Allergy and Immunology Curriculum

Department: Internal Medicine

Faculty Coordinator: Mitch Carroll, M.D. & Shounak Das, M.D.

Hospital: Texas Health Presbyterian Hospital Dallas

Periods offered: All

Length: 4 weeks

Max no. of residents: 1

First Day Contact: Mitch Carroll

First Day Time: 8:00 a.m.

First Day Place: Jackson IM Clinic

Weekends: None

I. Course Description:

Throughout their 3 years of training each categorical resident spends one afternoon (Monday, Tuesday, Wednesday or Thursday) per week in the Jackson Internal Medicine Clinic. Additionally, each resident spends a dedicated month seeing patients in the Clinic. Each resident is assigned patients for whom he or she is responsible during the entrie training experience. This continuity of care and long-term patient follow-up provide the residents with exposure to a patient care setting similar to one many will enter upon completion of their training.

The clinic staff consists of internal medicine faculty members, registered nurses, medical assistants and patient care representatives. A multidisciplinary approach to patient care is practiced by utilizing the services of nurses for patient education as well as a pharmacist and registered dietitian who specialize in diabetes education.

II. 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: The resident will conduct, record and interpret a comprehensive clinical medical history.

• Make informed recommendations about preventive, diagnostic and therapeutic options and interventions based on clinical judgment, scientific evidence, and patient preference. Examples: Resident will demonstrate the ability to gather, organize, analyze and synthesize data to generate a well-reasoned differential diagnosis; formulate a treatment plan; and implement treate follow-up.

• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: The resident will order appropriate testing, acting on those results in conjunction with exam findings and patient input.

• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: Residents will perform procedures including skin/punch biopsies, pap smears, hemoccult testing and arthrocentesis.

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

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Residents will have an outpatient experience that includes a wide variety of patients, diagnoses, and treatment modalities.

• Access and critically evaluate current medical information and scientific evidence. Examples: Residents will use available databases, journal articles and other reference materials.

• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of allergy and immunology. Examples: Same as above.

• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Resident will synthesize this knowledge with guidance from attending.

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: The resident will receive face to face evaluation and feedback from attending at each session and cumulative evaluations periodically.

• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: Same as above.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: Attending will facilitate an environment where residents fell supported and thus more above to communicate openly and honestly with the attending.

• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: Residents will use available databases, journal articles and other materials.

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. Examples: The resident will communicate effectively with other members of the health care team to ensure that the plan of care is understood.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: The resident will ensure that all the patient's questions have been satisfactorily answered.

• Interact with consultants in a respectful, appropriate manner. Examples: The resident will communicate clearly with the subspecialist regarding the reason they are requesting their services as consultants.

• Maintain comprehensive, timely, and legible medical records. Examples: The resident will document completely and legibly each interaction with or regarding the patient.

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. Examples: The resident will be aware of and utilize pharmacy discount programs and available charity services.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: Residents are expected to gradually develop higher levels of understanding and skills. They are also expected to become more efficient over time and be able to assess/treat more patients per clinic session as their training progresses.

• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: The resident will counsel patients on weight loss, smoking cessation, and obtaining recommended cancer screenings.

• 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. Examples: The resident will work with the hospital financial counselors and social workers to guide patients towards appropriate help.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall


2. Clinical