Curriculum for outcomes-based Medical Knowledge

(one of the ACGME six general competencies):

           (updated 2/1/04 by James Hellerman, MD)

 

              Outline

 

       I.     Nuts and Bolts (or Introduction)

       II.    Measurable Goals & Objectives ("Outcomes")

       III.   Teaching Methods ("How you will learn")

       IV.    Outcome Assessment and Feedback

 

 

 

I.     Nuts and Bolts  (or Introduction)

      

       A.  Key Faculty 

           All faculty participate in the curriculum for the

           general competency of Medical Knowledge

          

      

       B.  Self-motivated independent study is key to your continued learning.  A

           textbook of medicine (Harrison's or Cecil) plus MKSAP should

           be primary sources of medical information.  This information

           should be discussed for clinical relevence with faculty.

           Additional sources of information will be suggested during

           various rotations (see the OnLineCurriculum). You should 

           read one medical journal regularly and thoroughly (e.g., 

           NEJM) as well as The Medical Letter.  The Washington Manual 

           is useful for quick, concise information as is

           Sanford Guide to ID.

           Authoritative online information is available from

           Up To Date and World Medical Leaders.  Online versions of 

           Harrison's and Cecil are both found at Merckmedicus (but you

           must own a paper copy of one of these as well).

           Each year (usually in October), you will have an opportunity

           to test your knowledge by taking the In Training Examination 

           (sponsored by the ACP-ASIM).  The results are usually 

           available by January, and they allow you to see if there are

           any topics to which you should devote more attention.  For 

           example, if you do well in all areas except Rheumatology, 

           you might decide to spend more time studying Rheumatology.  

           The Medical Education Department does not use the In

           Training Examinations to "grade" you; however, the aggregate

           results of all of the residents are used to see if changes

           should be made in our teaching program.  Again, for example, 

           if we see that residents do well in all areas except

           Endocrinology, then we would conclude that we should be

           spending more time teaching Endocrinology.

           Residents who need more experience with standardized tests

           may be given the opportunity to take a different Internal

           Medicine Exam (602-955-6971).

           All residents will have completed Step 1 and Step 2 of the 

           USMLE before starting the Internal Medicine Residency;

           before completion of the PGY-2 year, all residents should

           have successfully completed all 3 steps of the USMLE.

           After completing residency, you will want to take the

           ABIM Certifying Examination in Internal Medicine.  If your

            In Training Examination Scores have been running below the

            national 40th percentile, you should anticipate 

            that you are at risk for not passing the ABIM Certifying

            Examination.  

            Preparation to take the ABIM Certifying Examination 

            requires more than a few months and should begin in your

            PGY-1 year.  In addition to careful and repetitive review 

            of the MKSAP and Harrison's, a medical journal (such as 

            NEJM) and The Medical Letter, other resources you may wish 

            to use include:

            - ACP/ASIM Clinical Cases 

            - Video Board Reviews available in the SBH library such as

              Mayo Clinic, Cleveland Clinic, Harvard, or purchase 

              your own.

            - Up To Date online or via CD subscription and/or

              World Medical Leaders 

            - Board Review Courses are probably more useful for

              recertification; however, some residents feel more secure

              after taking a course such as the Mayo Internal Medicine

              Review (usually offered in July) Cornell or Columbia 

              or Dr. Conrad Fischer’s review courses.

              Some quick sources of online information (e.g., for when

              you are night float) are listed below.  There are also

              textbooks located in the ER and On Call suite.

 

 

 

  II.  Measurable Goals and Objectives for Medical Knowledge

 

       A.  Outcomes required to document competency

          

           The fundamental goals of this curriculum are for residents

           to demonstrate medical knowledge of:

 

           [ ] basic, clinical, and social sciences

               including

           [ ] knowledge of pathophysiology & mechanisms of disease

          

           Residents are expected to 

           [ ] apply medical knowledge to clinical problem-solving,   

              [ ] clinical decision-making and

              [ ] critical thinking (e.g, EBM)

           [ ] demonstrate the skills, motivation and self-direction

               to stay abreast of evolving biomedical knowledge

           [ ] share their knowledge with students, junior

               residents and peers

            

                             

           

           The paragraphs below describe the knowledge,

           skills, attitudes, and habits that residents will

           demonstrate to indicate competency at each level of

           training.  Such competency progresses from "knowing" to

           "knowing how" to “can teach”.

 

      

 

 

       B.  Demonstrate the following:

           Knowledge and Skills

               PGY-1

               - At the conclusion of this year, the PGY-1 resident

                 will demonstrate sufficient medical knowledge to be

                 capable of functioning as a team leader.  Specifically

                 the PGY-1 will develop the necessary medical

                 knowledge, as well as skills in data gathering, and

                 critical thinking to be able to apply these with

                 clinical reasoning at a level sufficient to assume a

                 team leadership role.

 

                 PGY-1 will be able to conduct a focused literature

                  search utilizing OVID, PubMed, and other search

                  engines.

                 PGY-1 will know background and definition of

                  “evidence-based medicine”

                 PGY-1 will add to their knowledge of General

                   Internal Medicine, Ambulatory Care, and

                   Critical Care Medicine

               

 

 

             

               PGY-2

               - At the beginning of this year, the resident will

                 be able to utilize medical knowledge and critical

                 thinking to make independent decisions based on

                 previous clinical experiences.  As the PGY-2 year

                 progresses, the resident will acquire additional

                 medical knowledge and develop the ability to

                 recognize and manage new clinical problems, while

                 seeking appropriate consultation.

                 

                 PGY-2 will be able to define Evidence-based Medicine

                 and utilize it for patient care.

 

                 PGY-2 will add to their knowledge of Emergency

                 and Critical Care Medicine, Ambulatory and

                 General Internal Medicine. 

 

               PGY-3

               - At the conclusion of this year, the resident will be

                 able to demonstrate mastery of a broad area of

                 medical knowledge sufficient to allow him/her to

                 practice independently.  The resident will now have a

                 sufficient knowledge base (as well as problem-solving

                 skills and clinical judgment) to allow him/her to

                 teach other residents and to evaluate the knowledge

                 and performance of junior residents.

               

                 PGY-3 will be able to distinguish when the best

                 available evidence applies to their patients, and when

                 their patients have traits which distinguish them from

                 those on which a study was based.  Moreover, PGY-3

                 will be able to determine when “Pearls”, anecdotes,

                 and “mindful practice” supercede the best available

                 evidence. 

              

                 PGY-3 will acquire knowledge to function as a

                 Consultant and PGY-3s will share their knowledge with

                 peers and junior Residents on rounds, at Journal

                 Clubs, M&M and Noon-time conferences.

                   

                

                  

  III.  Teaching Methods and How You Will Learn

 

        Residents will acquire the above knowledge, skills,

        attitudes and habits by utilizing the following:

 

        Videos/DVDs:

          -Evidence-based medicine CD and text of

            Daniel J. Friedland.

        Online resources:

          -Where to rapidly retrieve information regarding

           disasters or bioterrorism.

          -How to search on line for Consensus Statements, Guidelines,

           and other medical information.

          -Understand the history of EBM (and its limitations).

          -Johns Hopkins Internet Learning Center

          -BlackBoard.Com

          

 

 

 

 

        Conferences:

                  Core Lecture Series

                  Deborah Bonelli on OVID and other

                                   Search engines

 

                                

        Experiences: 

                  Boolian search exercises during

                    Block Ambulatory Rotation

                 

              

        Independent Study:  Harrison’s

                            MKSAP

                            NEJM

                            (UpToDate and MedStudy, as adjuncts only)

 

  IV.   Outcome Assessment and Feedback

 

        Competency at each level of training in this

        discipline will be documented by the resident by

        means of the following:

 

 

        Knowledge:        PGY-1 MCQ prepared by CMRs

                                Completion of Johns Hopkins ILC Modules

                                Completion of BlackBoard modules

                                In-Training Exam

                                Chart Stimulated Recall

                                Attending Global Assessment

 

 

                          PGY-2 MCQ prepared by CMRs

                                Completion of Johns Hopkins ILC Modules

                                Completion of BlackBoard modules

                                In-Training Exam

                                Chart Stimulated Recall

                                Attending Global Assessment          

 

                          PGY-3 MCQ prepared by CMRs

                                Completion of Johns Hopkins ILC Modules

                                Completion of BlackBoard modules

                                ABIM Global Rating Scale

                                In-Training Exam

 

        Skills:           Literature searches on topics of choice

                              With results included in portfolio

                         

                                        

 

       

 

        Residents must also provide anonymous evaluation

        and feedback of this aspect of the curriculum by using this

        link.