ACGME Core Competencies

ACGME Core Competencies:

Our Internal Medicine Residency Program will follow the guidelines and policies of the Accreditation for Graduate Medical Education (ACGME). The following is a list of the competencies:

Patient Care
Medical Knowledge
Practice Based Learning and Improvement (self-improvement)
Interpersonal and Communication Skills
Professionalism (basis for all physician skills)
Systems Based Practice (working with the health care system)

The house staff evaluation process is milestones driven and competency based. In our curriculum, educational program descriptions for the core rotations have been restructured around these core competencies.

Principle Educational Goals by Relevant Competency and Expected Progressive Responsibilities

Below, principle educational goals for the Inpatient and Outpatient rotations are indicated for each of the six ACGME competencies. The second column of the table indicates the most relevant principle teaching/learning activity for each goal, using the legend below. Most of the conferences are held at the inpatient site at Danbury Hospital. All in-house on-calls are applicable to inpatient responsibilities. Included in this section are Attending responsibilities and evaluation tools for the resident's maturation and growth.

Patient Care

Medical Knowledge

Patient Care

Residents are expected to:

Provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease, and care at the end of life.
Gather accurate, essential information from all sources, including medical interviews, physical examination, records, and diagnostic/therapeutic procedures.
Make informed recommendations about preventive, diagnostic, and therapeutic options, and interventions that are based on clinical judgment, scientific evidence, and patient preferences.
Develop, negotiate and implement patient management plans.
Perform competently the diagnostic and therapeutic procedures considered essential to the practice of general internal medicine.

Ensuring that patient care is compassionate, appropriate and effective for the treatment of health problems and the promotion of health is accomplished by:

Attending Rounds, Morning Report and Intern Report (as outlined above under Principle Teaching/Learning Activities): During the formally structured morning and intern reports, patient case presentations, all are supervised and critiqued by attending physicians so as to ensure that residents are able to:
- Conduct accurate, comprehensive medical interviews and physical exams
- Generate an acceptable differential diagnosis
- Make proper diagnostic and therapeutic decisions
- Execute appropriate investigational and/or interventional strategies, based on both available evidence and patient preference

Floor Attendings are assigned to resident teams on a block basis, and round with them each day. In addition to their teaching capacities, it is their responsibility to monitor and mentor residents individually to ensure the evolution and maintenance of professional behaviors and attitudes with regard to patients and their families.

Mini-Clinical Evaluation Exercise (Mini-CEX): An attending physician observes a resident conduct history, physical exam, therapy and counseling (all or a part) on a selected patient. The relevant section is then discussed and reviewed. The medical problem(s) is identified, and a rational, evidence-based management strategy is compiled. Evaluation is documented on paper or electronically and filed into resident's records.

Principle Educational Goals	Learning Activities
Interview patients more skillfully	DPC, AR
Examine patients more skillfully	DPC, AR
Define and prioritize patients' medical problems	DPC, AR, MR
Generate and prioritize differential diagnoses	DPC, AR, MR
Develop rational, evidence-based management strategies	DPC, AR, MR

Medical Knowledge

Residents are expected to:

Demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and demonstrate the application of that knowledge to patient care and education of others.
Apply an open-minded and analytical approach to acquiring new biomedical and clinical knowledge.
Develop applicable knowledge of the basic clinical and behavioral sciences that underlie the practice of internal medicine.
Apply this knowledge in developing critical thinking, clinical problem-solving and clinical decision-making skills in specific cases under their care.
Access and critically evaluate current medical information and scientific evidence and modify knowledge base accordingly.

Teaching Attending are selected for their demonstrated compassionate approach and clinical skills to demonstrate those behaviors in their rounds and other resident contacts. All residents take medical knowledge and In-service examinations each year; their progress is monitored and discussed over three years.

Principle Educational Goals	Learning Activities
Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of medical inpatients	DPC, AR, MR, NC, GR, M&M, CPC, CL
Access and critically evaluate current medical information and scientific evidence relevant to patient care	DPC, AR, JC, CPC, CL

Practice Based Learning and Improvement

Residents are required to be able to efficiently access scientific literature and demonstrate competency in the application of appropriate methodology and analytic tools, so as to improve their personal patient care practices while minimizing the possibility of making significant medical errors . This function is facilitated via CIFC Health and Danbury Hospital by the provision of the following modalities:

On-line access to all major and most minor on-line journals and publications.
On-line access to select medical texts.
24-hour access to the offerings of Danbury Hospital's Horblit Health Science Library.
Formal and ongoing training in the use of the Computerized Physician Order Entry System (CPOE).
24-hour pharmacist coverage hospital-wide.
Telemetry Web Viewer.
PACS system which provides on-line access of current and past radiographic imaging, inclusive of formal radiologist readings.
On-line access to current and past dictated reports, which include histories and physicals, consultant reports, etc.

These modalities are available at Danbury Hospital at every computer on every floor involved in patient care as well as in in-call rooms. Most of these are also available from the CIFC Health ambulatory clinic site. Residents receive ongoing feedback with regard to their performance from Attending, nursing, medical assistants, pharmacists, and the inhouse information technology group. Formal evaluations are performed by program directors every six months.

Residents also are required to participate in independent clinical research with faculty sharing common interests. Such research is generally presented at formal scholarly gatherings ranging in scale from Danbury Hospital's Annual Joseph L. Belsky, MD Research Day to the regional or National ACP meetings or any other peer reviewed venue.

Interpersonal and Communication Skills:

Residents are expected to:

Demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of healthcare teams.
Provide effective and professional consultation to other physicians and healthcare professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.
Use effective listening, verbal and nonverbal, questioning, and narrative skills to communicate with patients and families.
Interact with consultants in a respectful, timely and appropriate fashion.
Maintain comprehensive, timely and legible medical records.

History and physical, progress notes and consult notes are reviewed by their respective attending physicians, and regularly by program directors. Timely completion of medical records are tracked and feedback given to residents when needed.

Interaction with their patients and family members are observed by their respective attending physicians, senior residents and program directors to ensure residents' communication skills are adequate and acceptable.

Principle Educational Goals	Learning Activities
Communicate effectively with patients and families	DPC, AR
Communicate effectively with physician colleagues at all levels	DPC, AR, JC, MR
Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of hospitalized patients	DPC, CRM
Present patient information concisely and clearly, verbally and in writing	DPC, AR, MR
Teach colleagues effectively	DPC, AR, JC, MR, CPC, M&M

Professionalism:

Residents are expected to:

Demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward their patients, their profession and society.
Demonstrate respect, compassion, integrity, and altruism in their relationships with patients, families, and colleagues.
Demonstrate sensitivity and responsiveness to patients and colleagues, including gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors, and disabilities.
Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
Recognize, identify and modify deficiencies in peer performance when in a supervising position.

Residents should behave professionally towards patients, families, colleagues and all members of the Healthcare team. This is evaluated by:

Residents' evaluations of one another (PGY-1 of PGY2-3 and PGY2-3 of PGY-1) to help evaluate peer interactions.
Evaluations by nursing staff to help evaluate residents' relationships with the nursing staff.
Evaluation by patients to help evaluate the resident's interaction with their patients .
Mini-CEX, an attending observes a short interaction between the resident and a selected patient.
Residents also participate in the ACGME sponsored teleconference on professionalism, as well as the Annual Cultural Sensitivity Seminars.

Principle Educational Goals	Learning Activities
Behave professionally toward patients, families, colleagues, and all members of the health care team	DPC, AR, CRM, MR

Ambulatory Rotation

Residents’ ambulatory experiences come in several forms. It is through the composite of these experiences, where the residents attain and develop the knowledge and skills that are necessary for delivering outstanding ambulatory patient care. The bulk of these experiences occur at our site as continuity clinics, where residents develop long-standing relationships with a panel of their own patients. In addition, during several structured ambulatory rotations, which are called Medical Home Blocks, Residents acquire additional knowledge and skills in primary care and specialty outpatient medicine.

The Continuity Clinic at CIFC Health

Learning and caring for the “whole patient” can only occur when the patient feels comfortable enough to allow the physician to understand his/her life, not just as a patient, but as an individual. This is achieved, over time, at our Continuity Clinic, where Residents take on first-contact, and primary responsibility for a group of patients most of whom are referred or recruited into the Residents’ own practices. These patients are drawn from a variety of settings; some are discharged from the hospital by the same Resident, some are referred to the practice from other specialty clinics and Danbury Hospital, and many are self-referred from our surrounding communities for primary care. This diversity of patient origin allows our Residents to learn the ambulatory diagnostic and therapeutic approaches to patients with acute illnesses, and the longitudinal delivery of high quality care to patients with chronic medical conditions.

Faculty members supervise Residents at all times at CIFC Health. All Resident clinic offices are equipped with computers with access to electronic medical records, clinical management resources, UpToDate, and Medline.

Medical Home Blocks

During these blocks, Residents spend most of their clinical time in the ambulatory setting, and have minimal or no inpatient responsibilities. During these blocks, Residents will act as office-based physicians, and spend a large portion of their time seeing patients in the general medicine clinics. Aside from these practical experiences, several structured and comprehensive didactic series fill out the rest of the Medical Home Block. These include a basic primary care lecture series, several case-based teaching reports, and a weekly Internal Medicine conference. In addition, all Residents also attend teaching sessions on primary care psychiatry, addiction medicine, and quality improvement.

ACGME Curriculum and Teaching Health Center

Our Internal Medicine Residency Program will follow the guidelines and policies of the Accreditation for Graduate Medical Education (ACGME). The following is a list of the competencies:

Patient Care
Medical Knowledge
Practice Based Learning and Improvement (self-improvement)
Interpersonal and Communication Skills
Professionalism (basis for all physician skills)
Systems Based Practice (working with the health care system)

Principle Educational Goals by Relevant Competency and Expected Progressive Responsibilities

In the tables below, the principle educational goals for the Inpatient and Outpatient rotations are indicated for each of the six ACGME competencies. The second column of the table indicates the most relevant principle teaching/learning activity for each goal, using the legend below. Most of the conferences are held at the inpatient site at Danbury Hospital. All in-house on-calls are applicable to inpatient responsibilities. Included in this section are Attending responsibilities and evaluation tools for the resident’s maturation and growth.

Legend for Learning Activities

AR: Attending Rounds
DPC: Direct Patient Care
JC: Journal Club
GR: Grand Rounds
MR: Morning Report
NC: Noon Conference
M&M: Mortality and Morbidity
CL: Computer Literacy
CPC: Clinical Pathology Conference
CRM: Case Manager Interaction

(1) Patient Care

Residents are expected to:

Provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease, and care at the end of life.
Gather accurate, essential information from all sources, including medical interviews, physical examination, records, and diagnostic/therapeutic procedures.
Make informed recommendations about preventive, diagnostic, and therapeutic options, and interventions that are based on clinical judgment, scientific evidence, and patient preferences.
Develop, negotiate, and implement patient management plans.
Perform competently the diagnostic and therapeutic procedures considered essential to the practice of general internal medicine.

Ensuring that patient care is compassionate, appropriate and effective for the treatment of health problems and the promotion of health is accomplished by:

Attending Rounds, Morning Report and Intern Report (as outlined above under Principle Teaching /Learning Activities): During the formally structured morning and intern reports, patient case presentations, all are supervised and critiqued by attending physicians so as to ensure that residents are able to:
- Conduct accurate, comprehensive medical interviews and physical exams
- Generate an acceptable differential diagnosis
- Make proper diagnostic and therapeutic decisions
- Execute appropriate investigational and/or interventional strategies based on both available evidence and patient preference.

Mini-Clinical Evaluation Exercise (Mini-CEX): An attending physician observes a resident conduct history, physical exam, therapy and counseling (all or a part) on a selected patient. The relevant section is then discussed and reviewed. The medical problem(s) is identified, and a rational, evidence-based management strategy is compiled. Evaluation is documented on paper or electronically and filed into resident’s records.

Principle Educational Goals	Learning Activities
Interview patients more skillfully	DPC, AR
Examine patients more skillfully	DPC, AR
Define and prioritize patients’ medical problems	DPC, AR, MR
Generate and prioritize differential diagnoses	DPC, AR, MR
Develop rational, evidence-based management strategies	DPC, AR, MR

Patient Care Progressive Responsibilities

PGY-1

Be able to perform a thorough and accurate physical exam on patients with common medical problems.
Gather essential information from other sources such as medical records and radiology.
Integrate the past and current clinical information to arrive at a problem oriented, prioritized, differential diagnosis.
Be able to initiate a correct management plan for common medical problems
Understand the indications, contraindications, and risks of commonly ordered medications, medical tests, and procedures.
Perform the ABIM-required internal medicine procedures with supervision.
Be able to prioritize patients’ problems so that daily patient care duties can be completed in an accurate and timely manner.
Understand appropriate monitoring and follow-up of patients, which includes laboratory data, test results, and medication use.

PGY-2

All of the above and additionally:

Be able to obtain a precise, logical and efficient history.
Be able to elicit subtle findings on physical examination.
Be able to use diagnostic procedures and therapies appropriately.
Be able to interpret results of diagnostic tests and procedures properly.
Be able to analyze clinical data to make informed decisions about patient management.
Weigh alternatives for diagnosis and treatment giving consideration to patient preferences, risks, benefits, and cost.
Counsel and educate patients about pertinent health issues, tests, and treatments
Manage multiple medical problems at once.
Be able to choose an appropriate care location for inpatient conditions.
Be able to perform most ABIM-required internal medicine procedures.

PGY-3

All of the above and additionally:

Be competent in the care for patients with the majority of internal medicine problems.
Consistently and thoroughly educate patients and their families.
Demonstrate the ability to devote an appropriate amount of time to diagnostic reasoning and treatment as related to the complexity of the problem(s).
Reason and perform well in ambiguous situations.
Perform all ABIM-required internal medicine procedures.

(2) Medical Knowledge

Residents are expected to:

Demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and demonstrate the application of that knowledge to patient care and education of others.
Apply an open-minded and analytical approach to acquiring new biomedical and clinical knowledge.
Develop applicable knowledge of the basic clinical and behavioral sciences that underlie the practice of internal medicine.
Apply this knowledge in developing critical thinking, clinical problem-solving and clinical decision-making skills in specific cases under their care.
Access and critically evaluate current medical information and scientific evidence and modify knowledge base accordingly.

Principle Educational Goals	Learning Activities
Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of medical inpatients	DPC, AR, MR, NC, GR, M&M, CPC, CL
Access and critically evaluate current medical information and scientific evidence relevant to patient care	DPC, AR, JC, CPC, CL

PGY-1

Demonstrate satisfactory knowledge of common medical conditions, sufficient to manage urgent complaints with supervision.
Complete all assigned Johns Hopkins Ambulatory Curriculum modules.
Be able to use various educational resources to seek information about patients' diseases.
Demonstrate knowledge of common procedural indications, contraindications, risks, and benefits.
Be able to apply learned medical knowledge to diagnosis, treatment, and prevention of disease.
Attend conferences such as Intern Report to continuously learn and reinforce medical knowledge and skills.

PGY-2

All of the above and additionally:

Demonstrate advancement in content knowledge and analytical thinking in order to develop well-formulated differential diagnoses for patients with uncommon diseases as well as patients with multiple problems.
Demonstrate knowledge of epidemiology and social and behavioral science and be able to apply that knowledge to the care of the patient.
Understand the indications, contraindications and risks of commonly used medications and procedures.
Demonstrate leadership and teaching skills in managing daily rounds and outpatient sessions.
Attend and participate in conferences such as Morning Report to continuously learn and reinforce medical knowledge and skills.
Independently present up-to-date scientific evidence to support hypotheses.
Develop knowledge of statistical principles such as sensitivity, specificity, predictive values, and numbers needed to treat odds ratios.

PGY-3

All of the above and additionally:

Regularly display self-initiative to stay current with new medical knowledge.
Demonstrate continued advancement in medical knowledge as appropriate for ABIM certification.
Demonstrate an investigatory and analytic approach to clinical situations.

(3) Practice Based Learning and Improvement

Residents are required to be able to efficiently access scientific literature and demonstrate competency in the application of appropriate methodology and analytic tools so as to improve their personal patient care practices while minimizing the possibility of making significant medical errors. This function is facilitated via CIFC Health and Danbury Hospital by the provision of the following modalities:

On-line access to all major and most minor on-line journals and publications.
On-line access to select medical texts.
24-hour access to the offerings of the Danbury Hospital’s Horblit Health Science Library.
Formal and ongoing training in the use of the Computerized Physician Order Entry System (CPOE).
24-hour pharmacist coverage hospital-wide.
Telemetry Web Viewer.
PACS system which provides on-line access of current and past radiographic imaging inclusive of formal radiologist readings.
On-line access to current and past dictated reports, which include histories and physicals, consultant reports, etc.

These modalities are available at Danbury Hospital at every computer on every floor involved in patient care as well as in in-call rooms. Most of these are also available from the CIFC Health ambulatory clinic site. Residents receive ongoing feedback with regard to their performance from Attending, nursing, medical assistants, pharmacists, and the in-house information technology group. Formal evaluations are performed by program directors every six months.

Residents also are required to participate in independent clinical research with faculty sharing common interests. Such research is generally presented at formal scholarly gatherings ranging in scale from Danbury Hospital’s Annual Joseph L. Belsky, MD Research Day to the regional or National ACP meetings or any other peer reviewed venue.

Principle Educational Goals	Learning Activities
Identify and acknowledge gaps in personal knowledge and skills in the care of patients	DPC, AR, MR, NC
Develop and implement strategies for filling gaps in knowledge and skills	JC, CL

Practice-Based Learning and Improvement Progressive Responsibilities:

PGY-1

Be self-motivated.
Be able to formulate clinical questions in the day-to-day care of patients.
Be able to locate scientific literature to assist in medical decision-making.
Be able to identify one's limitations of knowledge and skills and seek help when needed.
Accept feedback and develop self-improvement plans when appropriate.
Start to develop skills in teaching with patients, staff, and colleagues.

PGY-2

All of the above and additionally:

Be able to formulate, search, and answer clinical questions using the scientific literature.
Use an evidence-based approach to providing patient care.
Demonstrate continual self-evaluation to correct deficiencies and develop new skills.
Demonstrate teaching initiative and skills with patients, students, and colleagues.

PGY-3

All of the above and additionally:

Be able to appraise and assimilate scientific literature into daily practice.
Appropriately integrate EBM with expert opinion and professional judgment.
Effectively and efficiently utilize consultation services to improve both patient care and self-knowledge.
Be able to analyze personal practice patterns systematically, and look to continuously improve.
Demonstrate use of teaching skills to create an effective learning environment for students, junior house staff, and patients.

(4) Interpersonal and Communication Skills:

Residents are expected to:

Demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of healthcare teams.
Provide effective and professional consultation to other physicians and healthcare professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.
Use effective listening, verbal and nonverbal, questioning and narrative skills to communicate with patients and families.
Interact with consultants in a respectful, timely and appropriate fashion.
Maintain comprehensive, timely and legible medical records.

History and physical, progress notes, consult notes are reviewed by their respective attending physicians, and regularly by program directors. Timely completeness of medical records are tracked and feedback given to residents when needed.

Interaction with their patients and family members are observed by their respective attending physicians, senior residents and program directors to ensure residents’ communication skills are adequate and acceptable.

Principle Educational Goals	Learning Activities
Communicate effectively with patients and families	DPC, AR
Communicate effectively with physician colleagues at all levels	DPC, AR, JC, MR
Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of hospitalized patients	DPC, CRM
Present patient information concisely and clearly, verbally and in writing	DPC, AR, MR
Teach colleagues effectively	DPC, AR, JC, MR, CPC, M&M

Residents also consistently interact with other healthcare professionals including nursing staff, nursing administrators and other staff who participate in the “360-degree” resident evaluations on a regular basis.

Interpersonal Communication Progressive Responsibilities:

PGY-1

Be able to perform accurate, thorough, yet concise, oral presentations regarding patient care.
Use effective listening, narrative, and non-verbal skills to elicit information from patients.
Be able to use medical terminology appropriately.
Prepare written notes (office visit notes, admission notes, transfer notes, progress notes, discharge summaries, etc.), which are legible and timely.
Establish rapport with patients from a variety of backgrounds.
Demonstrate proficiency in use of verbal and nonverbal skills in interactions with colleagues, nursing, and ancillary staff.
Be able to effectively communicate uncomplicated diagnostic and therapeutic plans to patients and their advocates.
Be able to work as team members with medical students, senior residents, and attending physicians as well as with other members of the healthcare team.
When working with medical students, be able to observe students, demonstrate skills and give constructive feedback.

PGY-2

All of the above and additionally:

Progressively assume a leadership role, facilitating interactions between team members, including establishing expectations and overseeing patient care.
Be able to engage patients in shared decision-making or ambiguous or controversial scenarios.
Effectively discuss informed consent, resuscitation status, and death and dying with patients and families.
Should be able to negotiate most "difficult" patient encounters, including the irate patient.
Provide effective education and counseling to patients and families regarding health and illness.
Demonstrate an effective working relationship with other members of the healthcare team, including nurses and ancillary staff.

PGY-3

All of the above and additionally:

Be able to successfully negotiate nearly all difficult patient encounters with minimal direction.
Be able to function as team leaders with decreasing reliance on attending physicians.
Be able to function as a consultant, including completion of appropriate documentation and verbal communication with the requesting physician, whether serving as a consultant for general internal medicine or when on an elective.
Be able to demonstrate the development of long term professional relationships with patients followed since early in the PGY-1 year.

(5) Professionalism

Residents are expected to:

Demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward their patients, their profession, and society.
Demonstrate respect, compassion, integrity, and altruism in their relationships with patients, families, and colleagues.
Demonstrate sensitivity and responsiveness to patients and colleagues, including gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors, and disabilities.
Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
Recognize, identify and modify deficiencies in peer performance when in a supervising position.

Residents should behave professionally towards patients, families, colleagues, and all members of the Healthcare team. This is evaluated by:

Residents evaluations of one another (PGY-1 of PGY2-3 and PGY 2-3 of PGY-1) to help evaluate peer interactions.
Evaluations by nursing staff to help evaluate residents’ relationships with the nursing staff.
Evaluation by patients to help evaluate the resident’s interaction with their patients.
Mini-CEX, an attending observes a short interaction between the resident and a selected patient.
Residents also participate in the ACGME sponsored teleconference on professionalism, as well as the Annual Cultural Sensitivity Seminars.

Principle Educational Goals	Learning Activities
Behave professionally toward patients, families, colleagues, and all members of the health care team	AR, DPC, CRM, MR

Professionalism Progressive Responsibilities

PGY-1

Demonstrate respect and compassion in interactions with patients and their families, colleagues, and other members of the health care team.
Demonstrate respect, compassion, integrity, and honesty.
Be responsible for the safety and well-being of patients, colleagues and staff.
Appropriately maintain patient confidentiality.
Respond in a timely manner to staff needs, including pages and abnormal lab tests.
Follow directions.
Complete tasks assigned.
Maintain a professional appearance.
Be punctual.
Show responsibility for meeting program requirements.

PGY-2

All of the above and additionally:

Display initiative and leadership in his/her daily role as a resident physician.
Demonstrate commitment to ethical principles, including, but not limited to, patient confidentiality, informed consent, and business practices.
Demonstrate sensitivity to patient culture, gender, age, preferences, and disabilities.
Demonstrate progress in meeting some or most program requirements including the completion of scholarly projects.
Display initiative in career planning after the completion of residency.
Exhibit concern for the educational development of fellow residents and students.
Provide leadership.
Be willing to help colleagues.

PGY-3

All of the above and additionally:

Be able to act appropriately in the role as a medical consultant.
Demonstrate progress in meeting all program requirements.
Function as team leaders with decreasing reliance on attending physicians.
Be a self-directed learner.
Function as a role model.

(6) Systems-Based Practice:

Residents are required to develop an understanding of the local and national healthcare systems within which they operate, as well as the legitimate time and monetary constraints inherent to such systems. Likewise, they are required to employ the tools and techniques with which they are provided during initial orientation to control costs and ensure equitable allocation of resources while attempting to negate detrimental impact on patients and/or patient families.

These systems based practices include, but are not limited to,:

During outpatient rotations, identification of patients in the Health Centre who need urgent attention, hospitalization or referral.
Understanding and implementing cost effective care.
Using local and regional resources to provide care to underprivileged and indigent patients.
Using Electronic Medical Records to optimize care.
During hospital rotations, early identification of patients with the potential for hospital discharge within 24–48 hours.
Discussion of pertinent discharge issues with attending physicians on or before the evening prior to the anticipated discharge date.
Conveying the discharge plan to patients as well as affiliated staff the evening prior to the anticipated discharge date.
Use of established system to identify and address system and patient requirements prior to discharge so as to minimize the possibility of treatment delay.
Preparation and provision of appropriate patient/facility discharge instructions and transfer of care documents as completely as possible prior to the anticipated discharge.
Use of clear, simplified "layman’s" terms when preparing instructions meant to be understood by patients.
Ensuring patient understanding of any pharmaceutical or therapeutic modifications instituted during the course of admission.
Comparison and assurance of congruency between admission and discharge medication lists so as to ensure that any substitutions made secondary to established formulary restrictions are not carried through to discharge.

In an effort to maximize resident physicians’ abilities to effectively employ systemic approaches to error reduction and to improving patient care, quality improvement projects are continually conducted at the institution level, which is incorporated into the framework of residency training. These include formalized training sessions that ensure mastery of literature search methods, computer-based presentations, and computerized physician order entry as well as structured monitoring of select patient groups within both the hospital and outpatient environments.

Principle Education Goals	Learning Activities
Understand and utilize the multidisciplinary resources necessary to care optimally for hospitalized patients	DPC, CL, CRM
Collaborate with other members of the healthcare team to assure comprehensive patient care	DPC, CRM
Use evidence-based, cost-conscious strategies in the care of hospitalized patients	DPC, AR, MR, JC, M&M, CPC, CL

Systems Based Practice Progressive Responsibilities:

PGY-1

Meet requirements of medical practice at Danbury Hospital including: timely dictations and notes, timely evaluations of Attending, peers, others.
Display sensitivity to costs and be able to incorporate fundamental cost-effective analysis into care approaches, minimizing unnecessary care.
Assist patients in dealing with system complexity.
Be able recognize system problems.

PGY-2

All of the above and additionally:

Work well with their core team that includes other physicians, nurses, therapists and other healthcare professionals to assess, coordinate and improve patient care.
Be able to guide patients and families through the complex healthcare environment.
Demonstrate effective and timely participation in the system approach to outpatient follow-up in order to improve the quality of patient care delivery in the outpatient setting.
Demonstrate a basic understanding of the methods of controlling healthcare costs and appropriate allocation of resources.

PGY-3

All of the above and additionally:

Demonstrate the ability to adapt to change.
Be able to effectively coordinate care with other healthcare providers as needed.
Demonstrate familiarity of utilization of resources that assist with patient care and disposition.
Develop an understanding of medical delivery systems, including alternative care resources, ambulatory care resources, rehabilitation resources and continuing care resources.
Be able to practice effective allocation of health care resources that does not compromise the quality of care.
Provide improvement opportunities for the healthcare system.

Please Note: Since Direct Collaborative Patient Care Activity (DPC), where residents work together with an attending physician caring for individual patients, is the most fundamental teaching and learning activity on all core rotations for virtually all of the competencies, it is not separately mentioned under each rotation for each objective.

Graduate Medical Education

ACGME Core Competencies