DESCRIPTION
Longtudinal curriculum applied to all residents at all Internal Medicine Residency training sites
I. GOALS
Provide guidelines for certification in internal medicine procedures and to satisfy the American Board of Internal Medicine (ABIM) requirements. The mission of our program is to improve quality health care through maintenance of high standards of certification of individual internists, possessing the knowledge, skills, and attitudes necessary for the provision of excellent care. The residency program requires residents to obtain competency in the stated objectives to the level expected of a new practitioner.
II. OBJECTIVES
A. PATIENT CARE
Objective 1 : Demonstrate compassionate, appropriate, and effective patient care for the treatment of health problems and the promotion of health.
Objective 2: Observe Universal Precautions at all times.
B. MEDICAL KNOWLEDGE
Objective 1: Demonstrate medical knowledge of established and evolving biomedical, clinical, and cognate sciences regarding the procedures below, as well knwoledge application of this knowledge of the procedures to patient care.
Objective 2: Interpret results of procedure.
C. PRACTICE BASED LEARNING AND IMPROVEMENT
Objective 1: Recognize value of investigation and evaluation of patient care, the appraisal and assimilation of scientific evidence regarding the procedures below, and improvements in patient care.
Objective 2: Demonstrate ability in medical decision making based on interpretation of procedure results.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Communicate clearly, audibly and in lay language to explain the procedure, including risks and benefits, to the patient and family. Avoid medical jargon.
E. PROFESSIONALISM
Objective 1: Adhere to high ethical and moral standards and principles of confidentiality and scientific integrity.
Objective 2: Demonstrate commitment to professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
Objective 3: Recognize the legal requirements of informed consent.
F. SYSTEMS-BASED PRACTICE
Objective 1: Demonstrate awareness of and responsiveness to the larger context and health care system, as well as the ability to effectively call on other system resources to provide optimal health care.
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
III. METHODS
The trainees must be judged competent by the program director in the following required procedures as detailed in specific curriculum:
Advanced Cardiac Life Support (ACLS)
Abdominal paracentesis
Arterial puncture
Arthrocentesis
Central venous line placement
Lumbar puncture
Nasogastric intubation
Pap smear and endocervical culture
Thoracentesis
The Board recommends at least three as the minimum number of directly supervised, successfully performed above procedures by the end of the third year of residency training; confirmation of proficiency is not credible with fewer procedures.
Residents must also demonstrate competence in interpretation of electrocardiogram (EKG).
Residents should also demonstrate competency in interpretation of:
Chest X-ray
Gram stain sputum
Microscopic examination of urine
Spirometry
KOH/Wet Prep and peripheral blood smear
Other procedures residents should demonstrate competencies are:
Cryosurgery of skin
Elective cardioversion
Skin biopsy
Soft tissue and joint injection
Temporary pacemaker
Treadmill exercise test
Interpretation of ambulatory EKG
Interpretation of ambulatory BP monitoring
All residents must be thoroughly acquainted with all listed procedures. It is of import that all of the above listed procedures contain additional information under the curriculum subsection of “Clinical Experience Required and Organized Continuously” which can be found at http://www.med.illinois.edu/internalMed/residency/curriculum/.
Residents gain knowledge about lumbar puncture by first reading from standard medical textbooks, e.g. Cecil Textbook of Medicine, Harrison's, Ferri: Practical Guide to the Care of the Medical Patient, and The Merck Manual. S/he must be thoroughly acquainted with the indications, contraindications, specific technical aspects of the procedure, interpretation of results and complications. Universal Precautions must be observed at all times. The resident must first observe and then must perform at least three of the invasive required procedures satisfactorily under direct supervision. The certified and privileged medical staff supervising the procedure will also instruct the residents regarding the procedure. S/he must satisfy the cognitive and technical skills before allowed to perform independently.
The resident demonstrates professional and communication skills by explaining the procedure in lay terms to the patient and/or family. Once completed procedural skills are documented electronically by the resident and certified by the privileged medical staff on an on-going basis in various clinical rotations at the different sites.Universal Precautions will be observed at all times.
All procedures must be documented by a procedure note immediately in the progress note section to include:
• Who performed and who assisted the procedure
• Name of supervising attending
• Indications
• Informed consent including explanation of risk, and alternatives
• Type of anesthesia
• Approach used
• Findings
• Disposition of specimens
• Occurrence or lack of occurrence of complications
A follow-up note the next day must document any complications or if uneventful.
IV. EVALUATION
ACGME Competencies 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 global assessment per the attending physician. All procedures performed will be documented electronically..
Medical Knowledge will be evaluated by global assessment per the attending physician,
Practice-Based Learning and Improvement will be evaluated by global assessment per the attending physician.
Interpersonal and Communication Skills will be evaluated by global assessment per attending physician and additional information from nursing staff, patients and families.
Professionalism will be evaluated by global assessment per attending physician and additional information from nursing staff, patients and families.
System-Based Practice will be evaluated by global assessment of attending.
The evaluation method is accomplished electronically. Residents' performance 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 procedures performed in portfolios. This tool will provide individual learning, reflection and assessment.
Residents provide input on the core lecture series, which is used in scheduling future topics and speakers. Periodically, residents are surveyed to evaluate the curriculum and teaching faculty.
V. REFERENCES
Ferri: Practical Guide to the Care of the Medical Patient (current edition)
Harrison's Principles of Internal Medicine (current edition)
Procedures in Practice, 1989. Philadelphia, PA: ACP Publications
The Merk Manual (current edition)
Vander Salm, T.D., Cutler, B.S., Wheeler, H.B. Atlas of Bedside Procedures. 1988: Little Brown and Co
Rev 12/01/2005