To make physicians into specialists in Internal Medicine by equipping them with requisite knowledge, skills, character qualities, and habits essential for them to demonstrate competence in patient care, knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal and communication skills relevant to the treatment of Non-Internal Medicine specialty health problems: medical ophthalmology, office gynecology, otolaryngology, non-operative orthopedics, and palliative care.
Competence Goal
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the prevention and treatment of basic outpatient eye, ENT, gynecologic, orthopedic and palliative care problems in adults.
Learning Objectives - Residents are taught one or more of the following patient care skills. Each resident is taught how to:
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Demonstrate the ability to provide patient care across the spectrum of clinical disorders seen in the subspecialties of internal medicine and non-internal medicine specialties in ambulatory settings. MPC/WT, ITE, DO

Demonstrate relevant history-taking, accurate physical examination, informed differential diagnosis, reasonable diagnostic evaluation, and appropriate treatment for common outpatient ophthalmologic problems including diseases of the conjunctiva, cornea, sclera, and retina; glaucoma; disorders of eye movement; and visual impairment. MPC/WT, ITE, DO

Demonstrate relevant history-taking, accurate physical examination, informed differential diagnosis, reasonable diagnostic evaluation, and appropriate treatment for common outpatient gynecologic problems including pelvic floor dysfunction, urinary incontinence; prevention, diagnosis, and treatment of gynecologic cancers; diagnosis and nonsurgical management of breast disease; reproductive endocrinology and infertility; family planning; psychosomatic and psychosexual counseling; reproductive problems; sexual dysfunction; gynecologic infections.
MPC/WT, ITE, DO

Demonstrate relevant history-taking, accurate physical examination, informed differential diagnosis, reasonable diagnostic evaluation, and appropriate treatment for common outpatient ENT problems including sinusitis, auditory dysfunction, vertigo, rhinitis, hoarseness, throat pain, and cervical adenopathy. MPC/WT, ITE,
DO

Demonstrate relevant history-taking, accurate physical examination, informed differential diagnosis, reasonable diagnostic evaluation, and appropriate treatment
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for common outpatient orthopedic problems including cervical and low back pain, joint pain, bone- and joint-related disabilities, osteoporosis, fractures, prosthetics, and rehabilitation. MPC/WT, ITE, DO

Demonstrate relevant history-taking, accurate physical examination, informed differential diagnosis, reasonable diagnostic evaluation, and appropriate treatment for common outpatient palliative care and chronic pain problems. MPC/WT,
ITE, DO

Demonstrate the ability to prevent, counsel, detect, and diagnose and treat genderspecific diseases. MPC/WT, ITE, DO
Competence Goal
Residents must demonstrate knowledge of Non-Internal Medicine specialty health problems: medical ophthalmology, office gynecology, otolaryngology, non-operative orthopedics and palliative care.
Learning Objectives– Residents are taught to be competent in the knowledge of these areas. Each resident is given multiple opportunities to demonstrate competence in:

The knowledge of the core content of general internal medicine which includes the internal medicine subspecialties, non-internal medicine specialties listed above. MPC/WT, ITE, DO

The knowledge to treat medical conditions commonly managed by internists.
MPC/WT, ITE, DO

The knowledge to provide basic preventive care. MPC/WT, ITE, DO
Competence Goal
Residents must demonstrate the skills and habits to investigate and evaluate their care of patients and to continuously improve patient care based on constant self-evaluation and life-long learning.
Learning Objectives – Residents are taught the following skills and habits. Each resident is given multiple opportunities to demonstrate:
 The skill and habit of setting learning and improvement goals.
MPC/WT, ITE,
DO
 The skill and habit of identifying and performing appropriate learning activities.
MPC/WT, ITE, DO
Competence Goal
Residents must demonstrate the ability to call effectively on other resources in the system to provide optimal health care.
Learning Objectives - Residents are taught the following skills. Each resident is given multiple opportunities to demonstrate competence in:
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 The ability to coordinate patient care within the health care system relevant to their clinical specialty.
MPC/WT, ITE, DO
Competency Goal
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
Learning Objectives – Residents are taught to seek and possess the following character traits. Each resident is given multiple opportunities to demonstrate:
 Accountability to professional commitments.
MPC/WT, ITE, DO
Competency Goal
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with health professionals.
Learning Objectives - Residents are taught the following skills. Each resident is given multiple opportunities to demonstrate competence in:
 Communicating effectively with physicians.
MPC/WT, ITE, DO

MPC – Mentored Patient Care: Practical teaching and role modeling during direct patient care during clinical rotations.
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LSC - Lectures/Seminars/Conferences
 Grand Rounds

Noon Conference

Residents Conference
 Clinic Conference

Morning Report

Journal Club

Morbidity and Mortality

Clinical-Pathological Conference

Board Review Sessions

Quality Improvement Course
 Palliative Care Course

Ultrasound Course

Procedure Simulation

Coding Course

Professionalism
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WRT - Weekly Reading/Testing/Feedback
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
WT – Weekly Tests evaluating knowledge base for all competencies and subspecialties.
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DO - Direct Observation of competency-based performance by qualified faculty guided by PGY-specific, milestone-based assessment tools. Included in MSF.

DO –P - Direct Observation by Peers evaluation of competency-based performance, guided by PGY-specific, milestone-based assessment tools.
Included in MSF.

ITE - In-Training Exam

The residency program follows the ACGME Duty Hour Requirements.

Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call and moonlighting activities.

Residents must be scheduled for a minimum of one day free of duty every week
(when averaged over four weeks). At-home call cannot be assigned on these free days.

Duty periods of PGY-1 residents must not exceed 16 hours in duration.

Duty periods of PGY-2 residents and above may be scheduled to a maximum of
24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities.
Strategic napping, especially after 16hours of continuous duty and between the hours of 10:00p.m. and 8:00 a.m., is strongly suggested.

It is essential for patient safety and resident education that effective transitions in care occur. Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.

Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.

In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient.
Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Under those circumstances, the resident must: appropriately hand over the care of all other patients to the team responsible for their continuing care; and, document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.

PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

Residents in the final years of education (PGY2 and 3) must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. This preparation must occur within the context of the80-hour, maximum duty period length, and one-day off-in-seven standards.

While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances
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when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.

In unusual circumstances, residents may remain beyond their scheduled period of duty or return after their scheduled period of duty to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity of care for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of the patient or family. Such episodes should be rare, must be of the residents’ own initiative, and need not initiate a new ‘off-duty period’ nor require a change in the scheduled ‘off duty period.’

Residents must not be scheduled for more than six consecutive nights of night float.
 PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night
During the Rotational Clinic or as a full one month rotation, the resident will do at least 8 half day clinics per week in 2-5 of the designated specialties. Dr. Carlos
Clark will approve the proposed specialty specific learning objectives and documentation passport. He will assess completion of professional commitments based on the documentation in the passport and feedback from attendings in the clinics. The clinic also has the flexibility to be devoted to a single specialty (ie, Paliative Care with Dr. Grumbles).

UTMB Library Homepage with access to filtered and unfiltered resources, including: o ACP Pier o DynaMed o Textbooks o Up-to-Date o Cochrane o PubMed
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