LEGIBLE ADMISSION NOTE 13. HELP FIRST YEAR RESIDENT DICTATE COMPLETE H&P AT THE TIME OF ADMISSION 14. OVERSEE THE COMPLETION OF APPROPRIATE ORDERS IN A REASONABLE TIME BY THE FIRST YEAR RESIDENT 84 MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SUPERVISE FIRST YEAR RESIDENT IN SELECTING CORRECT ORDER SET FOR ADMISSION DIAGNOSIS 2. REVIEW MEDICAL DIAGNOSTIC WORK UP AND TREATMENT PLAN ON EACH PATIENT BEFORE MORNING REPORT PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW 2. REVIEW FIRST YEAR RESIDENT’S H&P TO MAKE SURE THAT ALL COMPONENTS ARE PRESENT SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CHECK TO MAKE SURE PATIENT IS ASSIGNED TO THE HOSPITAL WARD WHOSE NURSING STAFF CAN DELIVERY THE MOST APPROPRIATE LEVEL OF CARE 2. 3. REVIEW ALL HOME MEDICATIONS AND RENEW AS APPROPRIATE FOR PATIENT’S ADMISSION NEEDS SUPERVISE FIRST YEAR RESIDENT IN WRITING ADMISSION ORDERS IN CORPORATION WITH THE CASE MANAGER WITH THE GOAL OF GETTING THE PATIENT THE MOST TIME-EFFICIENT, COST-EFFICIENT, AND SAFEST CARE FOR THE PROBLEMS THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL FOR PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. ATTEND TO THE PATIENT IN THE EMERGENCY ROOM FOR ADMISSION AS SOON AS POSSIBLE AFTER CALLED BY THE FIRST YEAR RESIDENT 2. 3. 4. 5. 6. BE APPROPRIATELY AND PROFESSIONALLY ATTIRED COMMUNICATE IN A PROFESSIONAL MANNER WITH THE ER PHYSICIANS, NURSES, AND STAFF FOLLOW ALL HIPPA REGULATIONS IN REGARD TO THE CARE OF THE PATIENT INTRODUCE YOURSELF TO THE PATIENT AND FAMILY SHOWING RESPECT AND COMPASSION CALL ALL CONSULTANTS AND EXPLAIN EITHER VIA PHONE OR IN PERSON PATIENT’S CLINICAL COURSE AND WHY THE REFERRAL IS BEING MADE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WRITE AN ACCURATE ADMISSION NOTE 2. REVIEW ORDERS WRITTEN BY FIRST YEAR 3. COMMUNICATE WITH THE FAMILY AND PATIENT THE DIAGNOSES, THE NEED FOR ADMISSION, AND THE TREATMENT PLAN WITH THE FIRST YEAR RESIDENT 4. BE PRESENT DURING MORNING REPORT TO INSURE THE PATIENT IS PRESENTED ACCURATELY BY FIRST YEAR RESIDENTS AND BE READY TO DEFEND CARE ADMINISTERED DAILY ROUNDING SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INTERVIEW AND EXAMINE THE PATIENT DAILY 2. KNOW ALL THE PERTINENT INFORMATION REGARDING THE CARE OF THE ASSIGNED PATIENT 3. CREATE SOAP NOTE WITH COMPLETE AND ACCURATE ASSESSMENT AND PLAN 4. ANTICIPATE AND DISCUSS POTENTIAL COMPLICATIONS OF A PATIENT’S TREATMENT PLAN 5. REVIEW PATIENT LIST OF FIRST YEAR RESIDENT AND DISCUSS CLINICAL DECISIONS MADE ON A DAILY BASIS MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. READ DAILY ON THE DISEASE PROCESSES AND TREATMENT OPTIONS ON THE INPATIENTS THAT THE RESIDENT IS FOLLOWING 2. BE ABLE TO DISCUSS THE PATHOPHYSIOLOGY, RISK FACTORS, SIGNS, SYMPTOMS, DIFFERENTIAL DIAGNOSIS, APPROPRIATE DIAGNOSTIC WORK UP, TREATMENT PLAN, AND PREVENTATIVE STRATEGIES FOR THE TOP TEN DIAGNOSES: 85 I. II. III. IV. V. VI. VII. VIII. IX. X. 3. 4. COPD CHEST PAIN PNEUMONIA CONGESTIVE HEART FAILURE ATRIAL FIBRILLATION STROKE TIA SYNCOPE PANCREATITIS GASTROENTESTINAL HEMORRHAGE PREPARE FOR ASSIGNED PRESENTATIONS IN MORNING REPORT PARTICIPATE IN DISCUSSIONS IN MORNING REPORT WITH THE ATTENDING AND OTHER RESIDENTS AND STUDENTS ON THE HEALTHCARE TEAM 5. BE PREPARED TO EXPLAIN AND DEFEND THE RATIONALE BEHIND YOUR ASSESSMENT AND TREATMENT PLAN TO THE ATTENDING FACULTY MEMBER DURING ROUNDS PRACTICE-BASED LEARNING AND IMPROVEMENT: THE UPPER LEVEL RESIDENT WILL 1. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 2. ASSIST OR COORDINATE EFFORTS TO PERFORM “ROOT CAUSE ANALYSIS” STUDIES ON EVENTS THAT OCCUR THAT ARE UNEXPECTED OR CAUSE ADDITIONAL MORBIDITY/MORTALITY TO THE INPATIENT DURING THEIR HOSPITALIZATION 3. DISCUSS QUALITY IMPROVEMENT CASES WITH THE VICE-PRESIDENT OF PATIENT AFFAIRS DURING THE MORNING REPORT EACH FRIDAY SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. ROUND DAILY WITH THE CASE MANAGER AND DISCUSS THE CLINICAL HOSPITAL COURSE OF THE PATIENT PLANS FOR DISCHARGE & PLACEMENT, DURABLE MEDICAL EQUIPMENT NEEDED AT DISCHARGE, AND PLAN OF HOW THE PATIENT WILL OBTAIN MEDICATIONS UPON DISCHARGE 2. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 3. 4. DEMONSTRATE HOW TO FIND MEDICAL ANSWERS IN LESS THAN TWO MINUTES USING HANDHELD PDA ANTICIPATE AND AVOID POTENTIAL COMPLICATIONS OF HOSPITALIZATION SUCH AS DELIRIUM, NOSOCOMIAL INFECTION, OR DEEP VEIN THROMBOSIS/PULMONARY EMBOLUS 5. 6. 7. ASSIST FIRST YEAR RESIDENT IN UPDATING ACCURATELY THE INPATIENT LIST FOR MORNING REPORT PERFORM TIME MANAGEMENT SKILLS PROFICIENTLY IN ORDER THAT THE RESIDENT IS READY FOR ROUNDS WORK WITH THE CLINICAL PHARMACIST ON ROUNDS TO MAKE SURE THAT THE MOST APPROPRIATE AND COST EFFICIENT MEDICATIONS ARE USED AND ADVERSE DRUG REACTIONS OR DRUG-DRUG INTERACTIONS ARE AVOIDED PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. TREAT THE PATIENT WITH THE UTMOST RESPECT AND COURTESY 2. WORK WITH THE NURSES ON THE FLOOR TO DELIVER THE BEST AND MOST EFFICIENT PATIENT CARE POSSIBLE 3. COMMUNICATE IN PERSON AND IN CHART THE CURRENT ASSESSMENT AND TREATMENT PLAN GOALS FOR ALL OTHER HEALTHCARE TEAM MEMBERS 4. 5. BE AT MORNING REPORT AND ROUNDS PREPARED AND ON TIME DAILY SIGN OUT TO ON CALL TEAM IN THE EVENING INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CALL AND ACCURATELY DESCRIBE THE PATIENT’S CLINICAL COURSE AND THE REASON FOR CONSULTATION TO CONSULTANT PHYSICIAN 86 2. 3. 4. 5. 6. 7. ASSIST THE FIRST YEAR RESIDENT IN COMMUNICATING WITH CONSULTANT ON REFERRALS WRITE LEGIBLY SO ALL CARETAKERS CAN EASILY READ WRITE ORDERS THAT ARE CLEAR AND EASILY UNDERSTOOD KEEP PATIENT AND FAMILY INFORMED OF THE LATEST DEVELOPMENTS AS THEY UNFOLD EXPLAIN TO THE PATIENT AND FAMILY THE GOALS OF THE DAY’S TREATMENT PRESENT THE PATIENT’S ASSESSMENT AND PLAN ON ROUNDS TO THE ATTENDING FACULTY MEMBER DISCHARGE SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RECOGNIZE AND ASSIST FIRST YEAR RESIDENT IN RECOGNIZING AT WHAT POINT IN THE PATIENT’S HOSPITAL COURSE WHEN THE INPATIENT CAN BE SAFELY DISCHARGED 2. DISCUSS WITH THE ATTENDING FACULTY MEMBER THE RATIONALE FOR DISCHARGE, ASSESSMENT, AND POST-DISCHARGE PLAN 3. WRITE DISCHARGE ORDERS THAT ARE COMPLETE AND LEGIBLE NO LATER THAN EARLY AFTERNOON ON THE DAY OF DISCHARGE 4. 5. OVERVIEW DISCHARGE ORDERS WRITTEN BY FIRST YEAR RESIDENT DICTATE A DISCHARGE SUMMARY WITH ALL OF THE REQUIRED COMPONENTS INCLUDED AND THAT CAN BE USED AS A VALUABLE REFERENCE FOR ANY SUBSEQUENT TREATING PHYSICIANS 6. COMPLETE DISCHARGE MEDICATION LIST MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SUMMARIZE THE HOSPITAL COURSE, WHAT DIAGNOSES WERE PRESENT, WHAT TREATMENT PLANS WERE FOLLOWED, ALTERNATIVE TREATMENT PLANS THAT COULD HAVE BEEN UTILIZED, AND APPROPRIATE HOSPITAL FOLLOW UP REQUIRED 2. DISCUSS THE RATIONALE FOR THE TREATMENT RENDERED AND WHAT ISSUES NEED TO BE ADDRESSED AT FOLLOW UP OUTPATIENT VISITS PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. PRESENT AT THE MONTHLY QUALITY IMPROVEMENT CONFERENCE ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WORK WITH THE CASE MANAGER TO INSURE AT DISCHARGE THAT THE PATIENT HAS APPROPRIATE PLACEMENT, NEEDED DURABLE MEDICAL EQUIPMENT, ACCESS TO PRESCRIBED MEDICATIONS, AND FOLLOW UP WITH PRIMARY CARE PROVIDER 2. NOTIFY PRIMARY CARE PROVIDER OF PATIENT NEEDS AT THE NEXT POST-HOSPITALIZATION FOLLOW UP VISIT PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE PRESENT AT DISCHARGE TO BE ABLE TO CLEARLY COMMUNICATE TO PATIENT AND FAMILY THE SUMMARY OF THE HOSPITALIZATION, DISCHARGE PLANS, AND FOLLOW UP 2. SUPERVISE FIRST YEAR RESIDENT IN COMMUNICATION WITH THE FAMILY AND PATIENT AT DISCHARGE 3. COMMUNICATE TO NURSES THE DISCHARGE ORDERS 4. BE SENSITIVE TO POSSIBLE PATIENT, FAMILY, AND NURSING HOME TIME CONSTRAINTS REGARDING A PROMPT AND EARLY DISCHARGE 87 INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INFORM NURSING STAFF OF DISCHARGE 2. CLEARLY COMMUNICATE TO PATIENT AND FAMILY DISCHARGE INSTRUCTIONS 3. DISCUSS WITH THE ATTENDING PHYSICIAN THE DISCHARGE PLANS 4. EXPLAIN TO THE PATIENT AND FAMILY THE DIAGNOSES, MEANING OF TESTS UP TO DATE, NEEDS FOR FURTHER TESTING, RATIONALE BEHIND CURRENT TREATMENT PLAN NEUROLOGY 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE ONE-MONTH ROTATION OF NEUROLOGY DURING THE THIRD YEAR OF TRAINING WILL PREPARE THE RESIDENT FOR RECOGNITION, ASSIMILATION AND MASTERING THOSE ASPECTS OF NEUROLOGICAL DISEASES THAT ARE NECESSARY FOR DAILY PATIENT CARE. AT THE CONCLUSION OF THIS TRAINING, THE RESIDENT SHOULD HAVE KNOWLEDGE AND SKILL TO MANAGE THE MAJORITY OF THE NEUROLOGICAL PROBLEMS THAT ARE COMMONLY SEEN BY FAMILY PRACTITIONERS AND ALSO RECOGNIZE THE NEED FOR PROPER REFERRAL AND CONSULTATION BY A SPECIALIST FOR THOSE THAT ARE BEYOND HIS CAPABILITIES. THE NEEDED SKILLS WILL BE OBTAINED THROUGH SEVERAL RESOURCES, INCLUDING THE ATTENDING NEUROLOGIST’S IN-PATIENT AND OUTPATIENT PRIVATE PATIENTS PRIVATE PATIENTS, THE RESIDENT’S PANEL OF PATIENTS AT THE FAMILY MEDICINE CENTER, INTERNAL MEDICINE AND FAMILY MEDICINE SERVICE ROTATIONS AND DIDACTIC LECTURES/CONFERENCES. TO PROVIDE IN-PATIENT AND OUT-PATIENT LEARNING OPPORTUNITIES IN THE AREA OF NEUROLOGY THROUGH A ONEMONTH BLOCK ROTATION IN THE THIRD YEAR OF TRAINING AND CONTINUOUS LONGITUDINAL EXPERIENCE THROUGHOUT THE RESIDENCY. TO PROVIDE LEARNING OPPORTUNITIES IN THE AREA OF NEUROLOGY THAT DEMONSTRATE THE IMPORTANCE OF THE BEHAVIORAL SCIENCES AND DISEASE PREVENTION IN THE COMPREHENSIVE AND CONTINUING CARE OF THE PATIENTS AND THEIR FAMILIES. TO PROVIDE ADDITIONAL LEARNING OPPORTUNITIES IN NEUROLOGY BY AN ELECTIVE ROTATION DURING THE THIRD YEAR OF THE PROGRAM IF REQUESTED/NEEDED. THE RESIDENT WILL BE ABLE TO RECOGNIZE, DIAGNOSE, MANAGE AND REFER FOR CONSULTATION THE NEUROLOGY PROBLEMS WHICH MAY PRESENT TO HIS PRACTICE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. DISCUSS PSEUDO-SEIZURES, CONVERSION DISORDER, AND MALINGERING WITH THE PRECEPTOR NEUROLOGIST 2. PERFORM A COMPLETE NEUROLOGICAL EXAMINATION 3. BECOME COMPETENT AT A LUMBAR PUNCTURE 88 4. 5. TREAT URGENTLY CVA AND TIA KNOW THE WORKUP FOR HEADACHE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. HAVE A BASIC KNOWLEDGE AND BE ABLE TO PURSUE THE WORKUP OF: 1) ACUTE TRAUMA TO CNS 2) MENINGITIS 3) ALTERATIONS IN CONSCIOUSNESS 4) DEMENTIA/PSEUDODEMENTIA/ 5) CONFUSION 6) EPILEPSY/SEIZURE DISORDERS 7) MEMORY DISORDERS 8) GUILLAIN-BARRE SYNDROME 9) PARKINSON'S DISEASE 10) MULTIPLE SCLEROSIS 11) MYASTHENIA GRAVIS/POLYMYOSITIS 12) NARCOLEPSY 13) SUBDURAL/EPIDURAL HEMATOMA 14) NEUROGENIC HYSTERIA 15) BRAIN DEATH/VEGETATIVE STATES 2. UNDERSTAND INDICATIONS FOR 16) HERPES ZOSTER 17) BELL'S PALSY 18) MIGRAINE 19) VERTIGO 20) PAIN SYNDROME (LOW BACK/CHRONIC) 21) HEADACHES 22) CEREBRAL VASCULAR ACCIDENT 23) TRANSIENT ISCHEMIC ATTACK 24) DRUG INTOXICATION 25) MENIERE'S SYNDROME 26) HERNIATED INTERVERTEBRAL DISC 27) NEUROPSYPHILLIS 28) TOURETTE’S SYNDROME EEG, EMG, CT/MRI, AUDIOMETRY, VESTIBULAR FUNCTION TESTS, AND TENSILON/PORSTIGMIN TEST PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ABLE TO IDENTIFY THEIR OWN STRENGTHS AND DEFICIENCIES 2. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING 3. KNOW LIMITATIONS IN COMPLICATED NEUROLOGICAL PROBLEMS AND NEUROLO-TRAUMA SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. 89 SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING NEUROLOGICAL TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING 90 CARE OF THE FEMALE 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE GYNECOLOGY EXPERIENCE IS CONDUCTED IN THE PGY2 YEAR AND IS COMPRISED OF A 1 MONTH ROTATIONAL BLOCK WITH AN ASSIGNED OBSTETRICIAN/GYNECOLOGIST PRECEPTOR. THIS ROTATION IS PRIMARILY AN OUTPATIENT EXPERIENCE IN THE PRIVATE-OFFICE SETTING, BUT A PORTION MAY OCCUR IN THE INPATIENT SETTING WHERE THE RESIDENT HAS THE OPPORTUNITY TO PARTICIPATE IN HOSPITAL-BASED PROCEDURES (USUALLY AS THE FIRST SURGICAL ASSISTANT TO THE PRECEPTOR). RESIDENTS IN ALL THREE YEARS OF TRAINING RECEIVE A LONGITUDINAL EXPERIENCE IN GYNECOLOGY BY EXPERIENCES GAINED WITH DIAGNOSING AND TREATING GYNECOLOGIC PROBLEMS AND DISEASES FROM THEIR OWN CONTINUITY PATIENT PANEL. THE ROTATIONAL GOAL IS TO EDUCATE AND TRAIN THE RESIDENT PHYSICIAN IN THE DIAGNOSIS AND TREATMENT OF GYNECOLOGICAL PROBLEMS AND DISEASES THAT ARE COMMONLY ENCOUNTERED IN A STANDARD FAMILY MEDICINE PRACTICE. IN ADDITION TO THE EXPERIENCE ON THIS ROTATION, THE RESIDENT WILL ATTEND CARE OF THE FEMALE NOON CONFERENCES ON A REGULAR BASIS. ALSO, THE RESIDENT WILL SPEND TIME ON THE COMMUNITY MEDICINE AND THIS ROTATION IN THE BOWIE COUNTY REPRODUCTION CARE CLINIC. IN THIS CLINIC THE RESIDENT WILL BECOME PROFICIENT AT DOING PELVIC EXAMINATIONS AND PAP SMEARS WITH APPROXIMATELY 120 SUCH PROCEDURES DONE, NOT COUNTING PELVIC EXAMINATIONS DONE IN THE CLINIC AND ON OTHER ROTATIONS, SUCH AS THE EMERGENCY ROOM. SEE COLPOSCOPY CURRICULUM FOR FURTHER GYNECOLOGICAL EXPERIENCE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. DISCUSS WITH THEIR PRECEPTOR THE MOST COMMON GYNECOLOGIC PROBLEMS THAT ARE ENCOUNTERED WITHIN THEIR PRACTICE 2. LEARN HOW TO PERFORM AN APPROPRIATE GYNECOLOGIC HISTORY AND PHYSICAL EXAMINATION; INCLUDING A COMPLETE AND COMPREHENSIVE BREAST AND PELVIC EXAMINATION 3. KNOW THE ACCEPTED PREVENTIVE HEALTH MEASURES FOR WOMEN INCLUDING: PAP SMEARS, SELF-BREAST EXAMS, MAMMOGRAPHY, BONE DENSITY MEASUREMENT, COLORECTAL SCREENING, ETC. 4. APPRECIATE THE MULTIPLE FACTORS THAT PLAY A ROLE IN A WOMAN’S OVERALL HEALTH –INCLUDING INTERACTIONS BETWEEN FAMILY, CAREER, RELATIONSHIPS, AND THEIR COMMUNITY. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. REVIEW AND DISCUSS THE PHYSIOLOGY AND COMMON ABNORMALITIES OF THE NORMAL MENSTRUAL CYCLE. 2. BECOME FAMILIAR WITH THE VARIOUS CONTRACEPTIVE METHODS INCLUDING: HORMONAL ADJUNCTS, INTRA-VAGINAL AND INTRA-UTERINE DEVICES, AND BARRIER METHODS; AND HAVE THE OPPORTUNITY TO LEARN PROCEDURAL SKILLS SUCH AS DIAPHRAGM FITTING, PLACEMENT/REMOVAL OF IUDS. 3. LEARN THE DIAGNOSTIC WORKUP OF INFERTILITY PROBLEMS. 4. DEMONSTRATE PROFICIENCY IN PERFORMING AN ADEQUATE PAP SMEAR. 91 5. INTERPRET A STANDARD PAP SMEAR REPORT AND THE DIAGNOSTIC AND MANAGEMENT STRATEGY IN ADDRESSING VARIOUS PAP SMEAR ABNORMALITIES. 6. LEARN THE INDICATIONS FOR COLPOSCOPY AND WILL HAVE ADEQUATE OPPORTUNITY TO PERFORM AND BECOME PROFICIENT IN COLPOSCOPY EXAMINATIONS UNDER THE DIRECT SUPERVISION OF EITHER THEIR GYNECOLOGY PRECEPTOR, OR BY THE FAMILY MEDICINE FACULTY IN THE FMC. THIS WILL INCLUDE PERFORMING A CERVICAL BIOPSY AND/OR ENDOCERVICAL CURETTAGE WHEN CLINICALLY INDICATED. 7. 8. 9. BECOME PROFICIENT IN THE CLINICAL BREAST EXAMINATION. KNOW INDICATION OF MAMMOGRAPHY FOR THE PURPOSE OF SCREENING FOR BREAST CANCER. THE RECOMMENDATIONS FOR CALCIUM AND VITAMIN D SUPPLEMENTATION FOR THE PREVENTION OF OSTEOPOROSIS. RECITE INDICATIONS FOR ORDERING A BONE DENSITY STUDY TO SCREEN/DIAGNOSE OSTEOPOROSIS. 10. LEARN THE PRINCIPLES OF INTERPRETING A BONE DENSITY STUDY REPORT. 11. BECOME FAMILIAR WITH THE INDICATIONS AND TREATMENT OPTIONS FOR TREATING OSTEOPOROSIS. 12. DISCUSS THE DIAGNOSTIC AND TREATMENT STRATEGY FOR MANAGING URINARY INCONTINENCE IN THE FEMALE PATIENT. 13. PERFORM A COMPREHENSIVE ASSESSMENT FOR THE WORKUP OF STDS AND LEARN THE TREATMENT RECOMMENDATIONS FOR VARIOUS STDS. 14. LEARN HOW TO APPROPRIATELY COUNSEL THEIR PATIENTS ON STRATEGIES TO REDUCE OR PREVENT THE DEVELOPMENT OF STDS. 15. RECOGNIZE THE SIGNS OF MENOPAUSE AND BE FAMILIAR WITH THE DIAGNOSTIC AND MANAGEMENT OF THE SYMPTOMS OF MENOPAUSE IN THEIR PATIENTS. 16. DISCUSS DIAGNOSTIC APPROACH TO THE PATIENT WITH MENSTRUAL DISORDERS. 17. BE ABLE TO STATE THE INDICATIONS FOR AND PERFORM AN ENDOMETRIAL BIOPSY. 18. BECOME FAMILIAR WITH THE DIAGNOSTIC APPROACH TO THE PATIENT WITH SUSPECTED GYNECOLOGIC MALIGNANCY. 19. BE PROFICIENT IN PERFORMING AND INCISION AND DRAINAGE OF A BARTHOLIN’S CYST/ABCESS. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ABLE TO IDENTIFY THEIR OWN STRENGTHS AND DEFICIENCIES 2. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING KNOW LIMITATIONS IN COMPLICATED GYNECOLOGICAL PROBLEMS SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY 3. ADVOCATE FOR QUALITY PATIENT CARE 92 4. WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY 5. PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING GYNECOLOGICAL TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING 93 CARE OF THE SKIN 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE DERMATOLOGY EXPERIENCE IS CONDUCTED IN THE THIRD YEAR AND IS COMPRISED OF A ONE MONTH ROTATIONAL BLOCK WITH A DERMATOLOGIST PRECEPTOR IN AN OUTPATIENT PRIVATE-PRACTICE CLINIC SETTING. THE ROTATIONAL GOAL IS TO FAMILIARIZE THE RESIDENT PHYSICIAN TO THE MOST COMMON DISEASES OF THE SKIN THAT ARE ENCOUNTERED IN AN OUTPATIENT CLINICAL SETTING AND TO INSTRUCT THE RESIDENT ON THE PRINCIPLES OF TREATMENT OF THESE COMMON DISEASE STATES. RESIDENTS IN ALL THREE YEARS OF TRAINING WILL ALSO RECEIVE A LONGITUDINAL EXPERIENCE IN THE DIAGNOSIS AND MANAGEMENT OF COMMON SKIN MALADIES IN THEIR CONTINUITY CLINICS WITHIN THE FAMILY MEDICINE CENTER AND WILL GAIN EXPERIENCE IN COMMON DERMATOLOGIC PROCEDURES (SUCH AS PUNCH AND EXCISIONAL BIOPSIES OF THE SKIN) BY PARTICIPATING IN “LUMP & BUMP” CLINIC AT THE FAMILY MEDICINE CENTER. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. DISTINGUISH AND CLASSIFY SKIN LESIONS BASED ON APPEARANCE; INCLUDING PAPULAR, MACULAR, PUSTULAR, VESICULAR, BULLOUS, AND URTICARIAL LESIONS 2. RECOGNIZE AND DIAGNOSE BENIGN, PRE-MALIGNANT, AND MALIGNANT NEOPLASMS OF THE SKIN INCLUDING: ACTINIC KERATOSES, SEBORRHEIC KERATOSES, BASAL CELL CARCINOMAS, SQUAMOUS CELL CARCINOMAS, MALIGNANT MELANOMA, AND METASTATIC SKIN LESIONS 3. TREAT VARIOUS INFECTIOUS DISEASES OF THE SKIN INCLUDING: FUNGAL, BACTERIAL, VIRAL, AND PARASITIC DISEASE ENTITIES 4. 5. BECOME FAMILIAR WITH BOTH SYSTEMIC AND TOPICAL DRUG DELIVERY METHODS TO TREAT SKIN DISORDERS LEARN THE BASIC PRINCIPLES OF SKIN BIOPSY TECHNIQUES AND HAVE THE OPPORTUNITY TO PERFORM SUCH PROCEDURES UNDER THE SUPERVISION OF THEIR DERMATOLOGY PRECEPTOR OR FAMILY MEDICINE FACULTY ATTENDING 6. 7. 8. PERFORM THE PROPER TECHNIQUE OF INCISION AND DRAINAGE OF A SKIN ABCESS EDUCATE THEIR PATIENTS REGARDING PREVENTATIVE MEASURES TO REDUCE THE INCIDENCE OF SKIN DISEASES MAKE A HABIT OF PERFORMING A THOROUGH SKIN EXAMINATION DURING HEALTH MAINTENANCE VISITS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. BE ABLE TO DESCRIBE, RECOGNIZE, AND KNOW THE TREATMENT FOR THE FOLLOWING: 94 PSORIASIS PITYRIASIS ROSEA ACNE VULGARIS ACNE ROSACEA 2. 3. FUNGAL INFECTIONS OF THE SKIN (CANDIDA, TINEA) LICHEN PLANUS IMPETIGO VARICELLA/HERPES ZOSTER HERPES SIMPLEX URTICARIA CELLULITIS/ SKIN ABCESS ACTINIC KERATOSES SEBORRHEIC KERATOSES BASAL CELL CARCINOMA SQUAMOUS CELL CARCINOMA MALIGNANT MELANOMA DRUG ERUPTIONS PARASITIC DISEASE OF THE SKIN (SCABIES) ATOPIC DERMATITIS CONTACT DERMATITIS (POISON IVY) LEARN TO RECOGNIZE SKIN LESIONS SECONDARY TO MEDICAL TREATMENT BE ABLE TO APPRECIATE LESIONS SECONDARY TO SYSTEM ILLNESS SUCH AS LUPUS, NEUROSYPHILLIS, ERYTHEMA MULTIFORME, AND OTHERS PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. BE ABLE TO IDENTIFY THEIR OWN STRENGTHS AND DEFICIENCIES 2. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING KNOW LIMITATIONS IN COMPLICATED DERMATOLOGICAL PROBLEMS SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. 95 COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING DERMATOLOGICAL TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES FITZPATRICK’S CLINICAL DERMATOLOGY CLINICAL DERMATOLOGY: HABIF, TH 96 OTOLARYNGOLOGY 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE TWO WEEK BLOCK ROTATION OF ENT MEDICINE WILL PREPARE THE RESIDENT TO RECOGNIZE, ASSIMILATE AND MASTER THOSE ASPECTS OF ENT PROBLEMS AND DISEASES THAT ARE NECESSARY FOR DAILY PATIENT CARE. AT THE END OF THIS EXPERIENCE, THE RESIDENT WILL HAVE THE KNOWLEDGE AND SKILL TO MANAGE THE MAJORITY OF ENT PROBLEMS SEEN BY FAMILY PHYSICIANS. THE RESIDENT WILL ALSO LEARN TO RECOGNIZE THE NEED FOR PROPER REFERRAL TO AN ENT SPECIALIST FOR PROBLEMS THAT ARE BEYOND THE SCOPE OF THE RESIDENT’S CAPABILITIES. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. DISCUSS COMMON OTOLARYNGOLOGY PROBLEMS SUCH AS OTITIS MEDIA, ALLERGIC AND INFECTIVE RHINITIS, SINUSITIS, LARYNGITIS, VERTIGO, PHARYNGITIS/TONSILLITIS AND OTITIS EXTERNA 2. LEARN THE INTERPRETATION OF OUTPATIENT TESTS USED IN OTOLARYNGOLOGY SUCH AS AUDIOMETRY AND TYMPANOMETRY 3. 4. USE INSTRUMENTS SUCH AS THE INDIRECT LARYNGOSCOPE, NASOPHARYNGOSCOPE AND PNEUMATIC OTOSCOPE PERFORM OTOLARYNGOLOGY PROCEDURES SUCH AS REMOVAL OF FOREIGN BODIES FROM THE NOSE AND EAR, REPAIR OF FACIAL LACERATIONS, ANTERIOR NASAL PACKING AND CERUMEN REMOVAL 5. UNDERSTAND WHEN TO REFER TO OTOLARYNGOLOGY SPECIALISTS BASED ON ACUITY AND COMPLEXITY OF THE CONDITION MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. DISCUSS COMMON OTOLARYNGOLOGY PROBLEMS SUCH AS OTITIS MEDIA, ALLERGIC AND INFECTIVE RHINITIS, SINUSITIS, LARYNGITIS, VERTIGO, PHARYNGITIS/TONSILLITIS AND OTITIS EXTERNA 2. LEARN OUT TO INTERPRET THE OUTPATIENT TESTS USED IN OTOLARYNGOLOGY SUCH AS AUDIOMETRY AND TYMPANOMETRY 3. DISCUSS THE PROPER REFERRAL TO OTOLARYNGOLOGY SPECIALIST BASED ON ACUITY AND COMPLEXITY OF THE CONDITION. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 97 1. DISCUSS THE PROPER APPROACH TO THE PATIENT WITH THE OTOLARYNGOLOGY PROBLEMS LISTED ABOVE WITH THE OTOLARYNGOLOGY PRECEPTOR 2. USE THE RESOURCES LISTED IN EDUCATIONAL RESOURCES AS WELL AS PRIMARY OR SECONDARY LITERATURE TO ADVANCE THEIR KNOWLEDGE IN AREAS OF OTOLARYNGOLOGY WHERE THEY HAVE LIMITED EXPERIENCE SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING OTOLARYNGOLOGICAL TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) 98 AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES EDUCATIONAL RESOURCES WILL BE OBTAINED THROUGH SEVERAL RESOURCES INCLUDING THE ATTENDING OTOLARYNGOLOGIST’S IN-PATIENT AND OUT-PATIENT PRIVATE PATIENTS AND THE RESIDENT’S PANEL OF PATIENTS AT THE AHEC FAMILY MEDICINE CLINIC, FAMILY MEDICINE SERVICE ROTATIONS, AHEC PROCEDURE CLINIC, DIDACTIC LECTURERS, ON-LINE RESOURCES (EMEDICINE, UPTODATE, MD CONSULT) AND CONFERENCES. OPHTHALMOLOGY 3RD YEAR RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THIS IS A TWO WEEK ROTATION LOCATED IN A PRIVATE OPHTHALMOLOGIST’S OFFICE. IT WILL INCREASE KNOWLEDGE OF OCULAR DISEASES AND TEACH SKILLS A FAMILY MEDICINE PHYSICIAN MAY NEED IN PROVIDING PRIMARY CARE OF THE EYE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. CONDUCT SELF STUDY ON THE ABOVE TOPICS AND DISCUSS EACH WITH THEIR PRECEPTOR CHALZION CONJUNCTIVITIS REFRACTORY ERROR FOREIGN BODY GLAUCOMA DIABETIC RETINOPATHY TRAUMA CORNEAL ABRASION EYE PAIN VISION LOSS ZOSTER INVOLVEMENT OF EYE 2. 99 BECOME PROFICIENT AT HISTORY AND EXAMINATION 3. 4. 5. 6. DEMONSTRATE PROPER USE OF OPHTHAMOSCOPE AND SLIT LAMP PERFORM FLUORSCEIN STAIN EXAMINATION BE ABLE TO REMOVE FOREIGN BODY FROM EYE UNDERSTAND ANALGESIC AND ANTIBIOTIC THERAPY TO EYE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. UNDERSTAND THE ANATOMY AND PHYSIOLOGY OF THE OCULAR SYSTEM'S NORMAL GROWTH, DEVELOPMENT, AND VARIANTS 2. 3. 4. BE ABLE TO PERFORM OFFICE EVALUATION, DIAGNOSIS, AND TREATMENT OF DISEASES OF THE EYES DEVELOP FAMILIARITY WITH THE TESTS AND PROCEDURES USED IN EVALUATING THE PATIENT VISUALLY AND MEDICALLY. HAVE AN APPRECIATION FOR SPECIALTY TEAMWORK IN MANAGING PATIENTS AND WHEN CONSULTATIONS AND/OR REFERRALS ARE INDICATED AND THE AVAILABILITY OF PROCEDURES LOCALLY PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. DISCUSS THE PROPER APPROACH TO THE PATIENT WITH THE OTOLARYNGOLOGY PROBLEMS LISTED ABOVE WITH THE OPHTHALMOLOGY PRECEPTOR 2. USE THE RESOURCES LISTED IN EDUCATIONAL RESOURCES AS WELL AS PRIMARY OR SECONDARY LITERATURE TO ADVANCE THEIR KNOWLEDGE IN AREAS OF OPHTHALMOLOGY WHERE THEY HAVE LIMITED EXPERIENCE SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. 100 COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING OPHTHALMOLOGY TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES EDUCATIONAL RESOURCES WILL BE OBTAINED THROUGH SEVERAL RESOURCES INCLUDING THE ATTENDING OPHTHALMOLOGIST’S IN-PATIENT AND OUT-PATIENT PRIVATE PATIENTS AND THE RESIDENT’S PANEL OF PATIENTS AT THE AHEC FAMILY MEDICINE CLINIC, FAMILY MEDICINE SERVICE ROTATIONS, AHEC PROCEDURE CLINIC, DIDACTIC LECTURERS, ON-LINE RESOURCES (EMEDICINE, UPTODATE, MD CONSULT) AND CONFERENCES. 101 UROLOGY 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THIS ONE MONTH ROTATION WILL BE WITH THE PRIVATE UROLOGISTS IN HIS OFFICE. IT IS TO TEACH GENITOURINARY CARE AND FAMILIARIZE THE RESIDENTS WITH PRIMARILY OUTPATIENT UROLOGICAL CARE. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE RESIDENT WILL: 1. BE PROFICIENT AT THE HISTORY AND PHYSICAL EXAMINATION OF THE GENITOURINARY TRACT 2. KNOW WORK UP AND TREATMENT FOR THE FOLLOWING GENITOURINARY TRACT PROBLEMS: PYELONEPHRITIS CYSTITIS PROSTATITIS EPIDIDYMITIS URINARY OBSTRUCTION URINARY CALCULI BENIGN PROSTATIC HYPERTROPHY PROSTATE CANCER AND SCREENING GUIDELINES BLADDER CARCINOMA HEMATURIA VESICOURETERAL REFLUX ENURESIS IMPOTENCE HYDROCELE CIRCUMCISION BLADDER CATHERIZATION SUPRAPUBIC ASPIRATION MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. UNDERSTAND THE ANATOMY AND PHYSIOLOGY OF THE GENITOURINARY SYSTEM'S NORMAL GROWTH, DEVELOPMENT, AND VARIANTS 2. 3. 4. BE ABLE TO PERFORM OFFICE EVALUATION, DIAGNOSIS, AND TREATMENT OF DISEASES OF THE GENITOURINARY TRACT DEVELOP FAMILIARITY WITH THE TESTS AND PROCEDURES USED IN EVALUATING THE PATIENT GENITOURINARY TRACT HAVE AN APPRECIATION FOR SPECIALTY TEAMWORK IN MANAGING PATIENTS AND WHEN CONSULTATIONS AND/OR REFERRALS ARE INDICATED AND THE AVAILABILITY OF PROCEDURES LOCALLY 102 PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. DISCUSS THE PROPER APPROACH TO THE PATIENT WITH THE OTOLARYNGOLOGY PROBLEMS LISTED ABOVE WITH THE OPHTHALMOLOGY PRECEPTOR 2. USE THE RESOURCES LISTED IN EDUCATIONAL RESOURCES AS WELL AS PRIMARY OR SECONDARY LITERATURE TO ADVANCE THEIR KNOWLEDGE IN AREAS OF UROLOGY WHERE THEY HAVE LIMITED EXPERIENCE SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. EFFECTIVELY WORK WITH VARIOUS HEALTH CARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. 3. 4. 5. COORDINATE PATIENT CARE WITHIN THE HEALTH CARE SYSTEM TO THEIR CLINICAL SPECIALTY ADVOCATE FOR QUALITY PATIENT CARE WORK AS A VALUABLE TEAM MEMBER FOR PATIENT SAFETY AND IMPROVED PATIENT CARE QUALITY PARTICIPATE IN IDENTIFYING SYSTEMS ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEMS SOLUTIONS PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS 2. BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST 3. RESPECT PATIENT PRIVACY AND AUTONOMY 4. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK ON COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 103 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 3. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES COVERING UROLOGICAL TOPICS, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES EDUCATIONAL RESOURCES WILL BE OBTAINED THROUGH SEVERAL RESOURCES INCLUDING THE ATTENDING UROLOGIST’S INPATIENT AND OUT-PATIENT PRIVATE PATIENTS AND THE RESIDENT’S PANEL OF PATIENTS AT THE AHEC FAMILY MEDICINE CLINIC, FAMILY MEDICINE SERVICE ROTATIONS, AHEC PROCEDURE CLINIC, DIDACTIC LECTURERS, ON-LINE RESOURCES (EMEDICINE, UPTODATE, MD CONSULT) AND CONFERENCES. SCHOLARLY ACTIVITY 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE TWO WEEK ROTATION OCCURS DURING THE RESIDENT’S THIRD YEAR. THE RESIDENT WILL LEARN THE PRINCIPLES OF PEER REVIEW RESEARCH. THIS PROCESS STARTS IN THE FIRST YEAR DURING THE ORIENTATION PERIOD AND JOURNAL CLUB CONFERENCES. THE RESIDENT WILL RESEARCH THE MEDICAL LITERATURE FOR AN ANSWER TO A CLINICAL QUESTION THAT THE RESIDENT POSES. THE ANSWER IS PRESENTED IN THE YEAR’S FIRST JOURNAL CLUB CONFERENCE WITH A DISCUSSION OF THE EVIDENCE BASED LITERATURE. THE RESIDENT BEGINS TO GRASP THE DIFFICULT TASK OF CRITICALLY APPRAISING MEDICAL LITERATURE. THIS PROCESS CONTINUES THROUGH THE THREE YEARS AS JOURNAL CLUB CONFERENCES EXPAND THE RESIDENT’S KNOWLEDGE OF WHAT IS REQUIRED TO MAKE SCIENTIFIC RESEARCH STATISTICALLY SIGNIFICANT AND MEDICALLY RELEVANT. THIS JOURNEY CULMINATES NEAR THE END OF THE THIRD YEAR RESIDENT’S TRAINING WITH THIS ROTATION AND THE PERFORMANCE IMPROVEMENT ROTATION, BOTH TWO WEEK ROTATIONS THAT OCCUR DURING THE SAME MONTH. WHILE ON THIS ROTATION THE RESIDENT WILL MAINTAIN THE 4 HALF-DAY PER WEEK CONTINUITY CARE CLINIC SCHEDULE. DURING THE SCHOLARLY ACTIVITY SEGMENT OF THE MONTH THE RESIDENT WILL WORK WITH WILLIAM MCINTYRE, PHARM D. DR. MCINTYRE HAS DONE A SIGNIFICANT AMOUNT OF ONCOLOGICAL PHARMACOLOGICAL RESEARCH IN THE PAST. HE WILL DIRECT THE RESIDENT TO THE FAMILY PHYSICIAN INTERROGATORY NETWORK (FPIN). THERE THE RESIDENT WILL SERVE AS A PEER-REVIEWER FOR ORIGINAL SCIENTIFIC MEDICAL RESEARCH. THIS WILL CALL UPON ALL THAT THE RESIDENT HAS LEARNED OVER THE PAST THREE YEARS TO REVIEW THE ARTICLE AND DEEM IT STATISTICALLY SIGNIFICANT AND VALID. 104 PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. THERE ARE NO PATIENT CARE OBJECTIVES FOR THIS ROTATION. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. BECOME COMPETENT REGARDING MEDICAL KNOWLEDGE AS IT PERTAINS TO THE LITERATURE THAT IS BEING REVIEWED PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. PEER REVIEW AN ORIGINAL SCIENTIFIC ARTICLE OF MEDICAL LITERATURE 2. AS A PEER REVIEWER, WILL UTILIZE THE SKILLS LEARNED DURING THE RESIDENCY TO DETERMINE IF THE RESEARCH IS STATISTICALLY SIGNIFICANT, MEDICALLY RELEVANT, AND VALID 3. SUBMIT HIS/HER FINDINGS TO THE FAMILY PHYSICIAN INTERROGATORY NETWORK SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. THERE ARE NO SYSTEMS BASED PRACTICE OBJECTIVES FOR THIS ROTATION. PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 1. BE PROMPT FOR DEADLINES OR APPOINTMENTS AND PROFESSIONALLY ATTIRED DURING DUTY HOURS 105 INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. 1. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND HEALTH RELATED AGENCIES 2. MAINTAIN COMPREHENSIVE, TIMELY, ACCURATE, AND LEGIBLE MEDICAL RECORDS. TEACHING METHODS FREQUENT DISCUSSIONS AND CONSULTATIONS WITH DR. MCINTYRE AND DR. DOWNS ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES EDUCATIONAL RESOURCES WILL BE OBTAINED THROUGH SEVERAL ON-LINE RESOURCES (EMEDICINE, UPTODATE, MD CONSULT), UAMS ELECTRONIC ONLINE DATA BASE, AND JOURNAL CLUB CONFERENCES. PERFORMANCE IMPROVEMENT PROJECT 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THIS TWO WEEK ROTATION WILL BE THE CULMINATION OF A PROJECT STARTED AS A SECOND YEAR RESIDENT. SEE PERFORMANCE IMPROVEMENT PROJECT ROTATION IN THE SECOND YEAR. THE RESIDENT WILL NOW MEASURE THE IMPACT OF THE INTERVENTION UPON A SYSTEM TO IMPROVE MEDICAL CARE. THE RESIDENT WILL THEN PRESENT THE FINDINGS IN THAT MONTH’S JOURNAL CLUB. IF THE PROJECT HAS, IN FACT, IMPROVED COMPLIANCE TO A GUIDELINE OR THE QUALITY OR CARE ADMINISTERED BY THE RESIDENCY PROGRAM, IT WILL BE MADE A PERMANENT INTERVENTION IN THE SYSTEM OF CARE THAT IS GIVEN. THESE PROJECTS WILL BE KEPT ON RECORD. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. THERE ARE NO PATIENT CARE OBJECTIVES FOR THIS ROTATION. 106 MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. BECOME COMPETENT REGARDING MEDICAL KNOWLEDGE AS IT PERTAINS TO THE PERFORMANCE IMPROVEMENT PROJECT PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE NEED FOR BENCH MARKS AND TREATMENT GUIDELINES 2. APPRECIATE THE PHILOSOPHY OF CONTINUED QUALITY IMPROVEMENT IN MEDICINE 3. LEARN THE PROCESS OF OBTAINING A QUALITY SAMPLE FOR MEASUREMENT 4. MEASURE A PERFORMANCE THAT IS BOTH MEASURABLE AND MEANINGFUL 5. DESIGN AN INTERVENTION THAT WILL IMPROVE QUALITY OF CARE 6. IMPLEMENT THE INTERVENTION INTO THE SYSTEM 7. RE-MEASURE PERFORMANCE IN ONE YEAR 8. DRAW CONCLUSIONS FROM FINDINGS AND PRESENT THEM TO JOURNAL CLUB SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS BASED PRACTICE OBJECTIVES: THE RESIDENT WILL 1. UNDERSTAND THE SYSTEMS BY WHICH WE OPERATE IN DELIVERING MEDICAL CARE IN BOTH THE HOSPITAL AND THE CLINIC 2. BE COMPETENT IN TECHNOLOGY TO UTILIZE IT TO HELP DETERMINE PERFORMANCE TO BE MEASURED, MEASURING THE PERFORMANCE, AND DETERMINING IF THE CHANGE IN PERFORMANCE AFTER INTERVENTION IS SIGNIFICANT 3. KNOW THE SYSTEM WELL ENOUGH TO DETERMINE IN AN EFFECTIVE WAY HOW THE INTERVENTION CAN EASILY BE IMPLEMENTED WITHIN THE SYSTEM 4. FORESEE ALL THE CONSEQUENCES TO PATIENT CARE THAT THE IMPLEMENTATION OF THE INTERVENTION INTO THE SYSTEM MAY BRING, BOTH INTENDED AND UN-INTENDED PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONALISM OBJECTIVES: THE RESIDENT WILL 107 1. 2. 3. 4. 5. SHOW COMPASSION, INTEGRITY, AND RESPECT FOR OTHERS BE RESPONSIVE TO PATIENT NEEDS THAT SUPERSEDES SELF-INTEREST RESPECT PATIENT PRIVACY AND AUTONOMY ARRIVE PROMPTLY TO APPOINTMENTS AND DRESS ACCORDING TO RESIDENCY RULES WORK AS A TEAM PLAYER RESPECTING ALL OF THE HEALTHCARE TEAM WHO ARE IN THE SYSTEM (IT PERSONNEL, PHYSICIANS, NURSES, ADMINISTRATORS, AND OTHERS) THAT IS BEING ALTERED TO IMPROVE PATIENT OUTCOMES 6. RESPECT AND FOLLOW ALL RULES AND REGULATIONS ABOUT PATIENT CONFIDENTIALITY, INCLUDING FEDERAL HIPPA REGULATIONS, HOSPITAL PATIENT SAFETY RULES, OSHA STANDARDS, AND THE UAMS POLICIES AND PROCEDURE MANUEL INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. INTERPERSONAL AND COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH IT PERSONNEL, PHYSICIANS, NURSES, ADMINISTRATORS, AND ALL OTHER HEALTHCARE RELATED PERSONNEL WHO ARE INVOLVED IN THE RESEARCH, SET UP AND IMPLEMENTATION OF THE PERFORMANCE IMPROVEMENT PROJECT 2. PRESENT FINDINGS TO FACULTY AND STAFF OF AHEC SW IN A CLEAR AND CONCISE MANNER AT A JOURNAL CLUB CONFERENCE TEACHING METHODS ONE ON ONE TEACHING QUALITY ASSURANCE OFFICER OF THE HOSPITAL AND WITH THE ATTENDING FACULTY ADVISOR ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EMERGENCY MEDICINE 3RD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THIRD YEAR RESIDENTS WILL SPEND ONE MONTH ON THE EMERGENCY MEDICINE SERVICE. THIS MAY BE DONE AT ONE OF THE TWO EMERGENCY DEPARTMENTS IN THE HOSPITALS IN TEXARKANA OR AT OUT OF TOWN IN AN EMERGENCY ROOM AT THE DISCRETION OF THE PROGRAM DIRECTOR. THE RESIDENT WILL SPEND NO FEWER THAN 100 HOURS WORKING UNDER THE 108 SUPERVISION OF THE EMERGENCY ROOM PHYSICIAN ON DUTY DURING THE MONTH. THE RESIDENT IS TO STAY IN COMPLIANCE WITH DUTY HOUR RULES DURING THIS ROTATION. THE THIRD YEAR RESIDENT IS ENCOURAGED TO DO DAYTIME AND SOME THE THIRD YEAR RESIDENT WILL BE EXPECTED TO SEE PATIENTS INDEPENDENTLY AND PRESENT THE ASSESSMENT AND PLAN TO THE EMERGENCY ROOM PHYSICIAN. THE CASE WILL BE DISCUSSED AT DISPOSITION OR IF THE THIRD YEAR RESIDENT HAS ANY QUESTIONS. THE EMERGENCY ROOM PHYSICIAN MAY ALSO INTERVIEW THE PATIENT. THE THIRD YEAR RESIDENT IS TO DIRECT ALL CARDIAC CODES, RESPIRATORY FAILURES REQUIRING INTUBATION, AND TRAUMA CODES THAT OCCUR IN THE DEPARTMENT WHILE ON DUTY. NIGHTTIME SHIFTS. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. CARDIOVASCULAR EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE CARDIOVASCULAR SYSTEM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE CARDIOVASCULAR WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN, WHETHER THE PATIENT BE TREATED AS AN OUTPATIENT OR ADMITTED TO THE ACUTE CARE HOSPITAL 7. BE COMPETENT AT ADVANCED CARDIAC LIFE SUPPORT , ABLE TO CONDUCT A CARDIOVASCULAR CODE, AND OBTAIN CENTRAL LINE AND CHEST TUBE PLACEMENT EXPERIENCE TRAUMA EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION FOR A TRAUMA VICTIM, AS OUTLINED BY THE AMERICAN COLLEGE OF SURGEONS’ PUBLICATIONS ADVANCE TRAUMA LIFE SUPPORT 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE TRAUMA WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. 7. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WORKING WITH CONSULTANTS INCLUDING APPROPRIATE LEVEL OF CARE IN HOSPITAL BE COMPETENT AT ADVANCED TRAUMA LIFE SUPPORT AND ABLE TO CONDUCT A TRAUMA CODE CEREBRAL ARTERIAL INSUFFICIENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE NEUROLOGICAL EXAMINATION 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY, INCLUDING POSSIBILITY OF THE USE OF THROMBLYTIC AGENTS 6. COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. 109 BE COMPETENT AT NEUROLOGICAL PROCEDURES INCLUDING LUMBAR PUNCTURE RESPIRATORY FAILURE OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE PULMONARY SYSTEM 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE PULMONARY WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. 7. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN INCLUDING APPROPRIATE LEVEL OF CARE IN HOSPITAL BE COMPETENT AT PULMONARY EMERGENT PROCEDURES SUCH AS ENDOTRACHEAL OR CHEST TUBE PLACEMENT SPINAL CORD INJURY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE POSSIBILITY OF A SPINAL CORD INJURY 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. 7. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BE COMPETENT AT SPINAL CORD STABILIZATION AND IMMOBILIZATION PROCEDURES ABDOMINAL PAIN OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE ABDOMINAL EXAM 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT ABDOMINAL PROCEDURES INCLUDING ABDOMINAL PARACENTESIS, PELVIC EXAM, AND ANOSCOPY GASTROENTESTINAL HEMORRHAGE OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE ABDOMINAL EXAM 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT FLUID RESUSCITATION AND CARDIOVASCULAR STABILIZATION OF THE HYPOVOLEMIC PATIENT OBSTETRICAL/GYNECOLOGICAL OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 110 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE COMPLETE GYNECOLOGICAL EXAMINATION 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT OBSTETRICAL/GYNECOLOGICAL PROCEDURES SUCH AS PELVIC EXAM, OBTAINING FETAL HEART TONES, STABILIZATION OF MASSIVE ENDOMETRIAL HEMORRHAGE OPHTHALMOLOGICAL/OTOLARYNGOLOGICAL OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL EXAMINATION 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL PROCEDURES SUCH AS SLIT LAMP EXAMINATIONS, LARYNGOSCOPY, ANTERIOR NASAL PACKING, AND EXAMINATION FOR CORNEAL ABRASIONS ENVIRONMENTAL/TOXICOLOGY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION WITH ATTENTION DIRECTED TOWARD THE ENVIRONMENTAL AND TOXICOLOGY CAUSES OF SYMPTOMATOLOGY 3. 4. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT DIAGNOSING AND TREATMENT OF COMMON TOXICOLOGY SYNDROMES PEDIATRIC EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT PEDIATRIC PROCEDURES SUCH AS IV ACCESS, LUMBAR PUNCTURE, AND PASSED PEDIATRIC ADVANCED LIFE SUPPORT 111 COURSE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. READ THE ASSIGNED MATERIAL DESIGNATED FOR THE COURSE (SEE EDUCATIONAL RESOURCES BELOW) 2. READ UP ON THE PROBLEMS THAT PATIENTS HAVE AS THEY PRESENT TO THE EMERGENCY DEPARTMENT 3. BE READY TO DISCUSS THE ASSESSMENT AND PLAN FOR PATIENTS WHO PRESENT TO THE EMERGENCY DEPARTMENT TO THE ATTENDING PHYSICIAN PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. PARTICIPATE IN THE EDUCATION OF PATIENTS AND THEIR FAMILIES ABOUT THEIR CLINICAL COURSE IN THE PRENATAL CLINIC AND IN THE EMERGENCY DEPARTMENT IN ORDER THAT PATIENTS WILL BE ABLE TO MAKE INFORMED DECISIONS REGARDING THEIR CARE AND BE MORE COMPLIANT WITH TREATMENT PLANS 2. IDENTIFY WEAKNESSES WITH FEEDBACK FROM ATTENDING PHYSICIAN AND THEN UTILIZE THIS INFORMATION TO IMPROVE THEIR CARE OF PATIENTS 3. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING BY BEING ABLE TO MASTER THE ELECTRONIC MEDICAL RECORD OF THE HOSPITAL IN OBTAINING INFORMATION ON PATIENTS AND LOOKING UP AND LEARNING INFORMATION ABOUT OBSTETRICS ON THE UAMS LIBRARY DATABASE WEB SITE SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 1. WORK INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY a. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE EMERGENCY DEPARTMENT CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE b. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY 2. PARTICIPATE IN IDENTIFYING SYSTEM ERRORS & IN IMPLEMENTING POTENTIAL SYSTEM SOLUTION BY a. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE EMERGENCY DEPARTMENT TEAM FOR PATIENT SAFETY AND b. UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM EMERGENCY DEPARTMENT PROCEDURES 112 INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN ON THE EMERGENCY DEPARTMENT BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER DELIVERING OBSTETRICAL CARE ON THE EMERGENCY DEPARTMENT UNIT 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE ON THE EMERGENCY DEPARTMENT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE OBSTETRICAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSE-PRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES EMERGENCY MEDICINE: A COMPREHENSIVE STUDY GUIDE, 5TH EDITION CLINI, DAVID; MA, JOHN; TINTINALLI, JUDITH; KELEN, GABOR; STAPCZYNSKI, STEPHAN. AMONG THE MANY SOURCES AVAILABLE FOR THE RESIDENTS FOR ANSWERING CLINICAL QUESTIONS, THE UP-TO-DATE RESOURCE FOUND ON THE UAMS LIBRARY DATABASE RESOURCE PAGE WILL BE EXTENSIVELY UTILIZED. HTTP://WWW.UTDOL.COM/UTD/CONTENT/SEARCH.DO 113 ELECTIVES ANESTHESIA PROCEDURES RURAL FAMILY MEDICINE RHEUMATOLOGY HOSPITAL MEDICINE REHABILITATIVE MEDICINE WOUND CARE CARE OF THE ELDERLY MEDICAL MISSIONS PEDIATRIC EMERGENCY MEDICINE GASTROENTEROLOGY FAMILY MEDICINE PRACTICE SITE EVALUATION ADVANCED MATERNAL CARE COLPOSCOPY 114 ANESTHESIA – UPPER LEVEL ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT IS ASSIGNED TO AN ANESTHESIOLOGIST FOR THIS MONTH-LONG ROTATION. THE RESIDENT MEETS THE ATTENDING EACH MORNING IN THE OPERATING ROOM DEPARTMENT. THE RESIDENT WILL PERFORM CENTRAL LINE PLACEMENT, ARTERIAL LINE PLACEMENT, LUMBAR PUNCTURES FOR REGIONAL ANESTHESIA, AND ENDO- OR NASAL-TRACHEAL INTUBATION UNDER THE DIRECT SUPERVISION OF THE ANESTHESIOLOGIST. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DEVELOP AIRWAY MANAGEMENT SKILLS 2. DEMONSTRATE SAFE AND EFFECTIVE LUMBAR PUNCTURE TECHNIQUES 3. BECOME COMPETENT IN ENDOTRACHEAL INTUBATION 4. PLACE CENTRAL VENOUS AND ARTERIAL LINES SAFELY 5. QUICKLY IDENTIFY AN OBSTRUCTED AIRWAY 6. RECOGNIZE COMPLICATIONS OF GENERAL ANESTHESIA MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE RESIDENT WILL 1. DEMONSTRATE KNOWLEDGE OF THE UPPER AIRWAY 2. CORRECTLY UTILIZE THE BAG-VALVE-MASK DEVICE 3. STATE INDICATIONS AND CONTRAINDICATION FOR INHALATION ANESTHETIC AGENTS, INTRAVENOUS ANALGESICS, AND NEUROMUSCULAR BLOCKING AGENTS 4. 5. BE FAMILIAR WITH REGIONAL ANESTHETIC AGENTS, INCLUDING INDICATIONS AND ADVERSE EFFECTS COMPETENTLY UTILIZE STANDARD MONITORING TECHNIQUES TO EVALUATE VITAL SIGNS, LEVEL OF SEDATION AND PAIN CONTROL 6. IDENTIFY RISK FACTORS THAT MAY COMPLICATE THE PATIENT’S ANESTHESIA CARE PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SELF EVALUATE PERFORMANCE AFTER PROCEDURES 2. ASK FOR FEEDBACK FROM ANESTHESIOLOGIST REGARDING PROCEDURE PERFORMANCE 115 SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WORK IN INTERPROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND PATIENT CARE QUALITY 2. BE ABLE TO RECOGNIZE HOW THE MICRO-SYSTEMS IN THE OR INTERACT TO PROTECT THE PATIENT INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ANESTHESIOLOGIST BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE IN THE OR PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE OBSTETRICAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSE-PRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. 116 RURAL FAMILY MEDICINE -ELECTIVE UPPER-LEVEL RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE PGY 3 RESIDENT WILL HAVE THE OPPORTUNITY TO WORK WITH A FAMILY PHYSICIAN IN A DESIGNATED RURAL LOCATION IN TEXAS. THESE DESIGNATED RURAL COMMUNITIES ARE IN TOWNS WITH A POPULATION USUALLY LESS THAN 8,000 AND IN A COUNTY NOTED BY THE TEXAS STATE HEALTH DEPARTMENT TO BE SHORT OF PRIMARY CARE PHYSICIANS. THE RESIDENT WILL RECEIVE A STIPEND FROM THE STATE OF TEXAS AND STAY IN THAT COUNTY’S HOSPITAL. THEY WILL WORK WITH A FAMILY PHYSICIAN IN THAT COUNTY LEARNING HOW TO PRACTICE EFFICIENT AND HIGH QUALITY FAMILY MEDICINE WITH THE LIMITED RESOURCES THAT ARE CHARACTERISTIC OF SUCH RURAL FAMILY MEDICINE PRACTICE SITES. THE RESIDENT WILL CONTINUE A CONTINUITY CARE CLINIC IN THE RESIDENCY’S FAMILY MEDICINE CENTER AT LEAST ONE FULL DAY PER WEEK, USUALLY ON A MONDAY OR FRIDAY IN ORDER THAT THE ROTATION IS NOT COMPROMISED BY INORDINATE TRAVEL. EXCEPTIONS ARE MADE IF THE RURAL PRACTICE SITE IS GREATER THAN 100 MILES FROM TEXARKANA, TEXAS. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. LEARN THE COMMON DISEASE STATES SEEN IN RURAL PRACTICES 2. BECOME FAMILIAR WITH THE DIAGNOSTIC AND THERAPEUTIC APPROACH TO PATIENTS THAT A PHYSICIAN HAS TO UTILIZE IN A RURAL PRACTICE 3. UNDERSTAND WHAT MEDICAL PROBLEMS CAN BE HANDLED IN A RURAL SETTING AND WHAT NEEDS TO BE TRANSFERRED TO A NON-RURAL SETTING MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. DEVELOP A SOUND FUNDAMENTAL KNOWLEDGE OF AMBULATORY MEDICINE 2. UNDERSTAND WHAT CAN BE DONE IN AN AREA WHERE MEDICAL RESOURCES ARE LIMITED 3. HAVE A STRONG BASE OF COMPREHENSION OF THE PREVENTATIVE MEDICINE TOOLS THAT SHOULD BE UTILIZED IN AN AMBULATORY MEDICAL PRACTICE PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO SET UP SYSTEMS TO REVIEW THE OUTCOMES OF CERTAIN DIAGNOSES IN A RURAL PRACTICE SETTING 117 2. UNDERSTAND WHAT INTERVENTIONS CAN BE DONE IN A RURAL PRACTICE SETTING TO IMPROVE OUTCOMES OF THE MOST COMMON MEDICAL PROBLEMS SEEN 3. WORK WITH THE LOCAL RURAL HOSPITAL IN DEVELOPING AND EXPANDING A PERFORMANCE IMPROVEMENT PROGRAM THAT WILL BE COMPLIANT WITH JACHO SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO DESCRIBE THE SYSTEMS IN PLACE IN A RURAL HOSPITAL SETTING TO PROTECT PATIENTS FROM MEDICAL ERRORS 2. LEARN WHAT RESOURCES ARE AVAILABLE FOR PATIENT CARE IN THE WAY OF ANCILLARY SERVICES AND WHAT RESOURCES HAVE TO BE UTILIZED FROM OUTSIDE OF THAT PARTICULAR RURAL SETTING 3. ABLE TO FORM RELATIONSHIPS WITH OUTSIDE REFERRAL CENTERS TO HELP PATIENTS OBTAIN ALL SERVICES REQUIRED INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMPREHEND THE IMPORTANCE OF HAVING OPEN LINES OF COMMUNICATION BETWEEN THE RURAL HOSPITAL, LOCAL PHYSICIANS, OUT-OF-TOWN CONSULTANTS, AND LOCAL RURAL AUTHORITIES 2. WORK WITH IN MAKING SURE THAT THEY UNDERSTAND THEIR MEDICAL PROBLEMS, TREATMENT PLAN, AND WHAT TO DO IF COMPLICATIONS ARISE 3. COMMUNICATE EFFECTIVELY WITH THE HOSPITAL PATIENT CARE TAKERS IN KNOWING WHAT TO DO WHEN PROBLEMS ARISE SO THAT QUICK AND ERROR-FREE TRANSPORT TO LARGER HOSPITALS PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE RURAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. 118 ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. RHEUMATOLOGY GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL SPEND 2 – 4 WEEKS WITH A RHEUMATOLOGIST IN AN OUTPATIENT SETTING. THE RESIDENT WILL EVALUATE PATIENTS WITH RHEUMATOLOGICAL ILLNESSES. THE RESIDENT WILL LEARN THE WORK UP OF PATIENTS WITH ARTHRALGIAS AND COLLAGEN VASCULAR DISEASES. IN THAT SETTING, THE RESIDENT WILL SEE WHAT PHARMACOLOGICAL AND NON-PHARMACOLOGICAL MODALITIES ARE AVAILABLE TO PATIENTS WITH COLLAGEN VASCULAR PROBLEMS. THE RESIDENT WILL CONTINUE THEIR NORMAL CONTINUITY OF CARE CLINIC SCHEDULES. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO DIAGNOSE PATIENTS WHO HAVE ARTHRALGIAS AND OTHER RHEUMATOLOGICAL PROBLEMS 2. WRITE DOWN THE WORK UP OF PATIENTS WITH ARTHRALGIAS AND OTHER RHEUMATOLOGICAL PROBLEMS 3. KNOW THE BASIC TREATMENT MODALITIES AND THE MOST COMMON SIDE EFFECTS OF THE PHARMACOLOGICAL AGENTS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. KNOW THE PATHOPHYSIOLOGY THAT OCCURS WITH COLLAGEN VASCULAR DISEASES 2. UNDERSTAND HOW THE TREATMENT MODALITIES IMPACT THE PATHOPHYSIOLOGY OF RHEUMATOLOGICAL PROBLEMS 3. LEARN THE LONG TERM TREATMENT STRATEGIES FOR A PATIENT WITH A LIFE-LONG RHEUMATOLOGICAL ILLNESS 4. BE ABLE TO DISCUSS THE LABORATORY WORK UP FOR A PATIENT SUSPECTED OF HAVING A RHEUMATOLOGICAL ILLNESS 5. OUTLINE THE LONG TERM COMPLICATIONS WITH RHEUMATOID ARTHRITIS, LUPUS, POLYMYALGA RHEUMATICA, AND OTHER COLLAGEN VASCULAR DISEASES PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. 119 PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO EVALUATE THE EFFECTIVENESS OF ANY GIVEN TREATMENT PLAN AFTER IT’S IMPLEMENTATION 2. FOLLOW OUTCOMES OF TREATMENT AND BE ABLE TO COMPARE THEM THE STANDARDS ALREADY SET SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DESCRIBE HOW AN EFFECTIVE PRIMARY CARE – RHEUMATOLOGIST WORKING RELATIONSHIP WOULD WORK BEST FOR THE PATIENT 2. DISCUSS MECHANISMS TO INCREASE PATIENT SAFETY, ESPECIALLY GIVEN THE SHORT TERM AND LONG TERM COMPLICATIONS OF MAY OF THE MEDICATIONS UTILIZED FOR COLLAGEN VASCULAR DISEASES INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH PATIENTS TO MAKE SURE THAT THEY UNDERSTAND THEIR DISEASE PROCESS, KNOW HOW TO TAKE THEIR MEDICATION, AND KNOW WHAT TO DO IF AN EMERGENCY ARISES 2. HAVE PRODUCTIVE COMMUNICATION BETWEEN THE CONSULTANT AND THE PRIMARY CARE PROVIDER. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE RURAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. 120 EDUCATIONAL RESOURCES OXFORD TEXTBOOK OF RHEUMATOLOGY, 3RD EDITION HOSPTIAL MEDICINE UPPER LEVEL RESIDENT GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL WORK WITH THE HOSPITALIST TEAM AT ONE OF THE TWO TEACHING HOSPITALS. THEY WILL WORK AS AN INDEPENDENT TEAM MEMBER TAKING ADMISSIONS AS ANOTHER HOSPITALIST PHYSICIAN WOULD. THEY WILL BE EXEMPT FROM AHEC CALL AS THEY WILL TAKE CALL WITH THE HOSPITALIST TEAM. SUPERVISION WILL BE DONE BY ONE OF THE HOSPITALIST TEAM MEMBER PHYSICIANS WHO WILL WRITE NOTES ON EACH PATIENT DAILY AND FILL OUT AN END OF THE MONTH EVALUATION. THE RESIDENT WILL STILL SEE THEIR CONTINUITY OF CARE CLINIC PATIENT PANEL DURING THIS ROTATION. GOALS 1. PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH 2. 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 3. 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 4. 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 5. PROFESSIONALISM, AS MANIFESTED THROUGH A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION 6. INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND OTHER HEALTH PROFESSIONALS OBJECTIVES ADMISSION SKILLS PATIENT CARE OBJECTIVES: THE UPPER RESIDENT WILL 1. PERFORM AND DICTATE THE COMPONENTS OF AN H&P AT THE TIME OF ADMISSION 2. OBTAIN A COMPLETE HISTORY OR PRESENT ILLNESS 3. COLLECT PERTINENT PSYCHOSOCIAL INFORMATION 4. RECORD ELEMENTS OF THE PMH, SH, AND FH 5. SYSTEMATICALLY REVIEW THE 13 ORGAN REVIEW OF SYSTEMS 6. PUT A DETAILED MEDICATION LIST IN THE CHART 7. DOCUMENT A COMPREHENSIVE EXAMINATION COMPLETE WITH VITAL SIGNS AND RECTAL EXAM 8. DOCUMENT ALL LABORATORY AND IMAGING STUDIES 9. BE ABLE TO DISCUSS THE PRINCIPLE DIAGNOSIS AND THE REASON FOR ADMISSION 10. SUBSTANTIATE ALL PATIENT PROBLEMS IN THE ASSESSMENT 11. RECORD TREATMENT PLAN 121 12. DOCUMENT PERTINENT HISTORY AND PHYSICAL FINDINGS WITH A LEGIBLE ADMISSION NOTE 13. DICTATE COMPLETE H&P AT THE TIME OF ADMISSION 14. COMPLETE APPROPRIATE ORDERS IN A REASONABLE TIME MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SELECT CORRECT ORDER SET FOR ADMISSION DIAGNOSIS 2. REVIEW MEDICAL DIAGNOSTIC WORK UP AND TREATMENT PLAN ON EACH PATIENT BEFORE MORNING REPORT PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CLEARLY STATE TO THE ATTENDING WHAT HE/SHE DOES NOT KNOW SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CHECK TO MAKE SURE PATIENT IS ASSIGNED TO THE HOSPITAL WARD WHOSE NURSING STAFF CAN DELIVERY THE MOST APPROPRIATE LEVEL OF CARE 2. 3. REVIEW ALL HOME MEDICATIONS AND RENEW AS APPROPRIATE FOR PATIENT’S ADMISSION NEEDS WORK WITH THE CASE MANAGER WITH THE GOAL OF GETTING THE PATIENT THE MOST TIME-EFFICIENT, COST-EFFICIENT, AND SAFEST CARE FOR THE PROBLEMS THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL FOR PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL: 1. ATTEND TO THE PATIENT IN THE EMERGENCY ROOM FOR ADMISSION AS SOON AS POSSIBLE AFTER CALLED BY THE FIRST YEAR RESIDENT 2. 3. BE APPROPRIATELY AND PROFESSIONALLY ATTIRED COMMUNICATE IN A PROFESSIONAL MANNER WITH THE ER PHYSICIANS, NURSES, AND STAFF FOLLOW ALL HIPPA REGULATIONS IN REGARD TO THE CARE OF THE PATIENT 4. 5. 6. INTRODUCE YOURSELF TO THE PATIENT AND FAMILY SHOWING RESPECT AND COMPASSION CALL ALL CONSULTANTS AND EXPLAIN EITHER VIA PHONE OR IN PERSON PATIENT’S CLINICAL COURSE AND WHY THE REFERRAL IS BEING MADE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WRITE AN ACCURATE ADMISSION NOTE 2. REVIEW ORDERS WRITTEN 3. COMMUNICATE WITH THE FAMILY AND PATIENT THE DIAGNOSES, THE NEED FOR ADMISSION, AND THE TREATMENT PLAN 4. BE PRESENT DURING MORNING REPORT TO INSURE THE PATIENT IS PRESENTED ACCURATELY AND BE READY TO DEFEND CARE ADMINISTERED DAILY ROUNDING SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INTERVIEW AND EXAMINE THE PATIENT DAILY 2. KNOW ALL THE PERTINENT INFORMATION REGARDING THE CARE OF THE ASSIGNED PATIENT 3. CREATE SOAP NOTE WITH COMPLETE AND ACCURATE ASSESSMENT AND PLAN 4. ANTICIPATE AND DISCUSS POTENTIAL COMPLICATIONS OF A PATIENT’S TREATMENT PLAN 5. REVIEW PATIENT LIST AND DISCUSS CLINICAL DECISIONS MADE ON A DAILY BASIS MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. READ DAILY ON THE DISEASE PROCESSES AND TREATMENT OPTIONS ON THE INPATIENTS 122 2. BE ABLE TO DISCUSS THE PATHOPHYSIOLOGY, RISK FACTORS, SIGNS, SYMPTOMS, DIFFERENTIAL DIAGNOSIS, APPROPRIATE DIAGNOSTIC WORK UP, TREATMENT PLAN, AND PREVENTATIVE STRATEGIES FOR THE TOP TEN DIAGNOSES: I. II. III. IV. V. VI. VII. VIII. IX. X. 3. 4. COPD CHEST PAIN PNEUMONIA CONGESTIVE HEART FAILURE ATRIAL FIBRILLATION STROKE TIA SYNCOPE PANCREATITIS GASTROENTESTINAL HEMORRHAGE PREPARE FOR ASSIGNED PRESENTATIONS IN MORNING REPORT PARTICIPATE IN DISCUSSIONS IN MORNING REPORT WITH THE ATTENDING AND OTHER RESIDENTS AND STUDENTS ON THE HEALTHCARE TEAM 5. BE PREPARED TO EXPLAIN AND DEFEND THE RATIONALE BEHIND YOUR ASSESSMENT AND TREATMENT PLAN TO THE ATTENDING FACULTY MEMBER DURING ROUNDS PRACTICE-BASED LEARNING AND IMPROVEMENT: THE UPPER LEVEL RESIDENT WILL 1. REVIEW PATIENT’S CLINICAL HOSPITAL COURSE DAILY WITH THE ATTENDING IN ORDER TO MAKE IMPROVEMENTS IN PATIENT SAFETY AND UTILIZATION OF RESOURCES 2. ASSIST OR COORDINATE EFFORTS TO PERFORM “ROOT CAUSE ANALYSIS” STUDIES ON EVENS THAT OCCUR THAT OR UNEXPECTED OR CAUSE ADDITIONAL MORBIDITY OR MORTALITY TO PATIENT DURING THE HOSPITALIZATION 3. DISCUSS QUALITY IMPROVEMENT CASES WITH THE VICE-PRESIDENT OF PATIENT AFFAIRS DURING THE MORNING REPORT EACH FRIDAY SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. ROUND DAILY WITH THE CASE MANAGER AND DISCUSS THE CLINICAL HOSPITAL COURSE OF THE PATIENT PLANS FOR DISCHARGE AND PLACEMENT, DURABLE MEDICAL EQUIPMENT NEEDED AT DISCHARGE AND PLAN HOW THE PATIENT WILL OBTAIN MEDICATIONS UPON DISCHARGE 2. UTILIZE THE HOSPITAL CASE MANAGER TO OBTAIN THE GOAL OF DELIVERING EFFICIENT AND WELL-DOCUMENTED MEDICAL CARE 3. 4. DEMONSTRATE HOW TO FIND MEDICAL ANSWERS IN LESS THAN TWO MINUTES USING HANDHELD ANTICIPATE AND AVOID POTENTIAL COMPLICATIONS OF HOSPITALIZATION SUCH AS DELIRIUM, NOSOCOMIAL INFECTION, OR DEEP VEIN THROMBOSIS/PULMONARY EMBOLUS 5. WORK WITH THE CLINICAL PHARMACIST ON ROUNDS TO MAKE SURE THAT THE MOST APPROPRIATE AND COST EFFICIENT MEDICATIONS ARE USED AND ADVERSE DRUG REACTIONS OR DRUG-DRUG INTERACTIONS ARE AVOIDED PROFESSIONALISM OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. TREAT THE PATIENT WITH THE UTMOST RESPECT AND COURTESY 2. WORK WITH THE NURSES ON THE FLOOR TO DELIVER THE BEST AND MOST EFFICIENT PATIENT CARE POSSIBLE 3. COMMUNICATE IN PERSON AND IN CHART THE CURRENT ASSESSMENT AND TREATMENT PLAN GOALS FOR ALL OTHER HEALTH CARE TEAM MEMBERS 4. 5. 123 BE AT MORNING REPORT AND ROUNDS PREPARED AND ON TIME EACH DAY SIGN OUT TO THE ON-CALL TEAM IN THE EVENING INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. CALL AND ACCURATELY DESCRIBE THE PATIENT’S CLINICAL COURSE AND THE REASON FOR CONSULTATION TO THE CONSULTANT PHYSICIAN 2. 3. 4. 5. 6. 7. ASSIST THE FIRST YEAR RESIDENT IN COMMUNICATING WITH CONSULTANT ON REFERRALS WRITE LEGIBLY SO ALL CARETAKERS CAN EASILY READ WRITE ORDERS THAT ARE CLEAR AND EASILY UNDERSTOOD KEEP PATIENT AND FAMILY INFORMED OF THE LATEST DEVELOPMENTS AS THEY UNFOLD EXPLAIN TO THE PATIENT AND FAMILY THE GOALS OF THE DAY’S TREATMENT PRESENT THE PATIENT’S ASSESSMENT AND PLAN ON ROUNDS TO THE ATTENDING FACULTY MEMBER DISCHARGE SKILLS PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RECOGNIZE AT WHAT POINT THE PATIENT CAN SAFELY BE DISCHARGED 2. DISCUSS WITH THE ATTENDING PHYSICIAN THE RATIONALE FOR DISCHARGE, ASSESSMENT, AND POST-DISCHARGE PLAN 3. WRITE DISCHARGE ORDERS THAT ARE COMPLETE AND LEGIBLE NO LATER THAN EARLY AFTER NOON ON THE DAY OF DISCHARGE 4. DICTATE A DISCHARGE SUMMARY WITH ALL OF THE REQUIRED COMPONENTS INCLUDED AND THAT CAN BE USED AS A REFERENCE FOR ANY SUBSEQUENT TREATING PHYSICIANS 5. COMPLETE DISCHARGE MEDICATION LIST MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. SUMMARIZE THE HOSPITAL COURSE, WHAT DIAGNOSES WERE PRESENT, WHAT TREATMENT PLANS WERE FOLLOWED, ALTERNATIVE TREATMENT PLANS THAT COULD HAVE BEEN UTILIZED, AND APPROPRIATE HOSPITAL FOLLOW UP 2. DISCUSS THE RATIONALE FOR THE TREATMENT RENDERED AND WHAT ISSUES NEED TO BE ADDRESSED AT FOLLOW UP OUTPATIENT VISITS PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. PRESENT AT MONTHLY QUALITY IMPROVEMENT CONFERENCES ON THE FIRST TUESDAY OF THE NEXT MONTH ANY CASE THAT HAD UNEXPECTED COMPLICATIONS, UNDESIRED OUTCOME, OR PATIENT SAFETY ISSUES THAT MIGHT HAVE OCCURRED AND BE READY TO DISCUSS METHODS THAT COULD HAVE PREVENTED THESE UNDESIRED OUTCOMES, COMPLICATIONS, OR PATIENT AT RISK EVENTS SYSTEMS BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WORK WITH THE CASE MANAGER TO INSURE AT DISCHARGE THAT THE PATIENT HAS APPROPRIATE PLACEMENT, NEEDED DURABLE MEDICAL EQUIPMENT, ACCESS TO PRESCRIBED MEDICATIONS AND FOLLOW UP WITH THE PRIMARY CARE PROVIDER 2. NOTIFY PRIMARY CARE PROVIDER OF PATIENT NEEDS AT THE NEXT POST-HOSPITALIZATION FOLLOW UP VISIT PROFESSIONALISM: THE UPPER LEVEL RESIDENT WILL 1. BE PRESENT AT DISCHARGE TO BE ABLE TO CLEARLY COMMUNICATE TO PATIENT AND FAMILY THE SUMMARY OF THE HOSPITALIZATION, DISCHARGE PLANS, AND FOLLOW UP 2. SUPERVISE FIRST YEAR RESIDENT IN COMMUNICATION WITH THE FAMILY AND PATIENT AT DISCHARGE 3. COMMUNICATE TO NURSES THE DISCHARGE ORDERS 4. BE SENSITIVE TO POSSIBLE PATIENT, FAMILY, AND NURSING HOME TIME CONSTRAINTS REGARDING A PROMPT AND EARLY DISCHARGE INTERPERSONAL AND COMMUNICATION OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. INFORM NURSING STAFF OF DISCHARGE 124 2. 3. 4. CLEARLY COMMUNICATE TO PATIENT AND FAMILY DISCHARGE INSTRUCTIONS DISCUSS WITH THE ATTENDING PHYSICIAN THE DISCHARGE PLANS EXPLAIN TO THE PATIENT AND FAMILY THE DIAGNOSES, MEANING OF TESTS UP TO DATE, NEEDS FOR FURTHER TESTING, RATIONALE BEHIND CURRENT TREATMENT PLAN TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES CECIL’S TEXTBOOK OF INTERNAL MEDICINE WASHINGON’S MANUAL TARASCON POCKET PHARMACOPOEIA AND POCKET CRITICAL CARE SANFORD’S GUIDE TO ANTIMICROBIAL THERAPY, LATEST EDITION UAMS LIBRARY ONLINE ELECTRONIC DATA BASE WITH UP TO DATE AND OTHERS ACLS EDUCATIONAL MATERIAL REHABILITATIVE MEDICINE UPPER LEVEL RESIDENT ELECTIVE GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL ROTATE WITH A LOCAL PHYSIATRIST AT ONE OF THE TWO LOCAL REHABILITATIVE HOSPITALS. THE RESIDENT WILL CONTINUE THE USUAL CONTINUITY OF CARE CLINIC AT THE FAMILY MEDICINE CENTER’S CLINIC. THE RESIDENT WILL ROUND WITH THE PHYSIATRIST AND LEARN THE PRINCIPLES OF REHABILITATION MEDICINE. THE RESIDENT ALSO WILL WORK IN THE FIELDS OF REHABILITATIVE MEDICINE. THE RESIDENT WILL WORK WITH OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS, SPEECH THERAPISTS, AND REHAB HOSPITAL CASE MANAGERS. PATIENT CARE GOAL RESIDENTS MUST DEMONSTRATE CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. 125 PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DISCUSS THE APPROPRIATE TYPE OF PATIENTS THAT WOULD MAKE THE BEST CANDIDATES FOR INPATIENT REHAB 2. LEARN THE PRINCIPLES OF SPEECH, OCCUPATIONAL, AND SPEECH THERAPY 3. BE ABLE TO OUTLINE THE REHAB THERAPY GOALS AND TREATMENT FOR POST-STROKE AND JOINT REPLACEMENT PATIENTS MEDICAL KNOWLEDGE GOAL THE RESIDENT MUST CONTINUALLY SEEK TO LEARN ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. UNDERSTAND PHARMACOLOGICAL PRINCIPLES IN THE REHABILITATING PATIENT 2. BE ABLE TO DISCUSS THE PHILOSOPHY OF REHABILITATIVE MEDICINE AND HOW IT RELATES TO THE FUNCTIONAL STATUS OF PATIENTS PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. REVIEW NEW KNOWLEDGE OF REHABILITATIVE MEDICINE AND EVALUATE OWN’S PRACTICE AND HOW REHABILITATIVE MEDICINE IS UTILIZED SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DESCRIBE HOW AN EFFECTIVE PRIMARY CARE – PHYSIATRIST WORKING RELATIONSHIP WOULD WORK BEST FOR THE PATIENT 2. DISCUSS MECHANISMS TO INCREASE PATIENT SAFETY, ESPECIALLY GIVEN THE SHORT TERM AND LONG TERM COMPLICATIONS OF MAY OF THE MEDICATIONS UTILIZED FOR COLLAGEN VASCULAR DISEASES INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH PATIENTS TO MAKE SURE THAT THEY UNDERSTAND THEIR INCREASE FUNCTION AND INCREASE THEIR INDEPENDENCE AND MENTAL WELL BEING 126 REHABILITATION IS TO 2. HAVE PRODUCTIVE COMMUNICATION BETWEEN THE PHYSIATRIST AND THE PRIMARY CARE PROVIDER. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE RURAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES ESSENTIAL PHYSICAL MEDICINE AND REHABILITATION, GRANT COOPER, MD WOUND CARE UPPER LEVEL RESIDENT ELECTIVE GOALS AND OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL WORK IN THE HYPERBARIC OXYGEN UNIT AT WADLEY REGIONAL MEDICAL CENTER. THERE THE RESIDENT WILL LEARN THE INDICATIONS AND HOW TO IMPLEMENT HYPERBARIC OXYGEN THERAPY. THE RESIDENT WILL ALSO WORK WITH THE ATTENDING PHYSICIAN ON ANY WOUND CARE CONSULTATIONS THAT ARE RECEIVED THAT MONTH. THE RESIDENT WILL WORK WITH THE HOSPITAL’S WOUND CARE TEAM, ALSO. THIS WILL ENTAIL EVALUATING PATIENTS IN ALL HEALTH 127 CARE SETTINGS AND MAKING RECOMMENDATIONS FOR SUBSEQUENT TREATMENT FOR HEALING OF SKIN BREAKDOWN. THE UPPER LEVEL RESIDENT WILL ALSO CONTINUE SEEING PATIENTS AT THE RESIDENCY CONTINUITY OF CARE CLINIC. PATIENT CARE GOAL RESIDENTS MUST DEMONSTRATE CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. LEARN THE PRINCIPLES OF WOUND CARE 2. UNDERSTAND THE FACTORS THAT HAVE TO BE REVERSED TO HEAL WOUNDS 3. BE ABLE TO MAKE RECOMMENDATIONS FOR HEALING OF WOUNDS 4. DIAGNOSE CAUSES FOR SKIN BREAKDOWN 5. RECOGNIZE PATIENTS AT RISK FOR SKIN BREAKDOWN MEDICAL KNOWLEDGE GOAL THE RESIDENT MUST CONTINUALLY SEEK TO LEARN ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO PRESENT THE CAUSES AND PREVENTION OF SKIN BREAKDOWN 2. UNDERSTAND THE PATHOPHYSIOLOGY OF SKIN BREAKDOWN 3. DESCRIBE THE PRINCIPLES OF WOUND CARE PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RE-EVALUATE PATIENTS FOLLOWED IN CONTINUITY OF CARE CLINIC AND NURSING HOME FOR BEING AT HIGH RISK FOR DEVELOPING WOUNDS 2. IMPLEMENT CHANGES THAT WOULD HELP PREVENT SKIN BREAKDOWN IN PATIENTS SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DESCRIBE HOW AN EFFECTIVE PRIMARY CARE – WOUND CARE SPECIALIST AND WOUND CARE TEAM WORKING RELATIONSHIP WOULD WORK BEST FOR THE PATIENT 2. IMPLEMENT SYSTEMIC CHANGES IN HOSPITAL AND CLINIC THAT WOULD HELP INSURE PATIENT SAFETY AND PREVENTION OF SKIN BREAKDOWN 128 INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH PATIENTS TO MAKE SURE THAT THEY UNDERSTAND RISK FACTORS THAT PUT THEM AT RISK FOR SKIN BREAKDOWN 2. HAVE PRODUCTIVE COMMUNICATION BETWEEN THE WOUND CARE TEAM AND THE PRIMARY CARE PROVIDER. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE RURAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. EDUCATIONAL RESOURCES SELECTED READINGS ASSIGNED BY DR. PETER DINGLEDINE MEDICAL MISSIONS (3RD WORLD MEDICINE) UPPER LEVEL ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL ACCOMPANY THE LOCAL MISSIONS GROUP TO SOUTH AMERICA TO DELIVER CARE TO THOSE RESIDENTS OF THAT REGION. SEVERAL RESIDENTS OVER THE YEARS, MANY WHO ARE NOT CHRISTIANS, HAVE GONE ON THIS MONTH-LONG TRIP. THERE ARE ALWAYS SEVERAL FAMILY PHYSICIANS FROM THE NORTHEAST TEXAS REGION THAT HAVE GONE EVERY YEAR FOR OVER A DECADE. THESE PHYSICIANS WILL SERVE AS THE SUPERVISING PHYSICIANS DURING THIS MONTH. THEY WILL INTRODUCE AND MODEL FOR THE RESIDENT THE DIFFERENT GOALS AND OBJECTIVES IN TREATING PATIENTS IN THE THIRD WORLD. THE RESIDENT WILL ALSO BECOME FAMILIAR WITH THE DISEASES THAT ARE ENDEMIC TO THAT REGION BUT RARELY SEEN, IF EVER IN NORTHEAST TEXAS OR SOUTHWEST ARKANSAS. THE RESIDENT WILL BE REQUIRED TO PRESENT A NOON CONFERENCE ILLUSTRATING THE EXPERIENCE. THE NOON CONFERENCE WILL ALSO HIGHLIGHT THE MEDICAL KNOWLEDGE OBTAINED DURING THE MONTH IN SOUTH AMERICA. 129 PATIENT CARE GOAL RESIDENTS MUST DEMONSTRATE CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. BE ABLE TO TAKE A GOOD HISTORY FROM PATIENTS FROM ANOTHER CULTURE 2. RECOGNIZE THE OBSTACLES TO ACCESS TO UP TO DATE MEDICAL CARE IN RURAL SOUTH AMERICA 3. DISCUSS THE VITAMIN AND NUTRITIONAL DEFICITS THAT AFFECT PATIENTS IN SOUTH AMERICA 4. DIAGNOSE BASED ON THE HISTORY AND PHYSICAL EXAM THE UNUSUAL MEDICAL CONDITIONS NOT SEEN IN NORTH AMERICA 5. OUTLINE THE WORK UP FOR DISEASES SUCH AS VITAMIN DEFICIENCIES, MALARIA, AND OTHER DISEASES PARTICULAR TO THAT REGION OF SOUTH AMERICA MEDICAL KNOWLEDGE GOAL THE RESIDENT MUST CONTINUALLY SEEK TO LEARN ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. 2. 3. LEARN THE SIGNS AND SYMPTOMS OF MALARIA UNDERSTAND THE PATHOPHYSIOLOGY OF DISEASES THAT ARE ENDEMIC TO RURAL SOUTH AMERICA KNOW THE TREATMENT OPTIONS AVAILABLE TO THE POPULATION OF PATIENTS IN RURAL SOUTH AMERICA PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RECEIVE FEEDBACK THROUGHOUT THE MONTH FROM THE EXPERIENCED FAMILY PHYSICIANS AND ADJUST PATIENT CARE BASED ON THAT INFORMATION THROUGHOUT THE ROTATION. SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DESCRIBE HOW AN EFFECTIVE IMPACT PATIENT CARE IN A THIRD WORLD COUNTRY BY EXAMINING THE SYSTEMS OF CARE AND CHANGING SYSTEMS OF CARE TO IMPROVE ACCESS OF CARE AND QUALITY OF CARE TO THE PATIENTS 130 INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH PATIENTS TO MAKE SURE THAT THEY UNDERSTAND THEIR MEDICAL CONDITION AND TREATMENT IN SPITE OF THE LANGUAGE AND CULTURAL BARRIERS 2. HAVE PRODUCTIVE COMMUNICATION BETWEEN THE MISSIONS MEDICAL TEAM PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE MEDICAL MISSIONS ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. CARE OF THE ELDERLY UPPER LEVEL RESIDENT ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE UPPER LEVEL RESIDENT WILL DO A MONTH ROTATION AT THE CENTER ON AGING AGENCY. THIS IS AN AGENCY THAT HAS TWO COMPONENTS: CLINICAL AND EDUCATIONAL. THE RESIDENT WILL WORK WITH DR. JERRY STRINGFELLOW FOR THE MONTH IN THE CENTER ON AGING. THERE THEY WILL SEE PATIENTS IN THE CLINIC AND PARTICIPATE IN EDUCATIONAL ACTIVITIES AROUND THE COMMUNITY ON BEHALF OF THE CENTER ON AGING. THEY WILL ALSO PRESENT A NOON CONFERENCE ON A PERTINENT GERIATRIC TOPIC SUCH AS DEMENTIA, DEGENERATIVE NEUROLOGICAL DISEASES, AND OTHER GERIATRIC SYNDROMES. THE ATTENDING IS A RESIDENCY FACULTY MEMBER WHO HAS A CERTIFICATE OF ADDED QUALIFICATION IN CARE OF THE OLDER ADULT. PATIENT CARE GOAL RESIDENTS MUST DEMONSTRATE CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN IN THE CENTER OF AGING CLINIC, NURSING HOME, AND MAKING HOME VISITS FOR THE OLDER ADULT 131 2. 3. 4. 5. 6. BE ABLE TO DERIVE DIFFERENTIAL DIAGNOSES FOR COMMON GERIATRIC PROBLEMS DISCUSS WORK UP FOR COMMON GERIATRIC COMPLAINTS UTILIZE GERIATRIC PHARMADYNAMICS AND PHARMAKINETICS TO PROPERLY PRESCRIBE MEDICATIONS DESCRIBE HOW FUNCTION IS IMPORTANT IN SETTING TREATMENT GOALS FOR OLDER ADULT MEDICAL KNOWLEDGE GOAL THE RESIDENT MUST CONTINUALLY SEEK TO LEARN ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, AND COGNATE (E.G. EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL) SCIENCES AND THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. LEARN HOW DIFFERENTLY COMMON PROBLEMS MAY PRESENT THAN WITH YOUNGER PATIENTS 2. BE ABLE TO OUTLINE THE PATHOPHYSIOLOGY OF COMMON GERIATRIC SYNDROMES A. NORMAL HUMAN AGING, AGE-RELATED CHANGES IN TISSUES, ORGANS AND PHYSIOLOGIC FUNCTION, AND HOMEOSTASIS. B. AGE-RELATED CHANGES IN EPIDEMIOLOGY OF DISEASES, PRESENTATION OF ILLNESSES, RESPONSE TO THERAPY, PHARMACOKINETICS AND PHARMACODYNAMICS. C. THE ADJUSTMENTS NECESSARY IN HISTORY TAKING AND PHYSICAL EXAMINATION. D. PRINCIPLES OF BIOMEDICAL ETHICS, INCLUDING AN UNDERSTANDING OF DECISION-MAKING CAPACITY, COMPETENCE, AND AUTONOMY. E. PRINCIPLES OF FITNESS, EXERCISE AND REHABILITATION AS APPLIED TO OLDER PEOPLE. F. THE ELEMENTS AND CONDUCT OF COMPREHENSIVE GERIATRIC ASSESSMENT. G. NUTRITIONAL NEEDS OF OLDER PERSONS, INCLUDING RECOGNITION AND TREATMENT OF MALNUTRITION. H. HEALTH PROMOTION AND DISEASE PREVENTION STRATEGIES. I. RISKS AND BENEFITS OF SURGICAL INTERVENTIONS, PRE-OPERATIVE EVALUATIONS AND POST-OPERATIVE CARE. J. ORGANIZATION AND FINANCING OF HEALTH CARE FOR OLDER PERSONS. K. CARE AT THE END-OF-LIFE, INCLUDING MANAGEMENT OF PAIN, DYSPNEA, AND OTHER SYMPTOMS. L. DETECTIONS, EVALUATION AND MANAGEMENT OF THE FOLLOWING GERIATRIC SYNDROMES. 1. COGNITIVE IMPAIRMENT/DEMENTIA 2. DEPRESSION 3. INCONTINENCE (URINARY AND FECAL) 4. GAIT AND BALANCE DISORDERS 5. IMMOBILITY 6. PRESSURE ULCERS 7. POLYPHARMACY 8. SENSORY IMPAIRMENT 9. PAIN 10. FALLS 11. DELIRIUM PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. 132 PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. RECEIVE FEEDBACK THROUGHOUT THE MONTH FROM THE ATTENDING IN ORDER TO IMPROVE INTERVIEW TECHNIQUES, GOAL SETTING, PRESCRIPTION WRITING, AND OVERALL TREATMENT OF THE OLDER ADULT 2. REVIEW THE CARE OF OLDER ADULTS IN THEIR OWN CONTINUITY CARE CLINIC AND ALTER CARE BASED ON WHAT WAS LEARNED IN ROTATION SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEMS-BASED PRACTICE OBJECTIVES: THE UPPER LEVEL RESIDENT WILL 1. DESCRIBE HOW AN EFFECTIVE IMPACT PATIENT CARE OF OLDER ADULTS BY EXAMINING THE SYSTEMS OF CARE AND CHANGING SYSTEMS OF CARE TO IMPROVE ACCESS OF CARE AND QUALITY OF CARE TO THE PATIENTS 2. ANALYZE SYSTEMS OF CARE IN THE CLINIC, NURSING HOME, AND AT HOME IN ORDER TO IMPROVE THE QUALITY OF CARE AND ACCESS OF CARE FOR THE OLDER ADULT INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. COMMUNICATE EFFECTIVELY WITH PATIENTS TO MAKE SURE THAT THEY UNDERSTAND THEIR MEDICAL CONDITION AND TREATMENT PLAN 2. UNDERSTAND THE IMPORTANCE OF EFFECTIVE COMMUNICATION TO NOT ONLY THE PATIENT BUT THE LOVED ONES AND CARETAKERS OF THE PATIENTS 3. HAVE PRODUCTIVE COMMUNICATION BETWEEN THE MULTI-DISCIPLINARY MEDICAL TEAM FOR THE OLDER ADULT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE MEDICAL MISSIONS ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT 133 ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES PRINCIPLES OF GERIATRIC MEDICINE AND GERONTOLOGY (PRINCIPLES OF GERIATRIC MEDICINE & GERONTOLOGY) BY WILLIAM R. HAZZARD, JOHN P. BLASS, JEFFREY B. HALTER, AND JOSEPH G. OUSLANDER (HARDCOVER - JUL 1, 2003) EMERGENCY MEDICINE THIRD YEAR RESIDENT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THIRD YEAR RESIDENTS WILL SPEND ONE MONTH ON THE PEDIATRIC EMERGENCY MEDICINE DEPARTMENT AT ARKANSAS CHILDREN’S HOSPITAL. THE RESIDENT WILL SPEND NO FEWER THAN 100 HOURS WORKING UNDER THE SUPERVISION OF THE EMERGENCY ROOM PHYSICIAN ON DUTY DURING THE MONTH. THE RESIDENT IS TO STAY IN COMPLIANCE WITH DUTY HOUR RULES DURING THIS ROTATION. THE THIRD YEAR RESIDENT IS ENCOURAGED TO DO DAYTIME AND SOME NIGHTTIME SHIFTS. THE THIRD YEAR RESIDENT WILL BE EXPECTED TO SEE PATIENTS INDEPENDENTLY AND PRESENT THE ASSESSMENT AND PLAN TO THE EMERGENCY ROOM PHYSICIAN. THE CASE WILL BE DISCUSSED AT DISPOSITION OR IF THE THIRD YEAR RESIDENT HAS ANY QUESTIONS. THE EMERGENCY ROOM PHYSICIAN MAY ALSO INTERVIEW THE PATIENT. THE THIRD YEAR RESIDENT IS TO DIRECT ALL CARDIAC CODES, RESPIRATORY FAILURES REQUIRING INTUBATION, AND TRAUMA CODES THAT OCCUR IN THE DEPARTMENT WHILE ON DUTY. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. TRAUMA EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION FOR A TRAUMA VICTIM, AS OUTLINED BY THE AMERICAN COLLEGE OF SURGEONS’ PUBLICATIONS PEDIATRIC ADVANCE TRAUMA LIFE SUPPORT 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE TRAUMA WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. 134 TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WORKING WITH CONSULTANTS INCLUDING APPROPRIATE LEVEL OF CARE IN HOSPITAL 7. BE COMPETENT AT ADVANCED TRAUMA LIFE SUPPORT AND ABLE TO CONDUCT A TRAUMA CODE PEDIATRIC EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. OBTAIN AN EXTENSIVE HISTORY OF PRESENT ILLNESS AS IT PERTAINS TO THE CHIEF COMPLAINT 2. PERFORM A THOROUGH PHYSICAL EXAMINATION 3. DERIVE A DIFFERENTIAL DIAGNOSIS BASED ON THE HISTORY AND PHYSICAL EXAMINATION 4. IDENTIFY THE MOST APPROPRIATE WORK UP TO BE UNDERTAKEN, INCLUDING DIAGNOSTIC TESTING, BOTH IMAGING AND LABORATORY 5. 6. TREAT URGENTLY THOSE PROBLEMS THAT NEED TO BE ADDRESSED URGENTLY COMPOSE A TREATMENT PLAN WITH THE APPROPRIATE CONSULTANTS BASED ON HISTORY, EXAMINATION, AND RESULTS OF LABORATORY AND IMAGING STUDIES 7. BE COMPETENT AT PEDIATRIC PROCEDURES SUCH AS IV ACCESS, LUMBAR PUNCTURE, AND PASSED PEDIATRIC ADVANCED LIFE SUPPORT COURSE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. READ THE ASSIGNED MATERIAL DESIGNATED FOR THE COURSE (SEE EDUCATIONAL RESOURCES BELOW) 2. READ UP ON THE PROBLEMS THAT PATIENTS HAVE AS THEY PRESENT TO THE EMERGENCY DEPARTMENT 3. BE READY TO DISCUSS THE ASSESSMENT AND PLAN FOR PATIENTS WHO PRESENT TO THE EMERGENCY DEPARTMENT TO THE ATTENDING PHYSICIAN PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. PARTICIPATE IN THE EDUCATION OF PATIENTS AND THEIR FAMILIES ABOUT THEIR CLINICAL COURSE IN THE PRENATAL CLINIC AND IN THE EMERGENCY DEPARTMENT IN ORDER THAT PATIENTS WILL BE ABLE TO MAKE INFORMED DECISIONS REGARDING THEIR CARE AND BE MORE COMPLIANT WITH TREATMENT PLANS 2. IDENTIFY WEAKNESSES WITH FEEDBACK FROM ATTENDING PHYSICIAN AND THEN UTILIZE THIS INFORMATION TO IMPROVE THEIR CARE OF PATIENTS 3. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING BY BEING ABLE TO MASTER THE ELECTRONIC MEDICAL RECORD OF THE HOSPITAL IN OBTAINING INFORMATION ON PATIENTS AND LOOKING UP AND LEARNING INFORMATION ABOUT OBSTETRICS ON THE UAMS LIBRARY DATABASE WEB SITE SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 135 1. WORK INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY A. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE EMERGENCY DEPARTMENT CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE B. 2. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY PARTICIPATE IN IDENTIFYING SYSTEM ERRORS & IN IMPLEMENTING POTENTIAL SYSTEM SOLUTION BY A. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE EMERGENCY DEPARTMENT TEAM FOR PATIENT SAFETY AND B. UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM EMERGENCY DEPARTMENT PROCEDURES INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN ON THE EMERGENCY DEPARTMENT BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER DELIVERING EMERGENT AND URGENT MEDICAL CARE ON THE EMERGENCY DEPARTMENT UNIT 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE ON THE EMERGENCY DEPARTMENT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE ER ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER EMERGENCY CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. 136 EDUCATIONAL RESOURCES EMERGENCY MEDICINE: A COMPREHENSIVE STUDY GUIDE, 5TH EDITION CLINI, DAVID; MA, JOHN; TINTINALLI, JUDITH; KELEN, GABOR; STAPCZYNSKI, STEPHAN. AMONG THE MANY SOURCES AVAILABLE FOR THE RESIDENTS FOR ANSWERING CLINICAL QUESTIONS, THE UP-TO-DATE RESOURCE FOUND ON THE UAMS LIBRARY DATABASE RESOURCE PAGE WILL BE EXTENSIVELY UTILIZED. HTTP://WWW.UTDOL.COM/UTD/CONTENT/SEARCH.DO FAMILY MEDICINE PRACTICE SITE EVALUATION PGY 3 RESIDENT ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE RESIDENT WILL SPEND THE MONTH DOING AN EVALUATION ON A POTENTIAL PRACTICE SITE. THERE THE RESIDENT WILL BE WORKING AT THE SITE FOR POSSIBLE FUTURE PRIVATE PRACTICE WORK. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. TRAUMA EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. PERFORM EVIDENCE BASED MEDICINE IN THE SITE THAT IS BEING EVALUATED FOR FUTURE EMPLOYMENT MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. REVIEW THE TEN MOST COMMON DIAGNOSES SEEN IN THE PRACTICE AND REVIEW METHODS, TREATMENT, AND COMPLICATIONS OF THEM SINGS, SYMPTOMS, DIAGNOSTIC PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. IDENTIFY THOSE THINGS THAT ARE DIFFERENT IN THE CLINIC AND LEARN HOW TO GIVE GOOD CARE IN THAT ENVIRONMENT 137 2. STUDY THE HOSPITAL ENVIRONMENT AND LEARN WHAT YOU WILL HAVE TO CHANGE TO CONTINUE TO PRACTICE GOOD EVIDENCE BASED MEDICINE IN THAT DIFFERENT SETTING SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 1. OBSERVE THE PATIENT FLOW OF THE CLINIC AND LEARN HOW THE STRUCTURE AND ENVIRONMENT CAN BEST WORK FOR YOUR PRACTICE HABITS 2. LEARN THE DEMOGRAPHICS OF THE PATIENTS SEEN IN THE CLINIC AND WHAT PARTICULAR CHALLENGES THEY WILL PRESENT 3. 4. OBSERVE THE SYSTEMS FOR SCHEDULING OUTPATIENT TESTS, LABS, MAMMOGRAMS, AND OTHER STUDIES EVALUATE THE SYSTEM FOR ENSURING THAT TEST RESULTS ARE ADDRESSED AND THE SYSTEM FOR NOTIFYING THE PATIENT 5. BECOME EDUCATED WITH THE CALL SYSTEM, WHAT THE ON CALL PHYSICIAN IS RESPONSIBLE FOR, AND THE MECHANISMS BY WHICH PATIENTS CAN HAVE ACCESS TO THEIR PHYSICIAN AFTER HOURS AND HOW THE PHYSICIAN IS ABLE TO ACCESS THE PATIENT’S RECORDS AFTER NORMAL WORKING CLINIC HOURS. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN IN THE PRIVATE PRACTICE CLINIC BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE IN THE PRIVATE CLINIC AND THE HOSPITAL. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE PRIVATE PRACTICE CLINIC, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 138 7. DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. GASTROENTEROLOGY UPPER LEVEL RESIDENT ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF THE EDUCATIONAL EXPERIENCE THE RESIDENT WILL WORK WITH A LOCAL GASTROENTEROLOGIST. THIS WILL INCLUDE IN THE SETTING OF THE HOSPITAL, ENDOSCOPY SUITE, AND HIS CLINIC. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. TRAUMA EMERGENCY OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. ROUND WITH THE GASTROENTEROLOGIST IN THE HOSPITAL EACH MORNING 2. SEE CONSULTATIONS AND MAKE RECOMMENDATIONS FOR CARE UNDER THE DIRECTION OF THE GASTROENTEROLOGIST 3. OBSERVE ENDOSCOPIC PROCEDURES 4. KNOW THE INDICATIONS FOR ENDOSCOPY 5. WORK WITH THE GASTROENTEROLOGIST IN CLINIC 6. GAIN AND ACCESS ESSENTIAL PATIENT INFORMATION REGARDING THE FOLLOWING COMPLAINTS A. DIARRHEA B. CONSTIPATION C. ABDOMINAL PAIN D. BLOATING E. INDIGESTION F. FOOD INTOLERANCE G. NAUSEA/VOMITING H. DYSPHAGIA I. MELENA J. HEMATOCHEZIA K. MALNUTRION L. IRON DEFICIENCY ANEMIA M. ANO-RECTAL PAIN/DISCOMFORMT N. JAUNDICE O. LIVER FAILURE 7. DEVELOP AND CARRY OUT PATIENT MANAGEMENT PLANS FOR A. GASTRIC REFLUX B. GASTRIC ULCER C. ACUTE ABDOMEN D. GALL BLADDER DISEASE E. PANCREATITIS F. PANCREATIC CANCER G. IRRITABLE BOWEL SYNDROME 139 H. I. J. K. L. M. N. O. P. Q. R. S. T. BOWEL OBSTRUCTION ESOPHAGEAL VARICES HEMORRHOIDS INFLAMMATORY BOWEL DISEASE HEPATITIS GASTROINTESTINAL BLEEDING COLONIC POLYPS DIVERTICULAR DISEASE COLON CANCER ASCITES ALCOHOLIC LIVER DISEASE LIVER FAILURE MOTILITY DISORDERS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. BECOME COMPETENT THROUGH STUDY OF ASSIGNED READING MATERIALS OF ALL OF THE DISORDERS NAMED IN THE PATIENT CARE SEGMENT OF THIS CURRICULAR ITEM PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE THIRD YEAR RESIDENT WILL 1. DEMONSTRATE EVIDENCED BASED PRACTICE THROUGH APPRAISAL AND ASSIMILATION OF SCIENTIFIC INFORMATION, E.G. SCIENTIFIC JOURNALS, RELATED TO PATIENT CARE 2. SHOW THE ABILITY IN DECISION MAKING, WHICH INCORPORATES PATIENT ASSESSMENT WITH PATIENT VALUES AND PREFERENCES SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE FINANCIAL ISSUES OF HEATH CARE, WITH EMPHASIS ON UNDERSTANDING ACUTE AND CHRONIC CARE, AND MEDICATION COVERAGE AND THE ROLE OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS), AND OTHER THIRD PARTY PAYERS 140 2. ACTIVELY PARTICIPATE IN THE MULTIDISCIPLINARY APPROACH TO CARING FOR PATIENTS, INCLUDING APPROPRIATE RECOGNITION OF OTHER HEALTH PROFESSIONAL AND PARAPROFESSIONALS' ROLES AND DEMONSTRATE COMPETENCE IN TEAM INTERACTIONS, I.E. MEDICAL STUDENTS, RESIDENTS, PHARMACIST, PHYSICIAN'S ASSISTANT, ADVANCED PRACTICE NURSE, NURSES, OCCUPATIONAL AND PHYSICAL THERAPIST, SOCIAL WORKER INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN IN THE CLINIC AND HOSPITAL BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE IN THE PRIVATE CLINIC AND THE HOSPITAL. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE PRIVATE PRACTICE CLINIC, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. TEACHING METHODS IN AND OUT PATIENT DISCUSSION, EVALUATION OF X-RAYS, PRECEPTOR ROUNDS, FM ROUNDS, NOON CONFERENCES, AND MORNING REPORT ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. 141 LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES THE WASHINGTON MANUAL® GASTROENTEROLOGY SUBSPECIALTY CONSULT (THE WASHINGTON MANUAL SUBSPECIALTY CONSULT) (PAPERBACK) BY WASHINGTON UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF MEDICINE (EDITOR), C. PRAKASH GYAWALI (EDITOR), THOMAS M DE FER (EDITOR), KATHERINE E HENDERSON (EDITOR) COLPOSCOPY DESCRIPTION OF EDUCATIONAL EXPERIENCE THE FIRST YEAR RESIDENT WILL BE ASSIGNED TO COLPOSCOPY CLINIC EACH TUESDAY AFTERNOON DURING ONE OF THE MONTHS OF THE MATERNITY CARE ROTATION. DR. DOWNS WILL TRAIN THE RESIDENT IN A ONE ON ONE RESIDENT TO TEACHER ENVIRONMENT THE DIDACTIC AND PROCEDURAL SKILLS OF COLPOSCOPY. THE RESIDENT WILL HAVE SELECTED MATERIALS TO READ. DR. DOWNS WILL USING ONLINE STUDY GUIDES TAKE THE RESIDENT THROUGH THE TREATMENT GUIDELINES IN THE CARE OF THE ABNORMAL PAP SMEAR. THEY WILL ALSO HAVE “HANDS ON” TRAINING AS TWO TO THREE PATIENTS WILL BE SCHEDULED FOR COLPOSCOPY AND SUBSEQUENT COLPOSCOPIC PROCEDURES, INCLUDING BIOPSY AND THE LEEP PROCEDURE. THE RESIDENT, UNDER THE DIRECT SUPERVISION OF DR. DOWNS WILL PERFORM THERE PROCEDURES. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. PATIENT CARE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. DEMONSTRATE THE COMPETENCY OF PERFORMING A PELVIC EXAM AND OBTAINING A PAP SMEAR 2. BECOME PROFICIENT AT PERFORMING A BASIC COLPOSCOPY EXAM 3. EXHIBIT ABILITY TO LOCATE POTENTIAL ABNORMAL AREAS FOR BIOPSY 4. COMPETENTLY BIOPSY THE CERVIX AND PERFORM AN ENDOCERVICAL BIOPSY 5. SHOW AN ABILITY TO OBTAIN HEMOSTASIS AFTER BIOPSY 6. PERFORM A LEEP PROCEDURE MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. KNOW THE US PREVENTATIVE TASK FORCE AND ACOG RECOMMENDATIONS FOR CERVICAL CANCER SCREENING. 2. ABLE TO SUMMARIZE THE ACOG RECOMMENDATIONS FOR TREATMENT OF THE ABNORMAL PAP SMEAR 3. UNDERSTAND THE INDICATIONS FOR COLPOSCOPY 142 PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE FIRST YEAR RESIDENT WILL 1. EVALUATE THEIR PERFORMANCE TO DR. DOWNS AT THE END OF EACH SESSION WITH SUGGESTIONS FOR IMPROVEMENT 2. REVIEW PATHOLOGICAL REPORTS OF SUCCESS IN OBTAINING CELLS FOR REVIEW 3. CLEARLY STATE TO THE ATTENDING WHAT ONE DOES NOT KNOW OR UNDERSTAND SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. 1. WORK AS A TEAM WITH THE COLPOSCOPY NURSE TO DELIVER CARE BASED ON SAFETY AND THE BEST MEDICAL EVIDENCE AVAILABLE 2. IDENTIFY THE POTENTIAL ERRORS THAT OCCUR IN THE MEDICAL SYSTEMS THAT COULD JEOPARDIZE THE CARE OF THE PATIENT INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE PERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE NURSE AND THE FACULTY PHYSICIAN SO THAT THE HEALTH CARE TEAM CAN OPERATE AT IT MAXIMAL EFFECTIVENESS 2. IN AN COMPASSIONATE AND COMPREHENSIBLE WAY COMMUNICATE TO THE PATIENT EVERYTHING ABOUT THERE CONDITION AND THE TREATMENT THAT WILL BE REQUIRED 3. IN A TIMELY, COMPLETE, ACCURATE, AND LEGIBLE FASHION DOCUMENT THE PATIENT VISIT INTO THE ELECTRONIC MEDICAL RECORD PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE COLPOSCOPY SESSIONS, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF- INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 143 6. 7. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND DELIVER CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. TEACHING METHODS ONE ON ONE WITH THE COLPOSCOPY FACULTY PHYSICIAN, DR. DOWNS WITH OPEN DISCUSSION, ONLINE TEACHING RESOURCES, AND POWERPOINT PRESENTATIONS ASSESSMENT METHOD (RESIDENTS) AT THE END OF THIS ROTATION THE PRECEPTOR WILL EVALUATE THE RESIDENT AND THIS EVALUATION WILL BE REVIEWED AND SIGNED AND REVIEWED BY THE RESIDENT THEN PLACED IN HIS/HER FILE. ASSESSMENT METHOD (PROGRAM EVALUATION) THE RESIDENT WILL EVALUATE THE ROTATION AND PRECEPTOR BY A WRITTEN PROCESS AND THIS WILL BE ASSESSED BY THE PROGRAM DIRECTOR. IN EFFECTIVE OR POOR ROTATIONS WILL BE DISCUSSED WITH THE CHIEF RESIDENT AND PROGRAM DIRECTOR AS NEEDED. LEVEL OF SUPERVISION THE SPECIALTY PRECEPTOR OR FACULTY ATTENDING EDUCATIONAL RESOURCES US PREVENTATIVE TASK FORCE AND ACOG RECOMMENDATIONS PRESENTATIONS AND INFORMATION GIVEN AT TIME OF COURSE BY DR. DOWNS ASSIGNED CHALLENGER SERIES QUESTIONS ADVANCED MATERNAL CARE UPPER LEVEL ELECTIVE GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE THIRD YEAR RESIDENT WILL SPEND TWO MONTHS IN OBSTETRICS OR THIS ROTATION CAN BE DONE LONGITUDINALLY WITH THE RESIDENT DROPPING TO 3 CLINIC HALF DAYS A WEEK, ONE 23 HOUR SHIFT ON THE LABOR & DELIVERY SUITE EACH WEEK, AND SPENDING 5 HALF DAYS ON ROTATION. THIS WILL NOT BE DONE DURING THE TWO MONTHS OF INPATIENT MEDICINE. ON THE LABOR AND DELIVERY UNIT THE RESIDENTS ARE TO BE ON DUTY NO LATER THAN 8 AM ON THE ASSIGNED DAY AND STAY UNTIL AFTER ROUNDS ARE COMPLETED NO SOONER THAN 8 AM ON THE FOLLOWING DAY. THEY ARE UNDER THE COMPLETE SUPERVISION OF THE OBSTETRICIAN ON CALL AND ARE TO FOLLOW THE INSTRUCTION AND RULES AS PUT FORTH BY THE ATTENDING PHYSICIAN. THEIR DUTIES MAY ALSO INCLUDE TIME IN THE WRMC PRENATAL CARE CLINIC. THE RESIDENT IS THEY ARE TO PARTICIPATE OR PERFORM PROCEDURES OR PATIENT CARE RESPONSIBILITIES AS DIRECTED BY THE ATTENDING PHYSICIAN. THE RESIDENT IS EXPECTED TO BE THE PRIMARY PHYSICIAN ON COMPLICATED DELIVERIES, INCLUDING THOSE USING A VACUUM AND A PARTICIPANT IN OPERATIVE PROCEDURES. EXEMPT FROM AHEC CALL DURING THIS MONTH. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. 144 PRENATAL CARE OBJECTIVES: THE RESIDENT WILL 1. DETERMINE AN ACCURATE EDC EARLY IN PRENATAL CARE 2. IDENTIFY THE PROPER DIAGNOSTIC TESTS TO ORDER IN ROUTINE PRENATAL CARE 3. OBTAIN AN ACCURATE AND COMPLETE HISTORY IN THE PRENATAL VISIT 4. PERFORM A THOROUGH AND EXTENSIVE EXAMINATION DURING THE PRENATAL VISIT 5. RECOGNIZE COMMON ABNORMALITIES IN THE PRENATAL EXAM 6. IDENTIFY HIGH RISK PATIENTS 7. DEMONSTRATE THE ABILITY TO DELIVER COMPETENT PRENATAL CARE. BLEEDING IN PREGNANCY OBJECTIVES: THE RESIDENT WILL 1. LIST A DIFFERENTIAL DIAGNOSIS FOR BLEEDING IN PREGNANCY 2. ORDER THE PROPER DIAGNOSTIC TESTS FOR BLEEDING IN PREGNANCY 3. DEFINE A TREATMENT PLAN FOR BLEEDING IN PREGNANCY. ECTOPIC PREGNANCY OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF ECTOPIC PREGNANCY 2. DEVELOP A DIFFERENTIAL DIAGNOSIS FOR ECTOPIC PREGNANCY 3. IDENTIFY THE PROPER DIAGNOSTIC TESTS IN THE WORK UP OF ECTOPIC PREGNANCY 4. APPROPRIATELY TREAT OR REFER THE ECTOPIC PREGNANT PATIENT IN A TIMELY MANNER. SMOKING DURING PREGNANCY OBJECTIVES: THE RESIDENT WILL 1. DISCUSS ALL OF THE COMPLICATIONS OF SMOKING DURING PREGNANCY 2. DEVELOP A PLAN FOR SMOKING CESSATION WITH PRENATAL PATIENTS 3. IDENTIFY THE SCREENING TESTS THAT CAN BE UTILIZED FOR COMPLICATIONS OF SMOKING WHILE PREGNANT. PRETERM LABOR OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF PRETERM LABOR 2. DEFINE A DIFFERENTIAL DIAGNOSIS FOR PRETERM LABOR 3. IDENTIFY THE PROPER WORK UP FOR SUSPECTED PRETERM LABOR 4. KNOW THE TREATMENT PLAN FOR PRETERM LABOR 5. DESCRIBE HOW TO PREVENT PRETERM LABOR. PREMATURE RUPTURE OF MEMBRANES OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE SIGNS AND SYMPTOMS OF PREMATURE RUPTURE OF MEMBRANES 2. LIST THE DIFFERENTIAL DIAGNOSIS OF PREMATURE RUPTURE OF MEMBRANES 3. PERFORM AN APPROPRIATE EXAM TO DIAGNOSE PREMATURE RUPTURE OF MEMBRANES 4. ORDER THE CORRECT WORK UP FOR PREMATURE RUPTURE OF MEMBRANES 5. DESCRIBE THE TREATMENT PLAN FOR PREMATURE RUPTURE OF MEMBRANES 6. KNOW HOW TO PREVENT THE PREMATURE RUPTURE OF MEMBRANES. UTI IN PREGNANCY OBJECTIVES: THE RESIDENT WILL 1. UNDERSTAND THE SIGNIFICANCE OF ASYMPTOMATIC BACTURIA OR UTI IN PREGNANCY 2. BE ABLE TO DIAGNOSE BACTURIA OR UTI IN PREGNANCY 3. KNOW THE APPROPRIATE ANTIMICROBIALS TO TREAT UTI OR ASYMPTOMATIC BACTURIA IN PREGNANCY AND WHEN OR WHEN NOT TO USE THEM. 145 PRE-ECLAMPSIA/PREGNANCY INDUCED HYPERTENSION OBJECTIVES: THE RESIDENT WILL 1. KNOW THE RISK FACTORS FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 2. BE ABLE TO DETAIL THE SIGNS AND SYMPTOMS OF PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 3. LIST THE DIFFERENTIAL DIAGNOSIS FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 4. IDENTIFY THE PROPER DIAGNOSTIC WORK UP AND TESTS TO DIAGNOSE PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA 5. 6. DEFINE THE TREATMENT PLAN FOR PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA DEMONSTRATE WHAT CAN BE DONE TO PREVENT PREGNANCY INDUCED HYPERTENSION AND PREECLAMPSIA. GESTATIONAL DIABETES OBJECTIVES: THE RESIDENT WILL 1. RECOGNIZE THE RISK FACTORS FOR A PATIENT DEVELOPING GESTATIONAL DIABETES 2. KNOW THE SIGNS AND SYMPTOMS OF GESTATIONAL DIABETES 3. BE ABLE TO DIAGNOSE GESTATIONAL DIABETES AT ITS ONSET 4. IDENTIFY THE TREATMENT PLAN, INCLUDING MEDICATIONS AND FOLLOW UP FOR PATIENT WITH GESTATIONAL DIABETES 5. BE AWARE OF THE COMPLICATIONS OF A PREGNANCY MARKED BY GESTATIONAL DIABETES 6. LEARN WHAT CAN BE DONE TO PREVENT GESTATIONAL DIABETES 7. DETAIL POST PARTUM FOLLOW UP FOR PATIENT WITH GESTATIONAL DIABETES POST DATES OBJECTIVES: THE RESIDENT WILL 1. ASSIGN AN ACCURATE EDC TO EACH PREGNANCY AS EARLY AS POSSIBLE IN PRENATAL CARE 2. CONTINUALLY CONFIRM THE EDC WITH EACH PRENATAL VISIT 3. DEVELOP A PLAN FOR POST DATES PREGNANCY 4. KNOW WHEN TO ORDER FETAL ASSESSMENT FOR POST DATES PATIENT 5. DESCRIBE THE APPROPRIATE FETAL ASSESSMENT FOR POST DATES PATIENTS 6. BE ABLE TO INTERPRET FETAL ASSESSMENT TESTS FOR POST DATES PATIENTS 7. FORMULATE A TREATMENT PLAN FOR POST DATES PATIENTS BASED ON FETAL ASSESSMENT NORMAL LABOR AND SPONTANEOUS VAGINAL DELIVERY OBJECTIVES: THE RESIDENT WILL 1. DESCRIBE THE SIGNS, SYMPTOMS, AND STAGES OF NORMAL LABOR 2. PERFORM AT LEAST 30 VAGINAL DELIVERIES 3. DEFINE A DIFFERENTIAL DIAGNOSIS FOR SIGNS AND SYMPTOMS OF LABOR 4. IDENTIFY PROPER DIAGNOSTIC TESTS TO ORDER IN THE DIAGNOSIS OF LABOR 5. OUTLINE A TREATMENT PLAN FOR NORMAL LABOR, INCLUDING ANALGESIA OPTIONS 6. KNOW THE ANALGESIC AGENTS USED, THEIR ADVERSE EFFECTS, AND THE CLINICAL SITUATION BEST FOR EACH ANALGESIC AGENT TO BE UTILIZED ABNORMAL LABOR OBJECTIVES: THE RESIDENT WILL 1. KNOW THE SIGNS AND SYMPTOMS OF ABNORMAL LABOR 2. DEFINE A DIFFERENTIAL DIAGNOSIS FOR ABNORMAL LABOR 3. IDENTIFY THE PROPER DIAGNOSTIC WORK UP AND LABORATORY TESTS FOR ABNORMAL LABOR 4. DESCRIBE A TREATMENT PLAN FOR ABNORMAL LABOR 5. LIST THE STRATEGIES THAT CAN BE DONE TO PREVENT ABNORMAL LABOR ROUTINE POSTPARTUM CARE OBJECTIVES: THE RESIDENT WILL 1. DESCRIBE THE MANAGEMENT OF A NORMAL POSTPARTUM PATIENT 2. KNOW THE PROPER TESTS TO FOLLOW A NORMAL POSTPARTUM PATIENT 3. PERFORM EXAMINATIONS REQUIRED FOR A NORMAL POSTPARTUM PATIENT 4. BE ABLE TO APPROPRIATELY DISCHARGE A NORMAL POSTPARTUM PATIENT 146 POSTPARTUM COMPLICATION OBJECTIVES: THE RESIDENT WILL 1. KNOW THE SIGNS AND SYMPTOMS OF POSTPARTUM COMPLICATIONS 2. PERFORM ROUNDS ON PATIENTS THAT HAVE BEEN DELIVERED 3. DIAGNOSE POSTPARTUM COMPLICATIONS AS THEY ARISE 4. ORDER THE APPROPRIATE WORK UP FOR POSTPARTUM COMPLICATIONS 5. DEVISE A TREATMENT PLAN FOR POSTPARTUM COMPLICATIONS 6. KNOW WHAT THINGS CAN BE DONE TO PREVENT SOME POSTPARTUM COMPLICATIONS MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATIONS OF THIS KNOWLEDGE TO PATIENT CARE. MEDICAL KNOWLEDGE ACQUISITION OBJECTIVES: THE RESIDENT WILL 1. READ THE ASSIGNED MATERIAL ASSIGNED FOR THE COURSE (SEE EDUCATIONAL RESOURCES BELOW) 2. READ UP ON THE PROBLEMS THAT PATIENTS HAVE AS THEY PRESENT TO THE LABOR AND DELIVERY UNIT 3. BE READY TO DISCUSS THE ASSESSMENT AND PLAN FOR PATIENTS WHO PRESENT TO THE LABOR AND DELIVERY UNIT WITH THE ATTENDING PHYSICIAN PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. PRACTICE-BASED LEARNING & IMPROVEMENT OBJECTIVES: THE RESIDENT WILL 1. PARTICIPATE IN THE EDUCATION OF PATIENTS AND THEIR FAMILIES ABOUT THEIR CLINICAL COURSE IN THE PRENATAL CLINIC AND IN THE L&D UNIT IN ORDER THAT PATIENTS WILL BE ABLE TO MAKE INFORMED DECISIONS REGARDING THEIR CARE AND BE MORE COMPLIANT WITH TREATMENT PLANS 2. IDENTIFY WEAKNESSES WITH FEEDBACK FROM ATTENDING PHYSICIAN AND THEN UTILIZE THIS INFORMATION TO IMPROVE THEIR CARE OF PATIENTS 3. USE INFORMATION TECHNOLOGY TO OPTIMIZE LEARNING BY BEING ABLE TO MASTER THE ELECTRONIC MEDICAL RECORD OF THE HOSPITAL IN OBTAINING INFORMATION ON PATIENTS AND LOOKING UP AND LEARNING INFORMATION ABOUT OBSTETRICS ON THE UAMS LIBRARY DATABASE WEB SITE SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. SYSTEM-BASED OBJECTIVES: THE RESIDENT WILL 1. WORK IN INTER-PROFESSIONAL TEAM TO ENHANCE PATIENT SAFETY AND IMPROVE PATIENT CARE QUALITY BY A. WORKING WITH NURSES, NURSE PRACTITIONERS, AND ATTENDING PHYSICIANS ON THE L&D UNIT AND PRE-NATAL CARE CLINIC CORPORATELY AS A PART OF A TEAM TO DELIVERY COMPETENT CARE AND 147 B. 2. PARTICIPATE IN HEALTH CARE TEAM MEETINGS DESIGNED TO IMPROVE PATIENT CARE AND SAFETY PARTICIPATE IN IDENTIFYING SYSTEM ERRORS AND IN IMPLEMENTING POTENTIAL SYSTEM SOLUTIONS BY A. B. BEING ABLE TO DISCUSS THOSE MEASURES ALREADY PUT IN PLACE BY THE L&D TEAM FOR PATIENT SAFETY AND UNDERSTAND THEIR ROLE IN THE INTER-PROFESSIONAL TEAM AND PERFORM PROCEDURES SUCH AS DELIVERIES IN A WAY THAT IS SAFE FOR THE PATIENT AND NEWBORN. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. COMMUNICATION SKILLS OBJECTIVES: THE RESIDENT WILL 1. WORK WITH THE ATTENDING PHYSICIAN ON THE L&D UNIT BY KEEPING THE ATTENDING INFORMED OF PATIENTS’ CLINICAL COURSE, 2. COMMUNICATE WITH THE NURSING STAFF IN A PROFESSIONAL MANNER THAT FOSTERS TEAMWORK AND QUALITY PATIENT CARE, 3. EFFECTIVELY INSTRUCT AND INFORM PATIENTS OF THEIR CLINICAL PROGRESS AND INSTRUCTIONS FOR FURTHER CARE, 4. BE CONSIDERED A VALUABLE AND INFORMATIVE TEAM MEMBER DELIVERING OBSTETRICAL CARE ON THE L&D UNIT, AND 5. MAINTAIN COMPREHENSIVE, TIMELY, AND LEGIBLE MEDICAL RECORDS THAT ACCURATELY DEPICT THE PATIENTS’ CLINICAL COURSE DURING THEIR CARE ON THE L&D UNIT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED AND FINISH ALL ASSIGNED DUTIES BEFORE LEAVING THE HOSPITAL, 2. FOLLOW THE ATTENDING PHYSICIAN’S RULES AND REGULATIONS OF THE OBSTETRICAL ROTATION, 3. TREAT ALL OF THE HEALTH CARE TEAM WITH DIGNITY AND RESPECT, 4. BE RESPONSIVE TO THE NEEDS OF THE PATIENT OVER THE RESIDENTS’ SELF INTEREST, 5. RESPECT A PATIENTS’ PRIVACY AND AUTONOMY, 6. ABIDE BY HIPAA AND HOSPITAL BYLAWS, AND 7. DELIVER OBSTETRICAL CARE THAT IS SENSITIVE AND RESPONSIVE TO A PATIENT POPULATION THAT IS DIVERSE IN CULTURE, RACE, RELIGION, AND DISABILITIES. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES THE RESIDENT WILL READ AND BE PREPARED TO DISCUSS MATERIAL FROM ESSENTIALS OF OBSTETRICS AND GYNECOLOGY 148 BY NEVILLE HACKER (AUTHOR), J. GEORGE MOORE (AUTHOR), JOSEPH GAMBONE (AUTHOR) THE RESIDENTS WILL BE ASSIGNED ALL CHAPTERS AMONG THE MANY SOURCES AVAILABLE FOR THE RESIDENTS FOR ANSWERING CLINICAL QUESTIONS, THE UP-TO-DATE RESOURCE FOUND ON THE UAMS LIBRARY DATABASE RESOURCE PAGE WILL BE EXTENSIVELY UTILIZED. HTTP://WWW.UTDOL.COM/UTD/CONTENT/SEARCH.DO NIGHT FLOAT GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE UPPER LEVEL RESIDENTS WITH THE FIRST YEAR RESIDENT MEET THE MEMBERS OF THE MEDICINE TEAM AT, OR AROUND, 5 PM. AT THAT TIME, THE RESIDENTS FROM THE INPATIENT MEDICINE TEAM REVIEW EACH PATIENT ON THE INPATIENT LIST WITH THE NIGHT FLOAT TEAM. AT THE CONCLUSION OF THE MEETING, THE NIGHT FLOAT TEAM TAKES ALL CALLS FROM THE NURSE CARE TEAMS IN THE HOSPITAL REGARDING THE RESIDENCY’S PATIENTS AND ANY NEW ADMISSIONS. THE UPPER LEVEL RESIDENT CALLS ALL ADMISSIONS AND CHANGES IN STATUS OF THE INPATIENTS TO THE ATTENDING FACULTY MEMBER ON CALL. FOR ANY ICU ADMISSIONS, THE FACULTY MEMBER COMES OUT TO SEE THE PATIENT. THE FIRST YEAR RESIDENT SEES THE NEW ADMISSIONS AND WRITES ORDERS WITH THE GUIDANCE OF THE UPPER LEVEL RESIDENT. THE UPPER LEVEL RESIDENT THEN CALLS THE ATTENDING FACULTY MEMBER ON CALL TO REPORT THE ADMISSION ON ALL PATIENTS. AT 7 AM, THE FIRST YEAR RESIDENT IS TO HAVE THE LIST OF INPATIENTS UPDATED FOR MORNING REPORT. THE FIRST YEAR RESIDENT THEN PRESENTS ALL ADMISSIONS AND CHANGES IN STATUS OF INPATIENTS TO THE INPATIENT MEDICINE TEAM WITH DIRECTION OF THE UPPER LEVEL RESIDENT. THE FIRST YEAR RESIDENT AND THE UPPER LEVEL RESIDENT STAY TOGETHER AS A TEAM THROUGHOUT THE MONTH. FOR TWO WEEKS, THE TEAM WILL WORK THE NIGHT FLOAT SUNDAY THROUGH THURSDAY AND THEN FOR TWO WEEKS, THE TEAM WILL WORK ONLY FRIDAY NIGHTS. THERE ARE NO CONTINUITY CLINICS DURING THE TWO WEEKS ON NIGHT FLOAT. DURING THE TWO WEEKS THAT THE TEAM WORKS ONLY FRIDAY NIGHT, THOSE TWO RESIDENTS ARE IN CLINIC MONDAY THROUGH THURSDAY. PATIENT CARE GOAL RESIDENTS MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. OBJECTIVES: THE RESIDENT WILL: 1. DEMONSTRATE THE ABILITY TO INTERVIEW A PATIENT, GAINING PERTINENT FACTS IN AN EFFICIENT AN COMPLETE MANNER. 2. PERFORM A COMPLETE AND ACCURATE PHYSICAL EXAM. 3. EVALUATE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 4. PRIORITIZE PROBLEMS AND COMPLICATIONS OCCURRING IN HOSPITALIZED PATIENTS. 5. EFFICIENTLY EVALUATE AND STABILIZE PATIENTS NEWLY FROM THE EMERGENCY DEPARTMENT. MEDICAL KNOWLEDGE GOAL RESIDENTS MUST DEMONSTRATE KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL, AND SOCIAL-BEHAVIORAL SCIENCES, AS WELL AS THE APPLICATION OF THIS KNOWLEDGE TO PATIENT CARE. OBJECTIVES: THE RESIDENT WILL: 149 1. ARTICULATE THE PATHOPHYSIOLOGY, EVALUATION, DIAGNOSTIC WORK UP AND TREATMENT OF COMMON MEDICAL 2. PROBLEMS LEARN APPROPRIATE MANAGEMENT STRATEGIES FOR PROBLEMS COMMONLY OCCURRING IN HOSPITALIZED PATIENTS, SUCH AS FEVER, SHORTNESS OF BREATH, CHEST PAIN, ALTERED CONSCIOUSNESS, HYPOTENSION, AND OTHERS. INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE PERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES. OBJECTIVES: THE RESIDENT WILL: 1. COMMUNICATE EFFECTIVELY, VERBALLY AT MORNING REPORT AND THROUGH APPROPRIATE WRITTEN SIGN-OUT, WITH COLLEAGUES WHOSE PATIENTS ARE BEING COVERED. 2. COMMUNICATE EFFECTIVELY WITH NURSING STAFF REGARDING ACUTE PATIENT PROBLEMS. 3. COMMUNICATE EFFECTIVELY AND CONCISELY WITH ATTENDING PHYSICIANS WHOSE PATIENTS ARE ADMITTED AND EVALUATED DURING THE NIGHT. 4. COMMUNICATE WITH CONSULTING PHYSICIANS EFFECTIVELY, PROFESSIONALLY, AND IN A TIMELY MANNER TO INSURE GOOD PATIENT CARE. PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. OBJECTIVES: THE RESIDENT WILL: 1. BEHAVE PROFESSIONALLY TOWARD PATIENTS, FAMILIES, COLLEAGUES, AND ALL MEMBERS OF THE HEALTH CARE TEAM. 2. BE PROMPT TO MORNING REPORT AND THE AFTERNOON CHECK OUT WITH THE INPATIENT MEDICINE TEAM. 3. PREPARED FOR MORNING REPORT WITH ASSIGNMENTS PER THE ATTENDING PHYSICIANS. 4. ANSWER ALL PAGES WITHIN 15 MINUTES. 5. PROMPTLY ATTEND PATIENTS IN THE ER THAT ARE DEEMED TO BE ADMITTED OR INPATIENTS WHO ARE HAVING DIFFICULTY AND NEED THE BEDSIDE PRESENCE OF A PHYSICIAN. PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. OBJECTIVES: THE RESIDENT WILL: 1. ACKNOWLEDGE THE “GAPS” IN MEDICAL KNOWLEDGE 2. IDENTIFY ERRORS IN MEDICAL CARE AND UTILIZE MEDICAL LITERATURE, INFORMATION SYSTEMS AND TEACHERS TO ADDRESS THOSE ERRORS. 3. USE AN EVIDENCED-BASED APPROACH IN THE CARE OF PATIENTS. 4. UNDERSTAND AND UTILIZE THE INFORMATION TECHNOLOGY AVAILABLE TO YOU AT EACH SITE. 150 SYSTEMS-BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEST AND SYSTEM OF HEALTH CARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTH CARE. OBJECTIVES: THE RESIDENT WILL: 1. EFFECTIVELY UTILIZE THE RELATIVE LIMITED RESOURCES AVAILABLE DURING THE NIGHT TO ASSURE HIGH QUALITY PATIENT CARE AND PATIENT SAFETY. 2. WORK WITH THE CASE MANAGERS IN THE ER TO INSURE APPROPRIATE ADMISSION STATUS FOR THOSE PATIENTS ADMITTED AFTER 5 PM. ASSESSMENT METHOD THE RESIDENT WILL RECEIVE VERBAL FEEDBACK FROM THE ATTENDING PHYSICIAN THROUGHOUT THE ROTATION. AT THE END OF EACH MONTH, A WRITTEN EVALUATION WILL BE DONE BY THE ATTENDING PHYSICIAN. THE ATTENDING PHYSICIAN WILL BASE THE EVALUATION ON THE PERFORMANCE OF THE RESIDENT IN THESE 6 COMPETENCIES WITH INPUT FROM NURSES, NURSEPRACTITIONERS, AND OTHER MEMBERS OF THE HEALTH CARE TEAM. EDUCATIONAL RESOURCES ONLINE RESOURCES: UP TO DATE, DYNAMED WASHINGTON’S MANUAL, LATEST EDITION BASIC NIGHT FLOAT COVERAGE (HOW IT WORKS) TWO NIGHT FLOAT TEAMS WILL COVER EACH MONTH. EACH TEAM WILL BE COMPOSED OF A FIRST YEAR RESIDENT AND AN UPPER LEVEL. THEY WILL PICK UP THE BEEPER AND BOTH WILL BE “IN HOUSE CALL” UNTIL THE CONCLUSION OF MORNING REPORT EACH MORNING. THEY WILL PICK UP THE BEEPER AT 5 PM ON SUNDAY, MONDAY, TUESDAY, WEDNESDAY, THURSDAY, & FRIDAY EVENINGS, ANSWER ALL CALLS, AND ADMIT PATIENTS TO THE INPATIENT SERVICE UNTIL THE CONCLUSION OF MORNING REPORT. AT THE CONCLUSION OF MORNING REPORT, THEY WILL GO HOME IMMEDIATELY, BOTH FIRST YEAR AND UPPER LEVEL RESIDENTS. TEAM A WILL DO THE FIRST TWO WEEKS SUNDAY THROUGH THURSDAY AND TEAM B WILL DO THE SECOND TWO WEEKS SUNDAY THROUGH THURSDAY. ON THE TWO WEEKS THAT THE NIGHT FLOAT TEAM DOES NOT WORK MONDAY THROUGH THURSDAY, THEY WORK FRIDAY NIGHT 5 PM UNTIL 8 AM SATURDAY MORNING. ANY DAYS LEFT, THEY WILL EVENLY SPLIT MAKING SURE THAT ALL DUTY HOUR REGULATIONS ARE NOT COMPROMISED. DURING THE TWO OFF WEEKS DURING WHICH THEY ARE NOT ON CALL, THE UPPER LEVEL RESIDENT WILL SERVE IN CLINIC FULL TIME, EXCEPT FOR THURSDAY AFTERNOONS AND FRIDAYS. THE FIRST YEAR ON THE TWO WEEKS OF NIGHT FLOAT MONTH WILL, WHILE NOT IN THE 2 WEEK PERIOD OF NIGHT FLOAT, WORK CLINIC EVERY MORNING, EXCEPT FRIDAY MORNING AND COMPLETE DIDACTIC CURRICULUM VIA CHALLENGER ASSIGNMENT FOR THE MONTH. WHILE RESIDENTS ARE ON THEIR TWO WEEK NIGHT FLOAT, THEY WILL NOT SERVE IN THE CLINIC. 151 LONGITUDINAL CURRICULUM BEHAVIOR SCIENCE JOURNAL CLUB BEHAVIOR SCIENCE – LONGITUDINAL CURRICULUM GOALS AND OBJECTIVES BEHAVIORAL SCIENCE CURRICULUM DESCRIPTION UAMS/AHEC-SW IS COMMITTED TO PROVIDING STRUCTURED LEARNING OPPORTUNITIES AND EXPERIENCES IN THE AREA OF PSYCHIATRY AND BEHAVIORAL SCIENCE DURING OUR THREE YEAR RESIDENCY PROGRAM. THE EDUCATIONAL EXPERIENCE IS DESIGNED TO ACHIEVE THE FOLLOWING OVERALL GOALS: 1. TRAIN RESIDENTS TO CRITICALLY APPRAISE AND APPLY EVIDENCE-BASED KNOWLEDGE AND SKILLS IN THE AREA OF PSYCHIATRY AND BEHAVIORAL SCIENCES APPROPRIATE TO THE PRACTICE OF FAMILY MEDICINE. 2. PROVIDE OPPORTUNITIES TO DEVELOP SKILLS AND KNOWLEDGE THAT WILL LEAD TO THE MOST THERAPEUTIC DOCTORPATIENT RELATIONSHIP. PATIENT CARE GOALS 1. RESIDENT MUST BE ABLE TO PROVIDE PATIENT CARE THAT IS COMPASSIONATE, APPROPRIATE AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH. 2. RESIDENT SHALL DEMONSTRATE INTERVIEWING AND FORMULATION SKILLS FOR THE RECOGNITION AND EVALUATION OF THE PSYCHOLOGICAL, COGNITIVE AND BEHAVIORAL SYMPTOMS MOST COMMON TO PRIMARY CARE SETTINGS. 3. RESIDENT SHALL DEMONSTRATE KNOWLEDGE OF PSYCHIATRIC AND BEHAVIORAL PROBLEMS IN ORDER TO MANAGE EMERGENCY SITUATIONS, MAKE PRELIMINARY DIAGNOSIS AND INITIATE APPROPRIATE REFERRAL. 4. RESIDENT SHALL DEMONSTRATE KNOWLEDGE OF THE BIO-PSYCHO-SOCIAL MODEL OF MENTAL AND GENERAL MEDICAL ILLNESS AND WILL BE ABLE TO APPLY THIS MODEL IN THE MANAGEMENT OF MENTAL, GENERAL MEDICAL AND BEHAVIORAL PROBLEMS. 5. RESIDENT SHALL DEMONSTRATE SKILL IN THE USE OF PSYCHOLOGICAL STRATEGIES TO INTERVENE WITH PATIENTS WHO HAVE PSYCHIATRIC ISSUES. 152 COMPETENCIES RESIDENTS ARE EXPECTED TO: 1. GATHER ESSENTIAL INFORMATION ABOUT THE PATIENT BY PERFORMING AND DOCUMENTING A RELEVANT HISTORY AND CULTURALLY DIVERSE EXAMINATION. 2. MAKE INFORMED DIAGNOSTIC AND THERAPEUTIC DECISIONS BASED ON PATIENT INFORMATION, CLINICAL JUDGMENT AND PATIENT PREFERENCES. 3. IMPLEMENT EFFECTIVE MANAGEMENT OF THE PATIENT THROUGH PSYCHOPHARMACOLOGY, BRIEF THERAPY OR REFERRALS TO APPROPRIATE AGENTS. OBJECTIVES: 1. DISPLAY UNDERSTANDING OF THE SIGNIFICANCE OF THE EMPATHETIC RESPONSE IN EVERY PATIENT ENCOUNTER. 2. UNDERSTAND NORMAL PSYCHO-SOCIAL GROWTH AND DEVELOPMENT IN INDIVIDUALS AND FAMILIES. 3. IDENTIFY THE FAMILY LIFE CYCLE AND ITS IMPLICATION FOR FAMILY MEDICINE. 4. UNDERSTAND THE INITIAL EVALUATION AND MANAGEMENT OF BEHAVIORAL EMERGENCIES AND FAMILY SAFETY, TO INCLUDE: a. THE SUICIDAL PATIENT b. THE VIOLENT PATIENT c. THE PHYSICALLY ABUSED PATIENT d. THE SEXUALLY ASSAULTED PATIENT 5. DEVELOP AND UNDERSTANDING AND DEMONSTRATE SKILLS IN THE FOLLOWING: a. THE BATHE TECHNIQUE b. MOTIVATIONAL INTERVIEWING c. APPROPRIATE INTERVIEWING/COUNSELING SKILLS TO INCLUDE BUT NOT LIMITED TO BRIEF THERAPY OR SOLUTION FOCUSED TECHNIQUES d. UTILIZATION OF APPROPRIATE SCREENING INVENTORIES MEDICAL KNOWLEDGE GOAL THE RESIDENT SHALL DEMONSTRATE KNOWLEDGE OF THE COMMON MENTAL DISORDERS OF CENTRAL IMPORTANCE IN PRIMARY CARE, SUFFICIENT TO PERMIT ACCURATE DIAGNOSIS AND INITIATE APPROPRIATE TREATMENT, CONSULTATION AND/OR REFERRAL. RESIDENTS ARE EXPECTED TO: COMPETENCIES 1. DEVELOP AND APPLY SPECIFIC KNOWLEDGE FOR ASSESSMENT AND MANAGEMENT OF BEHAVIORAL PROBLEMS OBJECTIVES 1. DEMONSTRATE THE CAPABILITY TO RECOGNIZE THE COMMON SYMPTOMS OF THE FOLLOWING AND THEN DIAGNOSE, MANAGE AND, IF NECESSARY, APPROPRIATELY REFER PATIENTS WHO EXHIBIT PSYCHIATRIC DISORDERS IN BOTH CHILDREN AND ADULTS COMMONLY SEEN IN FAMILY MEDICINE. SUCH DISORDERS SHOULD INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING: a. MOOD AND ANXIETY DISORDERS b. SOMATOFORM AND PSYCHOSOMATIC DISORDERS c. ADJUSTMENT DISORDERS d. ORGANIC MENTAL AND PSYCHOTIC DISORDERS 153 e. f. g. h. i. j. k. PERSONALITY DISORDERS CHILDHOOD PROBLEMS – ADHD, ENURESIS/ENCOPRESIS AND CONDUCT DISORDERS EATING DISORDERS (ANOREXIA – BULIMIA) ALCOHOL AND OTHER SUBSTANCE DEPENDENT DISORDERS FACTITIOUS DISORDERS IMPULSIVE DISORDERS SEXUAL DISORDERS 2. MANAGEMENT SHOULD INCLUDE A THOUGH UNDERSTANDING OF PSYCHOPHARMACOLOGY 3. UNDERSTAND THE FOLLOWING THERAPEUTIC MODALITIES: a. BEHAVIOR MODIFICATION b. BIOFEEDBACK c. BRIEF SOLUTION FOCUSED THERAPY d. GROUP THERAPY e. THE GENERAL INDICATIONS, USE AND LIMITATIONS OF NEUROLOGICAL AND PSYCHOLOGICAL TESTING 4. BE ABLE TO FORMULATE A DIFFERENTIAL DIAGNOSIS INTERPERSONAL AND COMMUNICATION SKILLS GOAL RESIDENTS MUST DEMONSTRATE INTERPERSONAL AND COMMUNICATION SKILLS THAT RESULT IN THE EFFECTIVE EXCHANGE OF INFORMATION AND TEAMING WITH PATIENTS, THEIR FAMILIES AND PROFESSIONAL ASSOCIATES. RESIDENTS ARE EXPECTED TO: COMPETENCIES 1. COMMUNICATE EFFECTIVELY WITH PATIENTS AND FAMILIES ACROSS A BROAD RANGE OF SOCIOECONOMIC AND CULTURAL BACKGROUNDS 2. COMMUNICATE EFFECTIVELY WITH PHYSICIANS, OTHER HEALTH PROFESSIONALS AND HEALTH RELATED AGENCIES 3. WORK EFFECTIVELY AS A MEMBER OF OR LEADER OF A HEALTHCARE TEAM 4. MAINTAIN COMPREHENSIVE, TIMELY AND LEGIBLE RECORDS OBJECTIVES 1. UNDERSTAND AND ADDRESS FACTORS THAT INFLUENCE COMPLIANCE/NONCOMPLIANCE 2. DELIVER INFORMATION AND INSTRUCTIONS TO PATIENTS AND FAMILY IN A RESPECTFUL, CLEAR, AGE APPROPRIATE, CULTURALLY COMPETENT MANNER TO FOSTER PATIENT UNDERSTANDING AND COMPLIANCE. PROFESSIONALISM GOAL RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. RESIDENTS ARE EXPECTED TO DEMONSTRATE: COMPETENCIES 1. COMPASSION, INTEGRITY AND RESPECT FOR OTHERS 2. SENSITIVITY AND RESPONSIVENESS TO A DIVERSE PATIENT POPULATION, INCLUDING BUT NOT LIMITED TO DIVERSITY IN GENDER, AGE, CULTURE, RACE, DISABILITIES AND SEXUAL ORIENTATION 154 OBJECTIVES 1. REVIEW AND DISCUSS MEDICAL ETHICS, INCLUDING PATIENT AUTONOMY, CONFIDENTIALITY AND ISSUES CONCERNING QUALITY OF LIFE 2. DEMONSTRATE REASONABLE PROFESSIONAL BEHAVIOR, ETHICAL PRINCIPLES AND SENSITIVITY IN DEALING WITH DIVERSE PATIENTS AND PATIENT POPULATIONS INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING: a. DIVERSE ETHNIC POPULATIONS/CULTURES b. PERSONALITY DYSFUNCTIONS IMPACTING PHYSICIAN-PATIENT RELATIONSHIPS i. THE SEDUCTIVE PATIENT ii. THE DEMANDING PATIENT iii. THE TEARFUL PATIENT iv. THE NONCOMPLIANT PATIENT v. THE ANGRY PATIENT SYSTEMS BASED PRACTICE GOAL RESIDENTS MUST DEMONSTRATE AN AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTHCARE, AS WELL AS THE ABILITY TO CALL EFFECTIVELY ON OTHER RESOURCES IN THE SYSTEM TO PROVIDE OPTIMAL HEALTHCARE. RESIDENTS ARE EXPECTED TO: COMPETENCIES 1. WORK EFFECTIVELY IN VARIOUS HEALTHCARE DELIVERY SETTINGS AND SYSTEMS RELEVANT TO THEIR CLINICAL SPECIALTY 2. COORDINATE PATIENT CARE WITHIN THE HEALTHCARE SYSTEM RELEVANT TO THEIR CLINICAL SPECIALTY 3. INCORPORATE CONSIDERATIONS OF COST AWARENESS AND RISK-BENEFIT ANALYSIS IN PATIENT CARE OBJECTIVES 1. KNOW FACTORS THAT INFLUENCE HEALTH AND SAFETY IN THE HOME AND COMMUNITY 2. KNOW FAMILY SYSTEMS THEORY, ITS APPLICATION TO FAMILY MEDICINE AND WHEN TO INCLUDE OTHERS (FAMILY, CONSULTATION, ETC.) TO OPTIMIZE PATIENT CARE AND COMPLIANCE 3. OBTAIN EXPOSURE TO OTHER RESOURCES FOR CARE: a. SOCIAL WORK SERVICES b. SHELTER SERVICES AND FOOD BANKS c. COMMUNITY CRISIS RESOURCES d. SELF-HELP AND SUPPORT GROUPS e. SUBSTANCE ABUSE TREATMENT (OUT-PATIENT AND IN-PATIENT) f. HOSPITAL AND COMMUNITY RESOURCES PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE LONG LEARNING. RESIDENTS ARE EXPECTED TO DEVELOP SKILLS AND HABITS TO BE ABLE TO: COMPETENCIES 1. SYSTEMATICALLY ANALYZE THEIR PRACTICE, USING QUALITY IMPROVEMENT METHODS AND IMPLEMENT CHANGES WITH THE GOAL OF PRACTICE IMPROVEMENT 155 2. LOCATE, APPRAISE AND ASSIMILATE EVIDENCE FROM SCIENTIFIC STUDIES RELATED TO THEIR PATIENTS’ HEALTH PROBLEMS OBJECTIVES INCORPORATE CONSULTATIONS FINDINGS, APPLICABLE RESOURCES AND SCIENTIFIC EVIDENCE TO DEMONSTRATE THE CAPABILITY TO ELICIT, RECOGNIZE, DIAGNOSE AND MANAGE COMMON SYMPTOMS OF EMOTIONAL ASPECTS OF NONPSYCHIATRIC DISORDERS SUCH AS, BUT NOT LIMITED TO, THE FOLLOWING: 1. CHRONIC MEDICAL CONDITIONS 2. CHRONIC PAIN 3. TERMINAL ILLNESS, DEATH AND BEREAVEMENT 4. MARITAL PROBLEMS 5. ACUTE ILLNESS AND HOSPITALIZATION 6. STRESS MANAGEMENT 7. INTELLIGENCE TEACHING METHODS OPPORTUNITIES TO DEVELOP THE ABOVE GOALS, COMPETENCIES AND OBJECTIVES WILL BE PROVIDED THROUGH PGY 1 ORIENTATION LECTURES, BEHAVIORAL SCIENCE LECTURES, NOON CONFERENCES, PSYCHIATRIC ROTATION IN PGY 2, HOME VISITS (MINIMUM OF 5 HOME VISITS PER RESIDENT DURING 3 YEAR RESIDENCY), PRACTICE MANAGEMENT ROTATION IN PGY 2 AND PGY 3, MONTHLY BALINT SESSIONS, VIDEOTAPING (2 VIDEOTAPES PER RESIDENT PER YEAR), MONTHLY NURSING HOME ROUNDS AND DAILY INTERACTIONS WITH FACULTY, STAFF AND COMMUNITY PROFESSIONALS. ASSESSMENT METHODS 1. HOME VISIT REVIEWS 2. VIDEOTAPING REVIEWS 3. CHART AUDITS 4. PATIENT SATISFACTION SURVEYS 5. FACULTY, STAFF AND PEER ASSESSMENTS 6. ROTATION ASSESSMENTS 7. PSYCHOLOGICAL MEDICINE INVENTORY REVIEW FOR BALINT GIVEN AT THE BEGINNING OF PGY 1 AND THE END OF PGY 3 JOURNAL CLUB GOALS & OBJECTIVES DESCRIPTION OF EDUCATIONAL EXPERIENCE THE LAST FRIDAY OF EVERY MONTH EXCEPT FOR NOVEMBER, DECEMBER, AND JUNE IS RESERVED FOR JOURNAL CLUB. THIS SESSION WILL USUALLY LAST FROM 2 TO 2 ½ HOURS. EACH MONTH 2-3 RESIDENTS WILL BRING AN ASSIGNED ARTICLE TO CRITIQUE. ALL RESIDENTS WILL HAVE REVIEWED THE ARTICLES FOR THE SAKE OF DISCUSSION. THERE WILL BE ANOTHER RESIDENT ASSIGNED TO BRING A CLINICAL INQUIRY FOR THE NEXT MONTH’S JOURNAL CLUB WHILE 2-3 OTHER RESIDENTS WILL PRESENT THE ANSWER TO THE PREVIOUS MONTH’S CLINICAL INQUIRY. DISCUSSION WITH THE ENTIRE GROUP FOLLOWS. FINALLY, THE UPPER LEVEL RESIDENT COMPLETING HIS/HER PI/RESEARCH MONTH WILL PRESENT IN A POSTER SESSION THE RESULTS OF THEIR PERFORMANCE IMPROVEMENT PROJECT WITH SUGGESTIONS FOR IMPROVED QUALITY IN THE CLINIC OR HOSPITAL SETTING AND IDEAS FOR ANY PERFORMANCE IMPROVEMENT PROJECTS THAT COULD HAVE SPAWNED THE THEIR PROJECT. 156 PRACTICE-BASED LEARNING AND IMPROVEMENT GOAL RESIDENTS MUST DEMONSTRATE THE ABILITY TO INVESTIGATE AND EVALUATE THEIR CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING. OBJECTIVES PRACTICE-BASED LEARNING AND IMPROVEMENT OBJECTIVES: THE RESIDENTS WILL: 1. DEVELOP LIFELONG LEARNING SKILLS THROUGH PARTICIPATION AND DISCUSSION 2. LEARN EBM SKILLS THROUGH PRESENTATIONS OF PROJECTS AND DISCUSSION AND REVIEW OF ARTICLES TO BE PRESENTED 3. APPLY EBM SKILLS AS PART OF LIFELONG LEARNING TO IMPROVE PATIENT CARE BY ACTIVELY PARTICIPATING IN JOURNAL CLUB DISCUSSIONS 4. LEARN TO DEVELOP A WELL-BUILT (PICO) QUESTION FROM A CLINICAL SCENARIO BY BRINGING THE CLINICAL INQUIRY TO THE GROUP 5. 6. 7. 8. LEARN HOW AND WHERE TO FIND ANSWERS TO CLINICAL INQUIRIES AS ASSIGNED IN JOURNAL CLUB COMPETENTLY CRITICALLY APPRAISE AN ARTICLE ACCRUE KNOWLEDGE RELEVANT TO THE PRACTICE OF FAMILY MEDICINE DEVELOP PRESENTATION SKILLS BY PRESENTING ARTICLES, ANSWERS TO CLINICAL INQUIRIES, AND PERFORMANCE IMPROVEMENT PROJECT PROFESSIONALISM GOAL THIS COMPETENCY IS THE FOUNDATION FOR ALL OF THE OTHER GOALS AND OBJECTIVES. RESIDENTS MUST DEMONSTRATE A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES. PROFESSIONAL OBJECTIVES: THE RESIDENT WILL 1. ARRIVE TO WORK PROMPTLY ON TIME APPROPRIATELY ATTIRED TO THE JOURNAL CLUB CONFERENCES 2. TREAT ALL OF THE PRESENTERS AND PARTICIPANTS WITH DIGNITY AND RESPECT 3. ACTIVELY PARTICIPATE IN SCIENTIFIC DISCUSSION 4. READ THE ASSIGNED READINGS 5. BE PREPARED WHEN ASKED TO CRITICALLY APPRAISE ARTICLES, PRESENT PERFORMANCE IMPROVEMENT PROJECTS, PUT FORTH THE CLINICAL INQUIRY, AND DISCUSS THE CLINICAL INQUIRY IN AN INFORMED AND RESPECTFUL FASHION ASSESSMENT METHOD THE RESIDENT WILL BE EVALUATED BY ATTENDANCE, PREPARATION, AND PARTICIPATION IN JOURNAL CLUB CONFERENCES. EDUCATIONAL RESOURCES TO BE ASSIGNED DURING JOURNAL CLUB CONFERENCES 157