Competency

Objectives

Specific

Educational Experiences

Knowledge/ Skills

Integration/Application

Assessment

Tools

Patient Care

that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Gathers essential/accurate information via interviews and physical exams and reviews other data.

Competently performs some invasive procedures Prioritizes Knows indications, contraindications, & risks of some invasive procedures

a patient's problems

Prioritizes a day of work

Monitors and follows up patients appropriately

Provides services aimed at preventing or maintaining health such as immunization based upon current guidelines.

Works with all health care professionals to provide patient-focused care.

Writes pertinent and organized notes

Has timely and legible medical records

Has a good understanding of rational use of diagnostic tests.

Has a good knowledge and understanding of how and when to utilize the services of specialists, consultants and other services.

Specific Goals for PGY2 level:

Understands and weighs alternatives for diagnosis and treatment

Uses diagnostic procedures and therapies appropriately

Elicits subtle findings on physical examination

Obtains a precise, logical and efficient history

Interprets results of procedures properly

Is able to manage multiple problems at once

Makes informed decisions about diagnosis and therapy after analyzing clinical data.

Develops and carries out management plans.

Considers patient preferences when making medical decisions.

Triages patients to appropriate location

Capable on independently reviewing clinical findings, diagnostic studies such as X-rays, CT scans, peripheral smears, urine microscopy, gram stains, and ECGs

Specific Goals for PGY3 level:

Reasons well in ambiguous situations

Spends time appropriate to the complexity of the problem

3-4 Months of general medical ward experience as a PGY2  and 2 months of medical ward rotations as a PGY3. Admits and directly responsible for supervising the care of patients during long and short call, working with interns, students and other members of the ward team.

Instructs, trains and supervises junior housestaff on all procedures performed on patients on the ward team.

Incorporates teaching in to daily rounds and clinical activity.

Interact with specialist and consultants in managing complex patients.

Ensures that documentation of clinical findings and orders are complete on the medical record, reviews and countersigns notes of juniors, dictates a admit note on all patients, ensures that discharge summaries are completed on a timely manner.

Conducts daily work rounds and chart rounds to provide effective ongoing care and review daily progress of patients on team.

Coordinate the cases presented at the weekly peripheral smear rounds conducted by an hematologist as well as ECG and X-ray conferences that are part of the noon conference series.

Rotational evaluation by ward team teaching attending.

Evaluation by interns and students on performance in patient care as leader of ward team.

Quarterly/Mid year evaluation by advisor/PD

Annual bed-side evaluation of history and physical examination skills.

Evaluation at focused physical examination sessions (PERK) Program.

Periodic Chart review and chart audits for documentation and accuracy of orders.

Performance measure on compliance with adult immunization and other disease management programs instituted by the hospital.

Medical 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

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Demonstrates knowledge of basic and clinical sciences.

Has a good understanding of the patho-physiology of disease and disease mechanisms.

Applies knowledge to therapy

Specific Goals for PGY2 level:

Is aware of indications, contraindications and risks of commonly used medications and procedures

Demonstrates knowledge of epidemiologic and social-behavioral sciences.

Applies the basic, clinical, epidemiologic and social behavioral science knowledge to the care of the patient

Specific Goals for PGY3 level:

Demonstrates an investigatory and analytic approach to clinical situations

Teaching rounds of at least 4.5 hours of direct contact per week with a board certified teaching ward team attending during medical ward rotations.

1.5 hours of direct contact with teaching attending on post-call rounds each week during ward rotations.

Mandatory participation at Morning report, noon conference.

Participation at Board review conference series conducted three times a week form September through June during the PGY2 and PGY3 academic years.

Develops an atmosphere that promotes learning and academic achievement among team members.

Coordinates teaching activity in collaboration with the teaching attending by identifying patients for teaching rounds, maintaining rounding schedule and getting team together for teaching rounds on time.

Rotational evaluation by ward team teaching attending.

Evaluations by interns and students on residents medical knowledge as a clinician and a teacher.

Conference attendance statistics.

Quarterly/Mid year evaluation by advisor/PD

Performance at monthly in-service examination.

Interpersonal and Communication Skills

that result in effective information exchange and teaming with patients, their families, and other health professionals

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Demonstrates caring and respectful behaviors with patients and families.

Uses effective listening, narrative and non-verbal skills to elicit and provide information.

Works effectively as a member of the health care team.

Specific Goals for PGY2 level:

Works effectively as the leader of the health care team.

Creates and sustains therapeutic and ethically sound relationships with patients and families.

Provides education and counseling to patients, families and colleagues.

Is able to discuss end of life care with patient/families

Interact with patients, families during admission and follow-up care of patients.

Demonstrates respect and care when communicating with patients, family members and members of the ward team and avoids confrontation.

Confident and decisive yet avoids being arrogant. Capable of convincing other members of the team of his/her point of view using objective persuasion based on medical knowledge and standard references.

Interact with other ward team members, attending physicians, consultants and ancillary staff as the leader of the ward team.

Capable of maintaining composure in the setting of medical emergencies and functions effectively as leader of the code blue team.

Takes a leadership role in presenting and participating in academic conferences and is participates effectively in clinical and academic discussions.

Effectively summarizes complex case presentations.

Resolves conflicts within team in a fair and just manner.

Rotational evaluation by ward team teaching attending.

Conference attendance statistics.

Evaluation by interns and students on communication and interpersonal skills a an experienced clinician and team leader.

Quarterly/Mid year evaluation by advisor/PD

Bed-side clinical skill assessment.

Objective Structured Clinical Exercise (OSCE) and video taped assessment of communication skills using standardized patients.

Professionalism

as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Establishes trust with patients and staff

Does not refuse to treat patients

Is honest, reliable, cooperative and accepts responsibility

Shows regard for opinions and skills of colleagues

Demonstrates respect, compassion and integrity.

Is responsive to the needs of patients and society, which supercede self-interest.

Is free from substance abuse or satisfactorily undergoing rehabilitation

Specific Goals for PGY2 level:

Displays initiative and leadership

Is able to delegate responsibility to others

Demonstrates commitment to on-going professional development.

Demonstrates commitment to ethical principles pertaining to the provision or withholding of care, patient

    confidentiality, informed consent and business practices.

Demonstrates sensitivity to patient culture, gender, age, preferences and disabilities.

Acknowledges errors and works to minimize them.

Specific Goals for PGY2 level:

Is effective as a consultant

Residents are required to discuss end of life decision making, DNR requests with patients and family members at time of admission.

Serves as the primary advocate for patients well being and care.

Demonstrate a compassionate and caring attitude towards patients.

Considerate towards needs of interns and students and willing to chip in and help.

Communicate recommendations both verbally and in writing after evaluating patients for medical consultation.

Rotational evaluation by ward team teaching attending.

Evaluation by intern and students on residents  resident.

Quarterly/Mid year evaluation by advisor/PD

Bed-side clinical skill assessment.

Objective Structured Clinical Exercise (OSCE) and video taped assessment of communication skills using standardized patients.

Practice-Based Learning and Improvement

that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Uses written and electronic reference and literature sources to learn about patients' diseases

Understands his or her limitations of knowledge

Asks for help when needed

Is self motivated to acquire knowledge

Uses Pubmed, Ovid and other computerized sources of results and information to enhance patient care

Accepts feedback and develops self-improvement plans.

Specific Goals for PGY2 level:

Undertakes self-evalutation with insight and initiative.

Facilitates the learning of students and other health care professiionals.

Specific Goals for PGY3 level:

Analyzes personal practice patterns systematically, and looks to improve.

Compares personal practice patterns to larger populations.

Locates, appraises and assimilates scientific literature appropriate to specialty.

Applies knowledge of study design and statistics.

Lectures and workshops of clinical epidemiology, biostatistics and evidence based medicine that are presented during the multi-disciplinary medicine course.

Develop a presentation of a critically appraised clinical topic (CAT) as part of an evidence based medicine project during the multi-disciplinary medicine course.

Participate in monthly journal club conference. Present at least one paper at the journal club each year.

Presents a review or an update at the resident grand rounds lecture series.

Develop and present abstracts, posters and oral presentations based on interesting case reports and clinical research projects.

Rotational evaluation by ward team teaching attending.

Conference attendance statistics.

Evaluation by senior resident.

Quarterly/Mid year evaluation by advisor/PD

Evaluation of the MDM presentation at the end of the rotation by at least 3 faculty members.

Presentations at institutional research events such as the Annual Sinai-Grace Hospital, Research day

Presentation of posters and oral presentations at regional and national meeting of professional organizations such as the ACP

Systems-Based Practice

as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value

Builds on knowledge and skills acquired as a PGY1 and instructs and trains interns and students on:

Knowledgeable on clinical pathways and guidelines to provide cost effective patient care.

Is a patient advocate

Has constructive skepticism

Advocates for high quality patient care and assists patients in dealing with system complexity.

Lean about the services available at long tem care facilities, sub-acute rehabilitation units and nursing homes to arrange transfer of patients to such facilities when in-patient care is completed.

Utilized support services such as social workers and practice support nurses to expedite patient care.

Has the knowledge and capable of incorporating home care services to expedite and improve patient care.

Aware of the indication and cost of expensive diagnostics tests and uses such tests judiciously.

Understand the current health care system in the US and the extent of coverage under programs such as medicare, medicaide, managed care and third party fee for service system.

Know the cost of medications, formulary coverage and restrictions under managed care

Programs and availability of prescription assistance programs.

Specific Goals for PGY2 level:

Applies knowledge of how to partner with health care providers to assess, coordinate and improve patient care

Uses systematic approaches to reduce errors.

Participates in developing ways to improve systems of practice and health management.

Specific Goals for PGY3 level:

Demonstrates ability to adapt to change 

Provides cost effective care

Understands how individual practices affect other health care professionals, organizations and society.

Demonstrates knowledge of types of medical practice and delivery systems.

Practices effective allocation of health care resources that does not compromise the quality of care.

Provides leadership in organizing referral to out-patient services and home care services as well as transfer to long-term care facilities, rehab and nursing homes when clinically appropriate.

Initiates the participation of social workers, discharge planners and other support personnel to improve patient care, reduce length of stay and expedite discharge.

Demonstrate awareness and compliance with disease management guidelines.

Demonstrate sound clinical judgment in ordering expensive diagnostic tests and utilizing consultants.

Arranges for effective out patient care and follow up after discharge by reviewing formulary restrictions related to patients insurance plan.

Provides appropriate referral to social services, indigent care clinics and medication assistance plans when discharging uninsured patients.

Rotational evaluation by ward team teaching attending.

Conference attendance statistics.

Evaluation by interns and students.

Feedback provided to rounders and PD’s by practice support nurses, discharge planners and

Quarterly/Mid year evaluation by advisor/PD