Internal Medicine (PGY-1)

Description of Rotation or Educational Experience

This rotation is designed to expose the resident to the inpatient management of acute adult patients and common diagnostic entities. The resident will develop the ability to perform a logical and comprehensive history and physical exam, and formulate a differential diagnosis.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to be able to:

• Perform a complete and competent history and physical exam and present cases at morning report on the variety of patients admitted to a family medicine service.
• Independently assess patients admitted to the service, determine a differential diagnosis and management plan, and then guide them through treatment and discharge.

The resident is encouraged to familiarize themselves with the following procedures:

• Central venous line insertion
• Arterial line insertion
• Thoracentesis
• Paracentesis
• Lumbar puncture
• Nasogastric tub placement
• Arterial puncture
• Urinary catheter placement
• Arthrocentesis
• Decubitus ulcer debridement

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• This rotation fulfills family medicine-specific training and educational requirements in Adult Medicine, Inpatient Care, and Human Behavior and Mental Health.

Objectives

By the end of the rotation the resident is expected to be able to:

• Formulate an approach to ECG reading and identify abnormal electrocardiograms including abnormal conduction, ischemia, and injury.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

By the end of the rotation the resident is expected to be able to:

• Demonstrate ability to locate, and utilize relevant evidence based literature to provide optimal care.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Incorporate considerations of cost awareness and risk-benefit analysis in patient care

Objectives

By the end of the rotation the resident is expected to be able to:

• Work effectively with the patient, family, and community resources in giving care.
• Describe the roles of the various members of the hospital care team including nurses, physical therapists, pharmacists, dieticians, laboratory staff, and consultants.
• Discuss admission and discharge criteria, the use of long-term care facilities, and home care nursing in the management of the acutely ill patient.
• Demonstrate proficiency in coordinating the care of acutely ill patients during their hospitalization and transition to outpatient care.

Professionalism

Goal

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

Competencies

• Compassion, integrity, and respect for others
• Accountability to patients, society, and the profession
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

By the end of the rotation the resident is expected to be able to:

• Establish strong working relationships with nursing staff, care partners, case managers.

Interpersonal and Communication Skills

Goal

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

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies

Objectives

By the end of the rotation the resident is expected to be able to:

• Integrate a biopsychosocial perspective into patient care.

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Direct role-modeling and observation
• Education-centered rounds

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

· Directly by attending physicians

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

Resources and people residents have identified as useful, and encourage new rotators to become familiar with:

• Up-to-date
• Sladen library website
• Pharmacy
• “Curbside” consults
• Case management
• PT/OT
• CICU/MICU Fellow
• Faculty
• Above all, your colleagues on the in-patient team.