Download Curriculum Manual 2013-2014

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.
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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.
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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
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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
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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
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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
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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
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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.
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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.
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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
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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.
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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
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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.
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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.
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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.
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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
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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.
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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
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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
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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
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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
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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.
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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.
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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
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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.
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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
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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
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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.
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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
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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.
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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
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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
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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
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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.
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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
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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
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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.
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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
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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.
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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.
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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.
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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
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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
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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:
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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.
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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.
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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.
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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
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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
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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
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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.
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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
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