Core
Required
Rotation:
Block Rotation
INPATIENT ADULT MEDICINE
1) Location: North Colorado Medical Center
2) Duration:
a) R1 year: ten weeks (two 4-week blocks, and one 2 week block MNF)
b) R2 year: six weeks (one 2-week block, and one 4-week block MNF)
c) R3 year: six weeks (one 4-week block, and one 2-week block)
3) Goals and Objectives. By graduation, each resident is expected to demonstrate the following level of
general and specific competence (categories based on the ACGME Competencies).
a) Medical Knowledge.
i) Demonstrates good knowledge of basic and clinical sciences, uses textbooks and evidencebased resources to supplement knowledge; demonstrates good understanding of complex
relationships and disease processes.
ii) Medical Knowledge Competencies specific to this rotation include demonstrated knowledge
(and application of knowledge to patient care) in the following areas:
(1) Hematologic disorders: anemia, leukemia, lymphomas, thrombocytopenia, polycythemia,
transfusion reactions, clotting disorders (including deep venous thrombosis)
(2) Endocrine disorders: thyroid disease, diabetes mellitus, hypo- and hyperglycemia,
adrenal disease.
(3) Renal: acute and chronic renal failure, indications for dialysis, acid/base disorders, fluid
and electrolyte abnormalities
(4) Neurologic disorders: strokes, transient ischemic attacks, coma, meningitis, encephalitis,
seizure disorders, delerium, dementia
(5) Gastrointestinal disorders: esophagitis, gastritis, peptic ulcer disease, diarrhea, biliary
tract disease, upper GI bleeding, lower GI bleeding, pancreatitis, diverticulitis,
inflammatory bowel disease, hepatitis and other hepatic dysfunction.
(6) Infectious disease: pneumonia, urinary tract infections, meningitis, endocarditis,
cellulitis, diabetic foot ulcers, sepsis, tuberculosis, HIV/AIDS related disease.
(7) Cardiovascular disorders: angina, unstable angina syndromes, acute myocardial
infarction, arrythmias, hypertension, congestive heart failure, hyperlipidemias, peripheral
vascular disease, general fluid management.
(8) Pulmonary disorders: chronic obstructive pulmonary disease, reactive airway disease,
pulmonary lesions, pulmonary embolism, adult respiratory distress syndrome.
(9) Allergy/Immunology: severe allergic reactions including anaphylaxis, reactive airway
disease.
(10) Rheumatologic disease: rheumatoid arthritis, systemic lupus erythematosis, degenerative
osteoarthritis, gonococcal arthritis, septic arthritis.
(11) Oncologic disorders: gastrointestinal, uterine, ovarian, pulmonary, and renal
malignancies.
b) Patient Care.
i) Consistently develops an effective therapeutic relationship with patients and families that
includes sensitivity to culture, age, gender and disability; gathers essential and accurate
information from the patient and other sources (labs, xray, old records, family); develops a
detailed differential and is able to prioritize that differential based on urgency and likelihood;
develop a comprehensive treatment plan that incorporates patient preferences and health care
maintenance/disease prevention (when appropriate); appropriately involves consultations in
the care of patients.
ii) Performs accurate and complete physical exams; demonstrated competence to perform simple
procedures and more complex procedures that the resident plans to include in his/her future
practice (including knowledge of indications, contra-indications, appropriate consent,
complications (and how to address them), and follow up).
iii) Patient Care competencies specific to this rotation include:
(1) History taking. Demonstrate ability to perform a complete history and to cull from that
information data that is appropriate for the expedient care of the patient. The resident
must be able to:
(a) Obtain information from multiple sources and be able to share that information and
interact with other members of the health care team.
(b) Gain an adequate data base from collateral sources under somewhat less than ideal
circumstances (i.e. acute dementia, acute head trauma, etc.). The resident must also
be efficient in gaining information form the immediate family members and
acquaintances of the patient.
(c) Establish good lines of communication with the patient’s family and be able to keep
them well informed during the care of the patient.
(2) Physical examination. The resident will have completed several hundred histories and
physical examinations throughout the residency program. Through this experience, the
resident will:
(a) Appropriately and succinctly complete a total physical examination and be able to
glean the appropriate data from that examination.
(b) Demonstrate competence in examining uncooperative and severely ill patients and
direct the appropriate therapy from the information gained from this examination.
(c) Demonstrate expertise in completing systems directed physical examinations, and be
able to direct patient care in the most cost effective and humane manner possible.
(3) The resident will demonstrate ability to interpret the following laboratory data and apply
this data to patient care: urinalysis, electrocardiograms, blood chemistries (liver function,
endocrine, chemistry panels), hematology and coagulation panels, cardiac enzyme
analysis, body fluid analysis (spinal, pleural, ascitic), bactierial cultures with antibiotic
sensitivities and levels, chest X-rays and abdominal X-rays, intravenous pyelograms,
barium studies, radioactive lung and cardiac scans, CT angiogram, pulmonary function
tests, arterial blood gases
(4) Procedures. To synthesize and appropriately manage the care of the acutely ill patient,
the resident will demonstrate ability to perform a wide range of medically related
procedures. More importantly, the resident will learn the indications necessary to proceed
with the performance of the individual procedures. The resident will also demonstrate
knowledge of the risks and benefits of these procedures. These procedures include:
paracentesis, central line placement, thoracentesis, lumbar puncture, joint aspiration, NG
and feeding tube placement, cardiac resuscitation, endotracheal tube placement,
transcutaneous pacemaker use , arterial blood gas sampling, arterial line placement,
indications for and management of ventilatory support
(5) The resident will also demonstrate expertise in the management of psychological, sexual,
and social needs of the patient.
c) Practice-Based Learning and Improvement.
i) Investigates and evaluates his/her own patient care, appraises and assimilates scientific
evidence, and uses this information to work toward improvements in patient care.
ii) Practice-Based Learning and Improvement competencies specific to this rotation, include:
(1) Teaching rounds which include discussion of the evidence base for planned interventions.
(2) Researching and presenting didactic topics for the adult medicine team:
(a) Once to twice per block during the R1 rotations
(b) Once per week during the R2 rotation
(c) Once to twice per week during the R3 rotations
d) Interpersonal and Communication Skills.
i) Written documentation/communication is legible, timed and dated, complete (but with
appropriate conciseness), accurate and using appropriate language and abbreviations. Verbal
communication with patients, families, and members of the healthcare team are respectful and
e)
f)
effective (including effective presentation skills). Keeps supervising physicians up to date on
patients.
ii) Interpersonal/Communication skill competencies specific to this rotation include: Sensitivity
will be gained in dealing with the areas of death and dying, grief reactions in patient and
family, and women’s health care issues.
Professionalism. Consistently on-time, works hard, able to identify required tasks and complete
them in a timely and efficient manner; team-oriented and willing to assist with work load as needed
to optimize team function; able to identify need for help and request it; demonstrates a positive
attitude and interactions with team members; adheres to ethical principles in the course of his/her
practice; identifies and progresses toward personal educational goals; is receptive to, seeks, and
incorporates feedback.
Systems-Based Practice.
i) Demonstrates an awareness of the larger healthcare system, assists patients in dealing with
system complexities through the effective use of hospital and community resources;
participates in some system improvement through identification of errors and system problems
and initial discussion of potential system improvements; acts as an effective teacher of junior
residents and other members of the healthcare team.
ii) Systems-Based Practice competencies specific to this rotation include:
(1) Supervision and teaching of junior residents and medical students rotating on the service.
(2) The resident will be skilled in sharing information with and coordinating efforts of other
members of the health care team including nurses, nurse practitioners, physical therapists,
respiratory therapists, psychologists, and consultants.
(3) The resident will demonstrate skill in the use of hospital resources including care
coordination, pharmacy assistance and social work.
4) Methods:
a) During the R1 year, the resident will spend two 4-week block rotations on the inpatient adult
medicine service and one 2-week block of MNF. The resident will do complete histories and
physicals, data collection, appropriate procedures and demonstrate appropriate use of information
collected in regard to patient care. The first year resident functions as the primary physician for
the patients on the service, with close supervision by the second and/or third year resident. The
goal is to be the primary physician for 5-7 patients per day.
b) During the R2 year, the resident will spend one 2-week block rotation on the inpatient adult
medicine service. The R2 will spend two 2-week blocks on MNF. The resident will do complete
histories and physicals, data collection, appropriate procedures and demonstrate appropriate use of
information collected in regard to patient care. The resident will have primary responsibility for a
smaller number of service patients than the R1 on service, and in addition, will supervise the R1 on
a portion of their admissions and daily rounding.
c) During the R3 year, the resident spends one 6-week blocks acting as “Medicine Chief” on the
inpatient adult medicine service. The third year resident supervises every admission to the
medicine service done by more junior residents. In addition the third year resident rounds on all
patients on the service on a daily basis, and helps the interns with the provision of care to these
patients.
d) The service is attended by a full time family medicine faculty member. PharmD and Behavioral
Science faculty member also attend rounds several times each week.
e) The patients on the adult medicine service consist of NCFM patients admitted to the hospital and
“unassigned” patients - patients without an identified physician who present to the emergency
department and require admission. In addition, other providers frequently consult the medicine
service for medical management consultation.
f) If the medicine service has the equivalent of 14 patients, further “unassigned” admissions are
diverted to the NCMC hospitalist service. This serves to protect the educational interests of the
resident. Although the residents are required to follow any continuity patients admitted to the
hospital, when the continuity provider is not a resident (i.e. a nurse practitioner at NCFM) or the
continuity resident is unavailable (i.e. on an away rotation or vacation), all adult NCFM patients
are admitted to the medicine service. Even those patient followed by the continuity resident, are
followed along with the inpatient medicine team.
g) Every weekday morning, a didactic topic is presented to the adult medicine team. Presenters
include resident and faculty team members, Pharm D, dieticians, and other invited presenters.
There is a schedule of topics that rotate such that each first year resident hears each topic at least
once during his/her adult medicine rotations.
h) Other experiences in adult medicine include:
i) Adult medicine topics are included in the core didactic curriculum. In addition, many of the
medical staff CME conferences deal with medicine topics and the residents are encouraged to
attend these conferences.
ii) The FMC, including outpatient management and consultation.
iii) Required second year rotations: ICU, cardiology, pulmonology.
iv) Most residents do another elective in an adult medicine specialty during their second or third
year.
5) Evaluation: This curricular area is evaluated as outlined in the policy “Evaluation of Residents”.
RAC
Reviewed and Approved:
David Smith, MD, Program Director