Faculty Chair:
Leandrita Ortega, MD
Contacts:
Gregory Roth, MD
Thomas Hall, MD
Required Experiences:
Gerald Champion Regional Medical Center
Optional Experience:
None
Weekly Schedule PGY2 or 3:
The PGY 2 or 3 will schedule three 12-hour shifts per week with the hospitalist service during the 4 week rotation. They will have 3 continuity clinics per week while on this rotation. Whenever possible, residents should schedule their three shifts on consecutive days to provide continuity of patient care. In addition, residents will rotate consultation coverage for Champion Family Medicine Clinic patients who are hospitalized.
Residents in the GCRMC program will also spend 1 month as seniors on the Family Medicine Service at MMC in Las Cruces. See description of this
| Sunday | Monday | Tuesday | Wed | Thursday | Friday | Saturday |
| AIPS | AIPS | Clinic | Clinic | Clinic | AIPS | |
| AIPS | AIPS | Didactics | Off | AIPS |
Requirements:
AOA
Internal Medicine
The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year. This requirement can be met by either inpatient internal medicine or inpatient family medicine service.
At a minimum internal medicine training must include:
- Twenty-four weeks of inpatient experience.
- Four weeks of training in critical care medicine.
- Didactic and clinical training.
Internal medicine training shall include exposure to the following disciplines, in either inpatient or outpatient settings:
- Allergy and immunology.
- Cardiology.
- Dermatology.
- Endocrinology.
- Gastroenterology.
- Hematology.
- Infectious diseases.
- Nephrology.
- Neurology.
- Oncology.
- Pulmonology.
- Rheumatology.
The training program must provide an opportunity for the resident to develop competency in:
- The management of hospitalized adult patients.
- Cooperative management of patients with sub-specialists colleagues.
- Pre-operative medical evaluation.
ACGME
Residents must have at least 600 hours (or six months) and 750 patient encounters dedicated to the care of hospitalized adult patients with a broad range of ages and medical conditions. (Core)
Residents must have at least 100 hours (or one month) or 15 encounters dedicated to the care of ICU patients. (Detail)
Residents must provide care to hospitalized adults during all years of the program
Description of Rotation or Educational Experience:
The Family Medicine Service (FMS) rotation comprises the major portion of the Adult Medicine curriculum. The Resident will develop the skills and knowledge needed to treat the major acute illnesses of the cardiovascular, neurologic, endocrinologic, pulmonary, gastrointestinal, rheumatologic, infectious, nephrologic, hematologic diseases and the psychological and behavioral aspects of those diseases. The Family Medicine Service will also admit and manage pediatric cases and medical complications of pregnancy.
Admissions to the FMS come from:
1. Clinic Attendings and residents:
Residents and attendings may on the FMC may admit patients to the FMS. The resident and the attending in the clinic are responsible for completing the H&P, and writing orders, unless other arrangements have been made with the FMS team. It is required that the resident, who is the primary care physician (PCP) of the patient, aid in the management of his/her continuity patient in the hospital and write a daily note. However, the primary management of the patient will be the responsibility of the residents assigned to the FMS service.
2. Community Physicians
We admit and manage patients from various local practices. These include: Dr. Guererro, Dr Vigil, Dr Harrison, Dr Castrejon, Dr. Marquez, the physicians of Concentra Las Cruces, and the physicians of Quick Care.
3. ER patients:
Patients who present to the ER who do not have a primary provider may be admitted to the family medicine service. This occurs when the residency program is assigned to “city call’ which is shared with the Hospitalist service. The FMS service take ER city call on Sunday, Monday and Tuesday.
Expectations:
The FMS team usually consists of two PGY 1, and one Senior (PGY2 or 3) resident members. One additional PGY1 resident and a senior resident (PGY 2 or 3) rotates on night float.
Patient Numbers:
As per the ACGME the minimum number of patients that each resident should care for on service is 5 patients per resident. The ACGME sets no upper limit but too many patients can also have a negative impact on resident education, thus an upper limit of 10 patients per resident will be placed on the service. Once the service numbers rise above or fall below the limits stated above the senior resident on service and the attending will take action to assure an appropriate number of patients. There may be deviations from these number based on patient acuity and these adjustments must be agreed upon by the senior and attending on the service.
2. PGY2-3
The Senior Resident is the team leader and supervisor. The Senior conducts daily ward rounds in a format which they choose, which typically includes X-ray review, check out rounds and teaching rounds. The Senior resident will:
- Review and discuss the patient care of EVERY admission with the interns. This maximizes intern supervision and patient safety.
- Write an abbreviated Senior Resident Admit Note on each admission. S/he does not follow individual patients or write progress notes on a regular basis, except during weekend coverage or when junior residents are overwhelmed and the quality of patient care is affected.
- Attends to and coordinates all ward team functions.
- Conduct one afternoon clinic per week.
- Ensure that there are adequate numbers of admissions on the service (PGY1 Residents should be managing a minimum of 5, and a maximum of 10 patients each).
- Teaching: The Senior Resident should assign a mini-didactic topic to each PGY 1 weekly (15 min discussion on patient related topic). This teaching session will occur every thursday at 11 am.
- The Senior Resident facilitates a weekly case conference during which an intriguing inpatient case is presented and discussed at Friday conference.
- FMS patient management: The Senior Resident should assume the role of junior attending for management decisions regarding FP service patients. When decision points arise in their management, the Senior Resident is actively encouraged to make clinical decisions about the patient’s care that may be posed by the intern involved in the case. These decisions should be reviewed with the attending in a timely manner depending on the complexity of the patient’s illness.
- The Senior resident will pick up any patients that exceed the daily number cap of the PGY1 residents and round and write notes on these patients daily. The senior resident should follow the patient during their entire hospital stay to maintain continuity even if the PGY1 numbers are below cap.
PGY-2/3 residents in Alamogordo will be expected to perform history and physicals and round on patients at the discretion of the hospitalist with whom they are working on both the medical floor and ICU. Residents should participate in all procedures performed on the floor and in the ICU during their assigned shifts.
3. The AIPS Attending
is a FM faculty member assigned to FMS on a one week rotation. His/her role is that of consultant/teacher, as well as attending with direct patient care responsibility. He/she will go over all admissions with the Senior Resident as well as the Resident taking care of each admission and is expected to round daily on all the patients and discuss management issues with the primary PGY1 Resident involved. The FM attending is expected to be present at daily work rounds. S/he should also be available to act as a liaison for conflict resolution between the ward team, other hospital personnel and medical staff.
Residents in Alamogordo will work with the hospitalist on service during their scheduled shifts. Residents are encouraged to schedule shifts with different hospitalists in order to maximize their learning and develop relationships with the various members of the hospitalist staff including advanced practice nurses and physician assistants.
Call:
Residents will provide consultation coverage for all Champion Family Medicine clinic patients and the patients of core faculty of the program.
Weekends and Holidays:
See above.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of acute medical illness of the hospitalized person. Residents are expected to:
Competencies
Be able to perform standardized comprehensive assessments and develop acute treatment plans. (Patient Care, Medical Knowledge)
Objectives
- Perform and report developmentally, age, and setting appropriate history and physical examination (R1) as measured by global assessment.
- Generate an appropriate differential diagnosis (R1) as measured by global assessment.
- Make informed decisions about diagnostic and therapeutic interventions based on patient information, patient preferences, up-to-date scientific evidence, and clinical judgment (R1) as measured by global assessment.
- Develop and carry out patient management plans (R1) as measured by global assessment.
- Use information technology to support patient care decisions and patient education (R1) as measured by global assessment.
- Perform appropriate procedures, with attention to consent, technique, patient comfort and follow-up (R3) as measured by direct observation and checklist.
- thoracentesis
- paracentesis
- lumbar puncture
- Art line
- I&D of abscess
- central venous catheter
- EKG interpretation
- Anoscopy
- Collaborate with health care professionals, including those from other disciplines, to provide patient-focused care (R2) as measured by global assessment.
Medical Knowledge
Goal
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
Competencies
Be able to perform standardized comprehensive assessments and develop acute treatment plans. (Patient Care, Medical Knowledge)
Recognize self limitations with regards to practice and seek consultation with other health care providers to provide optimal care. Assess medical information to support self-directed learning (Medical Knowledge, Practice-based Learning, Improvement)
Objectives
- Demonstrates an investigatory and analytic thinking approach to clinical situations (R1) as measured by global assessment.
- Knows and applies basic and clinical knowledge in specified areas/diagnoses (R2) as measured by global assessment (REDI scale)
- Acute coronary syndrome
- Acute renal Failure
- Alcohol and Drug Withdrawal
- Asthma
- Cardiac Arrhythmia
- Cellulitis
- Chronic Obstructive Pulmonary Disease (COPD)
- Community-Acquired Pneumonia (CAP)
- Congestive Heart Failure (CHF)
- Delirium and Dementia/AMS/Encephalopathy
- Diabetes Mellitus/DKA/HONK
- Gastrointestinal Bleed
- Hospital-Acquired Pneumonia
- Pain Management
- Perioperative Medicine
- Sepsis Syndrome
- Stroke
- Urinary Tract Infection
- Venous Thromboembolism
- Pancreatitis
- Psychological Factors Affecting Medical Conditions
Practice- Based Learning and Improvement
Goal
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
Competencies
- Identify strengths, deficiencies and limits in one’s knowledge and expertise;
- Set learning and improvement goals
- Identify and perform appropriate learning activities
- Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
Objectives
- Recognizes his/her own strengths and limitations (R1) as measured by global assessment.
- Asks questions as an engaged, critical learner (R1) as measured by global assessment.
- Uses information technology to manage information, access on-line medical information, and support their own education (R1) as measured by global assessment.
- Facilitates the learning of students and other health care professionals (R2) as measured by global assessment and 360
Systems Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:
Competencies
- Coordinate patient care within the health care system relevant to their clinical specialty
- Work in interprofessional teams to enhance patient safety and improve patient care quality
Objectives
- Practices cost-effective health care and resource allocation that does not compromise quality of care (R3) as measured by global assessment.
- Advocates for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion (R3) as measured by global assessment and 360 eval.
- Recognizes that the patient is part of a greater system and provides care in a manner that supports continuity (R3) as measured by global assessment.
- Knows how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance (R3) as measured by global assessment.
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to demonstrate:
Competencies
- Compassion, integrity, and respect for others
- Responsiveness to patient needs that supersedes self-interest
Objectives
- Accepts responsibility for patient care (R1) as measured by global assessment
- Never misrepresents patient care information (R1) as measured by global assessment
- Consistently performs in a punctual, reliable and collegial manner (R1) as measured by global assessment
- Demonstrates dress, hygiene and manner of speech that consistently reflect appropriate standards (R1) as measured by global assessment
- Demonstrates a responsiveness to the needs of patients and society that supersedes self-interest (R1) as measured by global assessment
- Demonstrates accountability to patients, society, and the profession (R1) as measured by global assessment
- Demonstrates a commitment to excellence and on-going professional development (R1) as measured by global assessment
- Demonstrates a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, patient privacy, informed consent, and business practices (R1) as measured by global assessment
- Demonstrates sensitivity and responsiveness towards patients’ , colleagues’ and team members’ gender, age, culture, disabilities, ethnicity and sexual orientation (R1) as measured by global assessment
Interpersonal and Communication Skills
Goal
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient’s families, and professional associates.
Competencies
- Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
- Communicate effectively with physicians, other health professionals, and health related agencies
Objectives
- Makes organized and effective oral presentations (R1) as measured by presentation eval form.
- Document patient care and maintain essential components of the patient’s record of care (R1) as measured by global assessment.
- Creates and sustains a therapeutic and ethically sound relationship with patients and families (R2) as measured by 360 eval.
- Elicits and provides information using effective listening, nonverbal, explanatory, questioning, and writing skills (R1) as measured by 360 eval.
- Communicates with the patient, family and members of the healthcare team in a timely, developmentally and culturally appropriate manner (R1) as measured by 360 eval.
- Uses information technology to effectively communicate with all components of the health care team (R1) Remove?
- Works effectively and respectfully with others as a member or leader of a health care team or other professional group (R1) as measured by 360 eval.
Teaching Methods
Residents will provide medical care to patients under the direct supervision of the attending physician. They will be directly supervised on all procedures performed in the hospital. The PGY1 Resident will also give mini-lectures during teaching rounds each week and will participated in weekly conferences. The Senior resident will also give a case based presentation of a patient on the FMS service during weekly conference. Residents will be assigned specific reading topics to be completed by the end of their last month on the FMS service.
Assessment Method (Residents)
A 360 global assessment tool, procedure check lists and the REDI assessment tool will be used in assessment of the resident during their experience. All procedures will be recorded on New Innovations.
Assessment Method (Program Evaluation)
Residents will be provided with an evaluation of the rotation experiences and of the attending physicians as well and given the opportunity to provide feedback of the longitudinal rotation during their quarterly IEP assessments.
Level of Supervision
The resident is directly supervised by the attending physician during all procedures performed in the hospital. The PGY1 Resident will have supervision provided by a Senior Resident and Attending. The Senior Resident will be supervised by the Attending. The attending will see all patients on the service each day and will document their involvement in the patient’s care. An Attending will be available 24 hours a day.
Educational Resources
Readings
PGY2 Year
PGY3 Year
Videos
Books
Williams VW, Flanders SA, Whitcomb WF, Cohn SL, Michota FA, Holman R, Gross R, Merli GJ. Comprehensive Hospital Medicine An Evidence-Based Approach. Philadelphia, Pa: Saunders, Elsevier, 2007.
Marino, PL. The ICU Book 3rd ed. Baltimore, Maryland: Williams and Wilkins, 2006.
Organizations/Web Resources
American Academy of Family Physicians
Society of Teachers of Family Medicine
Residents as Teachers Curriculum Modules, Clerkship Directors in Internal Medicine (CDIM) and Association of Program Directors in Internal Medicine (APDIM)
American Thoracic Society reading list
Respiratory Physiology and Pulmonary Pathophysiology lectures by John B. West, MD, PhD
Society for Critical Care Medicine ICU guidelines
Cancer.net, American Society of Clinical Oncology-approved app for patients provides comprehensive cancer information
SNMFMRP Curriculum 