Internal Medicine Residency Program Competency-Based Goals ...gme.riversidecommunityhospital.com/documents/Electives.pdf · Practice-based Learning Residents must be able to investigate

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Internal Medicine Residency Program Competency-Based Goals and Objectives

If-Possible Electives Academic year: 2016-2017 Site Location: Variable Assigned Residents: PGY 1, PGY-2 and PGY-3

ALLERGY AND IMMUNOLOGY (Elective Rotation)

EDUCATIONAL GOALS AND OBJECTIVES

Introduction

The Allergy-Immunology rotation provides the resident with an opportunity to develop skills in the prevention, evaluation and management of allergic and immunologic conditions. As the scope of allergic and immunologic disorders is quite broad, the focus of this rotation will be on the approach to conditions commonly seen in primary care, such as allergies, asthma, dermatitis, rhinitis, and urticaria. The resident will gain additional exposure in such rotations as Dermatology, Infectious Disease, Pulmonology, and Rheumatology. The resident will also learn the management of emergent conditions, such as anaphylaxis, angioedema, hypersensitivity reactions, and status asthmaticus, and become familiar with skin testing, immunotherapy, and pulmonary function testing. Finally, the resident will understand appropriate indications for allergy and immunology referral.

Patient Care

By the end of the rotation, residents are expected to:

Demonstrate the ability to take a history focused on symptom severity, exposures/triggers, prior treatments, vaccinations, family and social history, and medications.

Differentiate between stable and emergent symptoms and elicit personal, environmental, and occupational triggers for symptoms.

Independently obtain the above information and identify barriers to patient compliance and care.

Independently obtain the above details for patients with complex medical histories and multiple co-morbid conditions.

Be comfortable with performing and documenting a normal exam of the eyes, ears, nose, throat, lungs, and skin.

Characterize abnormal exam findings common in allergic disease and asthma

Independently perform a complete exam and understand the sensitivity and specificity of physical findings.

Understand the indications, contraindications, complications, limitations, and interpretation of the following procedures, and become competent in their safe and effective use:

o peak expiratory flow rate (PEFR) o spirometry

Medical Knowledge

By the end of the rotation, resident are expected to:

Understand basic scientific principles involved in allergic and immunologic disease

The role of T and B lymphocytes, cytokines, immunoglobulins, mast cells, and complement in the immune response

The classification of immune-mediated damage (Type I-V)

The pathophysiology of primary/secondary immunodeficiency syndromes the wheal

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and flare response

The pathophysiology involved in airway obstruction immunization principles in adults

Learn an approach to the evaluation and management of life-threatening conditions, such as anaphylaxis, angioedema, and status asthmaticus and become skilled in the timely triage of and approach to common presenting complaints.

Learn approaches to managing immunologic or allergic disease in the setting of pregnancy, peri-operatively, and in patients with co-morbidities, such as diabetes and heart disease. Residents will also become familiar with the management of asthma and exercise-induced bronchospasm in athletes.

Understand statistical concepts, such as pretest probability, the number needed to treat, etc. and their effect on diagnostic workup and treatment.

Develop an understanding of the pathophysiology, clinical presentation, natural history, and therapy for the following conditions:

o Allergic bronchopulmonary aspergillosis o Allergic conjunctivitis o Allergy to food, inset venom, latex o Asthma and triad asthma o Common variable immunodeficiency o Dermatitis – atopic, contact o Eczema o Erythema nodusum o Hypereosinophilia syndrome o Hyper-immunoglobulin E syndrome o Hypersensitivity reactions o Immunoglobulin deficiency o Mastocytosis o Nasal polyps o Otitis media o Rhinitis – allergic and nonallergic, rhinitis medicamentosa, vasomotor o Serum sickness o Sinusitis o Stevens-Johnson syndrome o Urticaria o X-linked agammaglobulinemia o Understand indications for and interpretation of laboratory and diagnostic studies

relevant to the diagnosis and treatment of the above conditions, such as o C1 esterase testing o CT of lungs, sinuses o HIV testing o IgE testing o Immunoglobulin levels o Pulmonary function testing pre- and post-bronchodilator; exercise and methacholine

challenge testing o ImmunoCAP o Rhinoscopy o Skin testing for immediate and delayed hypersensitivity (Tine/PPD, anergy panel) o T and B cell assay and interpretation o Testing for neutrophil and macrophage function o Theophylline level o Total eosinophil count

Practice-Based Learning and Improvement


Access current clinical practice guidelines (http://www.aaaai.org/practice-resources/statements-and-practice-parameters/practice-parameters-and-other-guidelines-

http://www.aaaai.org/practice-resources/statements-and-practice-parameters/practice-parameters-and-other-guidelines-page.aspx



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page.aspx) and apply evidence- based strategies to the patient care.

Develop skills in evaluating studies in published literature, through Journal Club and independent study.

Learn to function as part of a team, including the primary care physician, allergist-immunologist, and clinic staff, to optimize patient care.

Respond with positive changes to feedback from members of the health care team.

Interpersonal and Communication Skills By the end of the rotation, residents are expected to:

Demonstrate organized and articulate written (electronic) and verbal communication skills that build rapport with patients and families, convey information to other health care professionals and provide timely documentation in the chart.

Develop interpersonal skills to educate and counsel patients, and where appropriate, promote behavioral change.

Demonstrate leadership skills to build consensus and coordinate a multidisciplinary approach to patient care.

Professionalism By the end of the rotation, residents are expected to:

Educate patients and their families in a manner respectful of gender, cultural, religious, economic, and educational differences on choices regarding their care.

Use time efficiently in the clinic to see patients and chart information.

Provide constructive criticism and feedback to more junior members of the team.

System-Based Practice By the end of the rotation, residents are expected to:

Understand policies for reporting allergic reactions in the hospital and outpatient setting.

Be able to discuss alternative care strategies, taking into account the social, economic, and psychological factors that affect patient health and use of resources.

Understand the impact of insurance status on patient access to care and be aware of the availability of case workers, counseling services, and other community resources to maximize care.

Demonstrate an awareness of and responsiveness to established quality measures, risk management strategies, and cost of care within our system.


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OPHTHALMOLOGY (Elective Rotation)

INTRODUCTION:

Residents will encounter common ophthalmology problems in both the inpatient and outpatient setting. The purpose of this rotation is to provide experience in dealing with ophthalmologic problems they are likely to encounter and develop an appreciation of the diagnostic and therapeutic modalities employed. It is particularly important that the resident obtain an understanding of which problems are appropriate to treat in the ambulatory setting and which conditions demand a referral to specialists.

EDUCATIONAL GOALS AND OBJECTIVES:

Patient Care

The resident will learn the proper management of the problems seen in this outpatient setting. By the end of this rotation, residents are expected to:

Prioritize patient problems

Prioritize a day of work

Monitor and follow up on patients appropriately

Demonstrate caring and respectful behaviors with patients and families

Gather essential, accurate information in interviews and physical exams, and review other data

Know indications, contraindications, & some risks of some invasive procedures

Perform some invasive procedures

Provide services aimed at prevention and maintenance of health

Work with all health care professionals to provide patient –focused care.

Understand and weigh alternatives for diagnosis and treatment

Spend time appropriate to the complexity of the problem

Medical Knowledge

The resident should know ophthalmologic terminology and understand the pathophysiology of the conditions listed below:

Approach to common ocular symptoms

Burning

Decreased vision

Discharge

Double vision

Dry eyes

Eyelid swelling or twitching

Flashing lights

Floaters

Foreign body sensation

Itchy eye

Light sensitivity

Ocular pain

Photophobia

Proptosis

Ptosis

Red eye.

Cataracts: Thorough appreciation of pathophysiology, medical and surgical management.

Glaucoma: Appreciate diagnostic criteria, consequences and management of different types of glaucoma.

Corneal Abrasions

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Conjunctivitis

Contact Lens- Related Problems

Dry Eye Syndrome

Pterygium

Subconjunctival Hemmorhage

Diabetic Retinopahy

Migraine By the end of this rotation, residents are expected to:

Demonstrate knowledge of basic and clinical sciences.

Apply knowledge to therapy

Recognize indications, contraindications and risks of commonly used medications and procedures

Demonstrate an investigatory and analytic approach to clinical situations

Practice-based Learning

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

Analyze practice 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 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 therapeutic effectiveness

Use information technology to manage information, access on-line medical information, and support their education

Facilitate the learning of students and other health care professionals By the end of this rotation, residents are expected to:

Understand his or her limitations of knowledge

Ask for help when needed

Acquire knowledge through self-motivation

Use computerized sources of results and information to enhance patient care.

Accept feedback and develops self-improvement plans

Locate, appraise and assimilate scientific literature appropriate to specialty

Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:

Create and sustain a therapeutic and ethically sound relationship with patients

Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills

Work effectively with others as a member or leader of a health care team or other professional group

By the end of this rotation, residents are expected to:

Write pertinent and organized notes

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Document timely and legible medical records

Use effective listening, narrative, and non-verbal skills to elicit and provide information.

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes 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 of clinical care, confidentiality of patient information, informed consent, and business practices

Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities


Establish trust with patients and staff

Treat all patients (does not refuse to treat a patient)

Show regard for opinions and skills of colleagues

Demonstrate respect, compassion, and integrity

Respond to the needs of patients and society, which supersedes self-interest

Delegate responsibility to others

Demonstrate sensitivity to patient culture, gender, age, preferences and disabilities

Acknowledge errors and works to minimize them

Systems-based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on Health System resources to provide care that is of optimal value. Residents are expected to:

Understand how their 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 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

Advocate for quality 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


Advocate for patients

Use systematic approaches to reduce errors

Demonstrate ability to adapt to change

Provide cost effective care

Understand how individual practices affect other health care professionals, organizations and society

Demonstrate knowledge of types of medical practice and delivery systems

Practice effective allocation of health care resources

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OTOLARYNGOLOGY (Elective Rotation)

INTRODUCTION

Many common problems seen in the day to day practice of medicine involve the ears, nose, mouth and throat. On this rotation, the resident will have the opportunity to observe, manage and participate in procedures involved in an outpatient setting. When appropriate, the resident will also have the opportunity to visit the OR on more complicated cases.


Patient Care

The resident will work closely with the attending physician while caring for patients in the office setting. By the end of this rotation, residents should be able to:


Uses diagnostic procedures and therapies appropriately

Elicit subtle findings on physical examination

Obtain a precise, logical and efficient history

Interpret results of procedures appropriately

Manage multiple problems simultaneously

Develop and carry out management plans

Consider patient preferences when making medical decisions

Triage patients to an appropriate location

Medical Knowledge

The resident will learn the pathophysiology and be able to relate it to the diagnosis and management of the following problems:

Hearing Loss

Tinnitus

Otitis Media and Externa

Cerumen Impaction

Epistaxis

Sinusitis

Dental Disease

Abnormal Taste and Smell

Oral Cancer

Oral Ulcers

Hoarseness By the end of this rotation, residents should be able to:


Demonstrate and apply knowledge of epidemiologic and social-behavioral sciences to the care of the patient

Demonstrate an investigatory and analytic approach to clinical situations



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Facilitate the learning of students and other health care professionals By the end of this rotation, residents should be able to:

Undertake self-evaluation with insight

Facilitate the learning of students and other health care professionals

Analyze personal practice patterns systematically and strive to improve.

Compare personal practice patterns to larger populations

Locate, appraise and assimilate scientific literature appropriate to specialty

Apply knowledge of study






By the end of this rotation, residents should be able to:

Create and sustain therapeutic and ethically sound relationships with patient and families

Provide education and counseling to patients, families and colleagues

Discuss end of life care with patients/families

Professionalism




Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities


Display initiative and leadership


Demonstrate commitment to on-going professional development

Demonstrate commitment to ethical principles pertaining to the provision or withholding of care, patient confidentiality, and informed consent and business practices

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Systems-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on Health System resources to provide care that is of optimal value. Residents are expected to:







Apply knowledge of how to partner with other health care providers to assess, coordinate and improve patient care


Participate in developing ways to improve systems of practice and health management

Demonstrate ability to adapt to change

Provide cost effective care

Understand how individual practices affect other health care professionals, organizations and society

Demonstrate knowledge of types of medical practice and delivery systems

Practice effective allocation of health care resources

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OUTPATIENT DERMATOLOGY (Elective Rotation)

INTRODUCTION

A practicing physician needs to recognize dermatologic disorders that are primary diseases and identify dermatologic manifestations that are expressions of the systemic disease. The resident will have the opportunity to learn procedures that will be valuable to know as a practicing primary care doctor. Residents will learn criteria for dermatologic referral.


Patient Care

The degree of direct patient care and ability to gain experience with procedures will vary with the setting. By the end of this rotation, residents should be able to:

Prioritize patient problems

Prioritize a day of work

Monitor and follow up on patients appropriately

Demonstrate caring and respectful behaviors with patients and families

Gather essential, accurate information in interviews and physical exams, and review other data

Know indications, contraindications, & some risks of some invasive procedures

Perform some invasive procedures

Provide services aimed at prevention and maintenance of health

Work with all health care professionals to provide patient –focused care.


Uses diagnostic procedures and therapies appropriately

Elicit subtle findings on physical examination

Obtain a precise, logical and efficient history

Interpret results of procedures appropriately

Manage multiple problems simultaneously

Develop and carry out management plans

Consider patient preferences when making medical decisions

Triage patients to an appropriate location

Medical Knowledge

The resident is likely to be exposed to the following dermatologic disorders:

Pruritis

Atopic dermatitis

Acne

Impetigo, furunculosis, and folliculitis

Psoriasis

Nevi, Dysplastic Nevi, and Melanoma

Urticaria

Fungal Infections

Warts

Manifestations of Systemic Diseases By the end of this rotation, residents should be able to:

Demonstrate knowledge of basic and clinical sciences.

Apply knowledge to therapy


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Demonstrate and apply knowledge of epidemiologic and social-behavioral sciences to the care of the patient








Facilitate the learning of students and other health care professionals By the end of this rotation, residents should be able to:

Understand his or her limitations of knowledge

Ask for help when needed

Acquire knowledge through self-motivation

Use computerized sources of results and information to enhance patient care.

Accept feedback and develops self-improvement plans

Undertake self-evaluation with insight

Facilitate the learning of students and other health care professionals







Write pertinent and organized notes

Document timely and legible medical records

Use effective listening, narrative, and non-verbal skills to elicit and provide information.

Work effectively as a member of the health care team

Create and sustain therapeutic and ethically sound relationships with patient and families

Provide education and counseling to patients, families and colleagues

Discuss end of life care with patients/families

Professionalism


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Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities By the end of this rotation, residents should be able to:

Establish trust with patients and staff

Treat all patients (does not refuse to treat a patient)

Show regard for opinions and skills of colleagues

Demonstrates respect, compassion, and integrity

Respond to the needs of patients and society, which supersedes self-interest

Display initiative and leadership


Demonstrate commitment to on-going professional development

Demonstrate commitment to ethical principles pertaining to the provision or withholding of care, patient confidentiality, and informed consent and business practices




Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on Health System resources to provide care that is of optimal value. Residents are expected to:







Advocate for patients

Demonstrate constructive skepticism

Advocate for high-quality patient care and assists patients in dealing with system complexity

Apply knowledge of how to partner with other health care providers to assess, coordinate and improve patient care


Participate in developing ways to improve systems of practice and health management

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NON-SURGICAL ORTHOPEDICS (Elective Rotation)

EDUCATIONAL GOALS AND OBJECTIVES FOR ORTHOPEDICS

Patient Care

To learn the basic approach to the evaluation of orthopedic injuries, not just the injuries themselves but also the associated injuries.

To gain an appreciation for the polytrauma patient and how the orthopedic injuries affect patient’s outcomes.

To understand the pain associated with orthopedic injuries and to treat the pain appropriately.

To learn splinting skills

To learn appropriate reduction techniques for shoulder/hip/knee/elbow/ankle dislocations

To gain better understanding of the x-ray findings in various injury patterns

Medical Knowledge

To learn common orthopedic injuries/conditions and their respective treatments.

To understand basic radiographs and appropriate views to evaluate orthopedic injuries.

To learn how to describe injuries and radiographic findings.

To become facile with splinting and casting.

To learn multiple reduction techniques for the shoulder, hip, elbow, knees and digit dislocations.

To recognize the associated non-orthopedic injuries that co-exist with many of these musculoskeletal injuries/conditions.

To garner an appreciation of the complications, including operative and non-operative, associated with these injuries.

To learn post-injury instructions and limitations.

Practice-Based Learning

To obtain the ability to predict orthopedic injuries based on a good history and physical.

To develop favorite reduction techniques based on patient encounters and to learn from one patient to the next.

To learn when special tests are available and when to use them in the Emergency Department.

Repetition of splinting and reduction techniques.

Repetition of x-ray interpretation of common films.


To learn how to describe/explain these injuries both to the patients and to colleagues.

To learn how to communicate post-injury instructions/limitations in a simple manner for better patient understanding.

Professionalism

To recognize the care of orthopedic patients requires a team approach.

To gain an appreciation for the pain aspects of orthopedic injuries and to treat that pain appropriately, being respectful of patient’s differing levels of pain tolerance.

To learn to deal with Orthopedic Consultants.

Systems-Based Practice

To learn which injuries require emergent or urgent orthopedic referral.

To understand the recommended follow-up periods for these injuries.

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OUTPATIENT GYNECOLOGY (Elective Rotation)

Rotation Goals and Objectives Goals:

Enhance skills in assisting women in maintaining reproductive system health.

Enhance skills in evaluation, diagnosis and management of common outpatient problems and illnesses seen in the Gyn office.

Improve the resident’s understanding of the systems of care available for the reproductive health of women in the gynecology office and community.

Learn when to appropriately refer women for Gyn specialty care.

Objectives:

Patient Care

Provide compassionate, appropriate and effective care to children in the Gyn Office.

Learn to include and utilize other health care professionals in the care of women.

Medical Knowledge

Use appropriate resources (Claude Moore HSL, Pediatric textbooks, InfoRetriever, etc.) to expand knowledge, answer patient care questions.

Use preceptors and senior residents to expand knowledge of issues related to the care of patients seen in the Gyn office.


Demonstrate the ability to incorporate new knowledge acquired from the medical literature and other resources (as above) to patient care decisions.

Interpersonal and Communication Skills:

Communicate effectively with patients, families, and with other healthcare professionals in the Gyn office.

Professionalism

Demonstrate the ability to work collaboratively with nurses and other staff in the Gyn office.

See patients in a timely manner appropriate to their medical needs.

Follow through on patient care and administrative responsibilities.


Develop an understanding of the systems of care in the Gyn office.

Utilize agencies such as Social Services, Women’s Shelter and Adult Protective Services appropriately.

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PSYCHIATRY (Elective Rotation)

Introduction

The inpatient Psychiatry service exposes the resident to patients with a broad variety of psychopathology. A full range of treatment modalities is used to treat inpatients, including pharmacotherapy, electroconvulsive therapy (ECT), and a variety of psychotherapies. Patients' physical health ranges from healthy to seriously ill. Residents at all levels will be expected to participate in inpatient care, rounds and conferences.


Patient Care

The resident rotating on Psychiatry will begin to develop their understanding and knowledge concerning the historical, cultural, legal, and ethical aspects of psychiatric treatment. Residents are expected to:

Demonstrate an ability to obtain thorough histories from patients hospitalized in an inpatient psychiatric unit.

Formulate a basic differential diagnosis and gather appropriate information to narrow the differential.

Demonstrate an ability to accurately diagnose psychiatric disorders seen in the inpatient setting.

Develop a biopsychosocial treatment plan.

Demonstrate safe prescription of psychotropic medications.

Demonstrate an awareness of appropriate psychotherapeutic techniques for issues arising during inpatient hospitalization.

Demonstrate the ability to coordinate thorough follow up plans for discharged patients.

Present cases succinctly and accurately

Understand the importance of proper documentation in the clinical record

Gain skills as a teacher

Medical Knowledge

The resident rotating on psychiatry must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to the care of patients with urgent and chronic psychiatric problems. Residents are expected to:

Demonstrate the ability to accurately diagnose patients using current DSM criteria.

Show an ability to appropriately seek consultation from other hospital services when necessary.

Develop an understanding of the symptomatology, epidemiology, genetics and course of the basic common psychiatric syndromes.

Develop a basic understanding of the pharmacokinetic and pharmacodynamic properties of commonly used psychiatric medications.

Develop a differential diagnosis of psychiatric symptomatology and the importance of biologic, psychologic and social aspects of symptoms.

Learn the use of ECT

Learn the appropriate use of laboratory and psychological testing

Practice-based Learning and Improvement

The resident rotating on psychiatry must demonstrate the ability to investigate and evaluate their care of medical 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 meet the following goals:

Demonstrate the ability to seek appropriate supervision.

Demonstrate the ability to incorporate lessons learned from supervision into new knowledge, skills and professional attitudes.

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Demonstrate the ability to educate medical students on basic principles of psychiatry.

Gain skills of self-education.

Interpersonal and Communication Skills The resident rotating on psychiatry must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

Demonstrate an ability to empathically interview patients with psychiatric disorders.

Demonstrate a basic ability to effectively communicate clinical information to a patient and his/her family.

Effectively communicate cross coverage issues to resident colleagues to provide continuity of care.

Demonstrate the ability to effectively communicate with other members of the treatment team.

Demonstrate competent consultation with other specialists and referring physicians.

Understand the importance of family in helping with assessment and treatment

Understand the role of other mental health professionals including psychologists, nursing staff, social work staff, and activity therapy staff.

Professionalism The resident rotating on psychiatry must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to:

Demonstrate sensitivity to patients’ ethnicity, gender, age, and disabilities

Demonstrate a commitment to ethical principles such as confidentiality and informed consent.

Demonstrate respect, compassion and integrity in carrying out patient care duties.

Demonstrate a commitment to pursuing professional development activities.

Complete documentation of patient encounters in a timely fashion.

Systems-based Practice The resident rotating on psychiatry 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. Residents are expected to:

Demonstrate an ability to effectively provide testimony in civil commitment hearings while maintaining a doctor-patient relationship.

Effectively coordinate patient care with a multidisciplinary team.

Understand the appropriate use of inpatient services and managed care

Understand the principles underlying interactions with the court system including involuntary commitment of psychiatrically ill patients

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SLEEP MEDICINE (Elective Rotation)

Introduction

The resident will become proficient in the evaluation and management of patients with common sleep disorders and become familiar with the basics of polysomnogram interpretation.

Patient Care: Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life. Upon completion of the rotation, residents are expected to:

Demonstrate an ability to obtain a comprehensive and accurate history of present illness for commonly encountered sleep disorders.

Demonstrate general physical examination skills with an emphasis on systems relevant to specific sleep disorders, such as upper airway examination in patients with suspected obstructive sleep apnea syndrome.

Develop and carry outpatient diagnostic and management plans in association with the supervising sleep medicine physician

Demonstrate the ability to interpret polysomnography, multiple sleep latency tests, and other diagnostic sleep testing.

Demonstrate the ability to provide a clear, concise note which directly addresses the problems presented by the patient and the questions asked by the referring physician.

Demonstrate caring and respectful behaviors when interacting with patients.

Counsel and educate patients and their families regarding sleep disorders, diagnostic procedures, and treatments.

Use information technology to support patient care decisions and patient education

Demonstrate an ability to work with a variety of health care professionals to provide patient-focused care ·

Medical Knowledge:

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others. Upon completion of the rotation, residents are expected to demonstrate a basic knowledge of:

Fundamental mechanisms of sleep, major theories in sleep medicine, and the accepted facts of basic sleep mechanisms

Chronobiological mechanisms

Respiratory physiology during sleep and the pathophysiology of sleep apnea.

Cardiovascular physiology during sleep and how it is affected by sleep apnea.

Ontogeny of sleep

Clinical manifestations and pathophysiology of common sleep disorders:

Treatment of common sleep disorders:

Practice-Based Learning: Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. Upon completion of the rotation, residents are expected to:


Use information technology to manage information, access on-line medical information and support their education, and apply this information to their practice in the diagnosis and management of patients with sleep disorders.

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Demonstrate teaching of students and other health care professionals on the rotation

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of healthcare teams. Upon completion of the rotation, residents are expected to:

Demonstrate an ability to develop a therapeutic and ethically sound relationship with patients and their families

Demonstrate an ability to use verbal and non-verbal skills to communicate effectively with patients.

Demonstrate effective listening skills

Work effectively with others as a member of a health care team

Professionalism:

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society. Upon completion of the rotation, residents are expected to:

Demonstrate compassion, respect, integrity and honesty.

Accept responsibility for direct patient care activities.

Always act in the best interest of the patient.

Demonstrate responsiveness to the needs of patients and society.

Demonstrate accountability to patients, society, and the profession

Demonstrate a commitment to excellence and on-going professional development

Demonstrate sensitivity to patient’s culture, ethnicity, age, gender, sexual orientation and disability.

Systems-Based Practice:

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care. Upon completion of the rotation, residents are expected to:

Appraise how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society.

Practice cost-effective health care and resource allocation that does not compromise the quality of care.

Advocate for quality patient care and assist patients in dealing with system complexities.

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PALLIATIVE CARE MEDICINE (Elective Rotation)

Introduction Palliative care medical experiences are intended to assist the resident’s transition from didactics to integrated clinical evaluation, decision-making, and management of patients. In addition, the resident should continue to develop skills in systematic clinical problem- solving and patient management abilities, establish and reinforce patterns of independent learning and self-evaluation, and improve skills in communication and medical record keeping. At the completion of this clinical rotation, the resident should have reached certain broad educational goals, including:

Continued development of systematic medical problem-solving, patient management abilities, and appropriate preventative medicine strategies in the context of a debilitating illness;

Expanded knowledge of both communicable and non-communicable diseases;

An understanding of the health and wellness issues of underserved and indigent patients and populations;

Improved clinical skills, including both diagnostic and therapeutic procedures.


Patient Care


Demonstrate knowledge and an advanced resident level of proficiency in the evaluation of patients at the end of life, and patients with specific symptom palliation needs.

Perform a careful and complete history and physical, with emphasis on communication with the patient and his/her family about end-of-life issues such as advance directives and prognosis.

Develop a basic treatment plan for patients with common symptoms associated with life-limiting illnesses.

Demonstrate knowledge of hospice, including the interdisciplinary meeting, and knowledge in determining a patient’s eligibility and appropriateness for hospice referral.

Identify indications for transferring patients to the inpatient Palliative Care service.

Medical Knowledge By the end of the rotation, residents are expected to acquire basic knowledge of the following: Symptom evaluation and management:

End of life issues: ethics and communication

Prognosis o Chronic medical conditions o Patients near the end of life


Utilize available resources to assist in making both timely and appropriate diagnostic and management decisions during palliative care consultations

Discuss outcomes of patient management plans with the attending physician

Evaluate and target areas for self-improvement


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Identify the qualities of a good consultant, incorporating professionalism into the process. Such qualities include promptness, efficiency, courtesy and respect for colleagues. The resident should demonstrate excellent communication skills, and the ability to correspond effectively with consulting clinicians and outside physicians

Develop aptitude, sensitivity and comfort discussing patient care issues related to advanced disease, life-limiting illness and end of life care with staff, patients, and families

Demonstrate consciousness of and respect for cultural differences in response to severe illness and death

Demonstrate consciousness of and respect for spiritual values held by patients and families

Demonstrate awareness of their reactions to grief and stress and discuss ways to deal with them

Understand the value of and how to conduct a family meeting for discussion of goals of care

Professionalism

Demonstrate respect for patients, families, and palliative care staff

Professional appearance

Promptness in arrival

Demonstrating an eagerness for learning and self-improvement


Demonstrate an understanding of cost-effective, evidence-based medicine when treating palliative care patients

Access appropriate interdisciplinary consultants for patient care

Demonstrate proficiency at operating within the context of an interdisciplinary group managing patients

Demonstrate cost efficiency in ordering tests and discharge planning, and fundamental knowledge of hospice and other case management financial plans

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PHYSICAL MEDICINE AND REHABILITATION (Elective Rotation)

Introduction

Residents rotating on the PM&R service will participate in the evaluation and care of patients recovering from neurologic injuries, with special emphasis on rehabilitation for victims of cerebral trauma, stroke, or spinal cord injury. Residents will participate in the care of inpatients and outpatient rehabilitation clinics.


Patient Care

The resident rotating will gain experience in understanding modalities of therapy and support available and their appropriate application to patients, and in understanding the prognosis for recovery and for the effectiveness of rehabilitation in enhancing recovery. Residents assist in evaluating patients for referral to rehabilitation and assist in direct care for patients undergoing neuro-rehabilitation. Residents are expected to:

Create independent, accurate & comprehensive written history & physicals, specifically targeted to identify impairments that impact a patient's level of function

Both identify and appreciate the various components of a comprehensive rehabilitative program, including the scope of treatment services and the role of each member of a multidisciplinary rehab team.

Independently propose daily management plans, incorporating patient preferences & values

Identify the distinction between impairments, disabilities, and community limitations and develop increased awareness about the relationships between common clinical disease entities, physical disability, psychosocial issues, quality of life, and maximizing functional outcomes.

Identify various methods to assess and measure neuromuscular function.

Medical Knowledge

The resident must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to care of patients with urgent and chronic medical problems. Residents are expected to:

Demonstrate knowledge of core basic science concepts, pathophysiology, & management

Apply core knowledge at the bedside, and demonstrate sound clinical reasoning skills

Demonstrate proficiency in basic musculoskeletal physical exam skills

Independently assess available clinical evidence & apply it to direct patient care

Give a concise & clinically relevant educational presentation to your team (team dependent)

Practice-based Learning and Improvement

The resident must demonstrate the ability to investigate and evaluate their care of medical 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 meet the following goals:

Evaluate their exam skills and knowledge and incorporate feedback from others.

Investigate and apply evidence from scientific studies to enhance patient care throughout the rotation.

Use information technology (computers, journals, etc.) to access and manage patient information and support their education and treatment decisions.

Participate in Mortality and Morbidity Conference in a manner that critiques and evaluates your performance and identifies key learning points.

Attend and participate in conferences and rounds.

Provide in-service talks to allied health personnel.

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Investigate the outcomes of their treatment decisions.

Participate in teaching rounds


The resident must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

Elicit information using effective questioning and listening skills.

Demonstrate caring and respectful behaviors (verbal and non-verbal) with patients.

Establish trust and maintain rapport with patients and family.

Complete all chart notes and dictations in a timely manner.

Present material clearly and accurately to patients and family.

Regularly visit the therapy areas to observe patients engaged in restorative activities.

Effectively communicate patient needs, verbally and in writing, to all multidisciplinary staff and other physicians involved with the patient.

Prescription writing: write inpatient therapy orders and prescribe home health or outpatient prescriptions that include the following essential elements: diagnosis, parts to be treated, procedures to be used with specifications of techniques and time, special instructions or precautions, home instructions for the patient, and number and frequency of treatments.

Utilize effective listening skills.

Participate in all relevant rounds and discussions.

Participate and eventually lead multidisciplinary rounds and family conferences.

Present their findings clearly and concisely to supervising faculty so that management can be discussed.

Professionalism

The resident must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Show leadership and become proficient at organizing and leading a family meeting.

Exemplify respect and compassion towards patients.

Show reliability, punctuality, integrity, and honesty.

Accept responsibility for own actions and decisions.

Apply sound ethical principles in practice, including patient confidentiality, informed consent, provision and withholding of care, and interactions with insurance or disability agencies.

Consider the effects of personal, social, or cultural factors in the disease process and patient management.

Demonstrate sensitivity to the patients who have different ages, social status, races, and genders.


The resident 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. Residents are expected to:

Gain knowledge about vocational rehabilitation and community resources for persons with spinal cord injury and musculoskeletal injuries.

Collaborate and work effectively with other health professionals and maintain appropriate behaviors.

Assess how their decisions affect others – patients, family, other health care professionals.

Integrate care of patients in hospital and community settings.

Recognize when tests are appropriate or may be under- or over-utilized.

Understand the cost of the treatments and diagnostic tests that are ordered.

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Gain familiarity and participate in the completion of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), including identification of impairment codes and co-morbidities.

Understand which physicians are involved in the treatment of patients with disabilities and what their role is.

Advocate for patients who need tests and treatments that might be inappropriately denied.

Describe Medicare and Medicaid requirements as it relates to documentation, elements of the exam, billing procedures, and codes.

Realize limitations on the ability of patients to pay for their medications, therapies, or equipment.

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DIAGNOSTIC RADIOLOGY (Elective Rotation)

Goals

Observe the workings of a clinical department and the role of diagnostic radiologists in the evaluation and treatment of patients

Appreciate the consultative role of the radiologist

Understand fundamentals of radiologic diagnosis and therapy in clinical situations

Objectives

Discuss value and limitations of common imaging procedures

Understand approach to interpretation of common imaging studies to formulate a differential diagnosis

Select appropriate radiological diagnostic tests for common problems

Understand basic normal anatomic features and variants; radiological anatomy

Learn indications and contraindications for imaging exams

Establish a foundation of understanding the interaction of radiation with biologic systems and radiation safety

Consistently demonstrate professional and ethical behavior

Demonstrate commitment to education

Communicate effectively and display teamwork

Documents

Internal Medicine Residency Program Competency-Based Goals ...gme.riversidecommunityhospital.com/documents/Electives.pdf · Practice-based Learning Residents must be able to investigate