General Residency Expectations: Difference between revisions

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Resident Expectations
==General Resident Expectations==


1. History Taking
===History Taking===


a. R1 – thorough
R1 – thorough


b. R2 – more focused
R2 – more focused


c. R3 – targeted
R3 – targeted
2. Physical Exam
===Physical Exam===
a. R1 – thorough
R1 – thorough
b. R2 – more focused (i.e.: more pertinent to chief complaint), increased reliability (consistent findings to preceptor)
 
c. R3 – targeted, reliable
R2 – more focused (i.e.: more pertinent to chief complaint), increased reliability (consistent findings to preceptor)
3. Patient Interaction
 
a. Exam Interaction
R3 – targeted, reliable
i. R1 –order exam in an opportunistic way; observing child during history taking and parent child interactions; learning pleasant distraction techniques
===Patient Interaction===
ii. R2 – increased comfort of above
====Exam Interaction====
iii. R3 – comfortable with above
R1 –order exam in an opportunistic way; observing child during history taking and parent child interactions; learning pleasant distraction techniques
b. Verbal Patient Instructions/Education
 
i. R1 – Able to give basic education (common childhood illnesses and conditions) after discussing with attending, working on confirmation of parent/family understanding (i.e. closed loop)
R2 – increased comfort of above
ii. R2 – Basic education without supervision as well as more in depth topics (i.e. well child anticipatory guidance)
 
iii. R3 – Proficient in education of complicated medical problems and well child anticipatory guidance with family demonstrating clear understanding
R3 – comfortable with above
4. Presentation
====Verbal Patient Instructions/Education====
a. R1 – full, with assistance
R1 – Able to give basic education (common childhood illnesses and conditions) after discussing with attending, working on confirmation of parent/family understanding (i.e. closed loop)
b. R2 – more focused, some assistance
 
c. R3 – targeted, independent
R2 – Basic education without supervision as well as more in depth topics (i.e. well child anticipatory guidance)
5. Interpretation of Data – labs, radiology, EKG
 
i. R1 – methodical evaluation and access resources to help interpret data, be familiar with techniques (i.e. CXR – ABCDE); familiarity with patterns of common conditions or gross abnormal results
R3 – Proficient in education of complicated medical problems and well child anticipatory guidance with family demonstrating clear understanding
ii. R2 – improved proficiency in evaluation of data without preceptor supervision
===Presentation===
iii. R3 – proficient evaluation
R1 – full, with assistance
6. Documentation
 
a. R1 – SOAP note format; include all aspects of note sections (CC, HPI, ROS, etc, etc); be aware of communication of problem, billing component; more global evaluation of patient and emphasize data gathering.  +++HPI/++DD/+A&P
R2 – more focused, some assistance
b. R2 – more focused.  ++ HPI/+DD/++A&P
 
c. R3 – pertinent positive and negative information in HPI with clear assessment and plan with appropriate diagnosis +HPI/+DD/+++A&P
R3 – targeted, independent
7. Time Management
===Interpretation of Data – labs, radiology, EKG===
a. Prioritization
R1 – methodical evaluation and access resources to help interpret data, be familiar with techniques (i.e. CXR – ABCDE); familiarity with patterns of common conditions or gross abnormal results
i. R1 –learning to rank tasks appropriately for individual patients and between patients (i.e. depart completed prior to completing note)
 
ii. R2 – ranking tasks appropriately with some preceptor support
R2 – improved proficiency in evaluation of data without preceptor supervision
iii. R3 – autonomously ranking and accomplishing tasks appropriately
 
b. Multitask
R3 – proficient evaluation
i. R1 – develop awareness of multiple tasks and determine order of completion for maximum efficiency in clinic
===Documentation===
ii. R2 – completing multiple tasks for maximum clinic efficiency with preceptor support
R1 – SOAP note format; include all aspects of note sections (CC, HPI, ROS, etc, etc); be aware of communication of problem, billing component; more global evaluation of patient and emphasize data gathering.  +++HPI/++DD/+A&P
iii. R3 – autonomously completing multiple tasks for maximum clinic efficiency
 
c. Ability to utilize ancillary staff
R2 – more focused.  ++ HPI/+DD/++A&P
i. R1 – become comfortable asking unit clerks and nurses for appropriate help in pt care.  Learning to access clinic support staff (case managers, unit clerks, nurses, etc)
 
ii. R2 – utilizing appropriately with some preceptor input
R3 – pertinent positive and negative information in HPI with clear assessment and plan with appropriate diagnosis +HPI/+DD/+++A&P
iii. R3 – proficient and autonomous utilization of ancillary staff
===Time Management===
8. Patients a day
====Prioritization====
a. R1 – 6-7
R1 –learning to rank tasks appropriately for individual patients and between patients (i.e. depart completed prior to completing note)
b. R2 – 10
 
c. R3 – 14-16
R2 – ranking tasks appropriately with some preceptor support
9. Guideline Practice (National and Local)
 
a. R1 – be familiar with existence of national and local guidelines for common conditions
R3 – autonomously ranking and accomplishing tasks appropriately
b. R2 – improved utilization of guidelines
====Multitask====
c. R3 – proficient with utilization of guidelines and documentation in notes justification if deviated from guidelines
R1 – develop awareness of multiple tasks and determine order of completion for maximum efficiency in clinic
10. Autonomy
 
a. R1 – with help, direct supervision with every patient
R2 – completing multiple tasks for maximum clinic efficiency with preceptor support
b. R2 – less help; review all patients and go in on complicated
 
c. R3 – relatively independent; review all patients and go in on patients when requested
R3 – autonomously completing multiple tasks for maximum clinic efficiency
11. Medical Knowledge
====Ability to utilize ancillary staff====
a. Developmental Milestones
R1 – become comfortable asking unit clerks and nurses for appropriate help in pt care.  Learning to access clinic support staff (case managers, unit clerks, nurses, etc)
i. R1 – utilizing charts
 
ii. R2 – memorizing charts
R2 – utilizing appropriately with some preceptor input
iii. R3 – knowing and utilizing in practice efficiently
 
b. Immunization Schedule
R3 – proficient and autonomous utilization of ancillary staff
i. R1 – utilizing charts
===Patients a day===
ii. R2 – memorized charts for routine schedule
R1 – 6-7
iii. R3 – memorized routine schedule and knowing how to use catch up
 
c. Health Maintenance
R2 – 10-12
i. R1 – learning schedules for preventative care
 
ii. R2 – memorized schedules for preventative care
R3 – 14-16
iii. R3 – special needs preventative care, Down’s
===Guideline Practice (National and Local)===
12. Procedures (Track Procedures)
R1 – be familiar with existence of national and local guidelines for common conditions
a. R1 – direct supervision
 
b. R2 – indirect supervision
R2 – improved utilization of guidelines
c. R3 – independent with help as needed
 
13. Differential Diagnosis
R3 – proficient with utilization of guidelines and documentation in notes justification if deviated from guidelines
a. R1 – complete with appropriate justification for likelihood of diagnosis and developing ability to choose most likely diagnosis
===Autonomy===
b. R2 – focused and relevant
R1 – with help, direct supervision with every patient
c. R3 – reliable diagnosis with well justified exclusions of other possible diagnosis (i.e. infant with fever and fussy, explain why not meningitis; or abdominal pain and constipation, why not acute abd/appendicitis)
 
R2 – less help; review all patients and go in on complicated
 
R3 – relatively independent; review all patients and go in on patients when requested
===Medical Knowledge===
====Developmental Milestones====
R1 – utilizing charts
 
R2 – memorizing charts
 
R3 – knowing and utilizing in practice efficiently
====Immunization Schedule====
R1 – utilizing charts
 
R2 – memorized charts for routine schedule
 
R3 – memorized routine schedule and knowing how to use catch up
====Health Maintenance====
R1 – learning schedules for preventative care
 
R2 – memorized schedules for preventative care
 
R3 – special needs preventative care, Down’s
===Procedures (Track Procedures)===
R1 – direct supervision
 
R2 – indirect supervision
 
R3 – independent with help as needed
===Differential Diagnosis===
R1 – complete with appropriate justification for likelihood of diagnosis and developing ability to choose most likely diagnosis
 
R2 – focused and relevant
 
R3 – reliable diagnosis with well justified exclusions of other possible diagnosis (i.e. infant with fever and fussy, explain why not meningitis; or abdominal pain and constipation, why not acute abd/appendicitis)

Revision as of 01:42, 13 January 2017

General Resident Expectations

History Taking

R1 – thorough

R2 – more focused

R3 – targeted

Physical Exam

R1 – thorough

R2 – more focused (i.e.: more pertinent to chief complaint), increased reliability (consistent findings to preceptor)

R3 – targeted, reliable

Patient Interaction

Exam Interaction

R1 –order exam in an opportunistic way; observing child during history taking and parent child interactions; learning pleasant distraction techniques

R2 – increased comfort of above

R3 – comfortable with above

Verbal Patient Instructions/Education

R1 – Able to give basic education (common childhood illnesses and conditions) after discussing with attending, working on confirmation of parent/family understanding (i.e. closed loop)

R2 – Basic education without supervision as well as more in depth topics (i.e. well child anticipatory guidance)

R3 – Proficient in education of complicated medical problems and well child anticipatory guidance with family demonstrating clear understanding

Presentation

R1 – full, with assistance

R2 – more focused, some assistance

R3 – targeted, independent

Interpretation of Data – labs, radiology, EKG

R1 – methodical evaluation and access resources to help interpret data, be familiar with techniques (i.e. CXR – ABCDE); familiarity with patterns of common conditions or gross abnormal results

R2 – improved proficiency in evaluation of data without preceptor supervision

R3 – proficient evaluation

Documentation

R1 – SOAP note format; include all aspects of note sections (CC, HPI, ROS, etc, etc); be aware of communication of problem, billing component; more global evaluation of patient and emphasize data gathering. +++HPI/++DD/+A&P

R2 – more focused. ++ HPI/+DD/++A&P

R3 – pertinent positive and negative information in HPI with clear assessment and plan with appropriate diagnosis +HPI/+DD/+++A&P

Time Management

Prioritization

R1 –learning to rank tasks appropriately for individual patients and between patients (i.e. depart completed prior to completing note)

R2 – ranking tasks appropriately with some preceptor support

R3 – autonomously ranking and accomplishing tasks appropriately

Multitask

R1 – develop awareness of multiple tasks and determine order of completion for maximum efficiency in clinic

R2 – completing multiple tasks for maximum clinic efficiency with preceptor support

R3 – autonomously completing multiple tasks for maximum clinic efficiency

Ability to utilize ancillary staff

R1 – become comfortable asking unit clerks and nurses for appropriate help in pt care. Learning to access clinic support staff (case managers, unit clerks, nurses, etc)

R2 – utilizing appropriately with some preceptor input

R3 – proficient and autonomous utilization of ancillary staff

Patients a day

R1 – 6-7

R2 – 10-12

R3 – 14-16

Guideline Practice (National and Local)

R1 – be familiar with existence of national and local guidelines for common conditions

R2 – improved utilization of guidelines

R3 – proficient with utilization of guidelines and documentation in notes justification if deviated from guidelines

Autonomy

R1 – with help, direct supervision with every patient

R2 – less help; review all patients and go in on complicated

R3 – relatively independent; review all patients and go in on patients when requested

Medical Knowledge

Developmental Milestones

R1 – utilizing charts

R2 – memorizing charts

R3 – knowing and utilizing in practice efficiently

Immunization Schedule

R1 – utilizing charts

R2 – memorized charts for routine schedule

R3 – memorized routine schedule and knowing how to use catch up

Health Maintenance

R1 – learning schedules for preventative care

R2 – memorized schedules for preventative care

R3 – special needs preventative care, Down’s

Procedures (Track Procedures)

R1 – direct supervision

R2 – indirect supervision

R3 – independent with help as needed

Differential Diagnosis

R1 – complete with appropriate justification for likelihood of diagnosis and developing ability to choose most likely diagnosis

R2 – focused and relevant

R3 – reliable diagnosis with well justified exclusions of other possible diagnosis (i.e. infant with fever and fussy, explain why not meningitis; or abdominal pain and constipation, why not acute abd/appendicitis)

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