INTERNAL MEDICINE |
DEFINITION:An
internist is a specialist trained in the diagnosis and treatment of a
broad range of diseases involving all organ systems, and is especially
skilled in the management of patients who have undifferentiated or
multi-system disease processes. An internist cares for hospitalized and
ambulatory patients and may play a major role in teaching or research.
GENERAL OBJECTIVES:At the completion of training, each resident will demonstrate the ability to function at a consultant level in the following areas:
Perform a thorough and comprehensive history and physical examination in a reliable and efficient manner, and integrate and interpret this data on patients with either single or multi-system diseases.
Document a patient's history, physical examination and progress clearly and concisely in the medical record, and present the relevant history and physical findings in a coherent, confident and precise manner.
Formulate a comprehensive problem list from the initial data base, establish priorities, and formulate an effective diagnostic and therapeutic plan.
Demonstrate a detailed knowledge base on a wide variety of internal medicine problems including the related basic science, demonstrate the ability to acquire up to date information in an efficient fashion, and demonstrate knowledge in the areas of:
Manage a wide variety of common and uncommon medical problems, utilize community resources effectively, and implement presently accepted preventive measures, and as well, competently manage:
Interpret the results of all common diagnostic tests and demonstrate an understanding of their costs, limitations, and complications. Perform and interpret common diagnostic and therapeutic procedures and demonstrate an understanding of their limitations and complications.
Interpret published material, and appropriately incorporate this acquired information into clinical practice, and demonstrate a basic understanding of the principles of clinical epidemiology, biostatistics, and research design.
Assess a patient at the request of a referring physician and communicate effectively suggestions for the diagnosis and management in a relevant and focused manner, and demonstrate knowledge of the consultation process.
Communicate effectively with patients and their relatives, with colleagues, and with other health care providers, and communicate effectively through the medical records and other written correspondence.
Teach effectively and communicate the acquired broad base of knowledge and clinical skills to other health care providers.
Demonstrate the characteristics of being a reliable, thorough, ethical and compassionate physician who understands the impact of psychological, social and economic issues on his/her patients, recognizes his/her limitations and refers patients to subspecialists appropriately.
Evaluates and manages clinical problems through an analysis and evaluation of the relevant medical literature, generates new knowledge or expands conceptual understanding through the formulation of appropriate questions, and demonstrates a commitment to the concept of the importance of research to the practice of clinical medicine. Senior
Resident:
Residency programs in internal medicine must ensure that they:
Rotations within a community setting must be offered. The residency period will be characterized by graded responsibility and by increasing levels of independent decision-making under supervision. The senior resident will demonstrate a level of knowledge, clinical skills, technical skills, and attitudes consistent with independent consulting practice. For a brief period of training, the resident will assume a leadership role in any of the following areas: a General Internal Medicine teaching unit, a General Internal Medicine consultation service, or an Intensive Care Unit. Examination:
Eligibility to sit in Internal Medicine examination, the multiple choice portion, is achieved after the satisfactory completion of two years of core residency. CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM
There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty. The content and organization of each accredited program in internal medicine must be consistent with the specialty training requirements to meet the general objectives identified. Residency programs in internal medicine must ensure that they:
In addition to exposure to the different sites of practice, residents must receive experience in the broad range of medical subspecialties. RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in internal medicine. This standard is interpreted for internal medicine, as follows:
There must be a sufficient number of teaching staff with qualifications acceptable to the academy to provide appropriate teaching and supervision of residents. There must be a faculty member whose responsibility it is to facilitate the involvement of residents in research and other scholarly work.
The clinical teaching unit (CTU) must be a principal setting for clinical education. However, programs may also have teaching services that are not organized as CTUs. The purpose of the CTU is to provide a convenient method of designating patients who are educationally appropriate for assignment to housestaff, to promote patient care as a team responsibility, and to provide senior residents with an opportunity to supervise their more junior colleagues. In addition to fulfilling the general principles listed above, an appropriately organized CTU will incorporate the following: i. there must be an identifiable head (at any given time) with authority to enforce the regulations governing operation of the CTU; ii. the staff of the unit must function as a team dedicated to excellent patient care. The housestaff team may consist of clinical clerks, residents, and a senior or chief resident, each of whom must assume responsibility at a level commensurate with ability and experience; iii. the most senior resident, under the supervision of the head of the CTU, is responsible, through teaching and supervision, for seeing that each member of the housestaff team assumes professional responsibilities that are suitable for his or her ability and experience. This resident is responsible to the head of the unit in administrative matters and to the attending staff members for matters involving professional service to patients; iv. patients in the unit must be the responsibility of a member of the teaching staff; v. geographic unity of a CTU is preferred. If this is not possible, geographic dispersion must not interfere with the educational process. f. Internal Medicine There must be organized clinical teaching units in internal medicine to provide all residents with experience in this setting. Each clinical teaching unit should be under the direction of a general internist and the staff of the unit should include teachers who are engaged in the practice of internal medicine while on the CTU. Opportunities for resident education in other circumstances outside of the clinical teaching unit must provide a sufficient number of teaching faculty to ensure that there is appropriate teaching and supervision for all residents. The internal medicine CTUs must provide an adequate but not excessive volume of appropriate patients. Such will afford experience in the diagnosis and management of a wide variety of clinical problems seen in the practice of internal medicine. These teaching units must provide opportunities for residents to learn about the complete spectrum of illness in an in-hospital ward or ambulatory setting defined above. g. Clinical Subspecialties An adequate number of patients and specialized staff must be available for the teaching of residents in the specialized areas of medicine. In addition, residents should also have the opportunity to learn aspects of other disciplines relevant to the practice of internal medicine. The resources and teaching arrangements in other subspecialty areas engaged in the training of residents in internal medicine must be sufficient to meet the goals of the internal medicine residency program. h. Consultative Medicine Residents must be educated in the essential skills necessary to provide a consultative service in the subspecialties of medicine and general internal medicine including consultations on patients presenting with difficulties in the diagnosis and management of complex and life threatening conditions, perioperative care, and the medical complications of pregnancy.
Community experiences must provide a learning environment with appropriate supervision, patient encounters, and opportunities for evaluation based on rotation specific objectives. This assumes administrative support and linkages with the university. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to internal medicine. ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM
The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
Organized scholarly activities such as journal clubs, research conferences and seminars must be a regular part of every program. They must provide rational learning objectives, effective educational methods and appropriate methods of student and programmatic assessment. Service demands must not seriously interfere with the ability of the residents to follow the academic program.
The academic program must include teaching in the basic and clinical sciences relevant to internal medicine.
The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to internal medicine.
The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.
Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.
Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.
Residents must be given opportunities to develop skills in management as applied to internal medicine such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.
The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.
There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to participate in clinical research during the course of the residency program. Clinical research is defined as research involving human subjects or experimental studies of direct clinical relevance.
A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.
All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university. SPECIALTY REQUIREMENTS: Approved residency including
This may occur in the following areas, relevant to the objectives of Internal Medicine and approved by the Internal Medicine Program Director. PROGRAMS (WITH TRAINING REQUIREMENTS): Doctor
of Medicine(M.D):
Eighteen months of approved residency training. Doctor
of Philosophy(Ph.D):
Forty eight months(four years)of approved residency training. |