UTMB Internal Medicine Residency Point-of-Care Diagnostic Ultrasound – PGY 3 Competency-Based Goals, Objectives, Milestones, Teaching Methods, and Milestone-Based Assessment Tools Overall Goal To make physicians into specialists in Internal Medicine by equipping them with requisite knowledge and skills of Point-of-Care Diagnostic Ultrasound 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 health problems in adults. Patient Care Competence Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health through the use of Point-of-Care Diagnostic Ultrasound (POCUS) Learning Objectives - Residents are taught the following patient management skills. Each resident is taught how to: Demonstrate accurate, complete, and relevant history-taking that justifies POCUS. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to perform a comprehensive and accurate physical examination that justifies POCUS. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to arrive at an appropriate differential diagnosis, outline a logical plan for POCUS pertaining to the patient’s complaints, and formulate a plan for management and follow-up treatment of the patient based on the results of the POCUS. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to effectively present the results of a POCUS orally and in writing and to defend the clinical assessment, differential diagnosis, and diagnostic and management plans. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to provide POCUS in a variety of roles, to include serving as the direct provider, the leader or member of a multi-disciplinary team of providers, a consultant to other physicians, and a teacher to the patient and other physicians. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to provide POCUS across the spectrum of clinical disorders seen in the practice of general internal medicine including the subspecialties of internal medicine and non-internal medicine specialties in both inpatient and ambulatory settings. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to provide POCUS for undifferentiated acutely and severely ill patients. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Demonstrate the ability to perform POCUS congruent with all Departmental and Hospital standards. MPC,LSC,WR/DO ,LB, 1 Demonstrate the ability to treat patients with POCUS that is safe, scientifically based, effective, efficient, timely, and cost effective. MPC,LSC,WR/ DO,CA, MINICEX, PBLM Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 Patient Care Milestones: Historical Data Gathering PC-A4 Role model gathering subtle and reliable information from the patient for junior members of the healthcare team. (30 months) Performing a physical exam PC-B4 Routinely identify subtle or unusual physical findings that may influence clinical decision making, using advanced maneuvers where applicable. (30 months) Clinical Reasoning PC-C4 Recognize disease presentations that deviate from common patterns and that require complex decision making. (36 months) Invasive procedures *PC-D2 Appropriately perform point-of-care ultrasound and provide post-procedure management for this procedure. (36 months) Diagnostic tests *PC-E4 Make appropriate clinical decision based upon the results of point-of-care ultrasound. (36 months) Patient Management PC-F7 Manage patients with conditions that require intensive care. (36 months) PC-F8 Independently manage patients with a broad spectrum of clinical disorders seen in the practice of general internal medicine. (36 months) PC-F9 Manage complex or rare medical conditions. (36 months) PC-F10 Customize care in the context of the patient’s preferences and overall health. (36 months) Consultative care *PC-G3 Provide internal medicine consultation with point-of-care ultrasound for patients with more complex clinical problems requiring detailed risk assessment. (36 months) Medical Knowledge Competence Goal Residents must demonstrate knowledge of POCUS as well as the application of this knowledge to patient care. Learning Objectives– Residents are taught to be competent in the knowledge of POCUS. Each resident is given multiple opportunities to demonstrate competence in: The knowledge of the broad spectrum of clinical disorders of general internal medicine diagnosable by POCUS. MPC,LSC,WR/ DO,CA, MINICEX, PBLM The knowledge to evaluate, by POCUS, patients with an undiagnosed and undifferentiated presentation. MPC,LSC,WR/ DO,CA, MINICEX, PBLM The knowledge to interpret basic POCUS images. MPC,LSC,WR/DO, WT,ITE, 2 Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 Knowledge Milestones: Knowledge of core content MK-A7 Demonstrate sufficient knowledge to evaluate complex or rare medical conditions and multiple coexistent conditions. (36 months) Diagnostic tests MK-B1 Understand indications for and basic interpretation of common diagnostic testing, including but not limited to routine blood chemistries, hematologic studies, coagulation tests, arterial blood gases, ECG, chest radiographs, pulmonary function tests, urinalysis and other body fluids. (12 months) MK-B2 Understand indications for and has basic skills in interpreting more advanced diagnostic tests. (18 months) *MK-B5 Understand prior probability and test performance characteristics. (36 months) Practice-Based Learning and Improvement Competence Goal Residents must demonstrate the skills and habits to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, 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 identifying strengths, deficiencies, and limits in one’s knowledge and expertise. MPC,LSC,WR/DO, PBLM, JCP, JCR The skill and habit of setting learning and improvement goals. MPC,LSC,WR/DO, PBLM , JCP, JCR The skill and habit of identifying and performing appropriate learning activities. MPC,LSC,WR/DO, PBLM , JCP, JCR The skill and habit of systematically analyzing practice using quality improvement methods, and implementing changes with the goal of practice improvement. MPC,LSC,QI course/DO, QIeval The skill and habit of incorporating formative evaluation feedback into daily practice. MPC,LSC,/DO, PBLM , JCP, JCR The skill and habit of locating, appraising, and assimilating evidence from scientific studies related to their patients’ health problems. MPC,LSC/DO, PBLM , JCP, JCR, M&Meval The skill and habit of using information technology to optimize learning. MPC,LSC/DO, PBLM , JCP, JCR The skill and habit of participating in the education of patients, families, students, residents and other health professionals. MPC,LSC/DO, PBLM , JCP, JCR, MINICEX Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 PBLI Milestones: Improve the quality of care for a panel of patients PBLI-A1 Appreciate the responsibility to assess and improve care collectively for a panel 3 of patients. (12 months) PBLI-A2 Perform or review audit of a panel of patients using standardized, diseasespecific, and evidence-based criteria. (24 months) PBLI-A3 Reflect on audit compared with local or national benchmarks and explore possible explanations for deficiencies, including doctor-related, system-related, and patient related factors. (24 months) PBLI-A4 Identify areas in resident’s own practice and local system that can be changed to improve affect of the processes and outcomes of care. (36 months) PBLI-A5 Engage in a quality improvement intervention. (36 months) Ask answerable questions for emerging information needs PBLI-B1 Identify learning needs (clinical questions) as they emerge in patient care activities. (12 months) PBLI-B2 Classify and precisely articulate clinical questions. (24 months) PBLI-B3 Develop a system to track, pursue, and reflect on clinical questions. (24 months) Acquires the best evidence PBLI-C1 Access medical information resources to answer clinical questions and library resources to support decision making. (12 months) PBLI-C2 Effectively and efficiently search NLM database for original clinical research articles. (12 months) PBLI-C3 Effectively and efficiently search evidence-based summary medical information resources. (24 months) PBLI-C4 Appraise the quality of medical information resources and select among them based on the characteristics of the clinical question. (36 month) Appraises the evidence for validity and usefulness PBLI-D1 With assistance, appraise study design, conduct, and statistical analysis in clinical research papers. (12 months) PBLI-D2 With assistance, appraise clinical guideline recommendations for bias. (24 months) PBLI-D3 With assistance, appraise study design, conduct, and statistical analysis in clinical research papers. (36 months) PBLI-D4 Independently, appraise clinical guideline recommendations for bias and costbenefit considerations. (36 months) Applies the evidence to decision-making for individual patients PBLI-E1 Determine if clinical evidence can be generalized to an individual patient. (12 months) PBLI-E2 Customize clinical evidence for an individual patient. (24 months) PBLI-E3 Communicate risks and benefits of alternatives to patients. (36 months) PBLI-E4 Integrate clinical evidence, clinical context, and patient preferences into decision-making. (36 months) Improves via feedback PBLI-F1 Respond welcomingly and productively to feedback from all members of the health care team including faculty, peer residents, students, nurses, allied health workers, patients and their advocates. (12 months) PBLI-F2 Actively seek feedback from all members of the health care team. (18 months) PBLI-F3 Calibrate self-assessment with feedback and other external data. (24 months) 4 PBLI-F4 Reflect on feedback in developing plans for improvement. (24 months) Improves via self-assessment PBLI-G1 Maintain awareness of the situation in the moment, and respond to meet situational needs. (24 months) PBLI-G2 Reflect (in action) when surprised, applies new insights to future clinical scenarios, and reflects (on action) back on the process. (36 months) Participates in the education of all members of the health care team PBLI-H1 Actively participate in teaching conferences. (12 months) PBLI-H2 Integrate teaching, feedback, and evaluation with supervision of interns’ and students’ patient care. (24 months) PBLI-H3 Take a leadership role in the education of all members of the health care team. (36 months) Systems-Based Practice Competence Goal Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as 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: The ability to work effectively in various health care delivery settings and systems relevant to their clinical specialty. MPC/DO,MSF ,TOC, NFCA, NFMR, The ability to coordinate patient care within the health care system relevant to their clinical specialty. MPC,LSC,/DO,MSF ,TOC, NFCA, NFMR, The ability to incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population based care as appropriate. MPC,LSC,/DO,MSF ,TOC, NFCA, NFMR The ability to advocate for quality patient care and optimal patient care systems. MPC,LSC,QIcourse/DO,MSF, CPI, QItest The ability to work in interprofessional teams to enhance patient safety and improve patient care quality. MPC,LSC,/DO,MSF ,TOC, NFCA, NFMR The ability to participate in identifying system errors and implementing potential systems solutions. MPC,LSC,QIcourse/DO,MSF, CPI, QItest MM The ability to work in teams and effectively transmit necessary clinical information to ensure safe and proper care of patients including the transition of care between settings. MPC,LSC,/DO,MSF ,TOC, NFCA, NFMR The ability to recognize and function effectively in high-quality care systems. MPC,LSC,/DO,MSF ,TOC, NFCA, NFMR Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 SBP Milestones: Works effectively within multiple health delivery systems SBP-A1 Understand unique roles and services provided by local health care delivery systems. (12 months) SBP-A2 Manage and coordinate care and care transitions across multiple delivery 5 systems, including ambulatory, subacute, acute, rehabilitation, and skilled nursing. (24 months) SBP-A3 Negotiate patient-centered care among multiple care providers. (36 months) Works effectively within an interprofessional team SBP-B1 Appreciate roles of a variety of health care providers, including, but not limited to, consultants, therapists, nurses, home care workers, pharmacists, and social workers. (6 months) SBP-B2 Work effectively as a member within the interprofessional team to ensure safe patient care. (6 months) SBP-B3 Consider alternative solutions provided by other teammates. (12 months) SBP-B4 Demonstrate how to manage the team by utilizing the skills and coordinating the activities of interprofessional team members. (36 months) Recognizes system error and advocates for system improvement SBP-C1 Recognize health system forces that increase the risk for error including barriers to optimal patient care. (12 months) Professionalism 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: Compassion, integrity, and respect for others. MPC,LSC/DO,MSF, Responsiveness to patient needs that supersedes self-interest. MPC,LSC/DO,MSF Respect for patient privacy and autonomy. MPC,LSC/DO,MSF Accountability to patients, society and the profession. MPC,LSC/DO,MSF Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. MPC,LSC/DO,MSF Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 Professionalism Milestones: Adhere to basic ethical principles P-A1 Document and report clinical information truthfully. (1 month) P-A2 Follow formal policies. (1 month) P-A3 Accept personal errors and honestly acknowledge them. (6 months) P-A4 Uphold ethical expectations of research and scholarly activity. (36 months) Demonstrate compassion and respect to patients P-B1 Demonstrate empathy and compassion to all patients. (3 months) P-B2 Demonstrate a commitment to relieve pain and suffering. (3 months) P-B3 Provide support (physical, psychological, social and spiritual) for suffering patients and their families. (24 months) P-B4 Provide leadership for a team that respects patient dignity and autonomy. (24 months) Provide timely, constructive feedback to colleagues 6 P-C1 Communicate constructive feedback to other members of the health care team. (12 months) P-C2 Recognize, respond to and report impairment in colleagues or substandard care via peer review process. (18 months) Maintain accessibility P-D1 Respond promptly and appropriately to clinical responsibilities including, but not limited to, calls and pages. (1 month) P-D2 Carry out timely interactions with colleagues, patients and their designated caregivers. (6 months) Recognize conflicts of interest P-E1 Recognize and manage obvious conflicts of interest, such as caring for family members and professional associates as patients. (6 months) P-E2 Maintain ethical relationships with industry. (30 months) P-E3 Recognize and manage subtler conflicts of interest. (30 months) Demonstrate personal accountability P-F1 Dress and behave appropriately. (1 month) P-F2 Maintain appropriate professional relationships with patients, families and staff. (1 month) P-F3 Ensure prompt completion of clinical, administrative, and curricular tasks. (6 months) P-F4 Recognize and address personal, psychological, and physical limitations that may affect professional performance. (12 months) P-F5 Recognize the scope of his/her abilities and ask for supervision and assistance appropriately. (12 months) P-F5.5 Demonstrate professional conduct at all times. (18 months) P-F5.6 Demonstrate good judgment to call for faculty assistance when appropriate. (18 months) P-F6 Serve as a professional role model for more junior colleagues (e.g., medical students, interns). (30 months) P-F7 Recognize the need to assist colleagues in the provision of duties. (30 months) Practice individual patient advocacy P-G1 Recognize when it is necessary to advocate for individual patient needs. (6 months) P-G2 Effectively advocate for individual patient needs. (30 months) Comply with public health policies P-H1 Recognize and take responsibility for situations where public health supersedes individual health (e.g. reportable infectious diseases) (24 months) Respect the dignity, culture, beliefs, values and opinions of the patient P-I1 Treat patients with compassion, dignity, civility and respect, regardless of race, culture, gender, ethnicity, age or socioeconomic status. (1 month) P-I2 Recognize and manage conflict when patient values differ from their own. (30 months) Confidentiality P-J1 Maintain patient confidentiality. (1 month) P-J2 Educate and hold others accountable for patient confidentiality. (18 months) Recognize and address disparities in health care 7 P-K1 Recognize that disparities exist in health care among populations and that they may impact care of the patient. (12 months) P-K2 Embrace physicians’ role in assisting the public and policy makers in understanding and addressing causes of disparity in disease and suffering. (36 months) P-K3 Advocates for appropriate allocation of limited health care resources. (36 months) Interpersonal and Communication Skills Competency Goal Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Learning Objectives - Residents are taught the following skills. Each resident is given multiple opportunities to demonstrate competence in: Communicating effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds. MPC,LSC, /DO,MSF ,MINICEX Communicating effectively with physicians, other health professionals, and health related agencies. MPC,LSC /DO,MSF, CA, PBLM, TOC, NFCA, NFMR, TPT, JCP Working effectively as a member or leader of a health care team or other professional group. MPC,LSC/DO,MSF, TOC, NFMR, TPT, JCP Acting in a consultative role to other physicians and health professionals. MPC,LSC,WRT/DO, CA, PBLM,MINICEX, JCP Maintaining comprehensive, timely, and legible medical records. MPC,LSC /DO, CA, TOC, NFCA Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 IPCS Milestones: Communicate effectively ICS-A1 Provide timely and comprehensive verbal and written communication to patients/advocates. (12 months) ICS-A2 Effectively use verbal and non-verbal skills to create rapport with patients/families. (12 months) ICS-A3 Use communication skills to build a therapeutic relationship. (12 months) ICS-A4 Engage patients/advocates in shared decision making for uncomplicated diagnostic and therapeutic scenarios. (24 months) ICS-A5 Utilize patient-centered education strategies. (24 months) ICS-A6 Engage patients/advocates in shared decision making for difficult, ambiguous or controversial scenarios. (36 months) ICS-A7 Appropriately counsel patients about the risks and benefits of tests and procedures highlighting cost awareness and resource allocation. (36 months) ICS-A8 Role model effective communication skills in challenging situations. (36 months) Intercultural sensitivity ICS-B1 Effectively use an interpreter to engage patients in the clinical setting including 8 patient education. (6 months) ICS-B2 Demonstrate sensitivity to differences in patients including but not limited to race, culture, gender, sexual orientation, socioeconomic status, literacy, and religious beliefs. (12 months) ICS-B3 Actively seek to understand patient differences and views and reflects this in respectful communication and shared decision-making with the patient and the healthcare team. (30 months) Transitions of care ICS-C1 Effectively communicate with other caregivers in order to maintain appropriate continuity during transitions of care. (12 months) ICS-C2 Role model and teach effective communication with next caregivers during transitions of care. (24 months) Interprofessional team ICS-D1 Deliver appropriate, succinct, hypothesis-driven oral presentations. (6 months) ICS-D2 Effectively communicate plan of care to all members of the health care team. (12 months) ICS-D3 Engage in collaborative communication with all members of the health care team. (30 months) Consultation ICS-E1 Request consultative services in an effective manner. (6 months) ICS-E2 Clearly communicate the role of consultant to the patient, in support of the primary care relationship. (12 months) ICS-E3 Communicate consultative recommendations to the referring team in an effective manner. (36 months) Health records ICS-F1 Provide legible, accurate, complete, and timely written communication that is congruent with medical standards. (6 months) ICS-F2 Ensure succinct, relevant, and patient-specific written communication. (24 months) ICS-F3 Write notes with appropriate details for disease severity/complexity, essential communication and coding/reimbursement. (30 months) Learning Activities MPC – Mentored Patient Care: Practical teaching and role modeling during direct patient care during clinical rotations. 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 9 Palliative Care Course Ultrasound Course Procedure Simulation Coding Course Professionalism WRT - Weekly Reading/Testing/Feedback Methods and Tools for Assessing Residents WT – Weekly Tests evaluating knowledge base for all competencies and subspecialties. 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 LB - Log Books for procedures NPF – Non-Physician Feedback (360° evaluation) evaluation by nurses, case managers, allied health personnel, and other team members assessing competency-based performance guided by PGY-specific, milestone-based assessment tool. Included in MSF. CA – Chart Audit (H&P; Progress Note) evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. PBLM - Problem Based Learning and Improvement module evaluation by qualified faculty assessing competency-based performance, guided by PGYspecific, milestone-based assessment tools. Mini-CEX – Mini Clinical Evaluation Exercise evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestonebased assessment tools with explicit performance criteria. TOC – Transition of Care evaluation by qualified faculty assessing competencybased performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. NFCA – Night Float Chart Audit (H&P) evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tool with explicit performance criteria. NFMR – Night Float Morning Report evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. TPT – Teaching Presentation Tool evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. JCP – Journal Club Presentation evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. 10 JCR – Journal Club Reflection evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. MM – Morbidity and Mortality reflection tool self-evaluation guided by PGYspecific, milestone-based assessment tools with explicit performance criteria. CPI – Clinic Practice Improvement evaluation by qualified faculty assessing competency-based performance, guided by PGY-specific, milestone-based assessment tools with explicit performance criteria. QI Course Test Duty Hours for Interns and Residents 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 11 hours free of duty between scheduled duty periods, there may be circumstances 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. Responsibilities, Supervision and Lines of Authority for Clinical Rotations 1. Team Composition: The typical ward team will consist of: 1 Attending (Faculty) 1 PGY-II or PGY-III (Resident) 1-2 PGY-I (Intern) 0-4 Junior Medical Students (JMS) 0-1 Acting Interns (Senior Medical Students, A I s) Other team members such as Case Managers, Nurses, Dieticians, Social Workers, etc. 2. Responsibilities of Members: a. Attending: Oversees team function and overall patient care Teaches house staff and medical students Monitors discharge planning and expeditious care of patient Accepts ultimate legal responsibility for patient's welfare Learns from other team members Assures attendance of team members at all required conferences. b. Resident: Is directly accountable to the attending for the entire service Writes a Resident Admit Note (RAN) on each admission. 12 Communicates diagnosis and plan of care to the patient's primary care physician. Leads work rounds by evaluating the intern treatment plan Plans discharges and coordinates patient follow-up Teaches interns and students, and sometimes faculty Assures attendance of self and team members to all required conferences. Faculty Notification: It is the responsibility of the resident to contact faculty immediately for the following issues: Potentially unstable patients Transfers to intensive care Deaths (expected and unexpected) Changes in patient status Procedures Unpleasant social issues Risk management issues Patients leaving or declining urgent treatment against medical advice Restricted drug/treatment approval Potential admissions better served on another service or with short-term outpatient follow-up c. Intern: Performs and records the admitting H & P on each patient Evaluates patients prior to work rounds so that he/she may develop a treatment plan for each of their patients Writes orders and daily notes Calls consultants "Checks out" the patients to the on call intern Teaches students, sometimes teaches resident and faculty Subspecialty Specific Logistics, Teaching, Evaluation, etc. 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 13 14