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