Ambulatory

PGY 1

Patient Care

•  Become proficient in obtaining a history and performing a physical exam in the out-patient setting
• Competently recognize and manage emergencies commonly seen in the outpatient setting

Medical Knowledge

• Be able to competently diagnose and manage common problems seen in the out-patient setting.
• Obtain medical knowledge in multiple specialty OP settings

Interpersonal and Communication Skills

• Become proficient in the documentation of care in the OP medical record
• Become proficient in providing a smooth transition for the patient in the out-patient setting by way of excellent communication skills with nursing and ancillary staff.

Practice-based Learning Improvement

• Become efficient in time management in the OP setting.
• Become familiar with some of the business skills  required in the practice of medicine
• Become competent in critically evaluating articles dealing with diagnosis, prognosis or therapy questions
• Learn how to incorporate evidence based medicine into their patient care decisions.

Professionalism

• Become skilled in remaining composed when under the stress of time constraints and demands of patients and staff.

Systems-based Practice

• Become adept in working with other physicians and health care providers in managing overall coordination of patient care
• Accurately define the different types of managed care models
• Accurately define the components of a superbill, ICD-9 codes, CPT E/M

PGY 2

Patient Care

• Become adept at recognizing and focusing on the chief complaint
• Develop the ability to guide the interview and exam with appropriate thoroughness in order to avoid the need for extended visits

Cardiovascular Disease

Patient Care

• Learn to obtain a history and perform a physical examination on a patient with an acute MI, cardiogenic shock, acute pulmonary edema, and unstable angina pectoris and the murmurs of valvular heart disease..
• Learn to assess the patient pre- and post- cardiac catheterization
• Become familiar with the procedures required for the urgent management of the patient with a critical condition.

Medical Knowledge

• Learn to recognize and react to the acutely ill patient with appropriate knowledge and skill.
• Learn to recognize an acute MI and differentiate it from unstable angina, pericarditis or chest pain of non-cardiac origin
• Differentiate between a Q wave and non-Q wave MI and understand the differences in management.
• Become familiar with the interpretation of hemodynamic data obtained from invasive and non-invasive testing.
• Become familiar with all vasopressor agents, inotropic agents and arteriolar vasodilators.
• Become familiar with the interpretation of chest films.
• Become familiar with hemodynamically significant arrythmias and their management.

Interpersonal and Communication Skills

• Learn the effective ways to communicate the need for urgent assistance to nursing and ancillary staff, and communication skills during CPR.
• Learn correct and sensitive manner of communicating bad news families.
• Improve focused yet complete case presentations.

Practice-based Learning Improvement

• Reinforcement of proper use of cardiac medications.
• Reinforcement of ACLS skills.

Professionalism

• Assume the role expected of a strong, caring physician in the setting of acute, life-threatening illness.

Systems-based Practice

• Consider costs of daily medical care, and monitor need for repetitive lab tests.
• Critical Care Medicine and Ventilator Units

Patient Care

• Become completely familiar with the compassionate care of an acutely or chronically ill patient off or on a ventilator.
• Become completely familiar with the proper use and settings of a ventilator.

Medical Knowledge

• Recognize and treat patients with respiratory failure
• Recognize and treat patients with circulatory failure
• Recognize and treat patients with metabolic,renal, hepatic and multi-organ failure
• Become familiar with the interpretation of ABG's and weaning parameters
• Ability to assess nutritional status and formulate appropriate enteral and parenteral nutritional formulations.
• Understand the treatment of decubitus ulcerations

Interpersonal and Communication Skills

• Develop the ability to correctly transmit information on rounds.
• Develop the ability to work closely with nurses and ancillary staff in the care of critically ill patients.

Practice-based Learning Improvement

• Understand the treatment of chronic infections, including the judicious use of antibiotics.
• Become competent in the interpretation of chest films in the critical care setting

Professionalism

• Develop an appreciation of the urgency and attention to detail that is required in treating patients in a critical care setting.

Systems-based Practice

• Become familiar with the multidisciplinary approach to the critically ill or chronically ventilated patient, including the need for close integration of nursing, rehab, pharmacy and social service input.
• Develop an awareness of the medical care costs in the critical care setting and continuously trying to keep these in check when patient care is not compromised.

Electives

Patient Care

• Understand the unique needs of the patient being treated by the subspecialist.

Medical Knowledge

• Become familiar with the major disease diagnosis and management of the subspecialty.

Interpersonal and Communication Skills

• Develop skill as a consultant, including providing a legible, organized and helpful consultation note.
• Develop skill in verbal/telephone communication with physicians who request consultations

Practice-based Learning Improvement

• Developing the habit of reading about patients and clinical situations seen during the rotation, since the time demands will be significantly lower than they are during a floor or unit rotation.

Professionalism

• Understand the role of the consultant in the care of the patient, including leaving the primary care of the patient to the primary physician, and not 'taking over.'
• Re-visit the patient at appropriate intervals to avoid additional unnecessary professional fees.

Systems-based Practice

• Develop an awareness of the multidisciplinary services available for that subspecialty.
• Remain aware of the expense involved in suggesting 'shotgun' diagnostic testing.

Emergency Medicine

Patient Care

• Gain experience in the evaluation and management of patients presenting to the ER for acute care.
• Developing a sensitivity to the really 'sick' patient
• Develop proficiency with emergency procedures

Medical Knowledge

Expanding the knowledge base of resident in acute care medicine to include:

o        Chest pain
o        Abdominal pain
o        Dyspnea/wheezing
o        Gyn problems
o        Poisoning
o        Psychiatric problems
o        Conditions requiring immediate resuscitation
o        Altered mental status
o        Minor trauma/musculoskeletal problems
o        Headache
o        Dizziness
o        GI Hemorrhage

Interpersonal and Communication Skills

• Develop effective nursing and ancillary communication in order to avoid delays in patient care.
• Developing skill at computerized charting and order entry.

Practice-based Learning Improvement

• Maintain a patient log to guide future reading.

Professionalism

• Cultivating a respectful language and behavior towards patients and colleagues in a traditionally chaotic, sometimes boisterous setting.

Systems-based Practice

• Develop the habit of recommending specific preventive medicine measures and referral to supportive agencies for economic or rehabilitation purposes.

General Internal Medicine Floors

Patient Care

• Become competent in the thorough and compassionate evaluation and management of the patient admitted to the hospital for an acute medical problem.
• Become proficient in obtaining a complete medical history and performing a complete physical examination on in-patients
• Become continually more efficient and learn to prioritize tasks in patient care.
• Become proficient at developing a complete differential diagnosis
• Develop the habit of perceiving and getting to know the patient as a person rather than a disease.

Medical Knowledge

• Formulate a rational diagnostic and therapeutic plan based on medical evidence
• Learn the appropriate use of consultants.

Interpersonal and Communication Skills

• Become skilled at the transfer of pertinent and focused important information to covering physicians.
• Become a skilled team player.
• Develop the habit of listening.
• Develop proficiency at presenting cases appropriate to all settings.
• Develop the habit of writing legible, thoughtful timed and dated medical records.
• Develop the habit of communicating with service attending physicians, private physicians and with the follow-up physicians who will continue the care of the patient after discharge.

Practice-based Learning Improvement

• Maintain a patient log and intended reading topics.
• Identify and expand resources for medical knowledge.
• Recognize and avoid medical errors and near misses.

Professionalism

• Develop the habit of speaking and acting in a respectful, compassionate manner during interactions with patients, families, colleagues, nursing and ancillary staff.
• Develop the habit of punctuality and regular attendance at conferences and meetings with families.
• Develop the habit of wearing a clean white coat and dressing appropriately when in patient care areas.

Systems-based Practice

• Understand and utilize supportive services
• Understand the principles of quality assurance and cost effective diagnosis and management.

Night float

Patient Care

• Become proficient at appropriate assessment of a patient.
• Develop awareness that a patient is really 'sick' and recognize the need for rapid intervention.
• Develop the ability to prioritize
• Develop the ability to be efficient.
• Develop proficiency at phlebotomy and gaining i.v. access

Medical Knowledge

• Develop an expertise in the management of pain.
• Review and become proficient at CPR/ACLS
• Become proficient in the management of i.v. fluid replacement and metabolic disorders.
• Discuss any questions with your supervising resident.

Interpersonal and Communication Skills

• Develop the habit of immediately leaving an appropriate timed note on a patients chart
• Develop skill in the sign-out process

Practice-based Learning Improvement

• Seek follow-up and feedback on your patient care.

Professionalism

• Develop a keen awareness of being available by pager or telephone if the pager is out of range (house staff lounge)
• Answer nursing calls promptly and respectfully.
• Dress appropriately.

Systems-based Practice

• Develop an awareness of the economic impact of tests and medications ordered.

Radiology Elective

Patient Care

• Direct patient interaction is not applicable in most situations.

Medical Knowledge

Become familiar with the indications for and principles of the interpretation of:

o        Plain films
o        Mammography
o        Contrast studies
o        CT
o        MRI
o        Ultrasound

Interpersonal and Communication Skills

• Observe the techniques used in dictation of reports
• Develop presentation skills for case report

Practice-based Learning Improvement

• Read after each session

Professionalism

• Develop the habit of punctuality

Systems-based Practice

• Explore the cost of usual radiological studies

Rheumatology Elective

Patient Care

• Become familiar with the complete immunologic and musculoskeletal history and the physical examination in the patient
• Perform arthrocentesis of the knee
• Be able to develop a differential diagnosis and treatment plan for the patient with a rheumatologic complaint
• Deliver compassionate care in the management of a chronic disease.

Medical Knowledge

• Understand the types of arthritis and the need for aggressive therapy in some circumstances.
• Understand the diagnosis and management of:
  o        Rheumatoid arthritis
  o        Osteoarthritis
  o        Systemic lupus erythematosis
  o        Crystal induced arthritis
  o        Infectious arthritis
  o        Spondyloarthropathies
  o        Soft tissue rheumatic conditions
  o        Muscular rheumatic conditions
  o        Metabolic bone conditions