Curricula Descriptions
Adult Medicine Curriculum - General Adult Medicine, Family Practice Service
| Goals: |
- To evaluate and manage adult patients integrating patient, family and community resources
- Develop skills in time management and balancing of rotation and outpatient responsibilities
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| Objectives: |
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The resident should develop attitudes and interpersonal skills that encompass the following:
- Awareness of the importance of the patient, physician and health care team partnering to promote optimal health.
- Self-directed learning and awareness of limitations, acceptance of responsibility and excellence in provision of patient care.
- Support and empathy for the patient and family through the process of illness, treatment and rehabilitation.
- Effectively communicate with patient, family, and other health professionals.
The resident should develop sufficient knowledge and therapeutic skills to:
- Obtain an accurate and complete history from patient, family, and other sources in an efficient manner.
- Perform a complete physical examination.
- Formulate a differential diagnosis and support a diagnostic impression and management plan.
- Provide appropriate treatment.
- Recognize the need and obtain appropriate specialty referral.
- Coordinate continuous care by engaging in discharge planning.
- Relate sufficient sign-out to allow covering physicians to provide seamless care.
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| Procedures: |
Know indications and techniques. Demonstrate performance of procedure. Log all procedures on procedure logger (www.newinnov.com). Competency based on number and evaluation.
- Thoracentesis
- Paracentesis
- Lumbar Puncture
- Central Venous Access
- Endotracheal Intubation
- Code Blue Management
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| Common Topics: |
This list is not meant to be inclusive, but these topics should be well understood. Read on all of your patients.
- Cardiology: heart failure, acute coronary syndromes, chest pain, hypertension
- Gastroenterology: upper and lower bleeding, abdominal pain, ulcer prophylaxis, acute abdomen, nutrition
- Pulmonary: chronic obstructive pulmonary disease, pneumonia, shortness of breath, respiratory failure, venous thromboembolic disease
- Endocrinology: diabetes, thyroid disease, adrenal disease
- Hematology: anemia, blood product use
- Nephrology: cerebrovascular disorders, weakness
- Surgical patients: preoperative, postoperative care and medical risk assessment
- Neonates, infants: dehydration, pneumonia, bronchiolitis, croup, failure to thrive, and routine newborn care.
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Teaching Strategies—rotations, tactics, resources
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| Noon Lectures |
Rotation/Cycle |
Responsible Faculty |
| EKG Basic Interpretation |
Yearly |
.. |
| Fluid Electrolyte Review |
Yearly (near beginning) |
.. |
| Antibiotic Management |
.. |
.. |
| DM |
Yearly |
.. |
| HTN |
Yearly |
.. |
| COPD |
Yearly |
.. |
| Anemia |
Yearly |
.. |
| Acute Renal Failure |
Yearly |
.. |
| Pulmonary Embolus |
Yearly |
.. |
| Preoperative Medical Assessment |
Yearly |
Miller |
| Peptic Ulcer Prophylaxis |
Yearly |
.. |
| Hyperlipidemia Management |
Yearly |
.. |
| Pneumonia |
Yearly |
.. |
| Heart Failure |
Yearly |
.. |
| Syncope |
Yearly |
Miller |
| GI Bleed |
Yearly |
.. |
| Abdominal Pain |
Yearly |
.. |
| Elevated Liver Enzymes |
Yearly |
Miller |
| Breast Complaints |
Yearly |
Miller |
| Roles of FP TPN, Tube Feeding |
First Years |
Kruse |
Rotation Experiences/Activities (Items marked with * address other curriculum goals and objectives but are integrated during this rotation.)
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| Rotation Mechanics |
A combination of junior and senior level residents covers the FPS. The FPS will care for 1st year resident patients (1st year residents are encouraged to be involved with social rounds), attending EAC, QFPC and their nursing home patients. Unassigned “no doctor” patients when QFPC attending is on call and senior patients when senior residents are on away rotation or nephrology rotation are also covered by the FPS. OB patients with a primary complaint that is non-OB in nature will go to service. OB patients with a primary complaint that is OB will go to the OB service.
In general, junior level residents should care for a larger number of patients with senior residents having a larger responsibility for resident and medical student teaching, psychiatry and in-patient consults, and supervision on intensive care or more ill patients.
All patients are to be seen and a note written by 8:30 a.m. or the time of attending rounds. The resident is responsible for knowing all details of the present admission and the complete past medical history. This includes review of old records. All specialty referral and significant changes in status should be discussed with the attending physician.
If the patient’s attending is not on the FPS – call the attending with admission details, significant changes in status and patient discharge. This and completion of faxed “discharge forms” is critical to continuity of care and patient satisfaction.
Unassigned Babies: The senior resident will contact labor and delivery each block. In general junior residents will provide hospital care, perform circumcisions and do follow-up for these babies in their continuity clinics.
Admissions: The FPS team will care for direct (before 5:00 p.m.) and emergency department admissions. The emergency department may write brief orders and the resident evaluate the patient later if the resident is in educational conference, family meeting or on hospital rounds.
Duty Hours: No in-house call is required on the FPS rotation. All residents receive two weekends off each 4-week block. Residents are encouraged to provide sign-out and cover each other as needed to alleviate fatigue. Junior level residents cover the FPS for 3 blocks. Senior level residents do 2 blocks each in the PGY2 and PGY3 year. Senior level residents who are not including maternity care in their future practice are encouraged to complete the FPS rotation as an additional elective.
During the first six months of an interns training, a senior resident on in-patient service is required to see EVERY daytime admission (7a.m. – 5p.m.) after the intern has completed the admission. This must include a thorough review of the written H & P, accompanying orders and a focused physical exam, performed by the senior resident. It is not required for the senior resident to write a note in the chart, however, any change in management from the intern’s original plan should be reviewed with the attending AND the intern (great opportunity for teaching), then documented. The intern must call the attending as soon as she/he has completed the admission. If at any time during the admission process, the patient becomes unstable or the intern is unsure of patient management, the intern must call the senior resident and / or attending physician ASAP for further guidance.
All ICU and otherwise critically ill daytime patient admissions must be seen by a senior resident ALWAYS (the entire year.) The senior resident must write a note in the chart and as above, review the intern’s note, orders and discuss any medical management changes with the attending and intern, then document the changes.
R1 to R2 and R3 to Attending Residents As Teachers Transition Policy
Purpose: to improve the transition in responsibility from Intern to 2nd year resident and from 3rd year resident to attending physician by providing a safe and temporary opportunity of increased responsibility and autonomy with hospitalized patient management.
R1 to R2 Proposal: Excepting ICU admissions, OB patients, or otherwise critically ill patients, during the last block (block 13) of the first year, interns would, if approved by faculty, perform hospital admissions without notifying their senior resident of the admit. In essence, they would be acting as a senior resident. Supervision would occur by working directly with the attending physician via telephone. If at any time the intern felt they needed help of any kind, they would page the senior resident, as usual, who would come to the hospital to assist with the admission. In the event of an ICU or critically ill patient, the senior resident would be required to be in house as always, assisting the intern with the admission, regardless of the intern’s comfort level or ability.
The 3rd year resident would also be responsible for completing the daily coding and billing card for each hospitalized patient. |
| Rotation Completion: |
- All attending physicians complete resident evaluations.
- Satisfactory completion of this rotation is determined by the program director in consultation with the supervising attending physicians.
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| Resources |
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QFMR Contact: Thomas Miller, M.D.
Last Revision: 9/18/08
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