Family Medicine Service I: This is an inpatient medicine service at Northwest Medical Center with one PGYI resident, one PGYII resident and supervision provided by a family medicine faculty attending.  The attending physician will round on a daily basis with the residents and will rotate on a weekly basis. The patients admitted to the service will consist of Family Medical Center and Northwest Family Medical Center patients, unassigned patients and consulted patients.  The PGYII resident is expected to:

• supervise the PGYI resident
• attend morning report
• maintain problem list/medication profile for all patients in the resident’s care
• make daily rounds with the attending
• be prepared to discuss history, physical exam and current treatment plan
• check out patient list with resident coming on call at the hospital each afternoon
• see all MICU and SICU patients prior to morning report
• see continuity clinic patients one half day per week in the p.m. in the FMC

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to have a measurable and progressive knowledge of the following.

Competencies

Top Disease Processes:

• COPD

• Pneumonia

• Angina

• MI

• CHF

• Atrial Fibrillation

• Pancreatitis

• GI Bleed

• Stroke

• TIA

• Sepsis

• Syncope

• Dehydration

• Gastroenteritis

• Pyelonephritis

Objectives

• Perform a history and physical examination.
• Know pathophysiology to include risk factors associated with the disease.
• Know the signs and symptoms of the disease.
• Define a differential diagnosis of the disease.
• Identify the proper labs and tests to order and understand their meaning in diagnosing the disease.
• Define a treatment plan for the disease.
• Demonstrate an ability to describe the basic pathophysiology, prevention, and management of the disease at the patient/family level.
• The resident will learn physician responsibility to his/her patients.
• The resident will learn the importance of documentation of medical records.

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to demonstrate knowledge and understanding in the diagnosis and management of the following:

Competencies

Symptomatic care pending diagnosis including:

• Pain control
• Nausea and vomiting
• Constipation and fever

Infectious diseases:

• Neonatal sepsis
• RSV
• HIV
• TB

Respiratory diseases:

• Acute respiratory failure
• Asthma
• COPD
• Carcinoma of the lung
• Pleural effusion
• Acute bronchitis
• Pneumonia
• Pulmonary embolism

Cardiovascular diseases:

• Coronary artery disease
• Cardiac arrhythmia
• Congestive heart failure
• Hypertension
• DVT’s
• Peripheral vascular disease

Hematological diseases:

• Neoplastic disorders and sickle cell anemia

Gastroenterological diseases:

• Appendicitis
• Cholecystitis
• Cirrhosis
• Esophageal disease
• Diverticulitis
• Inflammatory bowel disease
• Gastritis
• Hepatitis
• Pancreatitis
• Peptic ulcer disease
• Cancer of the GI tract

Endocrine disorders:

• Thyroid disease
• Diabetes and diabetic ketoacidosis

Urogenital tract disorders:

• Urinary tract infections
• Renal failure
• Renal calculi
• Pelvis inflammatory disease

Neurological problems:

• CVA
• TIA
• Meningitis
• Acute head injury

Acute psychiatric conditions:

• Drug overdose
• Suicidal ideation
• Delusions
• Hallucinosis

Oncologic diseases:

• Neoplastic processes of multiple primary tissue origins

Rheumatological conditions:

• Arthropathic as well as systemic effects of autoimmune and connective tissue disorders

The Resident should be able to demonstrate the following skills:

1. take a history and conduct a physical examination
2. interpret an electrocardiogram
3. interpret radiographs
4. evaluate and interpret laboratory test results
5. perform and interpret bedside pulmonary function studies
6. perform central line placement, lumbar puncture, intubation (endotracheal and nasogastric)
7. evaluate arterial blood gas results

Objectives

• The resident will become competent to diagnose and treat common diseases that require hospitalization by Family Physicians.
• The resident will learn their limitations, when a consultant is necessary and how to obtain a consult.

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify and perform appropriate learning activities.
• Use information technology to optimize learning.

Objectives

• The residents will identify strengths and limits of knowledge by progressive increases in their knowledge base.  This will be measured by successful completion of USMLE Step 3, in-training exam score, and preceptor evaluations.

• The resident will, with combined experiences, have progressive responsibility and knowledge.

• The resident becomes competent in the use of UpToDate, DynaMed, and journal searches.  The resident will learn to utilize a variety of knowledge sources.

• The resident will become competent in the use of EMR to track patients, recover lab data and medical reports.  The resident will become competent to use the PDA with Epocrates and 5-Minute Medical Consult.

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work in interprofessional and multidisciplinary teams to enhance patient safety and improve patient care quality.

Objectives

The resident will:

• Supervise the care delivered to patients admitted to the family medicine service by the service team under the guidance of the Family Medicine Faculty.
• Learn the different healthcare settings and systems and how to move their patients to the best setting for the patient.
• Communicate effectively when interacting with patient/family.
• Work with other residents, residency faculty, and other healthcare professionals to provide patient-focused care.
• Facilitate discharge planning.
• Practice cost-effective healthcare and resource allocation that does not compromise quality of care
• Be cognizant of the financial cost, risks and benefits of various procedures.
• Advocate for quality patient care and assist patients in dealing with system complexities.

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others.

Objectives

The resident will:

• Demonstrate adherence to ethical principles
• Show sensitivity and respect to diverse patient populations.
• Know when to seek consultation from other appropriate specialists to either manage or co-manage a patient for optimal care.
• Respond to pages and other consultations in a timely manner.
• Dictate comprehensive history and physical exams and discharge summaries in a timely manner

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies.

Objectives

• The resident will learn appropriate consultation, timely transfers, and other options of care for acute and chronic problems.
• The resident will demonstrate appropriate communications skills when supervising PGYI’s and medical students.

Faculty attending

References available at the AHEC Library:

 Bennet JC, Goldman L. Cecil textbook of medicine. 21^st ed. Philadelphia, Saunders, 2000. 2v

 Fauci A, et al. Harrison’s principles of internal medicine. 14^th ed. New York, McGraw-Hill, 1997.

 Rakel, RE. Saunders manual of medical practice. 2^nd ed. Philadelphia, Saunders, 2000.

 Pfenninger, JL, Fowler GC. Procedures for primary care physicians. St. Louis, MO, Mosby, 1994.

 Behrman RE, et al. Nelson textbook of pediatrics. 16^th ed. Philadelphia, Saunders, 2000.

 Sieberry GK. The Harriet Land handbook: a manual for pediatric house officers. 15^th ed. Mosby,     2000.

 Titinalli, JE. Emerency medicine: a comprehensive study guide. 5^th ed. New York. McGraw-Hill, 2000.

 Cunnigham. Willams obstretics. 20^th ed. Appleton & Lange, 1997.

On Line Resources:

 UpToDate

DynaMed