The Department’s expectations of your performance are aligned with the College of Medicine’s competency-based curriculum. You will be evaluated specifically according to these competencies:
- Professionalism
- Patient Care
- Medical Knowledge
- Practice Based Learning
- Interpersonal and Communication
- Systems Based Practice
Your performance in these competencies is determined by your proficiency in the goals below. Specific objectives are listed to guide you toward successful achievement of these goals.
Goal 1
Evaluate and manage patients hospitalized with an acute illness. (Patient Care, Medical Knowledge)
Objectives:
- Independently obtain and record patient histories in an efficient, organized, and thorough manner.
- Refine physical examination skills by performing and recording a physical examination in a logical, organized, and thorough manner incorporating advanced and disease-specific physical examination maneuvers when appropriate.
- Understand and be able to communicate the reason for a patient’s admission and learn admission criteria for common illnesses.
- Formulate a comprehensive but concise problem list with differential diagnosis as appropriate, based on the history, physical examination, and diagnostic tests obtained.
- Generate and communicate thoughtful assessments and plans for evaluation and management.
- Initiate and enter patient orders for admission, inpatient management, and discharge, understanding the rationale for each order.
- Provide interpretation of test ordered, including CBC, chemistries, urinalyses, coagulation studies, cultures, ECGs, telemetry, and x-rays.
- Recognize variations in common laboratory findings and vital signs, with particular attention to blood pressure, heart rate, and glucose monitoring.
- Develop familiarity with drugs of choice for common medical conditions (such as cardiac disease, diabetes, COPD, pneumonia, cellulitis), including the rationale for their use, contraindications, and proper adjustment according to age and renal function.
- Determine proper routes, rates, and choice of agent for electrolyte correction and fluid replacement.
- Modify the primary diagnosis and its management based on diagnostic information.
- Continuously reassess the patient throughout the day and hospital course.
- Recognize when a patient has met criteria for discharge, and secure the necessary paperwork, orders, medications, and post-discharge follow-up.
Assessment methods:
- Observation by resident and attending physician during concurrent evaluation of patients.
- Review by resident of all electronic orders.
- Daily participation in rounds, including independent oral presentation of all patients.
- Review of patient write-ups by attending physician and resident.
- Successful generation and entry of patient orders as monitored by resident.
- Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
- Summative feedback from the team using a standardized evaluation tool.
Goal 2
Work effectively as part of an inpatient team to care for patients but with more independence in preparation for residency training. (Professionalism, Patient Care, Interpersonal and Communication, Systems Based Practice)
Objectives:
- Present all new patients on rounds including focused history, physical examination, laboratory data, assessment, and plan in a concise, organized manner.
- Present concise and well-organized follow-up presentations on established patients with particular attention to the plans development and rationale.
- Weigh risks, benefits, evidence, and costs when recommending diagnostic and therapeutic plans.
- Write daily progress notes that thoughtfully, concisely, and legibly communicate to other members of the team the patient’s current status regarding the diagnostic work up and therapeutic plans.
- Establish excellent rapport with patients as their primary caregiver (without misrepresentation of student status), including addressing the emotional and social needs of the patient and appropriate family members.
- Effectively communicate with other members of the health care team including nurses, social workers, consultants, physical therapists, and ancillary staff.
- Consistently demonstrate respect, reliability, helpfulness and initiative modeling the highest degree of professional behavior.
- Identify patient discharge needs throughout the hospital course, incorporating team members early to overcome obstacles to discharge.
- Coordinate all activities surrounding discharge planning insuring that the patient and/or caregiver clearly understands the plan, how to take all discharge medications and their risks, any new safety concerns, follow up arrangements, and any other needs specific to the patient.
Assessment methods:
- Daily participation in rounds, including independent oral presentation of all patients.
- Review of patient write-ups by resident and attending physician.
- Successful generation and entry of patient orders as monitored by resident.
- Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
- Summative feedback from the team using a standardized evaluation tool.
Goal 3
Initiate a management plan for the important inpatient medical problems that were introduced during the 3rd year clerkship. In addition, be able to evaluate and initiate management for important inpatient medical emergencies. (Patient Care, Medical Knowledge, Practice Based Learning, Interpersonal and Communication, Systems Based Practice)
Objectives:
- Accurately recognize and development appropriate management plans for common medical conditions that require hospitalization, including the following:
– Abdominal pain
– Altered mental status
– Arrhythmias
– Drug and alcohol withdrawal
– Electrolyte abnormalities
– Gastrointestinal bleeding
– Hyperglycemia, DKA, or hyperosmolar syndromes
– Hypertensive emergency
– Hypotension
– Musculoskeletal pain or swelling
– Nausea and vomiting
– Renal failure
– Seizure
– Shock/Systemic Inflammatory Response Syndrome (SIRS)
– Shortness of Breath
– Syncope
- Apply an evidenced-based approach to problems and questions that arise in the clinical setting.
- Recognize when consultation from another service is required and initiate it in timely and respectful fashion to the consultant.
- Recognize potential sources of medical errors and be able to differentiate between individual vs. systems problems that can lead to adverse outcomes.
- Assess unforeseen patient emergencies and initiate appropriate evaluation and treatment.
- Recognize patients requiring immediate attention by a supervising physician and communicate appropriately.
- Identify objective criteria and findings that necessitate relocation to a higher level of inpatient care.
Assessment methods:
- Daily participation in rounds, including independent oral presentation of all patients.
- Participation in mandatory weekly Sub-Internship conferences focused on common medical conditions and identification of need for escalation of care.
- Participation in mandatory simulation sessions focused on shortness of breath, chest pain, arrhythmias, and cardiac conditions.
- Successful generation and entry of patient orders as monitored by resident.
- Successful communication of changes in status to resident and attending physician.
- Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
- Summative feedback from the team using a standardized evaluation tool.
Goal 4
Increase and refine procedural skills. (Patient Care, Medical Knowledge)
Objectives:
- Develop clinical comfort in phlebotomy, inserting intravenous catheters, urinary catheterization, and CPR as the opportunities arise.
- Develop skill through patient simulations in performing EKG’s, delivering oxygen, bag-mask ventilation, AED and defibrillator use, and delivery of emergency IV medications.
- Describe the elements of informed consent, including indications, contraindications, risks, and benefits of the following procedures (and observe/assist whenever possible):
– Lumbar puncture
– Paracentesis
– Thoracentesis
– Central line or peripherally inserted central catheter (PICC) placement
Assessment methods:
- Participation in a Clinical Skills Examination (CSE) at the beginning of the rotation to assess phlebotomy.
- Participation in mandatory simulation sessions focused on shortness of breath, chest pain, arrhythmias, and cardiac conditions.
Goal 5
Demonstrate interpersonal and written communication skills that result in effective information exchange and collaboration with patients, their families, and all members of the health care team. (Professionalism, Practice Based Learning, Interpersonal and Communication)
Objectives:
- Communicate effectively with patients and families across a broad range of socio-economic and cultural backgrounds.
- Demonstrate relationship building skills in each clinical encounter and inter-professional exchange.
- Elicit and recognize the perspectives and needs of families and provide care for patients within their social and cultural context.
- Include the patient and family in the decision-making process to the extent they desire.
- Recognize when interpreter services are needed and demonstrate how to use these services effectively.
- Provide education and patient instructions to patients and families, using written or visual methods, taking into account their health literacy level.
- Write organized, appropriately focused, and accurate patient notes, including admission, progress, cross-cover, and discharge notes and summaries.
- Perform safe hand-offs of patient information using electronic shift hand-off tools.
Assessment methods:
- Observation by resident and attending physician during concurrent evaluation and discharge planning of patients.
- Review of patient write-ups and discharge materials by resident and attending physician.
- Review of clinical hand-off materials by resident.
- Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
- Summative feedback from the team using a standardized evaluation tool.
Goal 6
Continue to develop and refine life-long learning skills and professional behavior. (Professionalism, Practice Based Learning)
Objectives:
- Recognize limits and deficits in knowledge, skills, and attitudes and initiate a plan to obtain help from faculty, colleagues, and other informational resources.
- Read daily about issues that affect patient care.
- Always place the needs of the patient first and act as the patient’s advocate.
- Recognize limits and deficits in knowledge, skills, and attitudes and initiate a plan to obtain help from faculty, colleagues, and other informational resources.
- Demonstrate personal accountability to patients, colleagues, and staff in order to provide the best patient care.
- Demonstrate integrity, compassion, respect, altruism, and empathy when interacting with all members of the health care team, patients, and their families.
- Demonstrate culturally effective care by understanding the important role of culture in the care of each patient, recognizing how one’s own beliefs affect patient care, and eliciting the cultural factors that may influence the care of the patient.
- Recognize the impact of stress, fatigue, and illness on learning and performance.
- Maintain appropriate professional boundaries with patients, families, and staff.
- Identify strengths, deficiencies, and limits in one’s knowledge and clinical skills through self-evaluation.
Assessment methods:
- Observation by resident and attending physician during concurrent evaluation of patients.
- Daily participation in rounds, including independent oral presentation of all patients.
- Successful entry of patient orders, communication with consultants, and implementation of patient care plan as monitored by resident.
- Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
- Summative feedback from the team using a standardized evaluation tool.