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 and the education of others.
Competency: Demonstrate an investigatory and analytic approach to clinical situations.
- Ask relevant clinical questions and utilize information resources aptly.
- Utilize consultations appropriately and eagerly engage consultants in mutual education about standard and up to date medical practice issues.
- Apply an open-minded, analytical approach to acquiring new knowledge by utilizing evidence-based medicine skills and critically evaluating current medical information.
- Apply knowledge acquired effectively to the care of patients.
- Work actively with faculty preceptors at the beginning of rotations to identify prescribed as well as individual learning objectives.
- Demonstrate commitment to lifelong learning by implementing strategies to increase knowledge based on self-assessment, faculty and peer feedback and performance on written exams.
- Utilize basic quality methods, such as root cause analysis, to assess sub-optimal patient outcomes and their precipitants within the current healthcare system.
Competency: Know, apply and teach the basic and clinically supportive sciences.
Knowledge/ Skills/Attitudes /Objectives:
- Develop informatics skills that foster the maintenance of a fundamental, current knowledge base for the practice of internal medicine.
- Remain current with new developments in internal medicine and the standard recommendations for quality care defined by large national professional organizations.
- Seek up to date medical information to augment one's knowledge base and support clinical problem solving and decision-making.
- Attend and participate in all required conferences on a regular basis.
- Communicate actively with specialists and other professionals to maintain a fundamental knowledge of their skills / abilities to enhance patient care.
- Optimize clinical decision making by considering current scientific information, risk / benefits, potential clinical outcomes, cost-effectiveness and patient preference of available tests and therapies.
- Demonstrate commitment to life-long learning.
- Participate in programmatic and self directed education of peers, medical students, other healthcare professionals and patients
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Competency: 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 ongoing professional development.
- Demonstrate honesty, integrity and reliability consistently.
- Seek, honor and complete assigned duties.
- Exhibit respect, compassion, and empathy in all interactions.
- Display self-awareness, recognize limitations, seek appropriate assistance and strive for self-improvement.
- Demonstrate commitment to lifelong learning including regular attendance at conferences and reading medical literature.
- Respond positively to constructive criticism.
- Acknowledge error, demonstrate accountability and strive for system improvement and error prevention.
- Inspire accountability in others by promoting peer review in a blameless environment.
- Dress and behave appropriately.
- Validate the significant role physicians play in society.
Competency: Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
- Recognize ethical dilemmas and consult with the hospital's ethics committee appropriately.
- Adhere to the primacies of confidentiality, scientific integrity, and informed consent.
- Recognize the situational need for determining competence and healthcare proxies.
- Address end-of-life issues in a timely and compassionate manner.
- Engage in ethical business practices.
- Interact with the pharmaceutical industry in a professional and principled manner.
- Competency: Demonstrate sensitivity and responsiveness to patients and colleagues' culture, age, gender, race, religion, and sexual preferences.
- Knowledge/Skills/Attitudes Objectives:
- Recognize the impact of culture, experience, age, gender, and disability on patient perceptions, preferences, compliance, and outcomes.
- Display sensitivity to the significant interplay of issues related to cultural beliefs, socioeconomic status and health literacy and how they relate to patients' utilization and compliance.
INTERPERSONAL SKILLS AND COMMUNICATION
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.
Competency: Create and sustain a therapeutic and ethically sound relationship with patients.
- Establish and maintain open lines of communication with patients and their families.
- Demonstrate HIPAA compliance while dealing with families and friends.
- Empower patients to make knowledgeable decisions through effective education.
- Demonstrate value and compassion for patient preferences.
- Interact respectfully with difficult patients.
- Maintain a therapeutic relationship with patients over time.
Competency: Use effective listening skills and elicit and provide information using effective non-verbal, explanatory, questioning and writing skill.
- Identify members of the health care team and explain their roles appropriately.
- Communicate with patient / caregiver in suitable, private settings.
- Elicit initial and interval histories from patients using effective verbal and non-verbal techniques.
- Provide verbal and written education keeping in mind the developmental and educational level of the patient and caregiver.
- Maintain legible, accurate, timely documentation.
Competency: Work effectively with others as a member or leader of a health care team or other professional group.
- Learn the names and roles of health care team members.
- Identify educational goals and objectives for team members when acting as the team leader.
- Facilitate team communication.
- Promote constructive reciprocal feedback amongst team members.
- Provide and obtain effective professional consultation to optimize patient care.
- Ensure seamless patient care by promoting effective communication across professions and systems of care.
Residents must be able to provide patient centered care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
Competency: Demonstrate caring, respectful and effective communication skills when interacting with patients and families.
- Interact in a culturally sensitive manner with all patients regardless of their socio-economic or insurance status.
- Demonstrate the ability to translate complex medical jargon to a level that the patient and his/her caretaker can understand.
- Demonstrate respectful recognition of patient capabilities, limitations and preferences.
Competency: Gather essential and accurate information about the patient.
- Obtain an accurate comprehensive history from the patient.
- Access additional sources of information from family, caretakers, witnesses and previous medical encounters.
- Convey value of the caretaker's opinions regarding the patient's health and illness.
- Perform a detailed and accurate physical examination.
Competency: Formulate diagnostic and therapeutic interventions based on patient information and preferences, current scientific evidence and clinical judgment.
- Formulate and prioritize a differential diagnosis.
- Recognize patients' comprehension and anxiety about their illness as well as their discomfort and financial stress related to testing.
- Obtain and interpret appropriate laboratory and radiological studies after the patient provides informed consent.
- Utilize data obtained to formulate diagnoses and synthesize an evidence-based management plan that is optimized by active patient participation.
- Recognize personal limitations and seek help aptly.
- Utilize subspecialty consultation appropriately.
- Demonstrate responsibility and accountability for decisions.
Competency: Develop and implement patient management plans that actively engage the patient.
- Educate patients and families regarding diagnoses, available therapies and the entailed risks and benefits.
- Create a management plan that encompasses patient and caretaker capabilities and preferences.
- Ensure patient and caregiver comprehension of the management plan.
- Provide written discharge instructions that the patient/caretaker can clearly comprehend.
Competency: Counsel and educate patients and families.
- Empower patients and families to make educated decisions by providing accurate, up to date Information.
- Utilize nutritional, rehabilitative and other ancillary personnel to extend patient education.
- Provide both good and bad news in a professional and empathetic manner.
- Recognize patient and family emotional response and connect them to the appropriate psychosocial resources.
Competency: Use information technology to optimize patient care.
- Access and update Electronic Medical Records as a data gathering resource.
- Use information technology tools (e.g. PDA, interactive web sites, computer based order entry) to optimize patient care and minimize iatrogenic complications.
- Review clinical standards of care and evidence based medicine routinely to enhance patient care.
Competency: Perform competently appropriate medical and invasive procedures.
- Know the indications, potential complications and alternatives for a given procedure.
- Explain the procedure and the entailed risks and benefits to the patient and caretaker in a language that is appropriate to their educational, developmental, and emotional status.
- Ensure adequate supervision and patient comfort while performing the procedure.
- Demonstrate and document proficiency in the required procedures.
Competency: Promote health maintenance and disease prevention.
- Provide anticipatory guidance and promote standard health maintenance based on age, gender and risk factors.
- Inform the patient about the indications, potential complications and possible outcomes including incidental findings of recommended screening tests.
- Promote routine vaccination based on standard recommendations.
- Access and maintain health maintenance records as a routine aspect of patient care.
Competency: Work with other health professionals to provide patient focused care.
- Participate in inter-disciplinary teams to optimize patient care and education.
- Recognize the value and promote comprehensive in-patient sign-outs.
- Encourage communication intra-professionally with involved sub-specialists.
- Educate and connect patient to appropriate community resources.
- Transfer information to other providers when appropriate.
SYSTEMS BASED PRACTICE
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
Competency: Understand how their patient care and other professional practices affect other healthcare professionals, the healthcare organizations and the larger society and how these elements affect their practice.
- Optimize interaction and communication with other health-care professionals, health-care organizations and community resources to promote quality patient care.
- Participate actively in quality initiatives undertaken by health care organizations.
- Optimize patient length of stay in acute care facilities by promoting appropriate transition to ancillary levels of care.
- Promote medication reconciliation across levels and systems of care.
- Familiarize with the epidemiology of major health issues in the local community.
- Understand how the local community demographics and socio-cultural beliefs affect health and disease.
Competency: Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
Knowledge /Skills/Attitudes Objectives:
- Understand the fundamental differences between the various insurance plans including local PPOs and HMOs, fee-for-service, Medicare, and state Medical Assistance.
- Recognize the guidelines determining provider and institutional reimbursement including fee-for-service, capitation, hospital DRGs.
- Document appropriately for different levels of care.
- Become familiar with various formulary guidelines and pre-certification requirements.
Competency: Practice cost-effective health care and resource allocation that does not compromise quality of care.
- Recognize resource limitation within the regional and global health care systems.
- Practice cost-effective medical care by considering cost / benefit analyses in all diagnostic and therapeutic decisions.
- Identify factors that contribute to rising health care costs and strive to contain costs by optimizing formulary compliance and avoiding unnecessary testing.
- Practice cost-effective patient care by optimizing length of stay in acute care facilities and promoting transition to sub-acute levels of care appropriately.
Competency: Advocate for quality patient care and assist patients in dealing with system complexities.
- Minimize perceived conflicts of interest between individual patients and their health care organizations through patient education.
- Recognize true conflict of interest between individual patients and their health care
- organizations and always advocate actively on the patient's behalf.
Competency: 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.
Knowledge /Skills/Attitudes Objectives:
- Identify and work with other health care professionals and organizations to optimize patient centered care.
- Connect patients with established disease management programs offered through their insurances or local institutions.
- Utilize practice performance data to sharpen population management skills and understand how that improves global system performance.
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.
Competency: Analyze practice experience and perform practice based improvement activities using a systematic methodology.
- Identify areas for improvement in the quality of patient care and implement strategies to augment one's knowledge base, procedural skills and decision-making skills on a continuous basis.
- Maintain and develop a desire to learn from sub-optimal outcomes and errors and to use these experiences to improve the system and processes of care.
- Familiarize with the process of population management and practice assessment.
- Utilize the necessary resources to complete the process of practice improvement including relevant medical literature, informatics and necessary personnel.
- Learn and apply basic quality techniques of root cause analysis and rapid cycle change as a member of a multidisciplinary team.
Competency: Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems.
- Learn the principles of evidence-based medicine and basic biostatistics (e.g. ARR, NNT, p-values, risk ratios, meta-analyses, etc.)
- Access search engines (e.g., Ovid, MD Consult) to effectively explore the available literature.
- Incorporate evidence-based medicine into daily practice to optimize patient care.
- Disseminate educational material to promote patient education as the foundation for compliance with disease management and prevention.
- Develop a foundation of informatics skills to filter the medical literature and keep current with standards of care.
Competency: Obtain and use information about their own population of patients and the larger population from which the patients are drawn.
- Learn the epidemiology of common diseases in the regional population including incidence, prevalence, risk factors and availability and utilization of resources.
- Apply epidemiologic information to improve health maintenance and disease management.
Competency: Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
- Appraise the literature on selected topics utilizing basic biostatistics and principles of evidence-based medicine.
- Prepare and participate in Journal Club.
- Complete a scholarly activity (e.g. basic science or clinical research project, literature review, conference presentation etc.) utilizing informatics skills and faculty support.
Competency: Use information technology to manage information, access on-line medical information and in support of their own education.
- Familiarize with practice management reports provided by payers and with the process of pay for performance.
- Access the current EMR system to generate practice performance reports to assess quality.
- Explore insurance based websites including CMS for available disease management resources and practice management / reimbursement guidelines.
- Seek opportunities to employ on line resources to maintain a current knowledge base, current CME certification and board certification status.
Competency: Facilitate the learning of students and other health care professionals.
- Assess and address the educational needs and objectives of other members of the healthcare team.
- Engage others including students, colleagues and patients in bi-directional learning.
- Explore and employ the principles of adult learning to optimize education as a team leader.
- Provide constructive feedback to students and colleagues and to listen as they reciprocate.