Learning Objectives and Milestones:
At the end of Internal Medicine Residency, the learner will be able to:
Competency: Patient Care
Milestone: Historical Data Gathering (PC 1)
1. Obtain an accurate, detailed and relevant history of a new complaint in an
efficiently customized, prioritized and hypothesis driven fashion. Mini-CEX;
Global evaluation
2. Obtain an accurate, detailed and verified history of current medication use
employing secondary sources if necessary (family, pharmacy, medical records)
Mini-CEX; Global evaluation
3. Obtain an accurate, detailed and verified history of chronic pain employing
secondary sources if necessary (family, pharmacy, medical records) Mini-CEX
4. Obtain a complete past medical history for a patient’s active clinical problems in
an efficient and customized fashion utilizing secondary sources when necessary
(family, medical records) Direct Observation; Global evaluation
Milestone: Performing a physical exam (PC 2)
1. Perform an accurate, focused physical examination that is appropriately targeted
to the patient’s complaints and medical conditions. Identify pertinent
abnormalities using common maneuvers. Mini-CEX; Global evaluation
2. Perform an accurate cardiovascular examination identifying subtle or unusual
findings that may influence clinical decision making. Mini-CEX
3. Perform an accurate lung examination identifying subtle or unusual findings that
may influence clinical decision making. Mini-CEX
4. Perform an accurate abdominal examination identifying subtle or unusual
findings that may influence clinical decision making. Mini-CEX
5. Perform an accurate musculoskeletal examination identifying subtle or unusual
findings that may influence clinical decision making. Mini-CEX
6. Perform an accurate neurological examination identifying subtle or unusual
findings that may influence clinical decision making. Mini-CEX
7. Perform an accurate pelvic examination identifying subtle or unusual findings
that may influence clinical decision making. Mini-CEX
8. Perform an accurate knee examination identifying subtle or unusual findings that
may influence clinical decision making. Mini-CEX
9. Perform an accurate shoulder examination identifying subtle or unusual findings
that may influence clinical decision making. Mini-CEX
10. Perform and accurate hip examination identifying subtle or unusual findings that
may influence clinical decision making. Mini-CEX
Milestone: Patient Management (PC 3)
1. Develop prioritized differential diagnoses, evidence-based diagnostic and
therapeutic plan for common ambulatory conditions. Direct observation;
documentation
2. Provide appropriate, patient-centered preventive care. Direct observation;
documentation
3. Teach patient about self-care. Patient/nursing evaluations
4. Create an updated active problem list complete with clinical goals. Direct
observation; documentation
5. Customize care in the context of the patient’s preferences and overall health.
Direct observation; patient evaluations
Competency: Medical Knowledge (MK 1)
Milestone: Knowledge of Core Content
Complete all assigned knowledge modules with acceptable passing post-test
scores. Report from curriculum product; Global Evaluation
Competency: Practice-based Learning and Improvement (PBLI 2)
Milestone: Improve the quality of care for a panel of patients (Team-based)
1. Appreciate the responsibility to assess and improve care collectively for a panel
of patients. Direct observation, Team evaluation
2. Review an audit of a panel of patients using standardized, disease-specific, and
evidence-based criteria. Direct observation, Team evaluation, test
3. Reflect an audit compared with local or national benchmarks and explore
possible explanations for deficiencies, including doctor-related, system-related
and patient-related factors. Direct observation, Team evaluation
4. Identify areas in resident’s own practice and local system that can be changed to
improve the processes and outcomes of care. Direct observation, Team
evaluation
5. Engage in a quality improvement intervention. Direct observation, Team
evaluation, QI score
Competency: Interpersonal and Communication Skills
Milestone: Communicate Effectively with patients and caregivers (ICS 1)
1. Provide timely and comprehensive verbal and written communication to
patients/advocates (including telephone skills). Test; Patient, faculty, nurse
evaluations
2. Effectively uses verbal and non-verbal skills to create rapport with
patients/families and build therapeutic relationships. Direct observation, nurse
and patient evaluations
3. Utilizes patient-centered education strategies. Mini-CEX “Teach-Back”
4. Engage patients/advocates in shared decision-making for difficult, ambiguous or
controversial scenarios. Mini-CEX
5. Follows-up on the results of diagnostic tests and studies appropriately in a timely
fashion, and communicates the results to the patient and other members of the
healthcare team as needed. Faculty, peer, nursing, patient evaluations
Milestone: Communicates effectively in interprofessional teams (ICS 2)
Effectively communicate plan of care to all members of the health care team.
Peers, faculty, nursing evaluations
Competency: Professionalism
Milestone: Has professional and respectful interactions with patients,
caregivers, and members of the interprofessional team (PROF 1)
1. Dress and behave appropriately. Peer, faculty, nursing, intern, student, patient
evaluations
2. Maintain appropriate professional relationships with patients, families and staff.
Peer, faculty, nursing, intern, student, patient evaluations
3. Recognize the need to assist colleagues in the provision of duties (team player).
Peer, faculty, nursing, intern, student evaluations
Milestone: Demonstrate Personal Accountability (PROF 2)
1. Ensure prompt completion of clinical, administrative and curricular tasks
(including attendance at required conferences and team meetings). Peer,
faculty, nursing evaluations
2. Recognize the scope of his/her abilities and ask for supervision and assistance
appropriately. Peer, faculty, nursing, intern evaluations
Competency: Systems-based Practice
Milestone: Works Effectively within an interdisciplinary team (SBP 1)
Demonstrate the ability to manage the patient-care improvement team by
utilizing the skills and coordinating the activities of interprofessional team
members as they work to improve care-delivery and clinical outcomes. Peer,
faculty, nursing, evaluations
1.
2.
3.
4.
Milestone: Identifies forces that impact the cost of health care and advocates
for cost-effective care (SBP 3)
Reflect awareness of common socio-economic barriers that impact patient care.
Test, Direct observation
Understand how cost-benefit analysis is applied to patient care (i.e. via principles
of screening tests and the development of clinical guidelines). Test
Identify the role of various health care stakeholders including providers,
suppliers, financiers, purchasers and consumers and their varied impact on the
cost of and access to health care. Test
Code outpatient visits and procedures appropriately. Direct observation, chart
audit
General Internal Medicine Affiliated Specialties Learning Objectives
Orthopedics:
1. Diagnose and treat common shoulder complaints
2. Diagnose and treat common hip complaints
3.
4.
5.
6.
Diagnose and treat common knee complaints
Diagnose and treat common back complaints
Appropriately refer patients for joint replacement surgery
Understand the indications for injections of the knee, subacromial bursa and
trochanteric bursa
Psychiatry:
1. Diagnose and treat major depression
2. Diagnose and treat generalized anxiety disorder
3. Appropriately counsel patients suffering from substance abuse
4. Recognize the interaction of chronic pain and mental health disorders
Allergy:
1. Perform a detailed history and physical in patients with environmental allergies
2. Perform a detailed history and physical in patients with asthma
3. Recall the differential diagnosis of urticaria
4. Understand the indications for allergy testing
5. Prescribe appropriate treatment for patients with environmental allergies
6. Prescribe appropriate treatment for patients with asthma
7. Utilize national asthma guidelines for the management of patients with asthma
Dermatology:
1. Learn to perform a complete skin exam and be able to properly describe lesions,
their distribution, and arrangement
2. Understand the basics of dermatologic therapy including proper use of topical
corticosteroids and indications for phototherapy
3. Become aware of which patients need referral to a dermatologist, either on a
routine or expedited basis
4. Diagnose and treat common skin rashes such as psoriasis, eczema and contact
dermatitis
5. Recognize suspicious skin lesions requiring biopsy
6. Recognize common subcutaneous lesions such as epidermal inclusion cyst and
lipoma
7. Diagnose and treat acne vulgaris
8. Perform shave biopsies, punch biopsies and skin tag removal
ENT:
1. Evaluate and manage a patient with cough
2. Evaluate and manage a patient with rhinorrhea
3. Evaluate and manage a patient with change in voice
4. Evaluate and manage a patient with chronic sinusitis
5. Evaluate and manage a patient with Eustachian tube dysfunction
Sleep Clinic:
1. Perform a detailed history and physical in patients with a complaint of daytime
sleepiness or poor sleep quality
2. Counsel a patient on good sleep hygiene
3. Interpret an overnight sleep study
4. Recall the indications for performance of an overnight sleep study
GYN/Women’s Health:
1. Prescribe appropriate family planning medications for patients and recognize
other methods of family planning along with the adverse effects and indications
for each
2. Perform adequate pelvic exams for preventative and diagnostic purposes,
including office evaluation of wet preps
3. Recite the indications and intervals for Pap testing and manage abnormal Pap
results
4. Recognize and manage domestic violence
5. Manage common gynecologic problems including dysmenorrhea, abnormal
menstrual bleeding patterns and vaginal discharge
6. Manage complaints related to menopause including menopausal symptoms and
postmenopausal bleeding
7. Evaluate and manage uncomplicated urinary incontinence; Recognize need for
referral
Preop clinic:
1. Obtain a relevant history for preoperative evaluation –direct observation
2. Evaluate a patient for perioperative cardiac risk based on current AHA/ACC
recommendations – direct observation
3. Prescribe cost-effective and evidence based preoperative testing based on the patient’s
perioperative cardiac risk factors – direct observation
4. Communicate preoperative management to consulting surgeons using evidence based
findings – chart review
5. Advise appropriate medication management preoperatively including recommendations
for chronic blood pressure medicines, diabetes medications, CKD, CHF, COPD – chart
review, direct observation
6. Recommend appropriate management of anticoagulants perioperatively for patients
with atrial fibrillation, history of DVT/PE and valvular disease – chart review
7. Recommend appropriate anticoagulant treatment for the prevention of DVT/PE in the
perioperative period – chart review
Pharmacotherapeutics:
Management of Chronic Anticoagulation
1. Outline INR goals according to Chest guidelines for patients with mechanical
heart valve replacement, atrial fibrillation, DVT and PE.
2. Adjust warfarin dose by protocol to maintain INR goal
3. Explain the indications for bridging therapy in the patient treated with chronic
anticoagulants for the above conditions
4. Counsel the patient treated with anticoagulants regarding interaction of diet,
over the counter therapies and prescribed medication classes with warfarin
Diabetes Education
1. Educate patients on carbohydrate counting
2. Demonstrate insulin administration for a patient, and ensure good patient
technique
3. Explore barriers to lifestyle change in the treatment of diabetes
Medication Reconciliation
1. Elucidate an accurate history of medication use from a patient using a variety of
resources, and including over the counter medications and supplements
2. Recommend changes to medication regimens to avoid side effects and drug-drug
interactions
RAC
1.
2.
3.
4.
5.
6.
7.
8.
9.
Appropriately diagnose and treat URI
Appropriately diagnose and treat UTI
Appropriately diagnose and treat Pharyngitis
Appropriately diagnose and treat Sinusitis
Appropriately diagnose and treat Cough
Appropriately diagnose and treat Gastroenteritis
Utilize an evidence-based approach to the diagnosis and treatment of acute abd pain
Utilize an evidence-based approach to the diagnosis and treatment of acute Back pain
Utilize an evidence-based approach to the diagnosis and treatment of acute Joint
pains/sprains
10. Appropriately diagnose and treat Ear complaints
11. Appropriately diagnose and treat Vaginitis
12. Appropriately diagnose and treat Red eye
HDC/ED – Transitions of Care
1. Work with a PharmD and nursing to perform a complete medication reconciliation
2. Understand the elements needed to bill the 2013 “Transitions of Care” code
3. Function as a member of an Interprofessional healthcare team in the delivery of
transitional care
4. Critically examine a discharge summary for clinic utility
5. Understand magnitude of hospital readmission rates at MUSC and nationwide
SS Acute Visits
1. Function as a member of an Interprofessional healthcare team in the delivery of care to
sickle cell patients
2. Recognize the utility of and apply acute care treatment plans for the patient with sickle
cell disease
3. Diagnose and treat complications of SS manifesting as pain
4. Apply the indications for blood transfusion in the patient with sickle cell
5. Understand the indications and the principles of management for hydroxyurea
6. Recognize sickle cell disease as an illness characterized by chronic pain
Pulmonary
1. Diagnose and treat patients with cough
2. Diagnose and treat patients with dyspnea
3. Diagnose and treat patients with COPD
4. Diagnose and treat patients with Asthma
5. Diagnose and treat patients with Sarcoidosis
6. Diagnose and treat patients with a pulmonary nodule
7. Become familiar with the indications for the following studies: bronchoscopy
with BAL and transbronchial biopsy, cardiopulmonary exercise testing, Chest CT,
diagnostic studies for deep venous thrombosis, mediastinoscopy, pleural fluid
analysis, pulmonary angiography, sleep study and ventilation perfusion scans.
Oncology/Hematology
1.
2.
3.
4.
5.
Diagnose and treat patients with anemia and erythrocytosis
Diagnose and treat patients with Thrombocytopenia and thrombocytosis
Diagnose and treat patients with Leukopenia and leukocytosis
Diagnose and treat patients with Coagulopathies and anticoagulant therapy
Understand the Principles of and indications for transfusion of various blood
products
6. Understand the Principles of carcinogenesis, Broad principles of cancer diagnosis
and treatment
7. Diagnose and treat patients with a wide variety of cancers including: Cancer of
the head and neck, Cancer of the lung and mediastinum, Cancer of the
esophagus and stomach, Cancer of the pancreas, liver, biliary tract, and small
intestine, Colorectal and anal cancer, Cancer of the kidney and bladder, Cancer
of the prostate, Cancer of the testis and other germ-cell neoplasms, Breast
cancer, Soft tissue and bone sarcomas, Cutaneous, intraocular, and visceral
melanomas, Central nervous system neoplasms, Lymphomas, leukemias, and
pancytopenia, Plasma cell neoplasms, Paraneoplastic syndromes, Cancers of
unknown primary site, Cancers in AIDS
8. Describe the Adverse effects of common cancer treatments
9. Understand available resources for Supportive care and enhancement of quality
of life in cancer patients
Cardiology
1. Develop experience and expertise in interpretation of 12-Lead
electrocardiograms.
2. Develop experience and expertise in interpretation of 24-hour ambulatory ECG
recordings.
3. Develop expertise and technical skill in the performance of exercise stress
testing.
4. Understand the indications for invasive and non-invasive cardiac diagnostic
studies.
5. Diagnose and treat patients with coronary artery disease, heart failure and
cardiomyopathies, valvular disease, pericardial disease, and arrhythmias.
6. Perform an accurate and reliable cardiac examination
7. Describe the pharmacologic properties and toxic effects of commonly used
cardiovascular drugs.
Gastroenterology
1. Diagnose and treat patient with inflammatory bowel disease including Crohn’s
and ulcerative colitis
2. Diagnose and treat patient with diarrheal illnesses,
3. Diagnose and treat patient with acute and chronic pancreatitis
4. Diagnose and treat patient with complex nutritional issues such as short bowel
syndrome
5. Diagnose and treat patient with achalasia and other disorders of the esophagus,
gastroesophageal reflux disease, peptic ulcer disease and chronic abdominal pain
6. Diagnose and treat Diverticular disease
7. Understand the indications, contraindications, and limitations of common
gastroenterology procedures including esophagogastrocuodenoscopy (EGD),
colonoscopy, endoscopiccholangiopancreatography (ERCP), as well as
endoscopic ultrasound.
Infectious Disease
1. Understand the principles of appropriate antibiotic use.
2. Recognize appropriate evaluation and treatment of osteomyelitis.
3. Recognize the side effects of antiretroviral agents used in treating AIDS.
4. Evaluate and manage HIV infection and its complications,
5. Evaluate and manage infections in the immunocompromised host, including
infections in patients who suffer from malignancy and its complications, and
those who have received solid organ or bone marrow transplants
6. Manage antibiotic administration and peripherally inserted central catheter
(PICC) lines both in the outpatient clinic and home setting,
7. Diagnose and manage viral hepatitis, including hepatitis B and C,
8. Diagnose and treat sexually transmitted diseases and infections of the
reproductive organs,
9. Understand the prevention, diagnosis and management of diseases associated
with international travel, including tropical infectious diseases
10. Understand the appropriate use of the Clinical Microbiology Laboratory and
how clinical specimens are processed and microorganisms are identified.
Endocrinology
1. Recognize the signs, symptoms, and appropriate therapy of hypothyroidism and
hyperthyroidism
2. Understand the presentation, pathophysiology, natural history and treatment of
Type 1 and Type 2 Diabetes Mellitus.
3. Recognize and learn appropriate therapy for various types of hyperlipidemia.
4. Diagnose and manage diseases of bone mineral metabolism including
osteoporosis, parathyroid disease, and Paget’s disease.
5. Learn the common causes and understand management of pituitary dysfunction
including hypopituitarism and hormonal overproduction.
6. Recognize the causes, work-up, and therapy of hirsutism and virilizing states.
7. Learn appropriate evaluation of adrenal syndromes including adrenal
insufficiency, hypercortisolism, mineralocorticoid excess, and incidental adrenal
masses.
8. Diagnose and treat changes in menstrual, gonadal/sexual function
Nephrology
1. Evaluate and manage glomerular disease
2. Evaluate and manage the progression of chronic renal failure (mostly diabetic
nephropathy)
3. Evaluate and manage urinary tract infections
4. Evaluate and manage lupus nephritis
5. Iterate the indications for percutaneous renal biopsy
6. Understand the indications for initiation of dialysis
7. Discuss risks and benefits of hemodialysis vs. peritoneal dialysis
8. Evaluate and manage renovascular hypertension
9. Evaluate and manage hypertension
10. Evaluate and manage renal stone disease –
11. Evaluate and manage renal cystic disease