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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
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)
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
PGY-3 MCQ prepared by CMRs
ABIM Global Rating Scale
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.