ROTATION SPECIFIC OBJECTIVES CTU INTERN ROTATION

Transcription

1 ROTATION SPECIFIC OBJECTIVES CTU INTERN ROTATION Residents will take part in two blocks as CTU intern in their R1 year. During this time they will function as junior housestaff on the CTU team. They will carry a case load up to ten patients. They will be responsible for the daily assessment, follow up, and documentation of issues for these patients. They will report to the ward senior in morning rounds. It is expected that all Internal Medicine residents will complete their CTU months within their first six months of training. They will have these months at the tertiary sites. Most residents will attempt to run morning rounds during their last week of the CTU rotation under the guidance of their senior. This is done in preparation for their own CTU senior rotaions. OBJECTIVES MEDICAL EXPERT Residents in Internal Medicine will be expected to demonstrate appropriate knowledge of the common presentation of clinical problems on the CTU and have an approach to problems that have an undifferentiated presentation. The resident will show the ability to collect and synthesize data to arrive at a diagnosis and propose a treatment plan. The resident will model ethical behaviour and practice in away to enhance patient outcome and safety. The Internal Medicine Resident will demonstrate competency in the Medical Expert role by: 1. Possessing an appropriate level of knowledge of the common admitting diagnosis on the CTU. This includes: a. specific diagnoses: i. CHF ii. Pneumonia iii. Acute renal failure iv. Dehydration v. COPD vi. Asthma 1

2 vii. GI bleeding viii. Urinary Tract Infections ix. Diabetes and its complications x. Metabolic disorders including: 1. Hyponatremia 2. Hypernatremia 3. Hyperkalemia 4. Hypokalemia 5. Hypercalcemia 6. Hyperglycemia 7. Hypoglycemia xi. Thrombo embolic disease xii. Complications of Alcohol and Drug abuse xiii. Stroke xiv. Soft tissue infection and osteomyelitis b. An approach to undifferentiated illness presentations including: i. Shortness of breath ii. Hypoxia iii. Decreased level of consciousness iv. Chest pain v. Abdominal pain vi. GI bleeding vii. Joint pain viii. Weakness ix. Weight loss x. Fever xi. Confusion xii. Hypotension xiii. Low urine output 2. Demonstrating the ability to perform a complete patient assessment including: a. Obtaining a history of appropriate scope for the patient problem b. Performing a physical examination appropriate for the patient problem c. Ordering appropriate investigations d. Correctly interpreting all data to come up with a patient problem list and differential diagnosis. 2

3 3. Demonstrate knowledge appropriate to the level of training in terms of proposing a treatment plan based on information obtained. This includes knowledge of : a. Practice guidelines of common medical conditions including: i. Pneumonia ii. COPD iii. CHF iv. Asthma v. Hypertension vi. Stroke prevention b. Use and side effects of common medications including: i. Duirectics ii. Antihypertensive medications iii. Medications used in CHF iv. Bronchodilators v. Steroids vi. GI medications including PPI, H2 blockers, antacids, laxatives vii. Sedatives, neuroleptics and antidepressants viii. Antibiotics ix. Anti thrombotic agents including ASA, Clopidogrel, Coumadin, Heparin x. Insulin and oral hypoglycemics 4. Demonstrating the appropriate level of knowledge for training in the area of end of life care including: a. Pain control b. Control of Nausea c. Dyspnea d. Appropriate use of consultative services, including Palliative care 5. Demonstrating appropriate clinical decision making skills and knowing the limits of their expertise. This will be demonstrated by knowing when to seek the advice of others. 6. Demonstrate an evolving knowledge base with respect to legal issues and medical ethics as it pertains to the CTU patient. This includes: a. Informed Consent b. Capacity and Substitute Decision Making c. Confidentiality d. Truth telling e. Issues related to End of Life Care 7. Practicing medicine in a way to enhance patient safety and participate in endeavours to reduce adverse events. 3

4 8. Demonstrating a proficiency in the following technical skills: i. Thoracentesis ii. Paracentesis iii. Lumbar puncture iv. Joint aspiration v. ECG interpretation 9. Demonstrating the ability to prioritize multiple issues in a patient 10. Demonstrate the ability to do a focused history and physical examination in a timely and organized fashion with little error or missed features. 11. Demonstrating the ability to make an accurate diagnosis and appropriate differential diagnosis. 12. Demonstrate the ability to independently stabilize an acutely ill patient. 13. Demonstrating appropriate use of consultative services 14. Demonstrating the ability to triage patients both on the CTU and referred patients in the ER and demonstrates the ability to recognize and prioritize competing demands 15. Being aware of the medical legal and ethical aspects of practice on the CTU and demonstrating a clear understanding of the following ethical issues: b. Informed Consent c. Capacity and Substitute Decision Making d. Confidentiality and Duty to report e. Truth telling f. Issues related to End of Life Care g. Handling requests for inappropriate treatments COMMUNICATOR The Internal Medicine Resident will demonstrate appropriate communication skills in the care of the CTU patients. This includes communication for the direct purpose of caring for the patient, documentation and dictated discharge summary. The Internal Medicine Resident will demonstrate competency in the Communicator role by: 1. Demonstrating a patient centered approach to communication that develops rapport and trust with patients, families and care givers. 4

5 2. Demonstrating the ability to accurately elicit and synthesize relevant information from patients, families, colleagues and other professionals and is able to communicate this in a succinct manner. 3. Demonstrating the ability to accurately convey relevant information and explanation to patient, families, colleagues and other professionals. 4. The ability to develop a common understanding on issues, problems and plans with patients, families and other professionals to develop a shared plan of care. 5. Demonstrating the ability to maintain an adequate health record 6. Demonstrating the ability to effectively communicate through written information about a medical encounter, including charting and dictated discharge summaries. 7. Demonstrating an approach to specific communication scenarios including: a. Informed consent b. Communication of treatment plan c. Breaking bad news d. Capacity assessment e. Disclosure of adverse event f. Addressing end of life issues COLLABORATOR The Internal Medicine Resident must demonstrate the ability to work with others in the health care team. The Internal Medicine Resident will demonstrate the Collaborator role by being able to: 1. Describe the role of the various health care team members in the care of the CTU patient, including: a. RN b. Occupational Therapy c. Physiotherapy d. Speech Language Pathology e. Social Work f. Dietician 2. Demonstrate respectful attitudes towards other colleagues and member of an interprofessional team. 3. Work effectively with the health care team to assess, plan and provide care for patients, including taking the lead in care, when appropriate. 4. Participate effectively in multidisciplinary rounds 5

6 5. Work effectively with peers, medical team members and other health care professionals to prevent, negotiate and resolve interprofessional conflict. 6. Work effectively with consultative services to ensure the best care for patients on the CTU. MANAGER The Internal Medicine Resident must demonstrate the ability to manage their time and others. They must show that they can balance patient care and educational activities and balance work and personal matters. The Internal Medicine Resident will demonstrate competence in the Manager role by: 1. Demonstrating appropriate time management including showing up to work on time and effectively dealing with patient care and educational activities so as to be able to leave at a reasonable time. 2. Demonstrate the ability to effectively prioritize consultation requests and competing demands 3. Making time to teach and attend educational rounds 4. Demonstrating the ability to balance work and personal needs 5. Ordering appropriate test and using limited resources wisely 6. Appropriately triaging patients not suitable for the CTU, such as patients requiring Intensive Care or surgical consultation. 7. Conducting daily team rounds and sign over rounds in an efiicient manner 8. Ensuring that other members of the CTU team are able to attend educational rounds HEALTH ADVOCATE The Internal Medicine Resident must demonstrate the ability to advocate on behalf of their patients to improve their overall health. They must demonstrate knowledge of issues in patient safety and prevention of adverse events on the CTU. The Internal Medicine Resident will demonstrate competency in the Health Advocate role by: 1. Advocating for their own patients to access appropriate tests, consultations and interventions in an appropriate timely fashion. 6

7 2. Recognizing and appropriately managing the conflict between health advocate of an individual patient and the manager of finite health care resources. 3. Appropriately identifying opportunities to educate patients about health promotion and disease prevention. 4. Counseling patients about their disease and measure to improve or control their disease. 5. Getting involved in quality assurance projects on the CTU in particular those projects that promote patient safety and reduce adverse events. 6. Attendance and active participation in Quality of Care rounds. 7. Appropriate reporting of adverse patient events SCHOLAR The Internal Medicine Resident must demonstrate the ability to improve on their knowledge and skills and to assist others in learning. This includes the ability to indentify gaps in their knowledge and the access information for practice and review literature in a critical manner. Residents in Internal Medicine are also expected to be involved in the teaching of junior learners, including providing teaching sessions and involvement in evaluation. The Internal Medicine Resident will demonstrate competency in the Scholar role by: 1. Identifying their own learning needs and resources to assist them 2. Being able to ask a clinical question and perform an focused literature search and critically review the literature 3. Teaching others. This includes the medical team by sharing of the results of a search of clinical question raised by an issue in patient care on the CTU. It also includes supervision and teaching of the clinical clerks, and participation in CTU teaching rounds. 4. Participation in evaluation of peers and clinical clerks as well as senior medical residents at the request of the attending physician. PROFESSIONAL The Internal Medicine Resident will demonstrate a commitment to their patients, profession and society though ethical practice. PGY1 is expected to demonstrate honesty, integrity, altruism and compassion. The PGY1 is expected to practice within the medical legal frameworks. The Internal Medicine Resident will demonstrate competence in the Professional role by: 7

8 1. Appearing neat, tidy and well groomed and wearing appropriate attire 2. Demonstrating appropriate relationships with patients 3. Demonstrating appropriate interactions with members of the health care team, including referring and consulting services. 4. Communicating absences from CTU to attending MD and/or senior medical resident. 5. Assuring proper sign over of patients when absent from the hospital. 6. Signing pager over to on call resident when absent from the hospital. 7. Attending teaching rounds and demonstrating respect for presenter and points of views of participants. 8. Recognizing the limits of their expertise. This will be demonstrated by knowing when to seek the advice of a senior medical residents, faculty attending or consultative service 9. Recognizing and responding to other s inappropriate behavior in practice 10. Recognize other professionals and need and respond appropriately. 11. Disclosing adverse events to health care team and patient. 12. Participation in the on call system, including making arrangements for call coverage in the event you are not able to meet your obligation and accommodates the needs of fellow residents in times of need for changes in call schedule. EVALUATION of Can Meds Roles will be done by the CTU Service Chief through a variety of means including: 1. Direct observation during patient care rounds and discussion with other attending physicians 2. Noting attendance and participation at teaching rounds 3. Feedback from team members and Chief Medical Resident 4. Direct feedback from the Allied Health Professionals though the Medical Staff review. 5. Review of clinical records, where appropriate. 8