Core Curriculum for Residents and Resources

Educational Program

The curriculum in each program must contain overall goals for the program, competency-based goals and objectives for each assignment at each educational level, regular didactic sessions and delineation of resident responsibilities for patient care, progressive responsibility for patient management, and supervision of residents over the continuum of the program.

The Accreditation Council for Graduate Medical Education (ACGME) specifies that each "residency program must require that its residents obtain competence in the six areas listed below to the level of a new practitioner.  Programs must define the specific knowledge, skills, and behaviors required and provide educational experiences as needed in order for their residents to demonstrate the following:

1.    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. (Patient Care)
2.    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. (Medical Knowledge)
3.    Residents must demonstrate the ability to investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (Practice-based learning and improvement)
4.    Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals. (Interpersonal and communication skills)
5.   Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  (Professionalism)
6.    Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to effectively call on other resources in the system to provide optimal health care. (Systems-based practice)

Residents must also be educated to recognize the signs of fatigue and sleep deprivation; and have an educational program regarding impairment including substance abuse.  The curriculum must advance residents' knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients and applied to patient care.  Each program has defined specific goals and objectives to meet these requirements.  These are usually included in the resident handbook and/or the description of the clinical rotations. 

Web-based courses
Rationale
The Graduate Medical Education (GME) Committee supported the development of web-based courses in order to assist programs with the six general competency curricular requirements and ensure that residents/fellows have a baseline knowledge of ethical issues, medical legal issues, Foundations in Systems Based Practice and the ACGME Competencies, and fatigue/sleep-deprivation.

Each course contains learning objectives, topic-specific content, selected references and links to other useful web sites, and a multiple choice quiz. Residents/fellows should find the information useful during their residency and in future medical practice.

Requirements for Completion
Residents and fellows who entered an accredited program on or after July 1, 2007 must complete four courses within the first six months of their training at UAMS. A score of 80% or greater must be obtained on each quiz contained in each course. Residents/fellows are given an unlimited number of attempts to take the quizzes, and the highest score obtained will be recorded.  The information in the courses is general in nature and is important both for the resident's education and for the institution.  The courses supply basic knowledge that applies to all areas of clinical practice.  

Completion of the courses is required for graduation from UAMS. Course completion status is always available on New Innovations for the resident, program director, and program coordinator to access; and is updated monthly.

Course Content
Ethics: has eight modules – What and Why of Ethics, Informed Consent, Confidentiality, Goals and Limits of Medical Care,  Medical Errors and Truth-telling, Research,  and Resource Allocation.

Medical Legal: has six modules - Medical Malpractice, Arkansas Rights of the Terminally Ill or Permanently Unconscious Act (ARTUPA), Emergency Medical Treatment and Active Labor Act (EMTALA), Informed Consent, Documentation, and Physician/Patient Relationship.

Foundations of Systems Based Practice and the ACGME Competencies: has seven modules – Disclosure, Medication Errors, Performance Improvement, Patient Safety, UAMS Emergency Incident Command System, Utilizing Restraints in Acute Care Settings, and Foundations in the ACGME Competencies.

SAFER (Sleep, Alertness and Fatigue Education in Residency): has nine short modules and takes approximately 40-50 minutes to complete. 

To access the above courses:

1. In your web browser, go to https://distance-ed.uams.edu

            Click Login to WebCT,

Type your WebCT ID and password.

WebCT ID = last name followed by first name, your middle initial may or may not be included. WebCT IDs are case sensitive, so be sure to use lower case.  For example, John E. Doe’s WebCT ID would be doejohn or doejohne). NOTE:  a few residents/fellows who have similar names will be assigned and notified of special WebCT IDs that must be used to log in to WebCT.

Password = last 4 digits of your social security number with no dashes.  For example, social security number 123-45-6789 would be 6789.

2.      This takes you to the "My WebCT" page

3.      From the list, click on the course that you wish to take

4.      Before you begin any of the modules, read the general information and instructions for completing the course found in the Begin Here icon

5.      Click on Homepage at the top of the page

6.      Click on the Course Content icon to access the course materials

7.      Then choose any module to begin

8.      If you have problems with access, call the UAMS Helpdesk at 686-8555.

Professional development speakers are listed on the Faculty Affairs web page at http://www.uams.edu/facultyaffairs/speakers_bureau.asp  Topics available include: 

The GME Committee supports several  institution-wide educational sources for residents:
Ethics
An excellent resource for ethics education is the text book, Introduction to Clinical Ethics by Fletcher et. al., which is located in each departmental library. Several departments and residency programs have a systematic  ethics instruction and assessment using a variety of formats.

Medical/legal and risk management
Mr. Kemal Kutait, Director of the MCPG Risk Management Department, provides a session on risk management and prevention at Housestaff Orientation/Registration each year.  In addition, he will provide a workshop on risk management to departments on an individual basis upon request.  

Sexual Harassment workshop
A 2-hour workshop by LJ Perrot, MD, JD, a licensed attorney and board-certified anatomic/forensic pathologist, is designed to present the legal basis of SH, dispel common myths, and suggest strategies for preventing and confronting SH.  Teaching methods include a didactic presentation, case studies, and small group discussion. 
The workshop will enable participants to:
    gain knowledge of sexual harassment issues
    protect oneself and one's medical practice against sexual harassment complaints
    develop strategies to confront sexual harassment

Contact information:  LJ Perrot, MD, JD, 686-8646, perrotlindaj@uams.edu

How to Break Bad News a 6-step protocol by Robert Buckman, Johns Hopkins University
When the news is painful, you must prepare to have a conversation.  Be prepared to listen.  Health-care providers talk too much, usually because they feel uncomfortable and don't know other ways to maintain their control and self-esteem.  
1) When you introduce the topic, do so in a private environment.  Sit down, introduce yourself and tell the patient/family what you do.  If family members or friends are present, get the patient's permission for them to listen.  Don't put a desk between you and the patient.
2) Look at your body language - be seated, use a handshake and make eye contact.  Talk slowly; when the news is a its worst, talk even slower.  If the patient looks away, stop talking and wait.
3) Learn the extent of the patient's knowledge.  Ask what he or she has been told so far.  Having this information is extremely important for the health-care provider because it enables "alignment".  Don't overreact to the patient who claims he or she was never told.  Ask the patient how much he or she wants to know.  Ask the patient if there's someone to whom he or she would rather you speak.  If the patient doesn't want to know, document that fact and proceed to the treatment plan and the follow-through.
4) If the patient wants to know, there is no easy, magical way of breaking the bad news.  Don't anticipate what the patient will say or how he or she will react to the news.  Fire a warning shot, such as "I'm afraid the situation is serious".  Or "This is difficult for me to say."  Stop frequently; this gives the listener permission to talk.  Ask, "Is this making sense?" or "Do you see what I mean?"  Validate the patient's  questions by saying, "That's an excellent question." or "You raise an important point."  Sometimes, the best you can do is absorb the patient's feelings or projections.  Don't look away unless the patient is crying.
5) Respond to the patient's feelings and reactions.  Remember that, primarily, the patient wants to believe that you understand what is happening to him or her.
6) Devise a plan based on the patient's priorities, and explain it to him or her.  Identify other sources of support.

Presented at University Hospital Consortium's Patient Safety Program, October 2001.

Biostatistics/research design
A three-part module of biostatistics produced by Dr. Dan Wilson from the University of Kansas Medical School is provided to all housestaff and program directors. These are used through self-study programs or as part of journal clubs within the training programs.  Click here to access module.

Quality Assurance/performance improvement
This topic is introduced in a session during Housestaff Orientation/Registration which occurs each June.  The topic is covered more in-depth during the Morbidity and Mortality and/or QA conferences within the training programs.

Physician impairment
this topic is introduced in a session during Housestaff Orientation/Registration which occurs each June.  Individual departments have additional education through Grand Rounds or didactic sessions.  Click here to access information from lectures by Drs. Frederick G. Guggenheim, Forrest B. Miller, and James Waldron, members of the Physician Health Committee. GME Committee policy on Physician Impairment, Drug Testing and Drug Abuse Intervention. 

Medical practice issues
The UH Compliance Office provides a course upon request.  
In addition, multiple internet resources are available:
Overview of the Medicare Program http://www.acponline.org/counseling/overviewmp.htm
AMA Physician Employment Contracts part I; part II

Resident teaching skills
A half-day course is presented at Housestaff Orientation/Registration which covers small group teaching, giving feedback and evaluating students. In addition, several training programs have individual modules on resident teaching skills.  Click here to access a very useful web site about teaching skills of residents.  http://www.residentteachers.com

Evaluation
Evaluation of residents:  Each residency program must have an effective plan for assessing residents' performance throughout the program and for utilizing results to improve resident performance.  Each program director has developed a plan which includes use of dependable measures to assess residents' competence in the areas of the six competencies noted above, mechanisms for providing regular and timely feedback to residents, and a process of using results to achieve progressive improvement in residents' competence and performance.

Program Evaluation

The program director with the teaching faculty has developed a plan to use resident performance and outcome assessment results in evaluating how effective the program is educating residents and improving the residency program.

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Last modified: 11/10/09