Goals and Objectives for Resident Competencies

I. Level I: Non-supervisory (PGY1 or as defined by the ROC). Before the house officer can move into a supervisory role, he or she must demonstrate attainment of the competencies represented in the following objectives. This house officer must achieve the role or reporter and interpreter, and demonstrate a capacity to become an excellent manager.

A. Patient Care: The house officer must:

1. be able to carry out all assignments agreed to in consultation with senior residents and faculty.
2. be able to provide clinical care in all settings in a relatively independent manner for most common internal medicine problems with only moderate supervision from senior house officers and  faculty.
3. demonstrate appropriate awareness of his or her limitations.
4. demonstrate the ability to conduct competent medical interviews and physical examinations.
5. demonstrate the ability to engage in informed discussions of clinical options for evaluation and treatment.
6. demonstrate the ability to identify key clinical factors and pattern groupings in the process of medical decision making.
7. demonstrate a willingness to consider cost and social issues in the process of medical decision making and patient care.
8. demonstrate the ability to perform all basic required procedures (including ACLS), to provide informed consent for those procedures and to interpret the results of the those procedures.
9. demonstrate the ability to document patient care in an effective and competent manner

B. Medical Knowledge: The house officer must
    1. demonstrate appropriate knowledge of basic and clinical science.
    2. demonstrate commitment to learning and to the educational process.

C. Practice-based Learning Improvement: The house officer must

1. demonstrate insight into his or her own knowledge deficiencies.
2. be able to define the concept of practice-base learning.
3. be able to define methods for incorporating practice-based learning into their educational strategies.
4. demonstrate commitment to the process of practice-based learning.
5. demonstrate command of Medical Knowledge Management including information resources and retrieval, critical appraisal and practice application.

D. Interpersonal & Communication Skills: The house officer must

1. demonstrate knowledge of the importance of highly developed interpersonal and communication skills to the provision of competent and compassionate medical care.
2. demonstrate the ability to develop effective therapeutic relationships with patients, their families and their significant others or designated representatives for making health care decisions.
3. demonstrate appropriate flexibility and the ability to understand and incorporate formative feedback.
4. demonstrate incorporation of the 5E's of communication into interaction with both patients and colleagues.
5. understand the role of consultants and the importance of effective and personal communication.
6. demonstrate the ability to communicate effectively with colleagues and other members of the health care team.

E. Professionalism: The house officer must

1. demonstrate understanding of the broad definitions of professionalism, including altruism, medical ethics, the professional role.
2. act in a professional manner in relations with patients, colleagues, related health professionals and all others involved in the provision or process of care.
3. demonstrate the importance of confidentiality and of patients' rights.
4. demonstrate circumspection in word and deed.
5. demonstrate commitment to learning from mistakes, honesty, compassion, and commitment to quality.
6. demonstrate the ability to recognize deficiencies in peers and provide formative feedback.

F. Systems-based Practice: The house officer must

1. demonstrate an understanding of the contexts and constraints of the health care delivery system
2. demonstrate the ability to apply knowledge of the health care delivery system to improve individual and community health

G. Teaching: The house officer must

1. demonstrate knowledge of the importance of the teaching role of the physician.
2. demonstrate a willingness to engage in teaching.

H. Organizational Skills: The house officer must demonstrate the ability to work in an effective, comprehensive and time-sensitive manner.

II. Level II (PGY2 through PGY3 as defined by the ROC) Level II assumes achievement of all Level I Competencies in addition to the following. Level II assumes a supervisory role for faculty. This resident should achieve the roles of manager and educator.

A. Patient Care: The house officer must

1. demonstrate the ability to move from identifying key clinical factors and patterns to consistently making accurate and rationale differential diagnoses and plans.
2. be able to consistently make appropriate decisions under the supervision of faculty attendings.
3. be able to teach procedures to those medical learners under his or her supervision.
4. demonstrate the ability to provide compassionate and competent end-of-life care or treatment of pain
5. demonstrate the ability to identify and address opportunities for disease prevention and health promotion

B. Practice-based Learning Improvement: The house officer must

1. demonstrate commitment to enhancing the learning of colleagues and patients through practice-based learning strategies.
2. demonstrate skill at identifying appropriate practice-based learning opportunities and at identifying appropriate resources and questions.

C. Interpersonal and Communication Skills: The house officer must

1. demonstrate the ability to lead effectively and to assume responsibility.
2. demonstrate ability to create an environment which fosters respect for patients, colleagues, and the educational process

D. Systems-based Practice: The house officer must demonstrate an ability to work within and lead a health care team.

E. Teaching: The house officer must

1. demonstrate effective clinical teaching skills with special respect to the microskills of clinical teaching.
2. create a nurturing environment which emphasizes the importance of learning and is conducive to learning.

F. Organization Skills: The house officer must

1. demonstrate commitment to the process of team orientation and management.
2. demonstrate commitment to an organizational process which places appropriate emphasis on time commitments to patient care, education and personal time as well as equity in the team setting for distribution of assignments, patient care, learning and personal time.
3. ensure adherence to work hours regulations and the policies and procedures of the Program

Level III. (Prepared to Practice Independently) The house officer is ready for graduation and has consistently demonstrated competence in all areas. The house officer can practice independently and has demonstrated the requisite knowledge, skills and attitudes required to perform as an independent practitioner of Internal Medicine. This house officer must be an excellent manager.