To equip IM residents to manage health problems found in non-US areas and to promote health in adults traveling, working, or living in non-US areas.
Competence Goal
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems found in non-US areas and the promotion of health in adults traveling, working, or living in non-US areas .
Learning Objectives - Residents are taught the following patient care skills. Each resident is taught how to:
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Demonstrate accurate, complete, and relevant history-taking skills related to illnesses found in non-US areas.
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Demonstrate the ability to perform a comprehensive and accurate physical examination related to illnesses found in non-US areas.
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Demonstrate the ability to formulate a differential diagnosis, investigative evaluation, and plan for management and follow-up for patients with illnesses found in non-US settings.
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Demonstrate the ability to impact patient care in non-US areas in a variety of roles, including direct provider, member of a multi-disciplinary team, a consultant to other physicians, and a teacher to the patient and other physicians.
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Demonstrate the ability to provide patient care in a variety of non-US health care settings to include the inpatient ward, the critical care units, the emergency setting and the ambulatory setting.
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Demonstrate the ability to treat non-US patients with practices that are safe, scientifically based, effective, efficient, timely, and cost effective.
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)
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Invasive procedures
PC-D2 Appropriately performs point-of-care ultrasound and provides 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)
Competence Goal
Residents must demonstrate knowledge of non-US health problems, as well as the application of this knowledge to patient care.
Learning Objectives– Residents are taught knowledge of non-US health problems. Each resident is given multiple opportunities to demonstrate competence in:
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The knowledge of the broad spectrum of clinical disorders seen in the practice of internal medicine in non-US areas.
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The knowledge non-clinical topics at a level sufficient to practice internal medicine in non-US areas.
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The knowledge to provide basic preventive care to patients traveling, working, or living in non-US areas.
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The knowledge to order and interpret basic clinical tests and images related to non-US illnesses.
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The knowledge to recognize and provide initial management of emergency medical problems related to non-US illnesses.
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The knowledge to use common pharmacotherapy for non-US illnesses.
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The knowledge to appropriately use and perform diagnostic and therapeutic procedures for non-US illnesses.
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)
MK-A8 Understand the relevant pathophysiology and basic science for uncommon or complex medical conditions. (36 months)
MK-A9 Demonstrate sufficient knowledge of socio-behavioral sciences including but not limited to health care economics, medical ethics, and medical education. (36 months)
Diagnostic tests
MK-B5 Understand prior probability and test performance characteristics. (36 months)
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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 related to non-US health problems.
Learning Objectives – Residents are taught the following skills and habits. Each resident is given multiple opportunities to demonstrate:
 The skill and habit of locating, appraising, and assimilating evidence from scientific studies related to non-US health problems.
 The skill and habit of using information technology to optimize learning about non-US health problems.
 The skill and habit of participating in the education of students, residents and other health professionals in non-US health problems.
Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 PBLI Milestones :
Acquires the best evidence
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-D3 With assistance, appraise study design, conduct, and statistical analysis in clinical research papers. (36 months)
Applies the evidence to decision-making for individual patients
PBLI-E3 Communicate risks and benefits of alternatives to patients. (36 months)
PBLI-E4 Integrate clinical evidence, clinical context, and patient preferences into decisionmaking. (36 months)
Participates in the education of all members of the health care team
PBLI-H2.1 Give honest assessment and feedback for interns who are supervised. (36 months)
PBLI-H3 Take a leadership role in the education of all members of the health care team. (30 months)
Competence Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and system of non-US 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 work effectively in non-US health care delivery settings.
 The ability to understand heath systems in resource poor areas and to define the needs for systemic change for disadvantaged and vulnerable people worldwide.
 The ability to advocate for quality patient care and optimal patient care systems in non-US settings.
 The ability to define, recognize, and contribute to high-quality care systems in various non-US settings.
Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 SBP Milestones :
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Works effectively within multiple health delivery systems
SBP-A3 Negotiate patient-centered care among multiple care providers. (36 months)
Works effectively within an interprofessional team
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-C5 Demonstrate ability to understand and engage in a system level quality improvement intervention. (36 months)
SBP-C6 Partner with other healthcare professionals to identify, propose improvement opportunities within the system. (36 months)
Practices cost-effective care
SBP-E4 Demonstrate the incorporation of cost-awareness principles into complex clinical scenarios. (36 months)
Competency Goal
Residents must demonstrate a commitment to compassion, respect and integrity related to non-US health problems.
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 patients, health workers, health educators worldwide.
 Meeting expectations and professional commitments related to the global health tract.
 Sensitivity and responsiveness to diverse populations and cultures worldwide.
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-A4 Uphold ethical expectations of research and scholarly activity. (36 months)
Demonstrate personal accountability
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-G2 Effectively advocate for individual patient needs. (30 months)
Respect the dignity, culture, beliefs, values and opinions of the patient
P-I2 Recognize and manage conflict when patient values differ from their own. (30 months)
Recognize and address disparities in health care
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)
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 in non-US populations.
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Learning Objectives - Residents are taught the following skills. Each resident is given multiple opportunities to demonstrate competence in:
 Communicating effectively with patients, families, educators, and health workers across a broad range of socioeconomic and cultural non-US backgrounds.
 Communicating effectively with non-US physicians, health professionals, and health related agencies.
 Working effectively as a member or leader of a health care team or other professional group in a non-US setting.
 Acting in a consultative role to other physicians and health professionals about non-US health problems.
 Maintaining comprehensive, timely, and legible global health portfolio documenting progressive competence and achievement of Goals and Objectives.
Outcomes Assessments (Milestones) – Residents are assessed through the assessment tools for the achievement of the following PGY-3 IPCS Milestones :
Communicate effectively
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-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)
Interprofessional team
ICS-D3 Engage in collaborative communication with all members of the health care team. (30 months)
Residents will function under the supervision and authority of the following Internists:
Evelyn Mbugwa, MBChB, M.Med. – Supervising Physician, Internal Medicine, Kijabe
Hospital
Scott Myhre, MD – Supervising Physician, Adult Ward, Kijabe Hospital
August Hein, MD – Supervising Physician, Adult Ward, Kijabe Hospital
Residents will thoroughly integrate into the teaching structure outlined by Dr. Achieng or her subordinate. Residents will be ready to present teaching conferences on specific topics, cases, or journal articles.
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Practical Teaching and Role Modeling During Direct Patient Care
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Lectures/Seminars/Conferences
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Grand Rounds
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Noon Conference
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Residents Conference
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Direct observation by qualified faculty guided by explicitly stated performance criteria and standard for proficiency
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Assessment of relevant PGY3 Milestones by Dr. Mbugwa and her designated staff.
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Global assessment by qualified faculty
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ITE - In-Training Exam
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LB - Log books for procedures
 The residency program follows the ACGME Duty Hour Requirements.
 Duty hours are limited to 80 hours per week, averaged over a four-week period,
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 inclusive of all in-house call activities.
Residents are provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
A 10-hour time period for rest and personal activities should be provided between all daily duty periods, and after in-house call.
The maximum of 24-hour continuous call, followed by up to 6 hours for transfer of care and educational activities is strictly implemented.
As per the expressed and written policies of Kijabe Hospital and under the discretion and supervision of Dr. Evelyn Mbugwa or her designated physician.
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