Competency

Objectives

Specific

Educational Experiences

Knowledge/ Skills

Integration/Application

Assessment

Tools

Patient Care

that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

To provide specific instruction in clinical skills that the trainees are required to become proficient during internal medicine residency training in a supervised setting using simulated cases and OSCEs, trained models and mannequins. These include clinical and physical examination skills, procedural skills, gynecological examination, ophtalmoscopy and otoscopy.

Develop proficiency in simple but important laboratory skills such as interpreting peripheral blood smears, urinalysis including microscopy and spirometry, wet mount.

All participants complete a comprehensive bedside examination under the supervision of clinical faculty.

(1.5 – 2 hours)

Trainees receive instruction followed by the opportunity to practice performing a gynecologic examination on trained models. (1.5 hours)

Instruction on performing common clinical procedures such as central lines, lumbar punctures, arthrocenthesis, thoracenthesis and paracenthesis. Trainees are provided with the opportunity to practice these procedures on mannequins in an non-intimidating setting. (Two 3 hour sessions)

Instruction on special clinical examinations skills such as opthalmoscopy an otoscopy that are more technically difficult. (Two one hour sessions)

Didactics on technical aspects as well as interpreting normal and abnormal findings. Trainees receive hands on training performing these studies and interpreting common abnormal findings.

Direct observation and assessment followed by immediate documented feedback on trainees history taking and physical examination skills.

observation and feedback on trainees clinical examination skills, respect for privacy and bedside skills.

Direct observation and feedback by supervising faculty.

Trainees receive extensive instruction on proper technique and common abnormal findings followed by an opportunity to practice on each other under the supervision of faculty with immediate feedback.

Direct observation and feedback. Additional skills assessment is conducted as part of the monthly in-training examinations that are administered to all trainees and contain multimedia photomicrographs for interpretation.

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

Provide instruction is selected topics that are not generally part of the traditional curriculum. These include instruction in pain managements in keeping with the current JCAHCO standards, early recognition of domestic violence, women’s health, pain management, clinical pharmacology, dermatology for the internist and pre-operative evaluation.

Specifically developed problem based workshops and lectures utilizing case studies, multi-media presentations developed and presented by faculty with special interest in each of the specified topics. Resident participate in a domestic violence workshop (3.5 hours), lectures on pain management including American Pain Society and JCACHO standards, pharmacology of analgesic and specialized analgesic techniques (2 hours), multi-media case studies on dermatology (2 hours) and case studies on pre-operative evaluation.

Direct observation during interactive workshops and lectures and subsequent evaluation and feedback during clinical rotations. Performance on monthly in-training examinations.

Interpersonal and Communication Skills

that result in effective information exchange and teaming with patients, their families, and other health professionals

Provide instruction in communication skills to improve interaction with patients, health care professionals and colleagues to improve patient care. Provide trainees with instruction on communication skills needed in some specific clinical situations as giving bad news, conduction a family conference and handling an angry or upset patient.

Trainees participate in two 3 hour workshop conducted by an expert with an PhD in communication on how to communicate effectively with patients and health care professionals. In addition trainees receive a multi-media CD Rom with valuable case scenarios. Additional interactive didactics on giving bad news, conducting a family conference, addressing code status and dealing with an angry patient are provided by the ethics committee of the hospital.

Trainees are evaluated and feedback provided by direct observations during the interactive sessions that involve significant role play and trainee participation. Additional evaluations and feedback is provided during clinical rotations by supervising faculty.

Professionalism

as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

To provide instruction on professional standards for ethical practice as set forth by organizations such as the AMA, Institute of Ethics, the American College of Physicians Center for Medical Ethics and Professionalism. To provide residents in specific instruction on topics such as end of life care, patient autonomy, informed consent, patient privacy and physician industry relations

Case based interactive didactic sessions of end of life care (2 hours), medical ethics (2 hour), conducting a family conference (1 hour) and professional standards of conduct and practice (1 hour). Case studies and lectures are conducted by the chairman of the ethics committee, members of pastoral services and faculty with special interest and training in professionalism and ethics. Residents participate in a diversity awareness & training workshop as well. 

Direct observation during interactive case study sessions and evaluation and feedback provided during patient care rounds.

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

To provide instruction and practice important skills needed to understand study design, interpret statistics, searching the literature, critical review of the literature and clinical decision making and rational use of diagnostic studies using likelihood ratios. Develop the skills necessary to critically appraise a clinical topic and present it to a larger audience as a powerpoint presentation.

Resident receive problem based interactive didactics on clinical epidemiology, medical statistics, using medline, clinical decision making and writing a research abstract. Most didactics are based on pre-assigned assignment and interactive discussion of results. Residents are assigned a clinical topic for review at the beginning of the course that is developed in to a critically appraised topic (CAT) for presentation at the end of the course.

Attendance and timely completion of assignments are used for evaluation during the course. At the end of the course, the residents present their MDM presentations as part of the noon-conference series. These presentations are evaluated by faculty and the resident is provided with both formal and informal feed back. Application of the skills acquired during MDM course is evaluated during clinical rotations and during mandatory presentations by residents during PGY2 and PGY3 such as journal club and resident grand rounds.

Systems-Based Practice

as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value

Provide instruction in the common health care insurance program models available in US including Medicare, Medicaid and the various managed care programs including HMO, PPO, capitation and Fee for Service. To understand the current guidelines for coding, documentation and the different levels for intensity of care in the in-patient and ambulatory setting. To understand optimum strategies to provide cost-effective, safe and responsible patient care while managing medical liability and malpractice risk. Trainees receive instruction on understanding the importance between standards of care, documentation, informed consent and medical liability risk. To understand setting related to common medical errors and develop skills and habits that would help to minimize medical errors such as safe prescription practice. To develop the knowledge and skills needed to optimize patient care and reduce length of stay by utilizing services such as social work, discharge planning, home care and transfer to skilled nursing facilities, in-patient and sub-acute rehabilitation facilities and nursing homes.

Trainees attend lectures, case studies and workshops on managed care (1 hour), documentation (1 hour), risk management (1-2 hours), reducing medical errors (1 hour) and safe prescription practice. Instruction on the importance of timely reporting of medical errors with the intent of process improvement is provided using the “Dr. Quality” program. Residents attend a 2 hour on-site didactic at the ambulatory clinic reviewing charts to understand common payee systems, importance of prescribing within managed care formularies, restrictions on referrals, consultations, diagnostic studies and patient co-pays. Residents participate in didactics organized by social workers, utilization review nurses and discharge planners to understand resources available to ensure safe patient after hospital discharge. The risk management department of the hospital conducts a workshop involving risk management specialist and lawyers.   

Interactive evaluation and feedback is provided during didactic sessions by faculty. On going evaluation of residents understanding of

Documentation, utilization of ancillary services and safe prescription practice are evaluated during clinical rotations by supervising faculty. Compliance with preventive care guidelines, prescribing within managed care formularies and adequacy of documentation including maintenance of problem lists, medications lists and progress notes in the ambulatory setting are evaluated by clinic preceptors.