First Year of Residency
(Also PG2 and PG3 )

EDUCATIONAL GOALS OF THE INTERNAL MEDICINE RESIDENCY PROGRAM,
BY YEAR OF TRAINING

Data Collection

First year residents are expected to perform the basic history and physical effectively, both comprehensive and focused. They are also expected to be able to abstract medical records and utilize the electronic medical record efficiently and effectively.

Knowledge

First year residents must begin to understand the basic pathophysiology of disease processes in all of the subspecialty disciplines of internal medicine. They will appreciate the pace of disease processes by working with patients who have problems ranging from the acute and immediately life-threatening to common chronic conditions. They will master the use of the computer to order tests, access medical records, and document patient care and will be expected to do computerized searches of the medical literature. They will cultivate the perspectives necessary for self-motivated learning. They will recognize the power of clinical research designs and develop an inquiring attitude regarding the source of conventional wisdom. They will facilitate the learning of students and other health care professionals.

Humanistic Qualities

First year residents must demonstrate the potential to develop the integrity, respect, and compassion characteristic of the fully trained internist. They must demonstrate the capability to put the patient's welfare before all other concerns. They will show mastery of effective interpersonal communication skills and demonstrate caring and respectful behaviors when interacting with patients and their families.

Professionalism and Ethical Behavior

First year residents will manifest the enthusiasm and commitment of critical members of the health care team in all matters of patient care and colleague interaction. First year residents will begin to integrate their medical skills into an effective component of an extensive team-care approach. They will display aptitude in communicating with patients and their families and other members of the health care team. They will learn the importance of maintaining timely medical records, and communicate effectively with colleagues and consultants through the electronic medical record.

First year residents will demonstrate ethical professional behavior and be able to identify common ethical problems in medical practice. They will be exposed to the laws and regulations concerning the practice of medicine.

Medical Care

All residents will be certified in advanced cardiac life support and develop mastery in responding to emergency situations. By the end of the first year of training, residents will be able to identify acutely ill patients and be able to initiate the management and evaluation of all medical conditions. They will master the commonly ordered laboratory and imaging tests in internal medicine, both indications and interpretation. They will also master the basic, common therapeutic interventions, with great emphasis on pharmacy and therapeutics. They will learn indications for consultation, both in inpatient and outpatient settings. They will understand the importance of discharge planning. They will gain an orientation to preventive medicine and be able to recognize common psychiatric conditions and substance abuse.

Procedures

First year residents will gain mastery in the following procedures: lumbar puncture, thoracentesis, paracentesis, arterial line placement, central line placement, and arthrocentesis. Procedure logs will be maintained and submitted at the end of each academic year. First year residents will demonstrate mastery of basic labs (EKGs, Gram's stains, reading of chest x-rays, urinalysis, etc.) by reason of a practical laboratory exam.

Research/In-Depth Reviews

First year residents will participate in on-going clinical research projects by reason of their involvement in the care of patients who are in these protocols.

Settings

PG-1s will rotate on general and subspecialty inpatient services and in the intensive care units. They will also have the opportunity to rotate in the emergency room, on outpatient block rotations in general medicine clinics and on consultation services. They will institute and maintain two longitudinal primary care practices (one at the VA and one at the University), and are expected to attend, at a minimum, 60% of the general academic conferences that the department puts on daily.

Residents will hone their data collection skills on all rotations, but focused histories and physicals will be perfected in ambulatory block rotations, emergency room settings, and longitudinal primary care practices. Pathophysiology of disease processes will be emphasized on inpatient rotations, especially critical care assignments. Regular ethics rounds, ethics consultations and specific departmental conferences on ethical issues, will be the means to discuss ethical issues with professional ethicists. Attending physicians will discuss all ethical issues that arise in patient care matters in an ad-hoc fashion. Most procedures will be done on inpatient services and intensive care unit rotations. The emergency room experience will provide the opportunity to suture and do numerous pelvic examinations. Routine screening pap smears in the residents' longitudinal clinics will provide another setting to perfect their skills.

6/2001