Ambulatory

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

Anesthesiology

Patient Care

• Be able to ventilate a patient via mask, and intubate the trachea of patients with easy airways.
• Be able to examine, classify and evaluate the airway of a patient.
• Be able to place peripheral i.v. lines with minimal assistance.

Medical Knowledge

• Understand the indications for commonly used anesthetic drugs
• Understand the major cardiovascular and respiratory effects of these drugs.
• Understand the basics of neuromuscular blockade (relaxants, train-of-four monitoring reversal)
• Understand key pre-operative findings in the history, physical and laboratory work.
• Recognize indications/contraindications and potential complications of regional blocks.

Interpersonal and Communication Skills

• Be able to deliver a concise, organized case presentation to staff that includes pre-anesthetic concerns.
• Be able to discuss a plan for anesthesia with the patient and family.
• Be able to formulate and describe a plan for the anesthetic management of ASA physical status 1-2 patients including anticipated problems and their solutions.

Practice-based Learning Improvement

• Become familiar with literature sources for anesthesiology

Professionalism

• Develop skill in the responsibility of arriving on-time at an early hour and an awareness of the inconvenience of delay for a surgical procedure

Systems-based Practice

• Become aware of the social need for ambulatory surgery patients to have adequate arrangements for transportation and supportive care in the home.

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.

Obstetrics and Gynecology

Patient Care

• Participate in antenatal assessment, the management of normal labor and delivery and postpartum care
• Perform a normal spontaneous vaginal delivery.
• Repair simple lacerations

Medical Knowledge

• Understand the principles of fetal heart rate monitoring
• Understand the indications for Cesarean section, breech delivery
• Understand the principles and performance of gyn examination, pelvic pain and abnormal uterine bleeding.

Interpersonal and Communication Skills

• Develop the habit of informing the supervising resident and/or attending physician of any changing situation
• Develop the habit of writing focused and legible notes.
• Develop skill at presenting cases in a complete yet focused manner

Practice-based Learning Improvement

• Develop the habit of reading, especially when waiting for labor to progress

Professionalism

• Learn to maintain confidences
• Learn to remain appropriate in dress and demeanor even when you are very fatigued.

Systems-based Practice

• Develop awareness of multidisciplinary preventive care, as this is often the only medical care that a woman will seek. 

Pediatrics

Patient Care

• Understand how to obtain a complete history and perform a complete pediatric examination
• Develop skill at rendering compassionate, appropriate care to patients.
• Develop proficiency at performing procedures on the pediatric patient

Medical Knowledge

• Understand the appropriate use of diagnostic studies in pediatrics
• Understand the basic therapeutic principles for effective therapeutic interventions.
• Understand normal growth and development of children
• Understand and use consultants effectively

Interpersonal and Communication Skills

• Become proficient in communication with a child and his/her parent(s)
• Develop skills in providing counseling, guidance and patient education
• Learn strategies and techniques for effective and efficient use of the telephone in patient and parent communication.

Practice-based Learning Improvement

• Develop the habit of regular attendance at conferences and other didactic sessions.
• Maintain a patient list to stimulate future reading.

Professionalism

• Develop the habit of being respectful and patient in dealing with pediatric patients and their parents.
• Develop an awareness of the vulnerability of dependent children and the risks to their well-being

Systems-based Practice

• Become aware of the many multidisciplinary needs of pediatric patients, including social service, child life, home care, nutrition, vision, dental and hearing evaluations. Etc.

Radiology

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

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

Interpersonal and Communication Skills

• Develop skill at interacting with chronically ill patients and their families, including the ability to listen yet lead the interaction
• Develop skill at appropriate case presentations
• Initiate learning skills needed as a consultant

Practice-based Learning Improvement

• Repeated use of techniques for arthrocentesis

Professionalism

• Become proficient at instilling confidence and optimism in patients.

Systems-based Practice

• Become aware of the need and the mechanisms for supplementing medical care with psychological, rehabilitative and financial support.

Surgery

Patient Care

• Develop skill at diagnosing and treating patients with surgical conditions in the pre-operative, operative and post-operative stages.
• Become proficient in obtaining a history, and completing a compassionate physical examination in the surgical patient.
• Developing basic techniques in suturing, assisting at surgery.
• Developing basic skills in endoscopy

Medical Knowledge

• Become familiar with differential diagnosis and management of
  o        Abdominal surgical conditions
  o        Liver, biliary tract and pancreatic surgical conditions
  o        Plastic surgical conditions

• Study and become familiar with the indications and contraindications for various diagnostic studies in surgical conditions

Interpersonal and Communication Skills

• Cultivate effective, non-threatening verbal communication techniques with colleagues and nursing/ancillary staff.
• Develop skill at presenting cases in a thorough yet focused manner
• Develop skill at writing a legible, appropriate and helpful consultation
• Develop the habit of telephoning referring physicians

Practice-based Learning Improvement

• Read about the technique after seeing a patient or being present at surgery
• Observe mentors and preceptors carefully

Professionalism

• Cultivate a calm appropriate demeanor.

Systems-based Practice

• Develop an awareness of the need for home care, social services, physical therapy, etc.