The second year of residency is the year of maturation and enrichment of clinical skills and experience. It is a demanding year with marked increases in responsibility. It is a transition year – one is still very much a student, but now a teacher also. The skills of organization, leadership and teaching will be perfected during this year. An inquiring mind, the pursuit of knowledge and the desire to provide excellence in patient care are the underpinnings of a successful year.

Patient Care Duties:

In-patient

All competencies required of an R1.

Leadership:

• Organizing and prioritizing patient care
• Working with the R1 to provide efficient, effective care for the patients.
• Developing the skill of over-seeing patient care, ensuring patient safety, while allowing the R1 to assume the primary care for each patient.
• Demonstrate evidence effective leadership in an emergency situation: assess the situation, make appropriate and needed emergency interventions to stabilize the patient, and delegate responsibility to other team members.

Teaching:

• Demonstration of effective history taking, including open-ended questions, patient directed interviews, active listening.
• Demonstration of a complete and thorough physical exam.
• Working with the R1 to develop a complete differential diagnosis
• Working with the R1 to develop a plan for evaluation and treatment of the patient.
• Reviewing the R1 History and Physical for organization and completeness.
• Working with the R1 on daily rounds, reviewing his/her findings, discussing the organization and completeness of the progress note, developing plans for the patient’s evaluation, treatment and disposition.
• Use evidence-based literature to direct patient care. Provide the team with relevant references pertinent to the patient care issues.

Out-patient

All competencies required of an R1.

Developing “phone medicine” skills: i.e. knowing when to give advice over the phone, provide prescriptive medicine, tell the patient to come to the ER, tell the patient to be seen the following day in the clinic.

Developing the skill of determining the need for hospitalization for one’s patient.

Develop the skills of seeing patients in an organized, timely fashion so as not to keep patients waiting.

Begin understanding the skill of self identified quality improvement for patient care: i.e. compliance with the guidelines for CHF, Type II Diabetes Mellitus, CAD.

Consult Services

While on subspecialty rotations, the resident’s role is that of consultant. Patient Care competencies that a second year resident should learn as a consultant include:

The ability to discern the questions being asked of the consultant.

A thorough review of the medical chart and studies, a thorough history and physical as it pertains to the questions being asked and complete documentation of such.

The skill of gathering the data and using such data to form an accurate assessment of the problem.

The skill of developing a plan to further evaluate and treat as required.

Communication with the consulting physician one’s assessment and recommendations.

The skill of appropriate follow-up in role as consultant.

Medical Knowledge:

In-patient/Out-patient/Subspecialty rotations:

All competencies required of an R1.

The resident is expected to build upon the knowledge obtained during internship. He or she should stay current with the literature, reading the current issues of NEJM and Annals of Internal Medicine on a regular basis.

The resident should continue to develop the skill of practicing evidence –based medicine, learning to ask patient centered questions, and choosing articles that represent well-designed studies when answering those questions. He/she should recognize the characteristics of a poorly designed study vs. a well-designed study. He/she should begin to develop an understanding of medical statistics.

The R2 should be working in his/her area of research with a mentor, to build a strong, in-depth, expert level of knowledge in this area. He/she should develop the knowledge of research design and conduct.

The resident should develop the ability to write and present conferences.

The resident should develop a knowledge base in the following areas: Ethics, End of Life, Gender health, Quality Improvement, Patient Safety, Addiction Medicine, Pain Management, Nutrition, Medical /Legal, Bioterroism.

System-Based Practice: All competencies required of an R1.