Ambulatory Medicine Internal Medicine Residency Program At .

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Ambulatory MedicineInternal Medicine Residency Program at University of Kansas Medical CenterAdapted from ABIM Developmental MilestonesPGY1 – standard textPGY2 – standard and italicized textPGY3, PGY4, PGY5 – standard, italicized and bold italicized textDirector: Jane Broxterman, M.D.Duration: Experience Specific Continuity Clinic – Longitudinal Experience Over 3 Years of Training – residentsare assigned continuity clinic during their continuity and consult clinic weeks(CCC 1 week). Practice location and attending staff are the same throughout aresident’s training Internal Medicine Subspecialty clinic experience – delivered during the continuityclinic and consult (CCC 1) weeks on a rotational basis. Residents are givenambulatory exposure to all of the IM subspecialty based clinics throughout 3 yearsof training Non-internal Medicine clinic experience – delivered during the continuity clinic andconsult (CCC 1) weeks on a rotational basis. Residents are given ambulatoryexposure to ophthalmology, sleep medicine, office orthopedics, allergy,dermatology, gynecology, otorhinolaryngology and rehabilitation medicineSupervision: Experience Specific - Attending Responsible for the Ambulatory ClinicFacility: University of Kansas Medical Center: Jane Broxterman, M.D. Kansas City Veterans Medical Center: Stephanie Thompson, M.D. Westwood Internal Medicine: Carnie Nulton, M.D. Required Didactics:1. Core and Case Conferences - Monday, Tuesday, Thursday, and Friday at12:00 PM Location Varies Daily2. Friday School – Friday 1:00 PM – 4:00 PM; residents on current CCC 1week attend specific Friday lectures on a rotational basis. BH1322 KUH3. Grand Rounds – Wednesday at 12:00 PM School of Nursing Auditorium4. Patient Safety Conference – Every Other Month - Sep, Nov, Jan, Mar, May at12:00 PM Clendening Auditorium5. Clinicopathologic Conference – Quarterly - Sep, Dec, Mar, Jun at 12:00 PM Clendening AuditoriumAmbulatory Experiences:1. Continuity Care of a Panel of Patients – This consists of half-day continuity clinic sessionsduring the resident’s assigned CCC 1 week. Residents will generally have 4 continuity clinicpatient care sessions during their assigned CCC week. Each clinic template is delineated by PGYlevel as well as competency within the clinic setting. Generally speaking; PGY 1 residents willsee 4 patients in a session; PGY 2 residents will see 5-6 patients, and PGY 3 residents will see6-7 patients in a clinic. Additionally, each resident will be assigned one half-day session a weekfor panel management as well a quality improvement time. Residents are assigned a practicelocation at the time at matriculation into the program. Current practice sites are: University ofKansas Internal Medicine, Kansas City VA Medical Center Primary Care, Westwood InternalMedicine. In these settings, residents provide comprehensive care for a panel of patients under1REV 08/2020

the supervision of a designated faculty member, who will remain the assigned clinic preceptorthroughout the resident’s training.During each CCC 1 week, residents will be given a minimum of 1 half-day session for self-studytime. During this time, each resident is to complete specific PEAC modules regarding ambulatoryeducation and our core curriculum. Modules are found online through the Physician EducationAssessment Center (PEAC). Modules are often discussed with the attending preceptor tofacilitate small group discussion as well as teaching pearls. Additionally, residents are tocomplete ongoing ABIM self-study questions (MKSAP) and submit them weekly to programleadership.2.Subspecialty Ambulatory ClinicsEach resident will rotate through both IM and non-IM sub-specialty clinics include during the CCC 1 week. On average, each resident will have 3 half-days assigned to specific clinics. Specialtyclinics vary depending on the resident’s overall curricular footprint, as we strive for every residentto have equal exposure and experience in all of the IM subspecialties. Additionally, residents willalso be scheduled to non-IM subspecialty clinics as listed above.3.Community Ambulatory Elective Rotation – Upper level residents are provided electiveopportunities to work with a private practice General Internist in the community setting in a blocksetting (3-week sequence). In these settings, residents provide general primary or acute careunder the direct supervision of an attending physician in the private practice setting.Educational Purpose:The ambulatory rotations provide invaluable experience in the assessment and care of internalmedicine patients in the outpatient setting. A complement of clinical and didactic elements aredesigned to prepare residents for continuity care, acute care, triage of medical issues and followup needs all unique to the outpatient setting.Educational Methods:Direct observation of patient care and bedside teaching occur in the setting of outpatient clinicswith the attending. Rotation schedules are structured to include a varying schedule of half-dayclinical experiences along with structured scholarly activities. The supervising attending reviewsand critiques the resident’s interpretation of diagnostic studies and formulation of assessmentsand plans. Residents attend didactic conferences as indicated above. Additionally, residents meetprior to their continuity clinic with a faculty member to discuss the learning module topicsassigned for that session. Recommended educational resources for this rotation include thefollowing:1. Up To Date at www.utdol.com – Available on all hospital computers www.utdol.com2. PEAC learning modules (Physician Education Assessment Center)3. Access Medicine. Available through the library including internal medicine text books as wellas textbooks from other specialties and subspecialties.4. Harrison’s Principles of Internal Medicine, Current Edition, by Anthony S Fauci, EugeneBraunwald, Dennis L. Kasper, and Stephen L. Hauser5. US Preventative Services Task Force – Clinical Practice REV 08/2020

AMBULATORY MEDICINE KUOVERALL GOALS and OBJECTIVES21OVERALL COMPETENCY PROGRESSION BY CORE COMPETENCY AND PGY LEVEL(Adapted from ABIM Developmental Milestones)CORE COMPETENCY: PATIENT CAREPGY LEVELGOAL History and Data GatheringOBJECTIVESa. Acquire accurate and relevant history from the patient in an efficiently customized,prioritized, and hypothesis driven fashionb. Seek and obtain appropriate, verified, and prioritized data from secondary sources(e.g. family, records, pharmacy)c. Obtain relevant historical subtleties that inform and prioritize both differentialdiagnoses and diagnostic plans, including sensitive, complicated, and detailedinformation that may not often be volunteered by the patient3d. Role model gathering subtle and reliable information from the patient for4junior members of the healthcare team when applicable521PGY LEVEL34521PGY LEVEL34521PGY LEVEL1PGY LEVELGOAL Performing a Physical ExaminationOBJECTIVESa. Perform an accurate physical examination that is appropriately targeted to thepatient's complaints and medical conditions. Identify pertinent abnormalities usingcommon maneuversb. Accurately track important changes in the physical examination over time in theoutpatient settingc. Demonstrate and teach how to elicit important physical findings for junior members ofthe healthcare teamd. Routinely identify subtle or unusual physical findings that may influenceclinical decision making, using advanced maneuvers where applicableGOAL Clinical ReasoningOBJECTIVESa. Synthesize all available data, including interview, physical examination, andpreliminary laboratory data, to define each patient’s central clinical problemb. Develop prioritized differential diagnoses, evidence-based diagnostic and therapeuticplan for common ambulatory conditionsc. Modify differential diagnosis and care plan based upon clinical course and data asappropriateb. Recognize disease presentations that deviate from common patterns and thatrequire complex decision makingGOAL Invasive Procedures:OBJECTIVESa. Awareness of indications, contraindications, risks and benefits of common ICUinvasive proceduresb. Appropriately perform invasive procedures and provide post-procedure managementfor common procedures when applicableGOAL Diagnostic TestsOBJECTIVESa. Make appropriate clinical decisions based upon the results of common diagnostictesting, including but not limited to routine blood chemistries, hematologic studies,coagulation tests, arterial blood gases, ECG, chest radiographs, pulmonary functiontests, urinalysis and other body fluids3REV 08/2020

21PGY LEVEL3452PGY LEVEL345b. Make appropriate clinical decision based upon the results of more advanceddiagnostic testsGOAL Patient ManagementOBJECTIVESa. Recognize situations with a need for urgent or emergent medical care including lifethreatening conditionsb. Recognize when to seek additional guidancec. Provide appropriate preventive care and teach patient regarding self-cared. With supervision, manage patients with common clinical disorders seen in thepractice of ambulatory internal medicinee. With minimal supervision, manage patients with common and complex clinicaldisorders seen in the practice of ambulatory internal medicinef. Initiate management and stabilize patients with emergent medical conditionsg. Manage patients with conditions that require intensive careh. Independently manage patients with a broad spectrum of clinical disordersseen in the practice of internal medicinei. Manage complex or rare medical conditionsj. Customize care in the context of the patient’s preferences and overall healthGOAL Consultative CareOBJECTIVESa. Provide specific, responsive consultation to other services when applicableb. Provide consultation for patients with more complex clinical problemsrequiring detailed risk assessment when applicableEvaluation MethodsFaculty evaluation, EPA, Direct Observation1PGY LEVELCORE COMPETENCY: MEDICAL KNOWLEDGEGOAL Core Content KnowledgeOBJECTIVESa. Understand the relevant pathophysiology and basic science for common medicalconditions in this ambulatory settingb. Demonstrate sufficient knowledge to diagnose and treat common conditions in theambulatory setting2c.3451PGY LEVELDemonstrate sufficient knowledge to evaluate common conditions in this ambulatorysettingd. Demonstrate sufficient knowledge to diagnose and treat undifferentiated andemergent conditionse. Demonstrate sufficient knowledge to provide preventive caref. Demonstrate sufficient knowledge to identify and treat medical conditions thatrequire intensive carea. Demonstrate sufficient knowledge to evaluate complex or rare medicalconditions and multiple coexistent conditionsb. Understand the relevant pathophysiology and basic science for uncommon orcomplex medical conditionsc. Demonstrate sufficient knowledge of socio-behavioral sciences including butnot limited to health care economics, medical ethics, and medical educationGOAL Diagnostic TestsOBJECTIVESa. Understand indications for and basic interpretation of common diagnostic testing,including but not limited to routine blood chemistries, hematologic studies, coagulation4REV 08/2020

tests, arterial blood gases, ECG, chest radiographs, pulmonary function tests,urinalysis and other body fluids2b. Understand indications for and has basic skills in interpreting more advanceddiagnostic testsc. Understand prior probability and test performance characteristicsEvaluation MethodsFaculty evaluation, ITE, Case Conference evaluation, Direct Observation21CORE COMPETENCY: PRACTICEBASED LEARNING AND IMPROVEMENTPGY LEVEL GOAL Ask Answerable Questions for Emerging Information NeedsOBJECTIVESa. Identify learning needs (clinical questions) as they emerge in patient care activities21PGY LEVEL3451PGY LEVEL3451PGY LEVEL34521PGY LEVELPGY LEVELb. Classify and precisely articulate clinical questionsc. Develop a system to track, pursue, and reflect on clinical questionsGOAL Acquires the Best AdviceOBJECTIVESa. Access medical information resources to answer clinical questions and libraryresources to support decision makingb. Effectively and efficiently search NLM database for original clinical research articlesc. Effectively and efficiently search evidence-based summary medical informationresourcesd. Appraise the quality of medical information resources and select among thembased on the characteristics of the clinical questionGOAL Appraises the Evidence for Validity and UsefulnessOBJECTIVESa. With assistance, appraise study design, conduct and statistical analysis in clinicalresearch papersb. With assistance, appraise clinical guideline recommendations for biasc. With assistance, appraise study design, conduct, and statistical analysis inclinical research papersd. Independently, appraise clinical guideline recommendations for bias and costbenefit considerationsGOAL Applies the evidence to decision-making for individual patientsOBJECTIVESa. Determine if clinical evidence can be generalized to an individual patientb. Customize clinical evidence for an individual patientc. Communicate risks and benefits of alternatives to patientsd. Integrate clinical evidence, clinical context, and patient preferences intodecision-makingGOAL Improves Via FeedbackOBJECTIVESa. Respond welcomingly and productively to feedback from all members of the healthcare team including faculty, peer residents, students, nurses, allied health workers,patients and their advocatesb. Actively seek feedback from all members of the health care teamc. Calibrate self-assessment with feedback and other external datad. Reflect on feedback in developing plans for improvementGOAL Improves via self-assessment5REV 08/2020

23452P1PGY LEVEL345OBJECTIVESa. Maintain awareness of the situation in the moment and respond to meet situationalneedsb. Reflect (in action) when surprised, applies new insights to future clinicalscenarios, and reflects (on action) back on the processGOAL Participate in education of all members of the health care teamOBJECTIVESa. Actively participate in teaching conferencesb. Integrate teaching, feedback, and evaluation with supervision of interns’ and students’patient carec. Take a leadership role in the education of all members of the health care team.Evaluation MethodsFaculty Evaluation, Journal Club evaluation, Patient Safety Conference evaluation, Case Conferenceevaluation21PGY LEVEL3451PGY LEVEL34521PGY LEVELPGY LEVELCORE COMPETENCY: INTERPERSONAL & COMMUNICATION SKILLSGOAL Communicate effectivelyOBJECTIVESa. Provide timely and comprehensive verbal and written communication topatients/advocatesb. Effectively use verbal and non-verbal skills to create rapport with patients/familiesc. Use communication skills to build a therapeutic relationshipd. Engage patients/advocates in shared decision-making for uncomplicated diagnosticand therapeutic scenariose. Utilize patient-centered education strategiesf. Engage patients/advocates in shared decision-making for difficult, ambiguous orcontroversial scenariosg. Appropriately counsel patients about the risks and benefits of tests andprocedures highlighting cost awareness and resource allocation whenappropriateh. Role model effective communication skills in challenging situations whenappropriateGOAL Intercultural sensitivityOBJECTIVESa. Effectively use an interpreter to engage patients in the clinical setting including patienteducation when appropriateb. Demonstrate sensitivity to differences in patients including but not limited to race,culture, gender, sexual orientation, socioeconomic status, literacy, and religious beliefsc. Actively seek to understand patient differences and views and reflects this inrespectful communication and shared decision-making with the patient and thehealthcare teamGOAL Transitions of CareOBJECTIVESa. Effectively communicate with other caregivers in order to maintain appropriatecontinuity during transitions of careb. Role model and teach effective communication with next caregivers during transitionsof careGOAL Interprofessional teamOBJECTIVES6REV 08/2020

1a. Deliver appropriate, succinct, hypothesis-driven oral presentationsb. Effectively communicate plan of care to all members of the health care teamc. Engage in collaborative communication with all members of the health care teamPGY LEVELGOAL ConsultationOBJECTIVESa. Request consultative services in an effective mannerb. Clearly communicate the role of consultant to the patient, in support of the primary carerelationshipc. Communicate consultative recommendations to the referring team in an effectivemanner134534521PGY LEVELGOAL Health RecordsOBJECTIVESa. Provide legible, accurate, complete, and timely written communication that is congruentwith medical standardsb. Ensure succinct, relevant, and patient-specific written communicationEvaluation MethodsFaculty Evaluation, 360 Evaluations, Journal Club Evaluation, Patient Safety Conference Evaluation,Case Conference evaluation1PGY LEVEL34521PGY LEVEL21PGY LEVEL1PGY LEVEL1PGY LEVELCORE COMPETENCY: PROFESSIONALISMGOAL Adhere to basic ethical principlesOBJECTIVESa. Document and report clinical information truthfullyb. Follow formal policiesc. Accept personal errors and honestly acknowledge themd. Uphold ethical expectations of research and scholarly activityGOAL Demonstrate compassion and respect to patientsOBJECTIVESa. Demonstrate empathy and compassion to all patientsb. Demonstrate a commitment to relieve pain and sufferingc. Provide support (physical, psychological, social and spiritual) for dying patients andtheir familiesd. Provide leadership for a team that respects patient dignity and autonomyGOAL Provide timely, constructive feedback to colleaguesOBJECTIVESa. Communicate constructive feedback to other members of the health care teamb. Recognize, respond to and report impairment in colleagues or substandard care viapeer review processGOAL Maintain AccessibilityOBJECTIVESa. Responsibilities including but not limited to calls and pagesb. Carry out timely interactions with colleagues, patients and their designated caregiversGOAL Recognize conflicts of interestOBJECTIVESa. Recognize and manage obvious conflicts of interest, such as caring for familymembers and professional associates as patients7REV 08/2020

21PGY LEVEL3451PGY LEVEL3452PGY LEVEL1PGY LEVEL3451PGY LEVELb. Maintain ethical relationships with industryc. Recognize and manage subtler conflicts of interestGOAL Demonstrate personal accountabilityOBJECTIVESa. Dress and behave appropriately. Scrubs are only to be worn on call and underneatha white lab coatb. Maintain appropriate professional relationships with patients, families and staffc. Ensure prompt completion of clinical, administrative, and curricular tasksd. Recognize and address personal, psychological, and physical limitations that mayaffect professional performancee. Recognize the scope of his/her abilities and ask for supervision and assistanceappropriatelyf. Serve as a professional role model for more junior colleagues (e.g., medicalstudents, interns)g. Recognize the need to assist colleagues in the provision of dutiesGOAL Practice individual patient advocacyOBJECTIVESa. Recognize when it is necessary to advocate for individual patient needsb. Effectively advocate for individual patient needsGOAL Comply with public health policiesOBJECTIVESa. Recognize and take responsibility for situations where public health supersedesindividual health (e.g. reportable infectious diseases)GOAL Respect the dignity, culture, beliefs, values and opinions or the patientOBJECTIVESa. Treat patients with dignity, civility and respect, regardless of race, culture, gender,ethnicity, age or socioeconomic statusb. Recognize and manage conflict when patient values differ from their ownGOAL ConfidentialityOBJECTIVESa. Maintain patient confidentiality2b. Educate and hold others accountable for patient confidentiality1PGY LEVEL345GOAL Recognize and address disparities in health c

2 REV 08/2020 the supervision of a designated faculty member, who will remain the assigned clinic preceptor throughout the resident’s training. During each CCC 1 week, residents will be given a minimum of 1 half-day session for self-study time. During this time, each resident

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