Curriculum for outcomes-based Patient Care

(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)

      

       Within the domain of Patient Care, the ABIM includes:

        - Interviewing

        - Physical Examination

        - Procedures

        - Clinical Judgment (ACGME)

        

       A.  Key Faculty 

          

           Interpretation of X-rays:  Radiology staff

                                      Pulmonary staff

                                      GI staff

                                      Neurology staff

 

           Interpretation of EKGs:    Cardiology staff

                                      ICU staff

                                      CMRs   

      

           Procedural Skills:         ICU staff

        

           Physical Exam:             All faculty

           Interviewing:              See Interpersonal and

                                        Communication Skills

 

       B.  Patient Care will be taught by floor teaching attendings,

           clinic preceptors.  Residents will also have prescribed

           independent study activities.

 

 

            

 

 

  II.  Measurable Goals and Objectives for Patient Care

 

       A.  Outcomes required to document competency

          

           The fundamental goals of this curriculum are for residents

           to

           [ ] gather and interpret data relevant to the care of the

               patient

           [ ] perform and interpret the physical examination

           [ ] perform and interpret appropriate procedures

           [ ] interpret

               [ ] laboratory test results

               [ ] EKGs

               [ ] radiographic studies

 

           Residents are expected to be able to

           [ ] minimize patient discomfort

           [ ] maintain patients’ rights and dignity  

           [ ] use clinical reasoning and clinical judgment

               to effect a management plan for the patient

           [ ] follow appropriate guidelines to promote patient

               health

                             

           

           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/or Skills

 

 

               PGY-1

               - gather patient data from all relevant sources

               - perform and interpret the physical examination

               - perform basic procedures and interpret data

               - interpret laboratory tests

               - interpret basic radiographic studies

                     (CXR, KUB)

               - interpret basic EKGs, stress tests, ECHOs

               - counsel and perform health maintenance activities

               - maintain patient’s comfort, dignity, confidentiality,

                      safety, and rights  

 

               PGY-2 will also

               - enhance data gathering and physical examination skills

               - perform more advanced procedures

               - interpret more complex radiographic studies

               - interpret more complex EKGs  

               - counsel and perform health maintenance activities

 

               PGY-3 will also

               - acquire the ability to function as consultant

                

           

  III.  Teaching Methods and How You Will Learn

 

        Residents will acquire the above knowledge, skills,

        attitudes and habits by utilizing the following:

 

        Videos/DVDs:

                 

                  

                          

                 

                  F. Daniel Duffy “Counseling for Behavior Change”

                            e.g. smoking cessation (ACP-ASIM)

                 

                  Dr. Humboe’s Yale Observation tapes with

                            Dr. Dharapak

 

        Reading:  Chapter 1 and 2 in “Bates’ Guide to Physical

                  Examination and History Taking” 8^th ed by

                  Lynn Bickley as well as rest of text and

                  Accompanying video.

                  Radiology Curriculum

                  Cardiology Curriculum 

                             

                  

                  

        Conferences:

                 

                  Physical Examination Noontime Conference Series

                  Radiology Noontime Conference Series

                  EKG Noontime Conference Series

                 

                                

          Experiences: 

                  Clinic, Hospital observation of Faculty

                  PGY-1 participate in OSCE with “standardized

                      resident” to counsel on:

                         Smoking Cessation

                         Weight management

                         Diabetes control

                         Fatigue/Depression

                  PGY-2 function as “standardized residents”

                  PGY-3 and CMRs record  and review 

                  

               

          Vignettes:  planned for future

 

  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/Skills:

                          PGY-1 Quiz or paper on Practice Guidelines

 

 

                          PGY-2 Quiz or paper on Counseling

                                        

 

                          PGY-3 Quiz or paper on Problem Patient

                              Review of “Counseling for Behavior

                                Change” and “Efficiency Through

                                Effective Communication”

                          ABIM Global Rating Scale

 

        Skills:          Direct Observation:

                          mini-CEX

                          Standardized Resident

 

                          Nursing, NF, CMR, evaluations

                          ABIM Global Rating Scale

                          Portfolio

                                         

 

       

 

        Residents must also provide anonymous evaluation

        and feedback of this aspect of the curriculum by using this

        Link.