General Residency Expectations

From Guide to YKHC Medical Practices

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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)