Hospitalist/Medical Consult Curriculum

Department: Internal Medicine

Faculty Coordinator: Steven Walters, MD

Hospital: Texas Health Presbyterian Hospital Dallas

Periods offered: All 12 periods to third year categorical residents

Length: 4 Weeks

Max no. of residents: 1

First Day Contact: Steven Walters, MD (Can be reached through the page operator, please contact prior to scheduling of rotation assignment of an attending)

First Day Time: 8:00 a.m.

First Day Place: MD On Call office

Weekends: None

1. Course Description:

This elective offered to one 3rd year resident monthly is designed to orient you to the practice of a dedicated hospitalist. The duties while on this rotation would include taking admissions with your attending on their admit days (up till 10:00 pm for no more than 2 days during the month, you will be allowed to leave after conference on the day after your admission day) and follow up on your patients daily. You will also travel to and participate in the care of patients at a long term care facility (LTAC), and take medicine consults on non-admission days. You will meet with your faculty for informal didactic training 2-3 times weekly to discuss the economics of hospitalist medicine (billing, coding, etc), perioperative management, and how to approach the medical consult. You will also be expected to attend morning report daily and all conferences.

2. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: Demonstration of the above in a dictated history and physical.

• Make informed recommendations about preventives, diagnostic and therapeutic options and interventions that are based on clinical judgement, scientific evidence, and patient preference. Examples: Demonstrated by assessments and plans in the progress notes.

• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: Demonstrated by the use of other health care professionals appropriately such as SW, Pharmacy, Physical Therapy, Home Health care to implement effective patient care.

• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine as a hospitalist. Examples: central line placement; Airway management; paracentesis; thoracentesis; EKG reading; vaginal culture; joint aspiration; pelvic and pap test.

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Demonstrated by active listening and participation during rounds, morning report and conferences.

• Access and critically evaluate current medical information and scientific evidence. Examples: Demonstrated by reading current literature regarding patients; demonstrated by participation in journal club and residents conference.

• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: Demonstrated by showing an understanding of the pathophysiology of disease and the pharmacology of drugs used in treating the disease. Demonstrated by resident's willingness to learn about new developments in the basic sciences by reviewing basic science journals.

• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Demonstrated by evidence of independent thinking demonstrated in the appraisal and plan.

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: Demonstrated by a resident's willingness to recognize his/her knowledge gaps and implement strategies to fill those knowledge gaps.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: Demonstrated by resident having an openness to admitting error and working with the system to analyze and correct the error.

• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: Use of on-line resources.

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients.

• Clear, concise, accurate communication in the orders and progress notes.

Professionalism:

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues.

• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.

• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.

• Recognize and identify deficiencies in peer performance.

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.

• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management.

• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room

Daily Morning Report 9:00-10:00 a.m. - Chairman's Conference Room

Wednesday mornings 7:30-8:00 a.m. - Clinical Grand Rounds - IM Training Room

Wednesday afternoons 12:15-1:00 p.m. - Grand Rounds - Haggar Hall

Friday mornings 7:30 - 8:00 a.m. - Coffeee with Cardiology - IM Training Room

2-3 weekly meetings with your attending for discussion of various topics.

2. Clinical

Admissions and consults on your assigned days with the Hospitalist staff.
LTAC patient management - At least once during he month with your attending.