Primary Care Residency Program
We have created a set of developmental milestones for you to use as a roadmap for your three year tenure here in our program. These have been developed to provide you with a transparent pathway to success as a primary care physician and will be the basis for your evaluations. These are essential in meeting an ACGME mandate as well as for your own personal benefit as you develop your skills as a primary care physician trainee. Try not to think of yourself as a PGY level trainee but as a physician in training along a continuum.
Professionalism serves as the building block on which all other competencies rest. A resident must treat all patients with dignity and respect. This means dressing and behaving appropriately and maintaining appropriate relationships with patients and staff. We expect you to be honest and to exhibit integrity and humility. These qualities that will serve you well and provide the basis for a successful career in primary care. We expect each trainee to take ownership of their patient panel.
Goals and Objectives
Residents begin their training as a learner and progress through various stages of development to become competent in their ability to care for patients independently as a doctor. Beyond basic competency a physician becomes proficient and ultimately acquires expertise in patient care. We expect that you will achieve certain landmarks by the end of your training which are termed Essential Professional Activities (EPAs). Several of these relate to the principles of the Patient-centered home curriculum we have developed for you. A detailed list of these follows below:
- Manage the care of patients in a general medicine continuity clinic
- Manage the care of patients on general internal medicine inpatient ward
- Manage the care of patients in the critical care unit
- Provide general internal medicine consultation to nonmedical specialties
- Behave professionally and honestly
- Provide preoperative assessment and preoperative care
- Manage transitions of care
- Lead interprofessional care teams
- Lead family meetings
- Assure patient safety
- Improve the quality of personal and system-level care
- Engage in lifelong learning
- Provide patient advocacy
Evaluative Tools and Techniques
- Direct observation of patient care by your preceptor
- Mini-CEX activity, quarterly
- Daily Chart reviews
- Feedback from your patients, nursing and yourself
- Conference participation
- Completion of scheduled modules
- Standardized testing (for ex: in-service exam)
How Milestone Objectives are Met
- Supervised Direct Patient Care Activities - residents are supervised directly by their assigned Attending. We use the validated mini-CEX tool to assess patient care on both inpatient and outpatient services.
- PGY-1; 6 miniCEX
- PGY-2: 6 miniCEX
- PGY-3: 6 miniCEX
- Learning Modules - each resident will complete the on-line Johns Hopkins Internet Learning Center (JHILC) modules assigned for the longitudinal ambulatory lecture series. There are 10-12 per year, 30-36 per 3 year cycle
- Inservice Exam-done on a yearly basis, to gauge a resident's medical knowledge with comparison to his/her peers. This exercise is meant to be formative. If deficiencies are noted the learner is referred to our online program we have developed to enhance medical knowledge.
- Multisource Feedback-each residents performance will be assessed by the nursing staff, case managers, fellow residents, chief residents, patients and a self-assessment with reflective feedback. Each resident will be responsible for 5 patient care evaluations in the outpatient setting per 6 months
- Chart Stimulated Recall - over the course of their first two years in residency the residents will participate in chart stimulated recall sessions. During their ambulatory rotations the residents will participate in a Chart Stimulated Recall session with one of the Chief Medical Residents. During these sessions, a resident's clinic notes will be reviewed, with the resident, and they will receive feedback on ways to improve their note and help them with efficiency in the outpatient setting.
- Quality Improvement Projects - every resident will participate in clinic quality improvement projects. This exercise will involve a biannual review of your patient panel (chronic disease management) and a follow up data-based action plan.
- E&M Coding - further knowledge about E&M coding, the resident will work with the clinical preceptor to enter E&M codes for patient visits
- Supervised performance of ambulatory procedures
Professionalism serves as the building block on which all other competencies rest. A resident must treat all patients with dignity and respect. This means dressing and behaving appropriately and maintaining appropriate relationships with patients and staff. We expect you to be honest and to exhibit integrity and humility. These qualities that will serve you well and provide the basis for a successful career in primary care.
We expect each trainee to take ownership of their patient panel. Violations in professional behavior will be taken seriously can serve as the basis for dismissal from the program if deemed egregious by the Residency Competency Committee and Program Director.
For More Information
Please contact us if you have questions about the Internal Medicine Residency Program at Danbury Hospital, or would like more information.