UTMB Internal Medicine Residency
Nephrology Clinics – PGY2
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, 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 outpatient practice of nephrology and the management
of outpatients with kidney diseases.
Patient Care
Competence Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of renal health problems and the promotion of renal health.
Learning Objectives - Residents are taught the following patient management skills.
Each resident is taught how to:
 Demonstrate accurate, complete, and relevant history-taking related to kidney
diseases. MPC,LSC,WR/ DO,CA, MINICEX,
 Demonstrate the ability to perform a focused and accurate physical examination
related to kidney diseases. MPC,LSC,WR/DO, CA, MINICEX
 Demonstrate the ability to arrive at an appropriate differential diagnosis, outline a
logical plan for specific and targeted investigations pertaining to the patient’s
complaints, and formulate a plan for management and follow-up treatment of the
patient with kidney diseases. MPC,LSC,WR/DO, CA, MINICEX
 Demonstrate the ability to effectively present the results of a consultation orally
and in writing and to defend the clinical assessment, differential diagnosis, and
diagnostic and management plans related to kidney diseases.
MPC,LSC,WR/DO,MSF,LB,CA, MINICEX
 Demonstrate proficiency in the management of disorders of the kidney including
disorders of mineral metabolism (nephrolithiasis and renal osteodystrophy);
disorders of fluid, electrolyte, and acid-base regulation; acute renal failure;
chronic renal failure and its management by conservative methods, including
nutritional management of uremia; end-stage renal disease; hypertensive
disorders; renal disorders of pregnancy; urinary tract infections; tubulointerstitial
renal diseases (inherited diseases of transport, cystic diseases, and other
congenital disorders); glomerular and vascular diseases (the glomerulonephritides,
diabetic nephropathy, and atheroembolic renal disease); genetic and inherited
renal disorders. MPC,LSC,WR/DO,MSF,LB,CA, MINICEX
 Demonstrate familiarity with issues related to renal transplantation including
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evaluation and selection of transplant candidates; administration of
immunosuppressants; clinical and laboratory diagnosis of rejection; medical
management of rejection; complications of transplantations; and the psychosocial
and ethical issues of renal transplantation. MPC,LSC,WR/DO,MSF,LB,CA,
MINICEX
Demonstrate familiarity with issues related to dialysis, including evaluation and
selection of patients for hemodialysis; medical complications in patients during
and between dialyses; long-term follow-up of patients undergoing chronic
dialysis; peritoneal dialysis; dialysis catheters; the psychosocial and ethical issues
of dialysis; and end-of-life care and pain management in the care of patients
undergoing chronic dialysis. MPC,LSC,WR/DO
Outcomes Assessments (Milestones) – Residents are evaluated through the assessment
tools for the achievement of the following PGY-2 Patient Care Milestones:
Historical Data Gathering
PC-A1 Acquire accurate and relevant history from the patient in an efficiently
customized, prioritized, and hypothesis driven fashion. (6 months)
PC-A2 Seek and obtain appropriate, verified, and prioritized data from secondary sources
(e.g. family, records, pharmacy) (9 months)
Performing a physical exam
PC-B1 Perform an accurate physical examination that is appropriately targeted to the
patient's complaints and medical conditions. Identify pertinent abnormalities using
common maneuvers. (6 months)
PC-B2 Accurately track important changes in the physical examination over time in the
outpatient and inpatient settings. (12 months)
Clinical Reasoning
PC-C1 Synthesize all available data, including interview, physical examination, and
preliminary laboratory data, to define each patient’s central clinical problem. (12
months)
PC-C2 Develop prioritized differential diagnoses, evidence-based diagnostic and
therapeutic plan for common inpatient and ambulatory conditions. (12 months)
Diagnostic tests
PC-E1 Make appropriate clinical decisions based upon the results 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)
PC-E2 Make appropriate clinical decision based upon the results of more advanced
diagnostic tests. (18 months)
Patient Management
PC-F1 Recognize situations with a need for urgent or emergent medical care including
life threatening conditions. (6 months)
PC-F2 Recognize when to seek additional guidance. (6 months)
PC-F3 Provide appropriate preventive care and teach patient regarding self-care. (6
months)
PC-F4 With supervision, manage patients with common clinical disorders seen in the
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practice of inpatient and ambulatory general internal medicine. (12 months)
PC-F5 With minimal supervision, manage patients with common and complex clinical
disorders seen in the practice of inpatient and ambulatory general internal medicine. (12
months)
PC-F6 Initiate management and stabilize patients with emergent medical conditions. (12
months)
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-G1 Provide specific, responsive consultation to other services. (24 months)
PC-G2 Provide internal medicine consultation for patients with more complex clinical
problems requiring detailed risk assessment. (36 months)
Medical Knowledge
Competence Goal
Residents must demonstrate knowledge of biomedical, clinical, epidemiological, and
social-behavioral sciences, as well as the application of this knowledge to the care of
outpatients with renal diseases.
Learning Objectives– Residents are taught to be competent in the knowledge of these
areas. Each resident is given multiple opportunities to demonstrate competence in:
 Demonstrate a core fund of knowledge in anatomy, physiology, pathology, and
pathophysiology as they relate to renal diseases. MPC,LSC,WR/DO, WT
 Demonstrate a core fund of knowledge in pathogenesis, natural history, and
management of diseases of the kidney and urinary tract including mineral
metabolism and its alteration in renal diseases, metabolic bone disease, and
nephrolithiasis; normal and abnormal blood pressure regulation; clinical
pharmacology; nutritional aspects of renal disorders; immunology of renal
disease; diagnostic immunology relevant to renal diseases; disorders of fluids and
electrolytes and acid-base balance; and renal diseases associated with systemic
disorders. MPC,LSC,WR/DO
 Demonstrate a core fund of knowledge in renal transplantation, including ;
indications for and contraindications to renal transplantation; rejection;
psychosocial aspects of organ donation and transplantation. MPC,LSC,WR/DO
 Demonstrate a core fund of knowledge in in issues related to dialysis its
complications. and extracorporeal therapy, including: the kinetic principles of
hemodialysis and peritoneal dialysis; the indication for each mode of dialysis; the
short-term and long-term complications. MPC,LSC,WR/DO
 Demonstrate a core fund of knowledge in appropriate utilization and
interpretation of clinical laboratory, radionuclide, and radiologic studies for the
diagnosis of renal diseases. MPC,LSC,WR/DO
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Outcomes Assessments (Milestones) – Residents are assessed through the assessment
tools for the achievement of the following PGY-2 Knowledge Milestones:
Knowledge of core content
MK-A1 Understand the relevant pathophysiology and basic science for common medical
conditions. (6 months)
MK-A2 Demonstrate sufficient knowledge to diagnose and treat common conditions that
require hospitalization. (12 months)
MK-A3 Demonstrate sufficient knowledge to evaluate common ambulatory conditions.
(18 months)
MK-A4 Demonstrate sufficient knowledge to diagnose and treat undifferentiated and
emergent conditions. (18 months)
MK-A5 Demonstrate sufficient knowledge to provide preventive care. (18 months)
MK-A6 Demonstrate sufficient knowledge to identify and treat medical conditions that
require intensive care. (24 months)
MK-A6.5 Demonstrate sufficient knowledge to diagnose and treat most patients on a
GIM ward. (18 months)
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-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-B3 Understand prior probability and test performance characteristics. (18 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 their
knowledge and expertise, to set learning improvement goals, to use information
technology to locate scientific studies related to their patients’ health problems, to
critically appraise clinical studies, to teach and to facilitate the learning of other
students and health care professionals. MPC,LSC,WR/DO, PBLM
 The skill and habit of incorporating formative evaluation feedback into daily
practice. MPC,LSC,/DO, PBLM
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The skill and habit of participating in the education of patients, families, students,
residents and other health professionals. MPC,LSC/DO, PBLM , MINICEX
Outcomes Assessments (Milestones) – Residents are assessed through the assessment
tools for the achievement of the following PGY-2 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
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
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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)
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 an outpatient setting, using systems relevant to
that setting. MPC/DO,MSF ,TOC
 The ability to coordinate patient care in an outpatient setting.
MPC,LSC,/DO,MSF ,TOC
 The ability to incorporate considerations of cost awareness and risk-benefit
analysis in an outpatient setting as appropriate. MPC,LSC,/DO,MSF ,TOC
 The ability to advocate for quality outpatient care and optimal outpatient care
systems. MPC,LSC,QIcourse/DO,MSF,
 The ability to work in interprofessional teams to enhance patient safety and
improve outpatient care quality. MPC,LSC,/DO,MSF ,TOC
 The ability to participate in identifying system errors and implementing potential
systems solutions. MPC,LSC,QIcourse/DO,MSF
 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
 The ability to recognize and function effectively in high-quality care systems.
MPC,LSC,/DO,MSF
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Outcomes Assessments (Milestones) – Residents are assessed through the assessment
tools for the achievement of the following PGY-2 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
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-2 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)
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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
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)
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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
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 and families 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
 Working effectively as a member of a health care team. MPC,LSC/DO,MSF
 Maintaining comprehensive, timely, and legible medical records. MPC,LSC /DO,
CA
Outcomes Assessments (Milestones) – Residents are assessed through the assessment
tools for the achievement of the following PGY-2 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
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ICS-B1 Effectively use an interpreter to engage patients in the clinical setting including
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
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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
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 Quality Improvement Course
 Palliative Care Course
 Ultrasound Course
 Procedure Simulation
 Coding Course
 Professionalism
WRT - Weekly Reading/Testing/Feedback
Methods and Tools for Assessing Residents
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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
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assessment tools with explicit performance criteria.
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
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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.
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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
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
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Writes a Resident Admit Note (RAN) on each admission.
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:
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c. Intern:
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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
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
Educational Resources
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UTMB Library Homepage with access to filtered and unfiltered resources,
including:
o ACP Pier
o DynaMed
o Textbooks
o Up-to-Date
o Cochrane
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o PubMed
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