The University of Toledo : Residency Program

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Residency Program - Goals and Objectives

Program Description	Curriculum
Goals and Objectives	Internal Medicine Residency Schedule
Internal Medicine Residency Conferences	How to Apply
Benefits	Contact Information

To view departmental Goals and Objectives, click here.

The Residency Program of the Department of Internal Medicine of the University of Toledo will provide the intellectual environment, formal instruction, and broad experience necessary for the resident to acquire the knowledge, skills, and attitudes essential to the practice of Internal Medicine.

The program will provide the facilities to accomplish the overall educational goals for each resident.

Goals: The goal of our residency program is to train Internal Medicine physicians who excel in each of the 6 competency areas and maintain a life-long commitment to continue to grow and develop in these areas. The objectives by which we hope to achieve this goal follow…

Objectives:

1.Patient Care

a. Participation in patient care and management (but are not limited to history and physical, procedures) on each rotation as documented by the faculty evaluation forms. Major performance deficits will be grounds for probation. Attendance and behavior are also considered in evaluating performance.

b. Completion of the required procedures and being proficient is a requirement for graduation from the program and eligibility requirement to sit for the American Board of Internal Medicine (ABIM). See policy IM 001-

c. Assessment will be based on monthly attending and peer evaluations.

2. Medical Knowledge

a. It is anticipated the our residents continue to grow their knowledge base in Internal Medicine. Resources for this include (but are not limited to) Harrison’s textbook of Internal Medicine, the residency core curriculum didactic and the MKSAP published by the American College of Physicians.

b. Assessment will be performed in the following way:

1. Monthly evaluations submitted by attendings and peers.

2. A monthly test is administered by the residency program to evaluate residence medical knowledge. A 60% correct answer score is required to satisfy this COMPETENCY for third year residents, 45% for second year residents and 35% for first year residents. At-risk residents are required to meet with the program director/associates to develop and implement a plan to remediate deficits. The frequency of these meetings will vary by resident and will be determined by the faculty advisor in consultation with the Residency Program Director.

3. Passing USMLE step three is a prerequisite for promotion from PGY2 to PGY3.

4. It is expected that residency graduates pass the ABIM examination and become certified.

3. Practice-Based Learning and Improvement

a. The resident need to successfully complete a practice based learning and improvement plan-as a third year –elective research month, the resident is to choose his project from a list of projects listed at the American Board of Internal Medicine web site.

b. Assists in chart audits and recommendations for improving patient care.

c. Assessment will be based on

1. Monthly evaluations by attendings and peers.

2. Review of the practice based learning project by the PD and associate PDs.

4. Interpersonal and Communication Skills

We believe this to be amongst the most crucial areas of competency. We evaluate competency in this area by

a. Mini-CEX exams

b. Monthly evaluations from attendings and peers

c. 360 evaluations performed by nursing and clerical staff.

5. Professionalism

a. Personal integrity, which includes strict avoidance of substance abuse, theft, lying, cheating, and unexplained absences. Unauthorized use of UTMC equipment and personnel for other than educational, professional, and patient care use is prohibited. Failure to follow this standard will be grounds for probation.

b. Other aspects of professionalism include cultural sensitivity, end of life care decisions, patient confidentiality and privacy, ethical behavior, respectful attitudes towards colleagues and students, timely medical record keeping, and responsiveness to patient needs.

c. Assessment will be performed using monthly evaluations provided by attendings, and peers (360 evaluations).

6. Systems-Based Practice

a. System based practice is incorporated in our training program to help our residents work effectively in various health care delivery areas including UT medical center, ST .Vincent’s Medical Center and out patient clinics. Residents are expected to co-ordinate patient care within the system utilizing resources including social workers, hospital discharge care co-coordinators, nursing staff and pharmacists. Residents will incorporate cost-benefit and risk-benefit aspects of health care practice assisted by the pharmacist. They will have guidance from the supervising faculty, pharmacist and the easily accessible literature search engines (Medline) and Up to Date on line. They will be patient advocates for quality of care, Residents will help with patient safety and improve care through proper documentation and communication when handing over care.

b. Assessment will be performed by

1. monthly evaluations from attendings and peers.

2. 360 evaluations

3. medical record compliance.

Detailed objectives based on PGY status are…..

1. Have you developed adequate tools to evaluate resident competencies in the six areas based on the goals and objectives? (please describe)

Yes, please see above list of goals and objectives which specifies these tools.

2. Can you provide any evidence of developing or using dependable measures to assess the residents' competence in each of these areas? (please describe)

We are continuing to develop additional ways to improve both the pedagogy as well as the assessment of the competencies. We have specifically empowered a CQI committee to ….

train the faculty in education of competencies
measure competencies in our residents with objective and valid metrics.

3. Can you provide any evidence of a process developed to link educational outcomes with program improvement? (please describe)

About 1 year ago, we initiated a process of testing medical knowledge with in house shelf exams on a monthly basis. Performance on these exams has steadily risen, and we anticipate improvement on the national inservice exam scores when they become available.

Page updated: August 14, 2008

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1. Patient Care
FIRST YEAR RESIDENT	SECOND YEAR RESIDENT	THIRD YEAR RESIDENT
Prioritizes patient problems	Prioritizes patient problems	Prioritizes patient problems
Prioritize a day of work	Prioritizes a day of work	Prioritizes a day of work
Monitors and follows up patients appropriately	Monitors and follows up patients appropriately	Monitors and follows up patients appropriately
Satisfactory performance on Mini CEX	Satisfactory performance on Mini CEX	Satisfactory performance on Mini CEX
Demonstrates caring and respectful behaviors with patients and families	Demonstrates caring and respectful behaviors with patients and families	Demonstrates caring and respectful behaviors with patients and families
Gathers essential, accurate information in interviews and physical exams, and reviews other data	Gathers essential, accurate information in interviews and physical exams, and reviews other data	Gathers essential, accurate information in interviews and physical exams, and reviews other data
Knows indications, contraindications, & some risks of some invasive procedures	Knows indications, contraindications, & risks of an increasing number of invasive procedures.	Knows indications, contraindications, & risks of all ABIM required invasive procedures
Completely performs some invasive procedures.	Completely performs a number of invasive procedures.	Completely performs ABIM required invasive procedures.
Provides services aimed at prevention and/or maintenance of health.	Provides services aimed at prevention and/or maintenance of health.	Provides services aimed at prevention and/or maintenance of health.
Works with all health care professionals to provide patient –focused care.	Works with all health care professionals to provide patient –focused care.	Works with all health care professionals to provide patient –focused care.
	Understands and weighs alternatives for diagnosis and treatment	Understands and weighs alternatives for diagnosis and treatment
	Uses diagnostic procedures and therapies appropriately	Uses diagnostic procedures and therapies appropriately
	Elicits subtle findings on physical examination	Elicits subtle findings on physical examination
	Obtains a precise, logical and efficient history	Obtains a precise, logical and efficient history
	Interprets results of procedures properly	Interprets results of procedures properly
	Able to simultaneously manage multiple problems	Able to simultaneously manage multiple problems
	Develops and carries out management plans	Develops and carries out management plans
	Considers patient preferences when making medical decisions	Considers patient preferences when making medical decisions
	Triages patients to appropriate location	Triages patients to appropriate location
		Reasons well in ambiguous situations
		Spends time appropriate to the complexity of the problem
2. Medical Knowledge
INTERN	SECOND YEAR RESIDENT	THIRD YEAR RESIDENT
Demonstrates knowledge of basic and clinical sciences.	Demonstrates knowledge of basic and clinical sciences.	Demonstrates knowledge of basic and clinical sciences.
Applies knowledge to therapy	Applies knowledge to therapy	Applies knowledge to therapy
	Is aware of indications, contraindications and risks of commonly used medications and procedures.	Is aware of indications, contraindications and risks of commonly used medications and procedures and commonly used medications.
	Demonstrates knowledge of epidemiologic and social behavioral sciences knowledge to the care of the patient.	Demonstrates knowledge of epidemiologic and social behavioral sciences knowledge to the care of the patient.
	Applies basic, clinical, epidemiologic and social behavioral science to the care of the patient	Applies basic, clinical, epidemiologic and social behavioral science to the care of the patient
		Demonstrates an investigatory and analytic approach to clinical situations.
3. Practice Based Learning &Improvement
INTERN	SECOMD YEAR RESIDENT	THIRD YEAR RESIDENT
Understands his or her limitations of knowledge	Understands his or her limitations of knowledge	Understands his or her limitations of knowledge
Asks for help when needed	Asks for help when needed	Asks for help when needed
Is self motivated to acquire knowledge	Is self motivated to acquire knowledge	Is self motivated to acquire knowledge
Use of computerized sources of results and information to enhance patient care.	Use of computerized sources of results and information to enhance patient care.	Use of computerized sources of results and information to enhance patient care.
Accepts feedback and develops self-improvement plans.	Accepts feedback and develops self-improvement plans.	Accepts feedback and develops self-improvement plans.
	Undertakes self evaluation with insight	Undertakes self evaluation with insight
	Facilitates the learning of students and other health care professionals.	Facilitates the learning of students and other health care professionals.
		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.
4. Interpersonal & Communication Skills
INTERN	SECOND YEAR RESIDENT	THIRD YEAR RESIDENT
Writes pertinent and organized notes.	Writes pertinent and organized notes.	Writes pertinent and organized notes.
Documents timely and legible medical records	Documents timely and legible medical records	Documents timely and legible medical records
Uses effective listening, narrative and non-verbal skills to elicit and provide information.	Uses effective listening, narrative and non-verbal skills to elicit and provide information.	Uses effective listening, narrative and non-verbal skills to elicit and provide information.
Works effectively as a member of the health care team	Works effectively as a member of the health care team	Works effectively as a leader of the health care team
	Creates and sustains therapeutic and ethically sound relationships with patient and families.	Creates and sustains therapeutic and ethically sound relationships with patient and families.
	Provides education and counseling to patients, families and colleagues.	Provides education and counseling to patients, families and colleagues.
	Able to discuss end of life care with patients/families.	Able to discuss end of life care with patients/families.
5. Professionalism
INTERN	SECOND YEAR RESIDENT	THIRD YEAR RESIDENT
Establishes trust with patients and staff.	Establishes trust with patients and staff.	Establishes trust with patients and staff.
Does not refuse to treat patients.	Does not refuse to treat patients.	Does not refuse to treat patients.
Is honest, reliable, and cooperative and accepts responsibility.	Is honest, reliable, and cooperative and accepts responsibility.	Is honest, reliable, and cooperative and accepts responsibility.
Shows regard for opinions and skills of colleagues.	Shows regard for opinions and skills of colleagues.	Shows regard for opinions and skills of colleagues.
Demonstrates respect, compassion and integrity.	Demonstrates respect, compassion and integrity.	Demonstrates respect, compassion and integrity.
Is responsive to needs of patients and society, which supersedes self interest.	Is responsive to needs of patients and society, which supersedes self interest.	Is responsive to needs of patients and society, which supersedes self interest.
	Displays initiative and leadership.	Displays initiative and leadership.
	Is able to delegate responsibility to others.	Is able to delegate responsibility to others.
	Demonstrates commitment to on-going professional development.	Demonstrates commitment to on-going professional development.
	Demonstrates commitment to ethical principals pertaining to the provision or withholding of care, patient confidentiality, and informed consent and business practices.	Demonstrates commitment to ethical principals pertaining to the provision or withholding of care, patient confidentiality, and informed consent and business practices.
	Demonstrates sensitivity to patient culture, gender, age, preferences and disabilities.	Demonstrates sensitivity to patient culture, gender, age, preferences and disabilities.
	Acknowledges errors and works to minimize them.	Acknowledges errors and works to minimize them.
		Is effective as a consultant.
6. Systems-Based Practice
INTERN	SECOND YEAR RESIDENT	THIRD YEAR RESIDENT
Is a patient advocate	Is a patient advocate	Is a patient advocate
Has constructive skepticism.	Has constructive skepticism.	Has constructive skepticism.
Advocates for high quality patient care and assists patients in dealing with system complexity.	Advocates for high quality patient care and assists patients in dealing with system complexity.	Advocates for high quality patient care and assists patients in dealing with system complexity.
	Applies knowledge of how to partner with other health care providers to assess, coordinate and improve patient care.	Applies knowledge of how to partner with other health care providers to assess, coordinate and improve patient care.
	Uses Systematic approaches to reduce errors.	Uses Systematic approaches to reduce errors.
	Participates in developing ways to improve systems of practice and health management.	Participates in developing ways to improve systems of practice and health management.
		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.

Department of Medicine : Residency Program - Goals and Objectives