Department of medicine

UIM

Educational Purpose:

This rotation is intended to give medical residents the experience of working with general medicine patients in an ambulatory care setting.  It is designed to develop the clinical skills required by a general internist when evaluating and managing undifferentiated problems in the office setting.  The rotation provides the residents with expert mentorship, direct supervision, and the resources to enrich the direct clinical experiences.

Goals and Objectives:

PGY-1

1.  To enhance the residents’ history taking and physical diagnosis skills.

2.  To develop differential diagnoses and formulate a treatment plan in an outpatient setting.

3.  To manage the outpatient illnesses which are commonly cared for by the general internist.

4.  To develop expertise in caring for outpatients with hypertension, diabetes, hyperlipidemia, and obesity.

5.  To understand the indications/need for appropriate outpatient subspecialty consultation.

6.  To demonstrate interpersonal skills and to communicate effectively with patients and families.

7.  To enhance the resident’s ability to care for the older adult population.

8.  To effectively work with an interdisciplinary team in the outpatient setting.

9.  To recognize the unique challenges associated with caring for a medically underserved population.

PGY 2 and 3

1.  To enhance the residents’ history taking and physical diagnosis skills.

2.  To develop differential diagnoses and formulate a treatment plan in an outpatient setting.

3.  To manage the outpatient illnesses which are commonly cared for by the general internist.

4.  To develop expertise in caring for outpatients with hypertension, diabetes, hyperlipidemia, and obesity.

5.  To understand the indications/need for appropriate outpatient subspecialty consultation.

6.  To demonstrate interpersonal skills and to communicate effectively with patients and families.

7.  To enhance the resident’s ability to care for the older adult population.

8.  To effectively work with an interdisciplinary team in the outpatient setting.

9.  To recognize the unique challenges associated with caring for a medically underserved population

10. To supervise medical interns as well as medial students on the ambulatory rotation.

Teaching Methods:

The majority of teaching on the UIM rotation is case-based, one-on-one teaching at the time of presentation to the clinic.  This teaching can include demonstration of history taking or examination skills, modeling communication or Socratic exploration of medical knowledge.  Residents and students present patients for in-depth discussion of differential diagnosis and therapy.  Residents are expected to attend Noon Conferences during this rotation.

Mix of Diseases and Pathological Material:

Leading diagnoses include diabetes, hypertension, hyperlipidemia, coronary artery disease, CVAs, CHF, COPD, asthma, GERD, chronic renal insufficiency, dementia, and arthritis. 

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.  The majority of the patients are older adults, however significant numbers of adolescent and younger adults are also represented.

Types of Clinical Encounters:

Each resident will see all patients requesting care for acute or chronic problems, if their primary provider is unavailable.  Cases will include consultations from subspecialty clinics, community physicians, and hospital discharges.  Residents have first contact with all patients.

Procedures and Services:

Residents often have the opportunity to perform ambulatory procedures such as arthrocentesis and joint injections.  All procedures are appropriately supervised by the attending physician.  Interns and residents are expected to interpret all EKGs and chest x-rays performed on their patients.

Supervision:

There are usually multiple upper level residents, as well as interns assigned to the UIM ambulatory rotation each month.  These residents independently evaluate patients as noted above.  All patients are then presented to the attending physician.  The attending physician directly supervises patient care and all procedures.  3rd year, and fourth year medical students are  frequently  assigned to UIM  each month and the resident actively participates in educating and supervising the student.  The resident interacts with the entire interdisciplinary team including the clinical pharmacists, the social worker, nurse case managers, diabetic educators, and dieticians.

Educational Resources to be Used and Reading Lists:

UIM has a wide selection of texts including primary care and comprehensive Internal Medicine texts.  Computer-based search engines are available in the clinic and residents often search the literature on the UIM rotation.

Morning report in which a clinical case is utilized to demonstrate important ambulatory relevant topics occurs three times per week.  Didactic lectures including bedside teaching is provided by the attending physicians.  The mini-CEX is utilized to directly observe the residents in history taking skills, physical examination, and clinical discussions for patients. 

Method of Evaluation of Resident Competence:

Residents are evaluated using the global evaluation form.  The nursing staff evaluates the residents.  Patient Care is assessed based on direct observation and complete review of all records.  Medical Knowledge is assessed through direct questioning and observation.  Interpersonal Skill and Communication is assessed by observation of interactions with patients and families.  The attending physician evaluates Professionalism through direct interaction and observation of the resident.  The nurses also evaluate resident professionalism. Systems-Based Practice and Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation.  Residents receive formative evaluation throughout the month.

The residents evaluate the rotation and the attending physicians through the E*Value system.  The General Medicine Division reviews the rotation evaluations and each attending anonymously receives his or her evaluations.

 
 
 

© Medical University of South Carolina | 171 Ashley Avenue, Charleston, SC 29425