General Residency Expectations

Resident Expectations

1. History Taking

a. R1 – thorough

b. R2 – more focused

c. R3 – targeted 2. Physical Exam a. R1 – thorough b. R2 – more focused (i.e.: more pertinent to chief complaint), increased reliability (consistent findings to preceptor) c. R3 – targeted, reliable 3. Patient Interaction a. Exam Interaction i. R1 –order exam in an opportunistic way; observing child during history taking and parent child interactions; learning pleasant distraction techniques ii. R2 – increased comfort of above iii. R3 – comfortable with above 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) 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 4. Presentation a. R1 – full, with assistance b. R2 – more focused, some assistance c. R3 – targeted, independent 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 ii. R2 – improved proficiency in evaluation of data without preceptor supervision iii. R3 – proficient evaluation 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 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 7. Time Management a. Prioritization 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 iii. R3 – autonomously ranking and accomplishing tasks appropriately b. Multitask i. R1 – develop awareness of multiple tasks and determine order of completion for maximum efficiency in clinic ii. R2 – completing multiple tasks for maximum clinic efficiency with preceptor support iii. R3 – autonomously completing multiple tasks for maximum clinic efficiency c. Ability to utilize ancillary staff 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 iii. R3 – proficient and autonomous utilization of ancillary staff 8. Patients a day a. R1 – 6-7 b. R2 – 10 c. R3 – 14-16 9. Guideline Practice (National and Local) a. R1 – be familiar with existence of national and local guidelines for common conditions b. R2 – improved utilization of guidelines c. R3 – proficient with utilization of guidelines and documentation in notes justification if deviated from guidelines 10. Autonomy a. R1 – with help, direct supervision with every patient 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 11. Medical Knowledge a. Developmental Milestones i. R1 – utilizing charts ii. R2 – memorizing charts iii. R3 – knowing and utilizing in practice efficiently b. Immunization Schedule i. R1 – utilizing charts ii. R2 – memorized charts for routine schedule iii. R3 – memorized routine schedule and knowing how to use catch up c. Health Maintenance i. R1 – learning schedules for preventative care ii. R2 – memorized schedules for preventative care iii. R3 – special needs preventative care, Down’s 12. Procedures (Track Procedures) a. R1 – direct supervision b. R2 – indirect supervision c. R3 – independent with help as needed 13. Differential Diagnosis a. R1 – complete with appropriate justification for likelihood of diagnosis and developing ability to choose most likely diagnosis b. R2 – focused and relevant 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)