DEPARTMENT OF INTERNAL
MEDICINE
Residency Program
Curriculum
Rotation Educational
Goals and Objectives
Categorized by ACGME Competencies
June, 2006
The
Department of Internal Medicine
Residency Program Curriculum
Rotation Educational Goals and
Objectives
Categorized by ACGME Competencies
June, 2006
Edited by Sue Kostka
Residency Education Coordinator
This document reflects the
educational goals and objectives of the 32 rotations available for resident
physicians in the University of Texas-Houston Department of Internal Medicine
training program. The goals and
objectives indicated for each rotation are categorized by relevant competencies
of the Accreditation Council for Graduate Medical Education (ACGME). The six newly defined areas of competency
which residents must obtain over the course of their training were introduced
in July, 2001. The ACGME Core
Competencies are defined as: Patient Care, Medical Knowledge, Interpersonal and
Communication Skills, Professionalism, Practice-Based Learning and Improvement,
and Systems-Based Practice.
Teaching
hospitals for resident physicians at the
This document was prepared in a collaborative effort by the faculty,
residents and staff of the Department of Internal Medicine of the
Acknowledgements and special thanks to Department of Internal Medicine
House Staff Training Program Director Dr. Mark A. Farnie, Associate Program
Director Dr. Eugene V. Boisaubin, and the 2005-2006 Assistant Chiefs of Service
for their help in preparation of this document.
This document is organized by rotations as they are located at the
various teaching hospitals, with a separate category for outpatient rotations
and descriptions of the learning activities at each teaching hospital. A list
of the rotations is attached, as well as a list of the definitions of the ACGME
competencies.
University of Texas-Houston Internal
Medicine Residency Program
Educational Goals and Objectives –
Residency Curriculum
Overview
List of Rotations
List of ACGME Core
Competencies
Description of Memorial Hermann Learning
Activities
Description of Lyndon B. Johnson General
Hospital Learning Activities
Description of M.D. Anderson Cancer
Center Learning Activities
Description of St. Luke’s Episcopal
Hospital Learning Activities
Outpatient
Rotations:
Memorial Hermann/LBJ Ambulatory Block
Rotation
Memorial Hermann General Medicine
Services A - D
Memorial Hermann CCU and Cardiology Ward
Service
Memorial Hermann Medical Intensive
Care Unit
Memorial Hermann Renal Inpatient
Service
Consultation
Services:
Memorial Hermann/LBJ
Cardiology Consultation
Memorial Hermann/LBJ Endocrinology
Consultation
Memorial Hermann/LBJ Gastroenterology
Consultation
Memorial Hermann/LBJ General Medicine
Consultation
Memorial Hermann/LBJ Hematology
Consultation
Memorial Hermann Hepatology
Consultation
Memorial Hermann/LBJ Infectious Disease
Consultation
Memorial Hermann/LBJ Pulmonary
Medicine Consultation
Memorial Hermann/LBJ Renal Consultation
Memorial Hermann/LBJ Rheumatology
Consultation
Memorial
Hermann Oncology Consultation Service
LBJ
Oncology Consultation Service
LBJ Emergency Room & Holding Area
LBJ General Medicine Services A – E
LBJ Medical Intensive Care Unit
MDACC General Medicine Consultation
St. Luke’s Episcopal Hospital
Rotations
Elective
A. PATIENT CARE
Residents are expected to provide
patient care that is compassionate, appropriate and effective for the promotion
of health, prevention of illness, treatment of disease and at the end of life.
Gather
accurate, essential information from all sources, including medical interviews,
physical examinations, medical records and diagnostic/therapeutic procedures.
Make
informed recommendations about preventive, diagnostic and therapeutic options
and interventions based on clinical judgment, scientific evidence, and patient
preference.
Develop,
negotiate and implement effective patient management plans and integration of patient
care.
Perform
competently the diagnostic and therapeutic procedures considered essential to
the practice of internal medicine.
B. MEDICAL KNOWLEDGE
Residents are expected to
demonstrate knowledge of established and evolving biomedical, clinical and
social sciences, and the application of their knowledge to patient care and the
education of others.
Apply an open-minded, analytical
approach to acquiring new knowledge.
Access and critically evaluate
current medical information and scientific evidence.
Develop clinically applicable
knowledge of the basic and clinical sciences that underlie the practice of
internal medicine.
Apply this knowledge to clinical
problem-solving, clinical decision-making,
and critical thinking.
C. INTERPERSONAL AND COMMUNICATION
SKILLS
Residents are expected to
demonstrate interpersonal and communication skills that enable them to
establish and maintain professional relationships with patients, families, and
other members of health care teams.
Provide effective and professional
consultation to other physicians and health care professionals and sustain
therapeutic and ethically sound professional relationships with patients, their
families, and colleagues.
Use effective listening, nonverbal,
questioning, and narrative skills to communicate with patients and families.
Interact
with consultants in a respectful, appropriate manner.
Maintain
comprehensive, timely, and legible medical records.
D.
PROFESSIONALISM
Residents are expected to
demonstrate behaviors that reflect a commitment to continuous professional
developmental, ethical practice, an understanding and sensitivity to diversity
and a responsible attitude toward their patients, their profession, and
society.
Demonstrate respect, compassion,
integrity, and altruism in relationships with patients, families, and colleagues.
Demonstrate sensitivity and
responsiveness to the gender, age, culture, religion, sexual preference,
socioeconomic status, beliefs, behavior and disabilities of patients and
professional colleagues.
Adhere to principles of
confidentiality, scientific/academic integrity, and informed consent.
Recognize and identify deficiencies
in peer performance.
E. PRACTICE-BASED
LEARNING AND IMPROVEMENT
Residents are expected to be able
to use scientific evidence and methods to investigate, evaluate, and improve
patient care practices.
Identify areas for improvement and
implement strategies to enhance knowledge, skills, attitudes and processes of
care.
Analyze and evaluate practice
experiences and implement strategies to continually improve the quality of
patient practice.
Develop and maintain a willingness
to learn from errors and use errors to improve the system or processes of care.
Use information of technology or
other available methodologies to access and manage information, support patient
care decisions and enhance both patient and physician education.
F. SYSTEMS-BASED
PRACTICE
Residents are expected to
demonstrate both an understanding of the contexts and systems in which health
care is provided, and the ability to apply this knowledge to improve and
optimize health care.
Understand, access and utilize the resources,
providers and systems necessary to provide optimal care.
Understand the limitations and
opportunities inherent in various practice types and delivery systems, and
develop strategies to optimize care for the individual patient.
Apply evidence-based, cost-conscious
strategies to prevention, diagnosis, and disease management.
Collaborate with other members of
the health care team to assist patients in dealing effectively with complex
systems and to improve systematic processes of care.
FOR MEMORIAL HERMANN HOSPITAL
ROTATIONS
UNIVERSITY OF
DEPARTMENT OF INTERNAL MEDICINE RESIDENCY PROGRAM
June, 2006
Morning
Report (MR) – These
sessions are held six mornings each week (M, T, W, Th,
F, from 8:00am to 9:00am, and on some Saturdays from 6:50am to 8:00am). All PGY1, PGY2 and PGY3s on inpatient floor
teams and all interns and residents on consult services meet with the Assistant
Chiefs of Service (CMRs) and one or more faculty
members to discuss two patients. The
patients are presented by the interns on the floor team or the PGY2 or PGY3 if
presented by a consult service, and then discussed by entire group of residents
and faculty members attending Morning Report.
The focus of the discussion is selected by the presenting resident. For example, some cases may be presented to
discuss a differential diagnosis, while others are
presented to discuss specific management issues.
Attending
Rounds (AR) –
Daily, including weekends, usually from 9:00am to noon, patients are presented
to the attending physician. Post call
rounds usually start at 6:00 am. Bedside
teaching is regularly included in the rounds.
Occasionally specialty cases are presented for discussion depending upon
the interests of the attending physician.
Learning activities include the physical exam, a discussion of
particular medical diseases, psychosocial and ethical themes, and management
issues.
Chairman’s
Rounds (CR) – The
Chairman of the Department of Internal Medicine meets weekly with the Memorial
Hermann team which is pre-call in the Kirkendall
Library at 2:00 pm on Tuesday afternoons for Chairman’s Rounds. The team who is presenting selects a patient for
presentation. The team presents the
patient, and the management and diagnosis of the patient is discussed.
Faculty Supervision (FS) – This learning activity occurs when a faculty
member is directly responsible for teaching and supervising a resident, often
on a one-to-one basis and typically in a team setting. The resident is responsible for direct
patient care, but the faculty member serves as a resource. The faculty member meets with the resident
often to supervise patient care and to provide feedback.
Directly Supervised Procedures - (DSP) – Residents learn
procedures under the direct supervision of an attending or fellow during some
rotations. For
example, in the Medical Intensive Care Unit the Pulmonary /Critical Care
attending or fellow, or the MICU attending, observe the placement of central
venous and arterial lines. Specific procedures used in patient care varies by
rotation.
Direct
Patient Care (DPC) – In
this teaching activity, residents admit their own patients and are responsible
for the ongoing care including management and discharge. Patient management is supervised by the
attending physician.
Noon
Conferences (NC) –
The noon conferences focus on monthly themes of the various specialty medicine
topics for eleven months of the year, i.e., Cardiology, Gastroenterology, Hematology,
etc. Exceptions to this are Grand
Rounds, held every Tuesday at noon throughout the year, and Senior Seminar,
where the topic is selected by the presenting resident. All residents on inpatient floor teams, as
well as those on ambulatory block rotations and electives, are expected to
attend. During the 12th month
of the year, the noon conferences are the Introductory Lecture Series.
Noon Conferences are comprised of the following:
(except for Journal Club):
Introductory
Lecture Series (ILS) –
These lectures are held during the month of July in place of other noon
conferences, except for Grand Rounds, which continues to be held every Tuesday throughout
the year. Various introductory topics
are presented by subspecialty and general medicine faculty to introduce interns
to basic and essential topics in internal medicine.
Core
Curriculum (CC) –
This noon conference is held on a weekly basis, and is structured in a board
review context where faculty members discuss a core topic in their specialty
field of medicine. Faculty members
review possible board questions related to the core topic with residents. By the end of an academic year, residents
should have had a thorough review of all topics covered in the Core Curriculum
of the residency training program.
Clinicopatholigic Conference (CPC) – This noon
conference are held once a month, and consists of discussions of
informative cases by clinicians, radiologists, and pathologists. The case is given to a discussant, an
internist or a specialist depending on the case, weeks ahead of the time of
presentation. The discussant is informed
of everything about the case except the diagnosis. The findings leading to the
ultimate diagnosis are discussed by a radiologist and pathologist at the end of
the conference.
Grand
Rounds (GR) – The
Department of Medicine hosts Grand Rounds every Tuesday from noon to 1:00pm . Speakers
from local, regional and national medicine training programs,
are invited to present topics from the broad spectrum of internal
medicine. All residents on inpatient
floor teams, as well as those on ambulatory block rotations and electives are
expected to attend.
Senior
Seminar (SS) - Senior Seminar is held in a noon
conference format. Upper level residents
present an in-depth review of a medical topic as well as their own
research. Residents are formally critiqued by both the associate program
director and their resident colleagues.
Medical
Jeopardy (MJ) –
Medical Jeopardy is held once a month at noon.
Residents form teams and compete against each other for various prizes
using a computerized medical game format.
Professionalism
Curriculum (PC) -
This is an organized series of recurring large and small group discussions
focusing upon current issues and dilemmas in medical professionalism and ethics
presented primarily by an associate program director. Lectures are usually presented in a noon
conference format.
Evidence
Based Medicine (EBM) – This is a series of noon monthly lectures
presented to allow residents to learn how to critically appraise journal
articles, stay current on statistics, etc.
The lectures are presented by an associate program director.
Morbidity and Mortality Conference (MM) – The M&M Conference is held occasionally at noon
throughout the year. A case, with an
adverse outcome, through not necessarily resulting in death, is discussed and
thoroughly reviewed. Faculty members
from various disciplines are invited to attend, especially if they were
involved in the care of the patient. The
discussion focuses on how care could have been improved.
Med/Path
Conference (MP) – This conference is presented once a month in a noon
conference format. A medicine resident
presents a case, and then the pathology resident discusses the pathology
finding including slides, involved in the case.
There are four to five cases discussed per meeting.