The Residents Handbook is available in the Intranet. It delineates responsibilities by level and by service. It should be read frequently and at least once at the beginning of each rotation. Guidelines are regularly updated.
Among the many responsibilities of a resident are:
-Provide high quality patient care
-Use evidence based medicine
-Accomplish procedures skills
-Carry out calls and Night Float
-Record of duty hours
-Full attendance to weekly continuity clinic
-Satisfactory performance in the six ACGME core competencies
-Participate in research
-Attend all teaching activities
-Teach junior members of the health team
-Proper clinical documentation
-Medical charts dictation within 1 week of discharge
-High quality endorsements
-Taking quizzes and exams and many others
These responsibilities are all important and are regularly assessed during residency.
New Innovations is used to register duty hours, vacation, patient logs, case logs, and evaluations. It is THE TOOL for the 21st century resident. Use of New Innovations is mandatory. Each resident is assigned a password to log in. Activity log may be done weekly or monthly. Compliance with this responsibility is monitored and reported. For any issues with New Innovations (NI) contact Jennifer Dominguez.
One of the most critical times in patient care is the endorsement of patients to incoming teams. Residents need to learn how to ensure patient safety at these critical times. Endorsements are also referred to as sign-outs or handoffs. With patient safety in mind, the leaving intern and resident have the responsibility to manage his or her critical patients and to emphasize the patient status during endorsement for a heightened follow-up care.
The endorsement sheet can be found in the intranet, under House Officer Suite. Endorsements should be complete and updated daily. It should always indicate current date, patient’s management plan, current labs, pending consults or labs, all critical or anticipated events for each patient and measures to be followed during the period.
All endorsements happen face-to-face with detailed oral communication between the outgoing team (intern and resident) and the incoming team (intern and resident). Complete endorsements in written and oral format improve patients’ outcomes and expedite patient care; it allows the whole team to be aware of the patients’ plan and makes residents knowledgeable of the patients’ condition. It also improves physician-patient-nurse-family relationship.
Chart dictation is done through the hospital telephone system. Each resident receives a dictation code, and instructions to the system. For issues regarding dictation contact Keisha Daniels- Murrell. Dictations are the responsibility of PGY2/3 on all general service patients they cared for. Dictation should be completed within a week of patients discharged and is encouraged to be done the day of discharge. A dictation guide is available in the intranet. Residents are not allowed to accumulate dictation charts for over 2 weeks, after which sanction s may be applied. Undictated charts are tracked by the Hospital Administration and affects faculty privileges, billing and patient follow-up. On the other hand, inability to comply with dictations responsibilities affects resident professionalism and will be reported on the resident’s file.
Residents are expected to comply with a certain number of procedures to be allowed promotion to the next level. Residents should keep a procedure log (see form available in the House officers Suite in the Intranet). In order for better tracking of resident proficiencies, all procedures should be logged in New Innovations. Procedure log should be regularly updated with Sarina Libonati. Procedure logs are part of the resident’s file.
During Internal Medicine Orientation Day, residents will be acquainted on and receive hands- on training on different procedures, techniques and equipment the hospital uses.
After Morning Report, residents present topics assigned by the Chiefs, attendings, or mentors. These presentations are usually in PPT format, but any other style is welcomed. Presentations are a way to train the residents to publicly present a case, a review or a journal club to their peers.
Comprehensive reviews on a given topic are discouraged as this applies to lectures. Good presentations are specific (not general) and to the point! Characteristics of a good presentation are:
- Based on a current clinical case the resident handled,
- Answer one clinical question,
- Include review of recent publications on the specific question,
- Elucidate the audience in any aspect of patient management,
- Have a teaching point.
A certain number of presentations/year is necessary for promotion (see Resident Handbook). Residents are evaluated on their presentations. Help is available to improve preparation and presentation skills. Both presentation and evaluation, or the lack thereof, are placed in the residents personal folder. To help prepare your presentation check CREATING AN EFFECTIVE PPT PRESENTATION.
Participation and Seeking Supervision
Residents are expected to get involved in the life of the program and of the hospital. They should get engaged according to preference in the different committees, both established and ad hoc. All residents MUST become involved in safety activities and present a project annually. All residents MUST have at least a research project completed by the end of residency.
Residents are required to seek supervision at all times, especially admissions, discharges, all transitions of care points and all critical moments including patient demise. Residents are expected to seek supervision from a senior or attending during procedures until they become certified to do so.
The purpose of the IM residency is to train young physicians to practice of medicine as sole professionals. For this reason each resident’s performance is monitored all the time to track his/her development from the early learning stages – beginner PGY1 – through to a stage that they can practice medicine in an unsupervised fashion – exiting PGY3.
With the many updates and changes In ACGME requirements regarding medical education including the Next Accreditation System (NAS), the Internal Medicine Milestones Project provides a framework to assess the progress of each resident physician towards competency in their specialty.
Below is a list of the milestones, adapted from the Internal Medicine Milestones Project , each resident be aware of and thrive to achieve through their passage at RUMC Internal medicine Residency Program. Please review this list regularly!
|1. Gathers and synthesizes essential and accurate information to define each patient’s clinical problems.2. Develops and achieves comprehensive management plan for each patient.3. Manages patients with progressive responsibility and independence.4. Skill in performing procedures.5. Requests and provides consultative care.6. Clinical knowledge.7. Knowledge of diagnostic testing and procedures.8. Works effectively within an interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and other support personnel).9. Recognizes system error and advocates for system improvement.10. Identifies forces that impact the cost of health care, and advocates for, and practices cost-effective care.11. Transitions patients effectively within and across health delivery systems.12. Monitors practice with a goal for improvement.13. Learns and improves via performance audit.14. Learns and improves via feedback.15. Learns and improves at the point of care.16. Has professional and respectful interactions with patients, caregivers and members of the interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel).17. Accepts responsibility and follows through on tasks.18. Responds to each patient’s unique characteristics and needs.19. Exhibits integrity and ethical behavior in professional conduct.20. Communicates effectively with patients and caregivers.21. Communicates effectively in interprofessional teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel).22. Appropriate utilization and completion of health records.|
Learning and Studying
Residents have a variety of resources at hand. They are required to read and study with every patient they care for. They are required to attend scholarly activities every morning (attendance is mandatory and monitored). Residents are encouraged to do self-learning and plan self- study activities that include using the ACP weekly curriculum, the John Hopkins modules, MKSAP and others.
With medical sciences and research advancing so rapidly, physicians MUST keep abreast with the latest developments in the field. Medical residents are required to have membership with ACP which gives them access to Annals of Internal Medicine and other journals free. Residents are strongly encouraged to get subscriptions to NEJM.
Currently residents have access to the RUMC Medical Library and to the NYMC and Mount Sinai libraries.
Recommended pocket companions for the IM resident. Residents receive a book allowance and we encourage using it on the below. These will be best dollars ever spent in residency.
Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine / Edition 4, only in paper version available in most libraries.
The Washington Manual of Medical Therapeutics, 4th Edition, in both paper and app versions.
Sanford Guide to Antimicrobial Therapy, 39 Edition, both in paper and web versions.
The ideals of altruism, accountability, excellence, duty, honor and integrity, and respect for others should be highly sought. All residents should be aware of the common lapses in professionalism and correct themselves. Otherwise a remediation and or probation plan is necessary to correct unprofessional behavior. Lapses are filed in the residents files.
The Ambulatory Medical clinic runs at 800 Castleton Avenue location, 2 blocks away from the main campus. Ambulatory clinic is schedule every 5 weeks to give the residents a full experience of the clinic without interruptions for inpatient care.
Residents are responsible for showing up on time, see all patients, determine the management plans and discuss them with their attending. Other activities include several subspecialty clinics and research activities and attendance to the weekly clinical review conducted by the medical director.
Subspecialty clinics also run on a schedule. Please show up on time and learn about your patient list ahead of time.