Ambulatory
Medicine
INTERNAL
MEDICINE RESIDENCY PROGRAM
Faculty:
Robert Healy, MD, Christopher Alcaraz, MD, Sanjiv Jain, MD Scott Paluska, MD,
Harikrishna Patel, MD, Otorhinolaryngology, Psychiatry, and Ann Robin,
MD
Sites:
Veterans Administration Illiana Health Care System (VAIHCS), Carle Clinic Association,
Description
4
week block rotation under direct attending supervision for required resident
ambulatory clinical experiences in psychiatry, dermatology, medical
ophthalmology, office gynecology, otorhinolaryngology, non-operative
orthopedics, and physical medicine and rehabilitation.
Additional Ambulatory
Medicine training takes place longitudinally throughout all 3 years,
specifically through Continuity Clinic and subspecialty rotations. Other
Ambulatory Medicine education occurs during weekly core conferences as well as
Grand Rounds, Morbidity and Mortality, and Journal Club.
I.
GOALS
Residents will have
sufficient instruction and clinical experience in psychiatry, dermatology,
medical ophthalmology, office gynecology, otorhinolaryngology, non-operative
orthopedics, and rehabilitation medicine to become familiar with those aspects
of care, in each specialty area, that can be diagnosed and managed by general
internists, and those that should be referred to, or managed jointly with other
specialists.
II. OBJECTIVES
A. PATIENT CARE
Objective 1:
Demonstrate clinical skills of comprehensive medical interview, history and
physical examination, including functional assessment and mental status as
needed.
Objective 2:
Demonstrate clinical skills in the thorough performance of medical interview,
physical examination, and diagnostic and therapeutic procedures.
Objective 3:
Perform and record procedures
Procedure Skills:
Residents will have the opportunity to achieve competence in additional
procedures that may be required in their future practice settings. These may include cryosurgical removal
of skin lesions, skin biopsies, and soft tissue and joint
injections.
Objective 4: Observe Universal Precautions at all times.
B.
MEDICAL KNOWLEDGE
Objective
1: Demonstrate principles of pain management, including proactive
treatment.
Objective
2: Demonstrate and evaluate a pharmacotherapeutic approach, including
objectives and options, selection of dose and parameters, and measurement of
response and outcome.
Objective
3: Assimilate knowledge of patient condition to recognize when
consultation is indicated.
Objective
4: Recognize and manage the following clinical problems found in the
ambulatory setting.
C.
PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1:
Demonstrate evidenced based practice through appraisal and assimilation of
scientific information, e.g. scientific journals, related to patient
care.
Objective 2:
Demonstrate ability in medical decision making, which incorporates medical
assessment and patient values and preferences.
D. INTERPERSONAL
AND COMMUNCATION SKILLS
Objective 1:
Create an atmosphere of positive regard for the patient and family to promote
the best medical outcome through accessibility, affability, and
continuity.
Objective 2:
Incorporate psychosocial and ethical concerns of the patient and family in the
development of the care management plan.
E.
PROFESSIONALISM
Objective 1:
Demonstrate humane and compassionate use of medical skills to include
high-quality care and technology, and an awareness of the limits of medical
intervention.
Objective 2:
Actively participate in the multidisciplinary approach to caring for patients,
including appropriate recognition of other health professional and
paraprofessionals’ roles and demonstrate competence in team interactions, i.e.
pharmacists, physician’s assistants, advanced practice nurses, nurses, social
workers, chaplains.
Objective 3: Recognize
the documentation and legal requirements of informed consent, and advanced
directives with understanding of the process of assessing a patient’s advance
directives, including the patient’s perspective.
Objective 4:
Model appropriate professional attitudes and behaviors of time management and
punctuality, reliability, peer support, community teaching, and ethical
behavior.
F. SYSTEM-BASED
PRACTICE
Objective 1:
Evaluate patients in ambulatory setting and formulate an appropriate,
cost-effective diagnostic and therapeutic plan.
Objective 2:
Demonstrate knowledge of ambulatory medicine delivery systems within the
specific department, the hospital, and in the community.
Objective 3:
Facilitate continuity of care of patients in the ambulatory setting, including
communication and collaboration with patients’ families, attending and
consulting physicians, pharmacists, physician’s assistants, advanced practice
nurses, nurses, support staff, technicians, social workers, and
chaplains.
Objective 4:
Recognize financial issues of health care, with consideration of cost
containment and emphasis on understanding acute and chronic care, and medication
coverage and the role of the Center for Medicare and Medicaid Services (CMS),
and other third party payers.
III.
METHODS
The ambulatory
medicine rotation is a fourweek experience scheduled at VAIHCS or Carle. It is continuously supervised by internists or
appointed non-medical faculty who are board qualified or board certified.
Residents evaluate and provide care for patients with problems ranging from
acute illness to complicated chronic diseases. Cost efficient assessment and
management are stressed. Evaluation of the patient in the context of
his/her social, economic, family, and community setting is emphasized.
Independent study is
assigned time to complete computer education modules, e.g. www.medtraining.org.
Modules to complete on the rotation include gram stain, urine analysis, and
peripheral blood smear.
Residents are required
to attend core conferences as well as continuity clinics.
Carle Ambulatory:
SAMPLE TRAINING
VAIHCS Ambulatory:
SAMPLE TRAINING
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Consults
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PACT Clinic is held in Building 98, Room c1-2 x45065. The contacts are Dr. Jaipour and Dr. Chen
Consults are held in Building 58, Room 341A x45290. The contact is Jackie Macallister.
V. EVALUATION
According to
Accreditation Council of Graduate Medical Education (ACGME), training and
evaluation must include the following competencies: Patient Care, Medical
Knowledge, Practice-Based Learning and Improvement, Interpersonal and
Communication Skills, Professionalism, and System-Based
Practice.
Patient Care will be evaluated by assessment of the attending physician, and additional information from nursing staff. Procedures performed are documented electronically.
Medical
Knowledge will be evaluated by
global assessment of the attending physician and senior resident, additional
information from nursing staff, Mini-CEX, specific to
discipline.
Practice-Based
Learning and Improvement will be evaluated by
global assessment of the attending physician.
Interpersonal and
Communication Skills will be evaluated by
global assessment of the attending physician and additional information from
nursing staff, patients and families and Mini-CEX, specific to
discipline.
Professionalism will be evaluated by
assessment of attending physician and additional information from nursing staff,
patients and families; and Mini-CEX, specific to
discipline.
System-Based
Practice will be evaluated by
assessment of attending physician and senior resident, and Mini-CEX, specific to
discipline.
The evaluation method
is primarily accomplished electronically. Residents’ performance in is
evaluated by the attending physician. Evaluations are reviewed with the
residents for formal feedback. Face to face interaction between the
attending physician and the resident is the required method. In addition,
ongoing feedback is provided related to residents’ patient care responsibilities
and activities.
Residents will
document the Ambulatory Medicine rotation in portfolios, e.g. procedures
performed, peer-reviewed chart audit. This tool will provide individual
learning, reflection and assessment. Additionally, residents evaluate the
Adult Medicine rotation.
Residents provide input on the Ambulatory Medicine core lecture series, which is used in scheduling future topics and speakers. Periodically, residents are surveyed to evaluate the Ambulatory Medicine curriculum and teaching faculty. As part of the electronic evaluation each resident is queried regarding Free Days to assure that averaged over the rotation, the resident had at least 1 day in 7 free of patient care duties.
V.
REFERENCES
Adult
Medicine
Adolescent
Medicine
Primary
Care
1987, 14: 1-241
"Adolescent Medicine, AAFP Home Study Self-Assessment,"
Monograph No 114, 1988.
"Health Care Needs of the Adolescent," Annals of
Internal Medicine, 1987, 110:930-935.
Washington Manual of Ambulatory Therapeutics, Tammy L. Lin,
M.D.
Dermatology
Office
Gynecology
Austin, RM and
McLendon, WW, Editorial entitled "The Papanicolaou Smear: Medicine's Most
Successful Cancer Screening Procedure is Threatened," JAMA, 277:9, March
5, 1997, pp. 754-755.
Cannistra, SA, and Niloff, JM, "Cancer of the Uterine
Cervix," The
Medical
Ophthalmology
Non-Operative
Orthopedics
Otorhinolaryngology
Physical Medicine and
Rehabilitation
Psychiatry