Download NOSM Internal Medicine Cardiology Rotation Learning Objectives

NOSM Internal Medicine Cardiology Rotation
Learning Objectives
Rotation Description:
PGY1 residents spend one rotation on a Cardiology rotation consisting of inpatient ward work,
consultations and outpatient clinics. At the beginning of this rotation, residents are asked to create a
personalized learning plan with the supervising faculty to direct their learning. The resident rounds on
in-patients admitted under the staff physician (MRP or as consultation), and then participates in
outpatient clinics or in the cardiac catheterization lab, performing arterial punctures and interpreting
angiographic findings.
At the end of each clinic, time is spent reviewing EKGs, as well as one-on-one teaching sessions on topics
requested by the resident.
Case based teaching and ambulatory clinics, combined with academic half day sessions, make up the
educational infrastructure on this rotation.
PGY4 residents are strongly encouraged to complete one or two blocks of elective time in Cardiology. For
all elective rotations, the resident is expected to develop objectives based on their own learning goals,
however the level of independence is noted within these clinical goals & objectives.
Assessment:



Residents are informally evaluated throughout the rotation with continual feedback.
Multi-source feedback is sought once per rotation from the health care team, along with the
review of consultations and discharge summaries.
A formal assessment of the resident is completed at the end of the rotation, based on these
goals and objectives, using One45 the NOSM web-based system.
Approved: RPC Electronic Vote September 2016
MEDICAL EXPERT
Please use Overall Program Outcomes mapping noted below (e.g. MEC 1.3) for level specific
descriptions regarding you particular level of performance.
ME = Medical Expert
C = Competency
1.
Integrates knowledge of pathophysiology, clinical presentation, diagnosis and management in
the care of patients with the following common cardiac conditions (MEC 1.3):
•
Coronary artery disease – Includes stable angina/coronary artery disease, acute
coronary syndromes (unstable angina pectoris/Non-ST elevation myocardial infarction
and ST-elevation myocardial infarction) post-MI management including complications of
myocardial infarction and secondary prevention.
•
Congestive heart failure – Includes both right and left sided heart failure secondary to
systolic and diastolic dysfunction
•
Cardiomyopathies
•
Arrhythmias – Includes brady-arrhythmias and general indications for pacing along with
atrial (atrial fibrillation, atrial flutter, AVNRT, AVRT and atrial tachycardia) and
ventricular tachy-arrhythmias.
•
Valvular heart disease – Includes obstructive and regurgitant aortic and mitral valve
disease, rheumatic valvular disease.
•
Infective endocarditis – Includes indications for prophylaxis.
•
Hypertension – Includes refractory hypertension.
•
Pericardial diseases – Includes acute pericarditis and cardiac tamponade.
•
Congenital Heart Disease – Bicuspid aortic valve disease and ASD.
•
Peripheral arterial disease - Includes thoracic and abdominal aortic aneurysm and
dissection.
•
Pulmonary Hypertension – Includes venous thrombo-embolic disease
2.
Obtains a detailed, accurate and relevant cardiovascular history in patients who present with
common cardiac conditions (MEC 2.2).
3.
Develops an approach to the evaluation of patients presenting with the cardinal cardiac
symptoms of (MEC 1.3; 2.2):
•
Chest pain
•
Dyspnea
•
Palpitations
•
Syncope
Approved: RPC Electronic Vote September 2016
4.
Performs and interprets a detailed cardiovascular physical examination including assessment of
the JVP, central arterial waveform, precordium, and peripheral manifestations of cardiac
disease. Is familiar with physical examination findings encountered in patients who present with
common cardiac conditions (MEC 2.2).
5.
Applies knowledge of the usual indications/contraindications, adverse effects, toxicity, and
pharmacokinetics of the common classes of cardiovascular drugs when planning patient care
(MEC 3.1; 3.2; 5.2).
•
Beta-blockers
•
Conventional and new anti-platelet and anti-thrombotic agents
•
ACE inhibitors and angiotensin receptor blockers
•
Vasodilator medications
•
Calcium channel blockers
•
Diuretics
•
Anti-arrhythmic agents
•
Digoxin
•
Lipid lowering agents
6.
Discusses the indications for common cardiovascular investigations (MEC 4.1):
•
Exercise testing
•
Exercise and resting perfusion studies
•
Transthoracic echocardiography
•
Transesophageal echocardiography
•
Stress echocardiography
•
Invasive electrophysiologic testing
•
Cardiac catheterization
7.
Recognizes the indications for various cardiovascular interventions (MEC 3.1; 3.2):
•
Percutaneous coronary intervention
•
Coronary artery bypass grafting surgery
•
Cardiac valve repair and replacement surgery
•
Pacemaker and defibrillator therapy
8.
Develops technical skills related to the practice of cardiology (MEC 3.4):
•
Performance and interpretation of the 12-lead electrocardiogram
Approved: RPC Electronic Vote September 2016
•
•
•
Interpretation of exercise stress testing
Interpretation of the chest radiograph for common cardiac abnormalities such as cardiac
chamber enlargement and pulmonary edema
Performance and interpretation of ankle-brachial index measurements
Please see the Royal College Objectives of Training document: 2.1.2 & 2.1.3 for comprehensive list of
Cardiology topics to learn about during your Internal Medicine Resident Program.
COMMUNICATOR
CanMEDS 2015
PGY 4
PGY 1
Competency
3. Share health care information and plans with patients and their families
Competency 3.1
The resident effectively shares health
The resident effectively shares basic
information and care plans with
health information and care plans with
patients and families at an appropriate patients and families at an appropriate
level of complexity and ensures patient level of complexity and ensures patient
and family understanding with little or and family understanding, with
no guidance.
guidance.
Competency 3.2
The resident recognizes when harm
The resident recognizes when harm
from health care delivery has occurred, from health care delivery has occurred
makes supervisor aware, and discloses and works with the supervisor to
the event to the patient and family in a disclose the event to the patient and
professional manner with little or no
family in a professional manner with
supervision.
direct supervision.
4. Engage patients and their families in developing plans that reflect the patient’s health care needs
and goals
Competency 4.1
The resident guides discussions that
The resident participates under
are open, non-judgmental and
supervision in discussions that are
responsive to the patient’s and family’s open, non-judgemental and responsive
psychosocial and cultural needs.
to the patient’s and family’s
psychosocial and cultural needs
Competency 4.2
The resident guides the patient and
The resident under supervision guides
family to other sources of information the patient and family to other sources
such as hospital patient care leaflets,
of information such as hospital patient
credible health care web sites or lay
care leaflets, credible health care web
press with little or no supervision.
sites or lay press.
5. Document and share written and electronic information about the medical encounter to
optimize clinical decision-making, patient safety, confidentiality, and privacy
Competency 5.1
The resident documents clinical
The resident documents clinical
encounters in the medical record in a
encounters in the medical record in a
complete, accurate and timely fashion, complete, accurate and timely fashion,
ensuring patient information is
ensuring patient information is
accessible.
accessible with guidance.
Approved: RPC Electronic Vote September 2016
COLLABORATOR
CanMEDS 2015
PGY 4
PGY 1
Competency
3. Hand over the care of a patient to another health care professional to facilitate continuity of safe
patient care
Competency 3.1
The resident identifies when a patient’s clinical status has changed in severity or
scope and care may be improved by transferring to CCU/ICU or need for urgent
invasive procedure. This decision must first be discussed with the supervisor or
attending physician.
LEADER
CanMEDS 2015
Competency
PGY 4
PGY 1
3. Demonstrate leadership in professional practice
The resident shows leadership through
Leadership qualities are demonstrated
delivering high quality patient-centred
by the resident who under supervision
care, effectively guiding the health care delivers high quality patient centred
team by clear communication,
care by managing team members
delegation and time management,
through clear communication,
demonstrating confidence and
delegation, effective time management
enthusiasm in a potentially unfamiliar
and exhibits confidence and enthusiasm
environment.
in unfamiliar environments.
4. Manage career planning, finances, and health human resources in a practice
Competency 4.2
The resident takes the opportunity to
discuss with their preceptor and mentor
possible strategies to sustain their
future practice and maintain a balanced
personal life.
Competency 3.1
HEALTH ADVOCATE
CanMEDS 2015
PGY 4
PGY 1
Competency
1. Respond to an individual patient’s health needs by advocating with the patient within and
beyond the clinical environment
Competency 1.2
The resident acts on opportunities to promote healthy lifestyle behaviours and
to increase compliance in patients by counselling them on change and directing
them to the appropriate resources (i.e. Smoking cessation).
Competency 1.3
The resident is aware of the modifiable The resident under supervision
risk factors for and potential
identifies risk factors for and potential
complications of chronic diseases and
complications of chronic diseases and
uses patient encounters as an
uses patient encounters as an
opportunity to develop a plan for
opportunity to screen for and
Approved: RPC Electronic Vote September 2016
interventions for these with little or no
guidance.
implement early interventions for
these.
SCHOLAR
CanMEDS 2015
PGY 4
PGY 1
Competency
1. Engage in the continuous enhancement of their professional activities through ongoing learning
Competency 1.1
The resident initiates opportunities to
Under supervision the resident
learn and teach as part of their own
develops a personal learning plan to
personal learning plan. The resident is enhance their professional
aware of their own learning needs and development, acknowledging the
actively seeks opportunities to be
requirement for continued medical
educated without being prompted.
education and learning.
2. Teach students, residents, the public, and other health care professionals
Competency 2.2
The resident promotes a safe learning environment by encouraging open,
collegial discussions and accepting feedback in a non-judgmental fashion from all
colleagues (including faculty) as exhibited in all interactions.
Competency 2.3
The resident participates in maintaining patient safety by readily acknowledging
their own skill and experience level in practical procedures, demonstrating an
appropriate level of confidence and seeking appropriate supervision.
Competency 3.4
3. Integrate best available evidence into practice
The resident applies scholarly evidence The resident works with the team to
to the care of patients with little or no apply scholarly evidence to the care of
guidance.
patients.
4. Contribute to the creation and dissemination of knowledge and practices applicable to health
Competency 4.1
The resident is able to evaluate
research and scholarly inquiry to
formulate a framework of evidenced
based practice with little or no
supervision.
The resident is able to evaluate
medical and scientific literature to
begin to construct an evidence based
practice with supervision.
Competency 4.5
The resident communicates relevant
medical evidence to other health
professionals, patients and families as
appropriate with little or no guidance.
The resident discusses relevant
medical evidence with supervisors and
disseminates it to other health
professionals, patients and families as
appropriate.
Approved: RPC Electronic Vote September 2016
PROFESSIONAL
CanMEDS 2015
PGY 4
PGY 1
Competency
1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical
standards
Competency 1.1
The resident takes ownership of all aspects of their own behaviours and
interactions.
Competency 1.2
The resident strives to strengthen their The resident takes ownership of all
intrinsic (non-medical expert)
aspects of their intrinsic (non-medical
CanMEDS competencies through
expert) CanMeds competencies
active self-reflection demonstrated by through active self-reflection
dedication and continual
demonstrated by dedication and
improvement.
continual improvement.
Competency 1.3
The resident responds to ethical issues The resident appropriately identifies
by recognizing their own biases,
ethical issues and seeks guidance.
finding common ground, and
considering professional obligations
with the goal of reaching a mutually
satisfactory outcome with little or no
guidance.
Competency 1.5
The resident exhibits professional use of technology by minimizing the use of
electronic devices during patient and team (includes physician, resident, and
clinical leader/charge nurse) encounters and adhering to all aspects of
regulations regarding the use and transmission of confidential patient
information (e.g. Privacy Act, CPSO guidelines for social media etc.)
2. Demonstrate a commitment to society by recognizing and responding to societal expectations in
health care
Competency 2.1
The resident demonstrates accountability by being on time, presenting
themselves appropriately, and reliably performing all their clinical duties.
Competency 2.2
The resident demonstrates a commitment to patient safety by recognizing their
own limitations (in all areas not only medical expert) and practising within them,
seeking assistance when required.
4. Demonstrate a commitment to physician health and well-being to foster optimal patient care
Competency 4.1
The resident balances influences on personal and professional performance by
taking care of personal needs (nutrition, rest, managing work hours, etc.) and
demonstrating strategies for stress management.
Competency 4.3
The resident recognizes when colleagues are in need, offers help, creates an
environment where it is safe to ask for help, and responds appropriately when
asked.
Resources:
NOSM Internal Medicine RPC. (2016). Internal Medicine Level Specific Outcomes. Northern Ontario
School of Medicine. Found on: MyCurriculum
Royal College. (2011). Objectives of Training in the Specialty of Internal Medicine (Ver. 1.3). RCPSC.
Approved: RPC Electronic Vote September 2016