To support the goal of avoiding fragmentation in both the residents’ clinical experience and educational opportunities, the Internal Medicine Residency Program has chosen to focus on the following schedule grouping didactics and other educational opportunities around a weekly academic half-day.
Every Friday afternoon from 1:00 p.m. to ~ 5:00 p.m., a series of topical core conferences are presented supervised by faculty. These conferences cover the major topics in General Internal Medicine and the Internal Medicine subspecialties. Acute care as well as interdisciplinary topics and issues arising in ambulatory and extended care settings are covered. The core curriculum series repeats every 18 months with revisions in content and presentation methods based on resident and faculty feedback. Formats include didactic settings, small group discussions, as well as simulation use. In addition to core Internal Medicine topical discussions, the following are incorporated into academic half-days (AHD) and other noontime conferences:
Acute Care/Ambulatory Preparation Series
All AHD in July are devoted to core topics relevant to preparing new interns/upper level residents for their inpatient service and continuity clinic experience. The series includes pertinent acute care topics, a seminar on EKG reading, and simulation experience at the Redmond Interdisciplinary Simulation Education Center (RISE Center).
Journal Club/Keefe conference
Peer-reviewed journal articles are presented lead by residents and supervised by Dr. Brian Keefe, senior core faculty, who leads discussions focusing on a systematic analysis of the article according to the fundamentals of evidence-based medicine. All residents are expected to attend. Faculty are also welcome.
RESIDENT CASE PRESENTATION
Residents deliver a short case presentation as an unknown as peers utilize group discussion to identify a differential diagnosis utilizing clinical reasoning techniques. The presentations and discussion is supported by faculty guidance and input. All residents are expected to participate at least once per academic year.
high value care Conference
High Value Care (HVC) topics are presented for discussion. Faculty present a clinical topic based on either a patient-case question in the PICO format or a case exemplifying a decision based on the cost and efficiency ethic. This allows for both the development of skills in evaluating the medical literature and group education in areas specific to active patient care.
The Ambulatory Core Curriculum will be integrated into the AHD and supplemented by an electronic syllabus utilizing the Johns Hopkins Ambulatory Internal Medicine Curriculum. Residents are assigned relevant topics throughout the 18 month curriculum applicable to the AHD topic.
PGY-1 residents are provided topical board-type reviews utilizing the Mayo Clinic Review modules, which are video-based presentations. These interactive sessions focus on broadening knowledge base and achieving familiarity with topics that are emphasized on the ABIM/AOBIM certifying examination. During the sessions, study questions are reviewed to reinforce clinical knowledge and test taking strategies. In addition, MKSAP is provided for our residents starting with the PGY-2 year free of charge by the Program.
Starting in July of 2017, Internal Medicine Grand Rounds will take place monthly in Redmond Regional’s main conference center. Grand Rounds are given by a variety of faculty as well as invited guest-experts, and may include topical reviews, case-based presentations, research presentations, and so on. All Redmond Internal Medicine residents are required to attend. All faculty as well as community physicians are invited.
NOON Report/M & M and Patient Safety Conference
Every second Monday, a case (or cases) is presented with a focus on clinical reasoning and patient safety. Clinical quality improvement issues such as near misses or actual adverse clinical events are also presented in a CQI format. Systems issues may be discussed as opportunities for improvement and not individual errors. These conferences are an integral part of the core curriculum as well as the medical system’s Quality Improvement and Patient Safety initiatives.
Values, ethics and Medical Humanities Conference
Once monthly, a patient-centered case or medical humanities topic is presented. Patient-centered cases may focus on bioethical, socio-cultural, spiritual/religious, suffering, discrimination, death and dying, and other topics relevant to human values. Interesting medical humanities topics such as history, art, music, literature, and the like may also be presented during these sessions. The conference takes place in Redmond Regional’s main conference center. All Redmond Internal Medicine residents are required to attend. All faculty as well as community physicians are invited.
program director conference
Every second Monday, a virtual case is presented and discussion is guided by Internal Medicine Program Director, Dr. Daniel Robitshek. Cases are often pulled from core medicine topics through the American College of Physicians virtual patient data bank. Discussion is held with a focus on clinical reasoning and management skills, with review of clinical guidelines. Integrating High Value Care principles is an important component of these conferences.
MORNING AND EVENING HAND-OFF REPORT
Every morning and evening, designated on-site residents will meet supervised by a faculty designate, nocturnist for a brief (15-20 minute) sign-out and discussion of admissions to the teaching services. Focused feedback is provided on the hand-off process.
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”
– William Osler
SIMULATION AND FUTURE LEARNING
Simulation is arguably the most prominent innovation in medical education over the past 15 years. The Redmond Center for Interdisciplinary Simulation Education (RISE Center) is a fully self-contained learning laboratory utilizing high fidelity patient simulators like Laerdal’s SimMan® 3G and Clinical Skills Training Models like CAE’s Blue Phantom central line mannequin with ultrasound capability. The goal of the Simulation Curriculum is to foster a highly experiential and contextual learning environment for our residents and other health professionals. The experience includes Patient Safety and Communication Skills Objective Structured Clinical Exam (OSCE) and the Common Critical Care Curriculum. Central venous catheter placements, chest tubes, endotracheal intubations, and “RUSH” ultrasound exams are among the many experiences provided that promote patient safety and quality patient care. Residents train and perfect their procedural skills as well as work through various patient scenarios that reflect best practices in the care of acute disease processes. The opportunity to work with other disciplines during these scenarios will allow for skill building in inter-professional teamwork and communication. Sessions can also be recorded for self-reflection, debriefing and formative feedback purposes.
In addition to those listed above, subspecialty conferences occur and residents on individual related rotations are invited to attend: Cardiac Cath Conference (Cardiology/EP rotation), Tumor Board (Hematology-Oncology rotation), and Chest Conference (Pulmonary rotation).
All residents will participate in a Continuous Quality Improvement (CQI) project as a requirement for graduation. Instruction in Quality Improvement models and project development will take place during PGY-1. Projects will be proposed and developed in coordination with a faculty coach/mentor during PGY-1 and implemented during PGY-2. All CQI projects will be completed by end of PGY-2 and prepared for either publication, abstract and/or poster presentation during PGY-3.
In addition, all PGY-1 and -2 residents are required to submit a clinical case vignette for presentation at a regional or national meeting such as the Georgia American College of Physicians annual conference. Other scholarly activity is encouraged and may take on one of many formats depending on the interest of the individual resident. Basic, clinical or translational research opportunities are available through either the multi-institutional Sarah Cannon Research Institute developed by HCA, multiple clinical research projects undertaken by Harbin Clinic, or as part of our affiliation with the Medical College of Georgia and Philadelphia College of Osteopathic Medicine. Other activity may include medical education/curriculum development, medical humanities, creative writing, as well as others. Redmond’s Residency Program will hold a resident/faculty Scholar Symposium each year, but also provide support for resident and faculty poster and abstract presentations at regional and national meetings and specialty conferences.