American University Of Beirut Medical Center Faculty Of Medicine .

Internal Medicine Residency Training Program CurriculumThe Department of Medicine hosts Grand Rounds every Tuesday from noon to1:00pm. Local, regional or international speakers are invited to present topics ofinternal medicine. All residents on inpatient floor teams, as well as those onambulatory block rotations and electives are expected to attend. Senior residents alsopresent grand round starting after the in-service exam.Morbidity and Mortality: held three times per year, prepared by chief residents andDepartment Chair. This is a joint effort between the department of Internal medicineand other departments (Surgery, Radiology, Emergency department.). A case, withan adverse outcome, is thoroughly reviewed and discussed. Faculty members fromvarious disciplines are invited to attend, especially if they were involved in the care ofthe patient. The discussion focuses on system-related deficiencies and suggestions forimprovement.Introductory Lecture Series start at the beginning of the academic year and focuseson: Punctuality, resident responsibilities on the floor as a leader and a teacher,importance of Documentation, teaching activities to attend throughout the year etcBoard Review sessions, started at the beginning of the year as preparation for the inservice exam, held on Mondays, Tuesdays and Thursdays at noon alternating withcore curriculum lectures. They are designed for internists as a comprehensive reviewof internal medicine as preparation for the in-training exam.2. Attending Rounds (AR)Attending rounds are scheduled daily on each inpatient regular floor. It is a one totwo-hour round led by the attending physician with the medical team (interns,resident/ Team leader, and students). Clinical cases are presented to and discussedwith the attending physician who can comment on the management plan. Bedsideteaching is regularly included in the rounds at least twice per week.In addition, on adaily basis one to two charts should be reviewed by the attending with peer to peer,resident, interns and students’ evaluations.3. Directly Supervised Procedures - (DSP)Residents learn to perform procedures under the supervision of an attending orfellow. For example, in the Medical Intensive Care Unit the Pulmonary /Critical Careattending or fellow observe and/or assist the placement of central venous lines andarterial lines. Specific procedures like Pleural tap, abdominal tap, Lumbar puncture,ABG’s withdrawal, IV-line insertion used in patient care varies by rotation(pulmonary elective, neurology elective, Respiratory care unit, regular inpatientfloor ). By the end of each year, residents are expected to be certified in a specificset of procedures.4. Morning report (MR)Four morning reports are schedules each week (7h30AM- 8h30AM). All residentsP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 8

Internal Medicine Residency Training Program Curriculumwho are on inpatient teams are required to attend the AM report. Each resident isrequired to prepare at least two reports per month. They are held in the presence ofthe Medical Chief Resident and one faculty member. This is an interactive, evidencebased discussion to assess diagnosis and approach to initial management of acutepatient issues on the inpatient wards. Once every two weeks, the float resident andinterns present overnight admitted cases focusing on decision making andmanagement.5. Medical Jeopardy (MJ)Medical Jeopardy is held once a month (last Friday of the rotation) at 7:30 AMinstead of the morning report. Residents form teams and compete against each otherfor various prizes using a medical game format (run by the chief resident).6. Journal Club (JC)Journal Club activity starts in September and is held every other Friday at 1pm.Junior and senior residents, critically appraise a selected article using a specificformat, supervised by a faculty member and the Medical Chief Resident.7. Ambulatory report (AmR):PGY1 residents are asked to choose cases encountered in the outpatient setting andpresent the approach to such cases using the available evidence. These interactivesessions are mentored by the Medical Chief Resident.8. Radiology Sessions (XR):Prepared by the medical chief residents and a senior resident from the radiologydepartment. Residents, interns and students on the floors attend these sessions everyother Wednesday at 1pm. They consist of a general overview, followed by aradiology Quiz, then discussion of relevant radiology cases encountered on the floors,in addition to other interesting cases prepared by the radiology resident. The sessionsfocus on interpretation of radiological findings with their clinical correlation.9. EKG Sessions (EKG):Prepared by a cardiology faculty member. Residents,interns and students on the floorsattend these sessions every other Wednesday at 1pm. They consist of systematic ECGReadings. By the end of these sessions, residents are able to recognize commonarrhythmias and EKG changes and initiate appropriate investigations and treatment.10. Chairman rounds: Once per week, on Tuesdays at 3:30 pm. The Department Chairor Professors round with a randomly selected medical team checking two to threecases and discussing mainly documentation issues as well as the case presentation,P. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 9

Internal Medicine Residency Training Program Curriculumapproach and management. The resident in charge is evaluated by the chairman or theprofessor.11. List of Evaluation MethodsCR- Chairman’s round evaluationDSP – Directly Supervised ProceduresGA – Global assessment by attending (myevaluation.com)NE – Nursing evaluationPDR–Program Director’s Review (or associate program directors) (twice annually)PRE—Peer evaluationPTE – Patient-to-Resident EvaluationMCX – Mini-CEX (Direct Observation Assessment Tool)MR- Morning Report EvaluationISE – In-service examinationPL – Procedure LogD. OVERVIEW OF RESIDENT RESPONSIBILITIES AND LONGITUDINALEDUCATIONAL GOALS1. Patient CareResidents are expected to: Provide patient care that is compassionate, appropriate and effective for thepromotion of health, prevention of illness, treatment of disease, and care at theend of lifeGather accurate, essential information from all sources, including medicalinterviews, physical examination, records, and diagnostic/therapeutic proceduresP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 10

Internal Medicine Residency Training Program Curriculum Make informed recommendations about preventive, diagnostic, and therapeuticoptions, and interventions that are based on clinical judgment, scientific evidence,and patient preferencesDevelop, negotiate, and implement patient management plansPerform competently the diagnostic procedures considered essential to thepractice of general internal medicineEnsuring that patient care is compassionate, appropriate and effective for the treatment ofhealth problems and the promotion of health is accomplished primarily by: Attending rounds: Faculty members are assigned to floor teams and round withthem daily. In addition to their teaching capacities, it is their responsibilities tomonitor and mentor residents individually to ensure adequate patient care, fromtaking history, to generating a diagnosis, to managing and eventually dischargingpatients.Faculty members rounding on the floors have to review at least 1 chartdaily and fill peer to peer, resident, interns, and students’ evaluations. Morning Report: During the structured morning report, patient casepresentations are critiqued by attending physicians so as to ensure that residentsare able to:o Conduct accurate, comprehensive medical interviews and physical examso Generate an acceptable differential diagnosiso Make proper diagnostic and therapeutic decisionso Execute appropriate investigational and/or interventional strategies basedon both available evidence and patient preferencePrinciple Educational GoalsLearning ActivitiesInterview patients more skillfullyDPC, AR, AmR, MRExamine patients more skillfullyDPC, ARDefine and prioritize patients’ medicalproblemsDPC, AR, MRGenerate and prioritize differentialdiagnosesDPC, AR, MRDevelop rational, evidence-basedmanagement strategiesDPC, AR, MRP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 11

Internal Medicine Residency Training Program CurriculumPatient Care Progressive ResponsibilitiesPGY-1 Medical interviewing: Able to discern complete and relevant historyBe able to perform a thorough and accurate physical exam on patients withcommon medical problemsGather essential information from other sources such as medical records andradiologyIntegrate the past and current clinical information to arrive at a problemoriented, prioritized, differential diagnosisBe able to initiate a correct therapeutic and diagnostic plans plan for commonmedical problemsUnderstand the indications, contraindications, and risks of commonly orderedmedications, medical tests, and proceduresPerform the required internal medicine procedures with supervision untilcertified to perform aloneBe able to prioritize patients’ problems so that daily patient care duties can becompleted in an accurate and timely mannerUnderstand appropriate monitoring and follow-up of patients, which includeslaboratory data, test results, and medication usePGY-2All of the above and additionally: Be able to obtain a precise, logical and efficient historyBe able to elicit subtle findings on physical examinationBe able to use diagnostic procedures and therapies appropriatelyBe able to interpret results of diagnostic tests and procedures properlyBe able to analyze clinical data to make informed decisions about patientmanagementDevelop and carry out patient care plansAbility to use information technology to assist in patient careWeigh alternatives for diagnosis and treatment giving consideration to patientpreferences, risks, benefits, and costCounsel and educate patients about pertinent health issues, tests, andtreatmentsManage multiple medical problems at onceBe able to choose an appropriate care location for inpatient conditionsBe able to perform most ABIM-required internal medicine procedures withoutsupervisionP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 12

Internal Medicine Residency Training Program CurriculumPGY-3All of the above and additionally: Be competent in the care of patients with the majority of internal medicineproblemsCommunicate effectively with patients and families regarding treatment plansand results of testing and thoroughly educate themDemonstrate the ability to devote an appropriate amount of time to diagnosticreasoning and treatment as related to the complexity of the problem(s)Reason well in ambiguous situationsPerform all ABIM-required internal medicine procedures without supervisionFunction as a consultant2. Medical KnowledgeResidents are expected to: Demonstrate knowledge of established and evolving biomedical, clinical andsocial sciences, and demonstrate the application of that knowledge to patientcare and education of others.Apply an open-minded and analytical approach to acquiring new biomedicaland clinical knowledge.Develop applicable knowledge of the basic clinical and behavioral sciencesthat underlie the practice of internal medicine.Apply this knowledge in developing critical thinking, clinical problemsolving, and clinical decision-making skills in specific cases under their care.Access and critically evaluate current medical information and scientificevidence and modify knowledge base accordingly.Teaching Attendings are selected for their demonstrated compassionate approach andclinical skills to demonstrate those behaviors in their rounds and other resident contacts.All residents take the In-service examinations each year; their progress is monitored anddiscussed over three years.Principle Educational GoalsLearning ActivitiesExpand clinically applicable knowledgebase of the basic and clinical sciencesunderlying the care of medical inpatientsDPC, AR, MR, NC, AmR, XR, EKGP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 13

Internal Medicine Residency Training Program CurriculumAccess and critically evaluate currentmedical information and scientificevidence relevant to patient careDPC, AR, JC, NC, AmRMedical Care Progressive ResponsibilitiesPGY-1 Demonstrate satisfactory knowledge of common medical conditions, sufficient tomanage urgent complaints with supervisionComplete 20 out of 43 assigned Johns Hopkins Ambulatory Curriculum modulesBegin to identify patterns of patient presentation for common medical problemsBe able to use various educational resources to seek information about patients'diseasesDemonstrate knowledge of common procedural indications, contraindications,risks, and benefitsBe able to apply learned medical knowledge to diagnosis, treatment, andprevention of diseaseAbility to apply pathophysiology to patient careAttend conferences to continuously learn and reinforce medical knowledge andskillsPGY-2All of the above and additionally: Complete an additional 15 out of 43 assigned Johns Hopkins ModulesDemonstrate advancement in knowledge and analytical thinking in order todevelop well-formulated differential diagnoses for patients with uncommondiseases as well as patients with multiple problemsDemonstrate knowledge of epidemiology and social and behavioral science andbe able to apply that knowledge to the care of the patientAbility to perform a literature searchUnderstand the indications, contraindications and risks of commonly usedmedications and proceduresDemonstrate leadership and teaching skills in managing daily rounds andoutpatient sessionsAttend and participate in conferences such as Morning Report to continuouslylearn and reinforce medical knowledge and skillsIndependently present up-to-date scientific evidence to support hypothesesP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 14

Internal Medicine Residency Training Program Curriculum Develop knowledge of statistical principles such as sensitivity, specificity,predictive values, number needed to treat and odds ratiosPGY-3All of the above and additionally: Complete an additional 15 out of 43 assigned Johns Hopkins ModulesRegularly display self-initiative to stay current with new medical knowledgeDemonstrate continued advancement in medical knowledgeDemonstrate an investigatory and analytic approach to clinical situations3. Practice Based Learning and ImprovementResidents are required to be able to efficiently access scientific literature and demonstratecompetency in the application of appropriate methodology and analytical tools toimprove their personal patient care practices while minimizing the possibility of makingsignificant medical errors. Available resources at AUBMC include: On-line access to all major and most minor on-line journals and publicationsOn-line access to Uptodate referenceOn-line access to select medical textsOn-line access to NEJM knowledge 24-hour access to the offerings of the Saab Medical Library24-hour pharmacist coverage hospital-widePACS system which provides on-line access to current and past radiographicimaging inclusive of formal radiologist readingsOn-line access to Electronic Health Records which include current and pastdictated reports (History and physical exam, consultant reports, radiology results,Lab Results, Pathology results, Procedures done, etc )These modalities are available to the house staff at every computer on every floorinvolved in patient care. Residents receive ongoing feedback regarding their performancefrom attendings, nursing, pharmacists, and the in-house information technology group.Formal evaluations are performed by program director and associate program directorsevery six months.P. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 15

Internal Medicine Residency Training Program CurriculumResidents also are required to participate in independent clinical research with facultyunder the Fellowship and Residency Research Program (FRRP).Principle Educational GoalsIdentify and acknowledge gaps inpersonal knowledge and skills in the careof patientsDevelop and implement strategies forfilling gaps in knowledge and skillsLearning ActivityDPC, AR, MR, NC, AmRJC, MR, AmR, DPCPractice-Based Learning and Improvement Progressive Responsibilities:PGY-1 Be self-motivatedBe able to formulate clinical questions in the day-to-day care of patientsBe able to locate scientific literature to assist in medical decision-makingBe able to identify ones limitations of knowledge and skills and seek help whenneededAccept feedback and develop self-improvement plans when appropriateStart to develop skills in teachingPGY-2 All of the above and additionally:Be able to formulate, search, and answer clinical questions using the literatureUse an evidence-based approach to providing patient careDemonstrate continual self-evaluation to correct deficiencies and develop newskillsDemonstrate teaching initiative and skillsPGY-3 All of the above and additionally:Be able to appraise and assimilate scientific literature into daily practiceAppropriately integrate evidence-based medicine with expert opinion andprofessional judgmentP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Page 16

Internal Medicine Residency Training Program Curriculum Effectively and efficiently utilize consultation services to improve both patientcare and self-knowledgeBe able to analyze personal practice patterns systematically, and look tocontinuously improveDemonstrate use of teaching skills to create an effective learning environment forstudents and junior house staff4. Interpersonal and Communication Skills:Residents are expected to: Demonstrate interpersonal and communication skills that enable them to establishand maintain professional relationships with patients, families, and other membersof healthcare teamsProvide effective and professional consultation to other physicians and healthcareprofessionals and sustain therapeutic and ethically sound professionalrelationships with patients, their families, and colleaguesUse effective listening, verbal and nonverbal, questioning, and narrative skills tocommunicate with patients and familiesInteract with consultants in a respectful, timely, and appropriate fashionMaintain comprehensive, timely, and legible medical recordsHistory and physical exam, progress notes, consultation notes are reviewed by theirrespective attending physicians, the residents in charge and regularly by the medical chiefresidents. Timely completeness of medical records are tracked and feedback given toresidents when needed.Interaction with patients and family members are observed by the respective attendingphysicians, senior residents, program directors as well as nurses and patients’ themselvesto ensure residents’ communication skills are adequate and acceptable.Residents also consistently interact with other healthcare professionals including thenursing staff, nursing administrators, and clinical case managers who participate in the"360-degree" resident evaluations on a regular basis.Principle Educational GoalsCommunicate effectively with patients and familiesP. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019Learning ActivitiesDPC, AR, NCPage 17

Internal Medicine Residency Training Program CurriculumCommunicate effectively with physician colleagues atall levelsCommunicate effectively with all non-phy

Internal Medicine Residency Training Program Curriculum P. BouKhalil, S. Abi Doumeth, A. Berjawi, J. Mhanna. 2019 Page 2 Internal Medicine Residency Training Program Curriculum I. Mission Statement II. Overview A. ACGME-I Core Competencies B. Internal Medicine Residency Program Overview 1. Categorical Program 2. Preliminary Program