Education Goals and Objectives
Goals and Objectives
The Eisenhower Internal Medicine Residency Program is designed to provide broad-based clinical training, with an emphasis on preparation, for comprehensive primary care and hospitalist medicine. The goal of our program is to assist residents in developing the competencies necessary to become outstanding comprehensive internists, capable of managing diverse patients with a broad range of diseases. Residents are given guidance and advice to develop their careers, achieve scholarship, and assure competencies needed for the next steps of their careers.
One of the unique features of the program is the balance between inpatient and outpatient experiences. Second and third year residents enjoy an innovative schedule that allows for a focused exposure to both inpatient and ambulatory medicine. Residents on ambulatory blocks benefit from close collaboration with community-based primary care and subspecialty faculty. During these rotations, residents build skills in office-based diagnosis and treatment, while managing diverse continuity practices. Residents on inpatient rotations enjoy graded responsibilities, with first year residents providing much of the direct patient care, and second and third year residents assuming increased responsibility for teaching, supervision and mastery of medical knowledge. A strong ethic of collegiality and support pervades both ambulatory practices and inpatient teams.
Inpatient training is centered at the newly expanded Eisenhower Medical Center. The Eisenhower Medical Center is very highly rated by our patients as a primary, secondary and tertiary care facility. Patients referred are often of a very complex nature but because of the large staff of Eisenhower primary care physicians, we also see a substantial number of common community diseases. Planned outside rotations at a large, inner city County Hospital provide residents with the opportunity to work with a diverse patient population and practice in a different healthcare system.
By the end of the residency:
•• Residents will be proficient in obtaining clinical data by patient interview, physical examination, and interpretation of imaging and laboratory data.
•• Residents will be proficient in utilizing clinical data to prioritize problems, and formulate differential diagnoses.
•• Residents will formulate diagnostic and therapeutic plans demonstrating awareness of risks, benefits, costs, patient preferences, as well as ethical and psychosocial dimensions.
•• Residents will have been taught excellent communication skills to use with patients, families and other members of the health care team, demonstrating respect, compassion and integrity.
•• Residents will demonstrate a commitment to ethical principles and to their professional responsibilities.
•• Residents will embrace the principles and practice of lifelong learning to maintain a broad knowledge base. They will keep abreast of the pertinent current literature and be able to translate this to effective clinical practice. Residents will be proficient in searching and critically analyzing the medical literature to answer clinical questions.
The competencies listed below are achieved through a required set of rotations, a didactic curriculum, scholarly activity, use of simulator lab, computer modules, and self-selected electives. Our residents, faculty and program are continuously evaluated to ensure success in achieving these competencies, goals and objectives.
Competency-Based Objectives of Training
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:
•• communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
•• gather essential and accurate information about their patients
•• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
•• develop and carry out patient management plans
•• counsel and educate patients and their families
•• use information technology to support patient care decisions and patient education
•• perform competently all medical and invasive procedures essential for the practice of general internal medicine
This includes competency in performing, using appropriate indications, contraindications and informed consent and evaluating the results of the following procedures:
•• nasogastric tube placement
•• Foley catheterization
•• pelvic examination and pap smears
•• EKG interpretation
•• PFT interpretation
•• CXR interpretation
•• basic life and advanced life support
•• arterial puncture
•• arthrocentesis injection of the knee and shoulder
•• central venous line placement
•• lumbar puncture
•• provide health care services aimed at preventing health problems or maintaining health
•• work with health care professionals, including those from other disciplines, to provide patient-focused care
Residents must demonstrate 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. Residents are expected to:
•• demonstrate an investigatory and analytic thinking approach to clinical situations
•• demonstrate a sufficient level of understanding of the clinical, basic and social sciences that underlie the practice of internal medicine and be able to demonstrate that they can apply their knowledge to patient care, patient education, and the education of other members of the health care team
•• areas of knowledge will include understanding the pathogenesis, pathophysiology, epidemiology, historical issues, relevant physical findings, test utilization, means of confirming a diagnosis, treatment, monitoring and prevention of the most common inpatient and outpatient clinical disorders cared for by internists
•• understand how various aspects of disease are affected by gender, age, ethnicity, culture and disability
Practice-Based Learning and Improvement
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
•• learn how to self-evaluate cognitive, technical, attitudinal and procedural aspects of care
•• locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
•• obtain and use information about their own 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 own education
•• facilitate the learning of students and other health care professionals
•• prior to the completion of training, all residents will demonstrate scholarly activity.
At a minimum this will include:
•• presentation of a 50-minute senior talk
•• presentation of original research or case report at a regional or national meeting
•• the application of evidence-based medicine skills through ongoing participation in journal club, resident rounds and subspecialty case conferences
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:
•• demonstrate effective written, verbal and non-verbal communication when
•• participating in patient care, consulting and collaborating with colleagues and
•• coworkers, teaching and presenting in the academic center and most importantly during information exchange and collaboration with patients and their families
•• 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
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
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care associated with the ability to effectively call on 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 own 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
•• 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
Core Rotations for Residents to Achieve the Competencies
•· All residents will have rotations in the intensive and coronary care unit, emergency medicine, urgent care, general medical wards at Eisenhower Medical Center and a planned medical ward rotation at a large, inner city County Hospital. In addition, learners will have a specific inpatient rotation focused on Perioperative Consultation, with pre and post-op continuity of care.
•· A Geriatric Medicine specific curriculum will focus on acquiring competencies related to the inpatient, ambulatory and nursing home settings with related didactic sessions.
•· Continuity of care will be based in a model Internal Medicine ambulatory care unit on Campus. During the subspecialty electives there will be ambulatory-based experiences in cardiology, endocrinology, gastroenterology, neurology, pulmonary, rheumatology and any of the other elective specialty rotations. In addition, sufficient opportunity is available for residents to elect rotations in a variety of other disciplines including women's health, complementary and alternative medicine, sports medicine, dermatology, radiology, pathology, and HIV medicine.
•· All residents are afforded the opportunity to use any of their elective time to participate in research or other scholarly activities. Residents will always be in an environment that allows access and consultation in all areas of general and subspecialty care. Residents will work on teams that have physicians, students, pharmacists, social workers, and case managers. Except for consultative services, residents will have primary responsibility with the attending physician for all direct aspects of medical care for the patients. There will always be 24/7 supervision by an inpatient Internist on site in the hospital.
•· In total, residents will spend no less that 33% of their residency in ambulatory care settings, have one day off each week averaged over 4 weeks, have limitations on work hours and patient volume that complies with ACGME regulations, and be given time to attend the curricular educational offerings. Individual scholarship with appropriate mentoring will be strongly encouraged.
There are several core conference series required in our program that enhance resident competency development:
•· Noon conferences are held Monday, Tuesday, Thursday and Friday every week throughout the year and emphasize patient care; medical knowledge, practice-based learning and systems based practice competencies. The curriculum for this conference series revolves around key inpatient internal medicine topics. Senior residents are also scheduled to give their required scholarly talks during this time slot. Many of the core lectures will be covered in this series.
•· "Intern Intake" is a weekly conference run by the chief residents or attendings specifically for the PGY 1 learners where basic topics related to management of acute medical problems in hospitalized patients are covered specifically geared to the PGY1 Learner.
•· Journal Club is a monthly, evidence-based conference, scheduled for all residents not assigned to the in-patient services.
•· Morbidity and Mortality Conference will be structured to teach to the specific competences related to the cases that are presented. This will occur in place of one of the noon teaching conferences once a month.
•· Medicine Grand Rounds are held every Thursday. Attendance is required.
•· Core lecture series provided for the MICU, CCU and inpatient Geriatric Services. The Geriatric Service lecture series places special emphasis on resident learning skills related to systems-based practice.
•· Morning Report is held every Monday, Tuesday, Wednesday and Friday morning. Morning report is structured so that 2 or 3 cases are presented as unknowns (by pre-selected residents) and the rest of the residents work through the cases with a faculty facilitator. Literature reviews about some aspect of the case are then provided by the resident presenters. We are planning to substitute one morning report a month with an Autopsy Conference taught jointly with the Pathology Department.
•· Chiefs Rounds in lieu of morning report twice a month for the general medicine ward teams. This is a case-based conference taught by the Program Director.
•· Ambulatory Case Conference before each continuity clinic session in the Internal Medicine Suite where residents see their general medicine continuity patients. Residents and faculty discuss cases that have been prepared by faculty with key reference articles provided. Each week there is a different topic covered.
•· Subspecialty Core Lectures Take place during subspecialty blocks that residents are required to attend. Some of these are didactic lectures specifically prepared for the residents and presented by key faculty members. Format is centered on cases seen by the resident.