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Principal Educa...
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families. Maintain accurat...
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woman exams. Resident...
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LBJ
PGY-1 and PGY-2...
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The University of T...
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Evaluation

  1. 1. evaluation4196.doc Page 1 Principal Educational Goals and Objectives by Relevant Competency The principal educational goals for residents on this rotation are indicated for the relevant ACGME competencies. The tables below each goal list the corresponding educational objectives, the relevant learning activities and the evaluation methods for each objective. The educational goals and objectives are applicable to PGY-1 residents and the expected competency levels demonstrated by the residents should reflect their respective level of experience. The Residents Ambulatory experience consists of time in the Pediatric, Surgery, OB/Gyn and Family Medicine Continuity of Care Clinics. Schedule: Monday Tuesday Wednesday Thursday Friday Pediatric Surgery OB/Gyn Pediatric AM-Family Clinic Clinic 8-5 Clinic Practice 9--5 8-5 9-5 8-12) PM-Pediatric Clinic 1-5pm Pediatric Clinic is located on the second floor of Lyndon B Johnson General Hospital, 5656 Kelley St. Houston, TX 77571; the average number of patients per ½ day session is 4-10. For each of the clinics, an attending physician from that specialty is present as well as senior residents. The role of the resident is to manage the continuum of care for children seen in the pediatric clinic setting and promote preventive health care for children. The resident must display the ability to Diagnose and manage common signs and symptoms; and/or common childhood conditions; Develop a logical and appropriate clinical approach to the care of children while providing sensitive support to patients and their families in the clinical setting and arrange for on-going support and/or preventive services. The resident must develop a differential diagnosis and formulate an appropriate work-up with diagnostic tests to establish a diagnosis for common childhood conditions and develop appropriate treatment plan for the diagnosis. Demonstrate knowledge and appropriately use common diagnostic tests in the outpatient Community Clinic setting. Demonstrate understanding of how to utilize physiologic monitoring and special technology. Participate effectively with other health professionals, specialists and other providers who refer patients both as the primary provider and as the consulting physician. Develop effective communication relationships with patients and their /home/pptfactory/temp/20101018124713/evaluation4196.doc
  2. 2. evaluation4196.doc Page 2 families. Maintain accurate, timely, legible and legally appropriate medical records in the Community Clinic setting. Provide sensitive support to patients and families of children in the Community Clinic setting. Demonstrate commitment to following ethical and professional principles and to ongoing professional development. Practice ethically and within medical-legal constraints in the care of children presenting to the outpatient Community Clinic. Interact with other health professionals, specialists and other providers who refer patients to the Community Clinic both as the primary provider and as the consulting pediatrician. Demonstrate knowledge of key aspects of outpatient health care systems including cost control, billing and reimbursement in the Community Clinic. The resident spends 4 ½ days per week in this clinic resulting in an average of 64 hours per rotation month. The Surgery Clinic is located on the 4 t h floor of Lyndon B Johnson General Hospital, 5656 Kelley St. Houston, TX 77571; the average number of patients per ½ day session is 5-10. For each of the clinics, an attending physician from that specialty is present as well as senior residents. The role of the resident is to demonstrate knowledge of risk-benefit analysis in determining the appropriate treatment for patients. The resident should be able to demonstrate and explain an understanding of the role of different specialists and other health care professionals in overall patient management. The resident should correctly communication between the surgeon and the referring physician. The resident should observe their upper level residents (PGY 3-5) perform the acquisition of necessary consultative services to assess and to reduce operative risk. The resident should observe the upper level residents perform the interface with home health services (nursing, nutrition, physical therapy, occupational therapy). The resident should observe the senior residents (PGY 3-5) perform coding for the billing of outpatient services. The resident should observe and senior residents (PGY 3-5) perform the interface of the outpatient office and the hospital in scheduling admissions and / or operations. The resident spends 2 ½ days per week in this clinic resulting in an average of 36 hours per rotation month. The OB/Gyn Clinic is located on the 2nd floor of Lyndon B Johnson General Hospital, 5656 Kelley St. Houston, TX 77571; the average number of patients per ½ day session is 5-10. For each of the clinics, an attending physician from that specialty is present as well as senior residents. The role of the resident is Direct Patient Care, Decision Making, Planning, Record Keeping, Order Writing and Continuing Management of Patients. Residents share duties with categorical PGY-1 OB-GYN residents. These duties include diagnosis of labor, techniques of delivery, pre- and post-op care and outpatient care with an emphasis on return OB visits and well- /home/pptfactory/temp/20101018124713/evaluation4196.doc
  3. 3. evaluation4196.doc Page 3 woman exams. Residents are responsible for completing a history and physical, writing daily progress notes, orders and plan of management, all with appropriate supervision. The resident spends 2 ½ days per week in this clinic resulting in an average of 32 hours per rotation month. The Family Medicine Clinic is located on the first floor of Lyndon B Johnson General Hospital, 5656 Kelley St. Houston, TX 77571; the average number of patients per ½ day session is 3. For each of the clinics, an attending physician from that specialty is present as well as senior residents. The role of the resident is to routinely care for five or six new or follow-up patients during a clinic session, where they are individually supervised by an attending faculty supervisor. Patients seen in the Continuity Clinic rotation include patients referred to the resident’s Panel Clinic after discharge from Memorial Hermann Hospital, patients referred to the panel clinic at LBJ Hospital, from the Emergency Department, or after discharge from an inpatient service, patients receiving primary care at Harris County’s Thomas Street Clinic, or the Good Neighbor Clinic. The majority of patients are seen through the Memorial Hermann or LBJ panel clinics. The resident spends 2 ½ days per week in this clinic resulting in an average of 32 hours per rotation month. The total hours spent in each clinic provides the resident with an average of 140 hours of ambulatory experience, +/-64 Pedi, +/-32 Surgery, +/-32 OB/Gyn and +/-32 in Family Practice, these hours are monitored by the program director and resident. Should it occur the resident will not meet the required hours additional clinic time is scheduled throughout the academic year to make up any difference. A. Patient Care GOAL: Manage continuum of care for children seen in the pediatric clinic setting and promote preventive health care for children. Principal Educational Objectives Learning Evaluation Activities Methods 1. Develop history and physical examination DPC, FS AE, FS, skills including chart documentation and PDR interviewing. 2. Review past medical history, family history, DPC, FS AE, FS, immunizations and development. PDR 3. Assure continuity of care when patients are DPC, FS AE, FS, admitted to the Inpatient Unit from the PDR Community Clinic. Communicate with hospitalists or specialists who provide care /home/pptfactory/temp/20101018124713/evaluation4196.doc
  4. 4. evaluation4196.doc Page 4 for patients admitted or provide care directly to patients admitted from the Community Clinic. 4. Function as the primary provider by DPC, FS AE, FS, providing family support and helping with PDR the transitions to and from the inpatient setting. 5. Develop short-term and long-term plans for DPC, FS AE, FS, patient care and integrate these into case PDR management or continuing care treatment plans. Recognize when it is necessary to update these plans. 6. Discuss the following preventive health DPC, FS, NC AE, FS, care topics with patients and their families: PDR a. Developmental assessments including normal screening. b. Plot growth curve c. Discipline and other parenting issues d. Immunizations – schedule, exceptions, side effects and contraindications e. Normal and abnormal sexual development of different ages f. Nutrition – obesity, breast feeding, infant feeding, vitamins and fluoride g. Screening lab data – lead and anemia 7. Refer patients to appropriate specialists DPC, FS AE, FS, and manage follow-up visits. PDR AMBULATORY PEDIATRIC OUTPATIENT ROTATION Faculty from The University of Texas Medical School at Houston Division of Community and General Pediatrics supervise the residents in clinic. Patients seen in these outpatient clinics (Community Clinics) include patients without a previously documented faculty physician from clinics or the emergency room, patients referred to the clinics, managed care patients, and patients requiring follow-up exams from inpatient care at MHCH or LBJ. Legend for Learning Activities AR – Attending Rounds GR – Grand Rounds NC – Noon DPC – Direct Patient Care JC – Journal Club Conferences CAT – Critically Appraised MR – Morning Report RC – Research Topics M&M – Morbidity and Conference EBM – Evidence-Based Mortality Conference SS – Senior Medicine Course MDR – Multidisciplinary Seminar /home/pptfactory/temp/20101018124713/evaluation4196.doc
  5. 5. evaluation4196.doc Page 5 E/C – Rounds SL – Ethics/Communication Subspecialty Conferences Lectures Legend for Evaluation Methods for Residents AE – Attending Evaluations PDR – Program Director’s DSP – Directly Supervised Procedures Review (twice annually) MR – Morning Report IE – In-Training Exam PR – Peer Review FS – Faculty Supervision & CR – Chart Review Feedback CSR- Chart Stimulated Review GOAL: Diagnose and manage common signs and symptoms that present to the Community Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Recognize and manage the following DPC, MR, FS AE, FS, episodic disorders: chronic pain, chicken PDR pox, colic, common intestinal parasites, conjunctivitis, dehydration, diarrhea, fever, influenza, lymphadenopathy, neonatal infections, respiratory tract infections, pharyngitis, thrush, vomiting and persistent cough. 2. Recognize the following common DPC, MR, FS AE, FS, behavioral problems and counsel parents: PDR abuse, attention deficit disorders, depression, encopresis, eating disorders, enuresis, feeding problems, psychosis, sleeping disturbances, and speech disorders. 3. Recognize and manage allergies including DPC, MR, FS AE, FS, allergic rhinitis and asthma. PDR 4. Recognize and manage common pediatric DPC, MR, FS AE, FS, ear, nose and throat problems including PDR antimicrobial prophylaxis, acute otitis media, chronic otitis, otitis externa, epistaxis, hearing screening, and sinusitis. 5. Recognize and manage common pediatric DPC, MR, FS AE, FS, eye problems including amblyopia, PDR strabismus, styes and chalazia, tearing, and vision screening. 6. Recognize and manage common pediatric DPC, MR, FS AE, FS, gastrointestinal problems including chronic PDR abdominal pain, constipation, gastroesophageal reflux, inguinal hernia and hydrocele, hepatomegaly, malabsorption syndrome and pyloric /home/pptfactory/temp/20101018124713/evaluation4196.doc
  6. 6. evaluation4196.doc Page 6 stenosis. 7. Recognize and manage common pediatric DPC, MR, FS AE, FS, genitourinary problems including dysuria PDR and frequency, urinary tract infections and undescended testes. 8. Recognize and manage common pediatric DPC, MR, FS AE, FS, cardiovascular problems including cardiac PDR disease, heart murmurs, hypertension referral and evaluation and SBE prophylaxis. 9. Recognize and manage common pediatric DPC, MR, FS AE, FS, dermatological problems including atopic PDR dermatitis, bacterial skin infections, contact dermatitis, diaper rash, epidermal tumors, hair and nail disorders, insect bites and infections, papulosquamous disorders, psoriasis, seborrheic dermatitis, superficial dermatophyte and yeast infections, vascular nevi, vesicular, bullous and pustular eruption, viral exanthems, and warts and molluscum contagiosum. 10 Recognize and manage vulvovaginitis. DPC, MR, FS AE, FS, . PDR 11. Recognize and manage common pediatric DPC, MR, FS AE, FS, musculoskeletal problems including bow PDR legs, knock knees, developmental dysplasia of the hip, flat feet, limping, scoliosis, toeing in and torsional deformities. 12 Recognize and manage common pediatric DPC, MR, FS AE, FS, . neurological disorders including PDR craniosynostosis, epilepsy, floppy infant, headaches, microcephaly, macrocephaly 13 Recognize and manage common endocrine DPC, MR, FS AE, FS, . problems including diabetes, PDR precocious/delayed puberty, short stature and thyroid disorders. GOAL: Evaluate and manage common signs and symptoms that present to the Community Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Evaluate and manage the following DPC, MR, FS AE, FS, common signs and symptoms: PDR a. General: Health supervision visits, Failure to thrive, weight loss or gain, fatigue, fever, constitutional symptoms, acute life- /home/pptfactory/temp/20101018124713/evaluation4196.doc
  7. 7. evaluation4196.doc Page 7 threatening event (“ALTE”), excessive crying b. Cardiorespiratory: Hypertension, rhythm disturbance, syncope, heart murmur, shortness of breath, chest pain, cyanosis, dyspnea, tachypnea, wheezing, stridor, inadequate respiratory effort, cough, hemoptysis, respiratory failure c. Dermatologic: Rashes, pigmentary changes, paleness, petechiae, purpura, ecchymoses, urticaria, edema d. EENT: Conjunctival injection, acute visual changes, ear, throat, eye pain, edema, epistaxis, foreign body, nasal, ear or eye discharge, hoarseness, stridor e. Endocrine: Polydipsia, polyuria, heat/cold intolerance, growth disturbance, normal and abnormal timing of pubertal changes f. GI/Nutrition/Fluids: Abdominal pain, mass or distension, ascites, dehydration, constipation, diarrhea, dysphagia, encopresis, hematemesis, inadequate intake of calories or fluid, jaundice, melena, rectal bleeding regurgitation, vomiting g. Genitourinary/Renal: Change in urine color, dysuria, edema, enuresis, frequency, hematuria, obstructive uropathy, oliguria, pain referable to the urinary tract, scrotal mass or edema, trauma to urinary tract or external genitalia h. GYN: Abnormal vaginal bleeding, pelvic or genital pain, vaginal discharge or odor, vulvar trauma or erythema i. Hematologic/Oncologic: Abnormal bleeding, bruising, lymphadenopathy, hepatosplenomegaly, masses, pallor j. Musculoskeletal: Arthritis/arthralgia, bone and soft tissue trauma, limp, limb or joint pain, variations in alignment (i.e., intoeing) k. Neurologic: Ataxia, change in sensorium, diplopia, headache, head trauma, hearing concerns, gait disturbance, hypotonia, lethargy, seizure, tremor, vertigo, visual disturbance, weakness l. Psychiatric/Psychosocial: Acute psychosis, anxiety, depression, behavioral concerns, conversion symptoms, child abuse or /home/pptfactory/temp/20101018124713/evaluation4196.doc
  8. 8. evaluation4196.doc Page 8 neglect, hyperactivity, suicide attempt GOAL: Diagnose and manage common childhood conditions that present to the Community Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Gather essential and accurate information DPC, MR, FS AE, FS, using problem-focused interview, exam PDR and diagnostic studies. 2. Formulate differential diagnoses with DPC, MR, FS AE, FS, appropriate epidemiologic considerations. PDR 3. Discuss appropriate prioritization of DPC, MR, FS AE, FS, patients and recognize patients with PDR potentially serious problems that require further evaluation, referral or hospital admission. 4. Recognize and manage the following DPC, MR, FS AE, FS, common childhood conditions: PDR 4a. General: Health supervision visits, colic, failure to thrive, fever, overweight, well- child and well adolescent care. 4b. Allergy/Immunology: Allergic rhinitis, asthma, recurrent infections, angioedema, serum sickness, and urticaria 4c. Cardiovascular: Heart murmurs, palpitations, congenital heart disease, myocarditis, cardiomyopathy, congestive heart failure, Kawasaki disease, rheumatic fever, bacterial endocarditis 4d. Dermatology: Abscess, atopic dermatitis, cellulitis acne, superficial skin infections, impetigo, molluscum, tinea infections, viral exanthems, verruca vulgaris, and other common rashes of childhood and adolescence 4e. Endocrine/Metabolic: Hypothyroidism, hyperthyroidism, diabetes mellitus, diabetes insipidis, precocious or delayed puberty, gynecomastia 4f. GI/Nutritional: Constipation, encopresis, gastroenteritis, foreign body ingestion, gastroesophageal reflux, nutritional issues, hepatitis, appendicitis, pancreatitis, inflammatory bowel disease, and bleeding in stool 4g. GU/Renal: Electrolyte and acid-base disturbances (mild), enuresis, /home/pptfactory/temp/20101018124713/evaluation4196.doc
  9. 9. evaluation4196.doc Page 9 glomerulonephritis, hematuria, Henoch Schonlein purpura, nephrotic syndrome, UTI/pyelonephritis 4h. Gynecologic: Genital trauma, labial adhesions, pelvic inflammatory disease, vaginal discharge or foreign body, STD’s 4i. Hematology/Oncology: Anemia, hemoglobino-pathies, neutropenia, leukocytosis, thrombocytopenia, abdominal and mediastinal mass (initial work-up) 4j. Infectious Disease: Cellulitis, cervical adenitis, pneumonia (viral or bacterial), laryngotracheobronchitis, periorbital and orbital cellulitis, initial evaluation and follow-up of serious deep tissue infections, dental abscess with complications, otitis media, sinusitis, upper respiratory tract infections, viral illness 4k. Musculoskeletal: Apophysitides, fractures, femoral retro- and anteversion, growing pains, limp, metatarsus adductus, sprains, stained Olgood-Shlater, tibial torsion 4l. Pharmacology/Toxicology: Common drug poisoning and overdose, ingestion avoidance 4m Neurology/Psychiatry: Seizures (evaluation . and adjustment of medications), developmental delay, acute neurologic conditions, behavioral concerns 4n. Pulmonary: Asthma exacerbation, bronchiolitis, croup, epiglottitis, pneumonia, sinusitis, tracheitis, viral URI and LRI 4o. Surgery: Initial evaluation of patients requiring urgent referral, pre- and post-op evaluation of surgical patients GOAL: Develop a logical and appropriate clinical approach to the care of children in the clinical setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Utilize principles of decision-making and DPC, FS AE, FS, problem solving skills in the care of children PDR in the clinical setting. 2. Identify and prioritize patients’ medical DPC, FS AE, FS, problems and generate appropriate PDR differential diagnoses. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  10. 10. evaluation4196.doc Page 10 3. Use appropriate timing for diagnostic and DPC, FS AE, FS, therapeutic interventions. PDR 4. Adjust pace to patient acuity and volume. DPC, FS AE, FS, PDR GOAL: Provide sensitive support to patients and their families in the clinical setting and arrange for on-going support and/or preventive services. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss issues such as growth and DPC, FS AE, FS, nutrition, developmental stimulation and PDR schooling with patients and their families. 2. Recognize problems and/or risk factors in DPC, FS AE, FS, the child or family (e.g., immunizations, PDR social risks, developmental delay) and appropriately intervene or refer. 3. Document drug allergies. DPC, FS AE, FS, PDR 4. Discuss outpatient management and DPC, FS AE, FS, parent education regarding chronic PDR asthma. 5. Recognize and respond appropriately to DPC, FS AE, FS, common reactions of family members to PDR recommendations for optimal health supervision and management of common illnesses in children. 6. Treat families in a non-judgmental, DPC, FS AE, FS, culturally sensitive manner. PDR B. Medical Knowledge GOAL: Develop a differential diagnosis and formulate an appropriate work- up with diagnostic tests to establish a diagnosis for common childhood conditions that present to the Community Clinic. Develop appropriate treatment plan for the diagnosis. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the pathophysiological basis of the DPC, MR, AE, FS, condition or injury. FS, NC PDR 2. Discuss criteria for hospital admission from DPC, MR, FS AE, FS, the outpatient setting. PDR 3. Utilize patient information, current scientific DPC, MR, FS AE, FS, evidence, and clinical problem-solving skills PDR to make informed diagnostic and therapeutic decisions. GOAL: Demonstrate knowledge and appropriately use common diagnostic tests in the outpatient Community Clinic setting. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  11. 11. evaluation4196.doc Page 11 Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss indications for and limitations of DPC, FS AE, FS, standard laboratory tests and imaging PDR studies including principles of sensitivity and specificity. 2. Demonstrate knowledge of the age- DPC, FS AE, FS, appropriate normal readings of standard PDR laboratory tests and imaging studies. 3. Interpret abnormalities in the context of DPC, FS AE, FS, specific physiologic derangements. PDR 4. Discuss therapeutic options for DPC, FS AE, FS, correction of abnormalities when PDR appropriate. Laboratory Tests a. CBC differential, platelet count, RBC indices b. Blood chemistries – electrolytes, glucose, calcium, magnesium, and phosphate c. Renal function tests d. Tests of hepatic function (PT, albumin) and damage (liver enzymes, bilirubin) e. Serologic tests for infection (e.g., hepatitis, HIV) f. ESR, CRP g. Routine screening tests (e.g., neonatal screens, lead) h. Wet preps and skin scrapings for microscopic examination, including scotch tape test for pinworms i. Thyroid function tests j. Culture for bacterial, viral and fungal pathogens, including stool culture k. Urinalysis l. Gram stain m. Developmental and behavioral screening tests (e.g., Connor’s Denver, depression inventory) Imaging/Radiographic Studies DPC, FS AE, FS, PDR a. Plain radiographs of the chest, extremities, abdomen, skull and sinuses /home/pptfactory/temp/20101018124713/evaluation4196.doc
  12. 12. evaluation4196.doc Page 12 b. Other techniques such as CT, MRI, angiography, ultrasound, nuclear scans (interpretation not expected) and contrast studies Other Testing DPC, FS AE, FS, PDR a. Appropriately order/use electrocardiogram and echocardiogram GOAL: Demonstrate understanding of how to utilize physiologic monitoring and special technology in the Community Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss appropriate monitoring techniques DPC, FS AE, FS, for age and clinical setting, describe the PDR indications and limitations of and interpret the results and measurement of the following monitoring modalities: cardiac monitoring, pulse oximetry and repeated assessment of temperature, heart rate, and blood pressure as clinically indicated during an office visit. 2. Appropriately use the following treatments/ DPC, FS AE, FS, techniques in the Community Clinic setting: PDR universal precautions, hand washing between patients, isolation techniques, administration of nebulized medication, injury, wound or burn care, and oxygen delivery systems. 3. Discuss normal and abnormal findings at DPC, FS AE, FS, tracheostomy, gastrostomy, or central PDR venous catheter sites and demonstrate appropriate intervention or referral. 4. Demonstrate the skills for assessing and DPC, FS AE, FS, managing pain and conscious sedation. PDR 5. Discuss indications for and use of DPC, FS AE, FS, behavioral techniques and supportive care PDR and other non-pharmacologic methods of pain control. C. Practice-Based Learning and Improvement GOAL: Utilize a logical and appropriate clinical approach to the care of children applying principles of evidence-based decision-making and problem solving skills. Principal Educational Objectives Learning Evaluation Activities Methods /home/pptfactory/temp/20101018124713/evaluation4196.doc
  13. 13. evaluation4196.doc Page 13 1. Develop and apply decision-making and FS, CAT, AE, FS, problem solving skills in the care of EBM, DPC PDR children. 2. Demonstrate ability to prioritize care FS, DPC AE, FS, needs: identify urgent issues that require PDR immediate attention, use appropriate timing for diagnostic and therapeutic interventions and adjust pace to acuity and volume. 3. Assess quality control and quality FS, EBM, DPC AE, FS, improvement processes and utilize PDR results to improve patient care practices and patient management in the Community Clinic setting. 4. Discuss how clinical pathways and FS, DPC AE, FS, practice guidelines can be used to PDR improve patient care for patients evaluated and treated in the Community Clinic setting. 5. Integrate professional scholarship FS, EBM, AE, FS, including electronic and print literature DPC, CAT PDR with emphasis on the integration of basic science with clinical medicine into decision-making regarding patient care. D. Interpersonal Skills and Communication GOAL: Participate effectively with other health professionals, specialists and other providers who refer patients both as the primary provider and as the consulting physician. Principal Educational Objectives Learning Evaluation Activities Methods 1. Communicate well and work effectively FS, DPC AE, FS, with fellow residents, attendings, PDR consultants, nurses, ancillary staff and referring physicians. 2. Develop and demonstrate skills as a team FS, DPC AE, FS, participant and leader in the care of PDR pediatric patients. 3. Present information concisely and clearly FS, DPC AE, FS, both verbally and in writing on patients to PDR other members of the health care team. 4. Utilize consultants appropriately and FS, DPC AE, FS, communicate in an effective manner. PDR 5. Communicate effectively while performing FS, DPC AE, FS, the role of pediatric consultant for PDR hospitalized patients managed by other providers (i.e., family physicians, /home/pptfactory/temp/20101018124713/evaluation4196.doc
  14. 14. evaluation4196.doc Page 14 surgeons, etc.) 6. Function as the primary care provider in a FS, DPC AE, FS, managed care model requiring PCP PDR involvement in obtaining continuing services from consultants and acquisition of durable medical equipment for children with complex diagnoses or chronic medical conditions. GOAL: Develop effective communication relationships with patients and their families. Principal Educational Objectives Learning Evaluation Activities Methods 1. Communicate with families in a FS, DPC, E/C AE, FS, developmentally, culturally-sensitive PDR manner that provides families/patient with the information they need to understand the illness/injury, participate in the care, give informed consent, and prevent future injury or dysfunction. 2. Effectively listen to the concerns of FS, DPC, E/C AE, FS, patients and their families and respond PDR with appropriate information and support. 3. Communicate to a given family and child FS, DPC, E/C AE, FS, the impact of each phase of care on the PDR final health care outcome, the psychosocial impact of illness on the child and family, and the financial burden to the family and the health care system. GOAL: Maintain accurate, timely, legible and legally appropriate medical records in the Community Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Write notes that clearly document the FS, DPC AE, FS, patient’s progress, relevant PDR, CR, investigations and treatment plan. CSR 2. Review the patient’s past records for FS, DPC AE, FS, information relevant to current visit. PDR, CR, CSR E. Professionalism GOAL: Provide sensitive support to patients and families of children in the Community Clinic setting. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  15. 15. evaluation4196.doc Page 15 Principal Educational Objectives Learning Evaluation Activities Methods 1. Treat families in a non-judgmental, FS, DPC, E/C AE, FS, culturally sensitive manner. PDR 2. Respond constructively to the “difficult” FS, DPC, E/C AE, FS, child and parent and utilize consultant PDR resources as appropriate. 3. Accept professional responsibility as the FS, DPC AE, FS, primary care physician for patients under PDR his/her care. 4. Partner with parents to develop plans to FS, DPC AE, FS, facilitate optimal health and development PDR for the patient. 5. Describe the role and beliefs of fathers, FS, DPC, E/C AE, FS, mothers, grandparents, other family PDR members and non-family members in understanding physician instructions, making health decisions and implementing management plans. 6. Develop treatment plans that take into FS, DPC, E/C AE, FS, account family religious views as they PDR relate to health care choices. 7. Describe the problems of indigent families FS, DPC, E/C AE, FS, in seeking acute and preventive medical PDR care for their children including barriers affecting compliance with medical instructions. GOAL: Demonstrate commitment to following ethical and professional principles and to ongoing professional development. Principal Educational Objectives Learning Evaluation Activities Methods 1. Demonstrate knowledge of ethical FS, DPC, E/C AE, FS, concepts of confidentiality, consent, PDR autonomy and justice. 2. Demonstrate knowledge of FS, DPC, E/C AE, FS, professionalism concepts such as PDR integrity, altruism and conflict of interest. 3. Increase self-awareness to identify FS, DPC, E/C AE, FS, methods to manage personal and PDR professional sources of stress and burnout. 4. Increase knowledge and awareness of FS, DPC, E/C AE, FS, personal risks concerning drug/alcohol PDR abuse for self and colleagues, including referral, treatment and follow-up. 5. Demonstrate initiative in seeking out and FS, DPC, E/C AE, FS, participating in continuing education and PDR /home/pptfactory/temp/20101018124713/evaluation4196.doc
  16. 16. evaluation4196.doc Page 16 professional development programs. GOAL: Practice ethically and within medical-legal constraints in the care of children presenting to the outpatient Community Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Describe the ethical issues involved with FS, DPC, E/C AE, FS, treating pediatric patients including PDR obtaining informed consent for procedures and the judicious use of diagnostic testing and therapeutic modalities. 2. Describe the potential ethical dilemmas FS, DPC, E/C AE, FS, that may present in the outpatient PDR Community Clinic setting including the following: a. Respect for patient autonomy and FS, DPC, E/C AE, FS, confidentiality in the evaluation and PDR treatment of sensitive conditions (i.e., pregnancy, request for contraception and sexually transmitted diseases). b. Treatment of disabled infants, children and FS, DPC, E/C AE, FS, adolescents. PDR c. Recruiting, enrolling and completing FS, DPC, E/C AE, FS, research in pediatric patients. PDR d. Deciding to accept/decline gifts, meals FS, DPC, E/C AE, FS, and CME support from pharmaceutical PDR representatives. e. Compliance with reporting requirements FS, DPC, E/C AE, FS, for infectious diseases, potential child PDR abuse and neglect, or sexual relationships between adolescents and adults. 3. Discuss how to handle situations where FS, DPC, E/C AE, FS, one’s own management goals for a PDR patient are in conflict with the family and/or attending physician and when transfer of care is appropriate. 4. Describe measures to be taken to reduce FS, DPC, E/C AE, FS, medical malpractice and liability in the PDR outpatient Community Clinic setting. 5. Describe sources of legal information FS, DPC, E/C AE, FS, regarding the following issues: PDR Patient/parent’s right to refuse treatment and the legal options available when parents refuse therapy or leave the Community Clinic against medical advice; Child and adult abuse/neglect reporting and the referral of abused parents to /home/pptfactory/temp/20101018124713/evaluation4196.doc
  17. 17. evaluation4196.doc Page 17 resources for their protection; and compliance with HIPAA regulations. F. Systems-Based Practice GOAL: Interact with other health professionals, specialists and other providers who refer patients to the Community Clinic both as the primary provider and as the consulting pediatrician. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the role of the pediatric FS, DPC AE, FS, consultant and provide pediatric PDR consultation to primary care providers and specialists in the outpatient Community Clinic setting. 2. Describe the role of outpatient and FS, DPC AE, FS, managed care case managers. Work PDR with these case managers to provide optimal health care (PGY-3/4 only). 3. Function as the primary care provider in FS, DPC AE, FS, a managed care model requiring PCP PDR involvement in obtaining continuing services from consultants and acquisition of durable medical equipment for children with complex diagnoses or chronic medical conditions. GOAL: Demonstrate knowledge of key aspects of outpatient health care systems including cost control, billing and reimbursement in the Community Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Utilize consultants and other resources FS, DPC AE, FS, appropriately. PDR 2. Demonstrate sensitivity to the financial FS, DPC AE, FS, status of patients; utilize resources PDR appropriately for patients/families needing financial assistance. 3. Describe the common mechanisms of FS, DPC AE, FS, outpatient Community Clinic cost control PDR in managed care settings, including pre- authorization. 4. Discuss common billing codes and FS, DPC AE, FS, documentation procedures for the PDR outpatient Community Clinic. Educational Goals and Objectives for Resident Rotations in General Surgery /home/pptfactory/temp/20101018124713/evaluation4196.doc
  18. 18. evaluation4196.doc Page 18 LBJ PGY-1 and PGY-2 Outpatient Clinic Objectives A.Medical Knowledge The resident should be able to critically evaluate and demonstrate knowledge of pertinent scientific information applicable to preoperative and postoperative conditions seen in the outpatient setting. B.Patient Care The resident should demonstrate an understanding and commitment to continuity of care through: 1. Preoperative patient evaluation to make or confirm a surgical diagnosis. 2. Correct interpretation of available diagnostic studies. 3. Correct pre-operative assessment of operative risk factors. 4. Accurate post-operative assessment of patient progress, including: a. Wound healing. b. Reconditioning. 5. Development of a patient care plan including timing of return to normal activities including work. The resident should be able to correctly perform (with supervision) minor ambulatory operations including: 1. Incision and drainage of superficial abscesses. 2. Excision of superficial skin lesions. 3. Closure of superficial lacerations. 4. Excision of small subcutaneous masses. Interpersonal and Communications Skills The resident should: 1. Observe initial contact with patients and patient families. 2. Observe explanation of surgical disease. 3. Observe explanation of surgical risk factors. 4. Observe the process of informed consent. 5. Effectively document the outpatient visit. Practice Based Learning and Improvement The resident should use books, journals, internet access and other tools available in the outpatient setting to learn about diseases and treatments that are observed in that setting. Systems Based Practice The resident should practice high quality, cost-effective patient care. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  19. 19. evaluation4196.doc Page 19 • The resident should demonstrate knowledge of risk-benefit analysis in determining the appropriate treatment for patients. • The resident should be able to demonstrate and explain an understanding of the role of different specialists and other health care professionals in overall patient management. • Junior residents (PGY 1-2) should observe and senior residents (PGY 3-5) should be able to perform correctly the communication between the surgeon and the referring physician. • Junior residents (PGY 1-2) should observe and senior residents (PGY 3-5) should be able to perform correctly the acquisition of necessary consultative services to assess and to reduce operative risk. • Junior residents (PGY 1-2) should observe and senior residents (PGY 3-5) should be able to perform correctly the interface with home health services (nursing, nutrition, physical therapy, occupational therapy). • Junior residents (PGY 1-2) should observe and senior residents (PGY 3-5) should be able to perform correctly coding for the billing of outpatient services. • Junior residents (PGY 1-2) should observe and senior residents (PGY 3-5) should be able to perform correctly the interface of the outpatient office and the hospital in scheduling admissions and / or operations. All residents should observe / learn the complexities of through processing an outpatient visit from patient scheduling to patient departure including registration, acquisition of third party payer approval, interface with nursing personnel, the actual surgeon visit, scheduling of necessary tests, acquisition of test results and scheduling follow-up Professionalism 1. The resident should dress in appropriate professional attire. 2. The resident should maintain and demonstrate high standards of ethical behavior. 3. The resident should maintain and demonstrate sensitivity to age, gender and culture of patients and other health care professionals. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  20. 20. evaluation4196.doc Page 20 The University of Texas-Houston Health Science Center Family Practice CONTINUITY CLINIC The Continuity Clinic rotation occurs one-half day each week throughout residency at the University of Texas. On the clinic morning or afternoon residents treat and follow their same patients while at UT. They routinely care for five or six new or follow-up patients during a clinic session, where they are individually supervised by an attending faculty supervisor. However, residents do not participate in clinic during the ER, MICU and CCU rotations, or when they are post-call. Patients seen in the Continuity Clinic rotation include patients referred to the resident’s Panel Clinic after discharge from Memorial Hermann Hospital, patients referred to the panel clinic at LBJ Hospital, from the Emergency Department, or after discharge from an inpatient service, patients receiving primary care at Harris County’s Thomas Street Clinic, or the Good Neighbor Clinic. The majority of patients are seen through the Memorial Hermann or LBJ panel clinics. Principal Educational Goals by Relevant Competency The principal educational goals for residents on this rotation are indicated for each of the six ACGME competencies in the tables below and numbered in the first column. The second column of the table lists the goal, the third column lists the most relevant learning activities for that goal, and the fourth column indicates the correlating evaluation methods for that goal. A detailed description of the on-going learning activities at Memorial Hermann and LBJ Hospitals is included in the front of the report for further information. • Develop a differential diagnosis and formulate an appropriate work-up with diagnostic tests to establish a diagnosis for common childhood conditions that present to the Community Clinic. Develop appropriate treatment plan for the diagnosis. • Demonstrate knowledge and appropriately use common diagnostic tests in the outpatient Community Clinic setting. • Demonstrate understanding of how to utilize physiologic monitoring and special technology in the Community Clinic setting. • Utilize a logical and appropriate clinical approach to the care of children applying principles of evidence-based decision-making and problem solving skills. • Participate effectively with other health professionals, specialists and other providers who refer patients both as the primary provider and as the consulting physician. • Develop effective communication relationships with patients and their families. • Maintain accurate, timely, legible and legally appropriate medical records in the Community Clinic setting. • Provide sensitive support to patients and families of children in the Community Clinic setting. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  21. 21. evaluation4196.doc Page 21 • Demonstrate commitment to following ethical and professional principles and to ongoing professional development. • Practice ethically and within medical-legal constraints in the care of children presenting to the outpatient Community Clinic. • Interact with other health professionals, specialists and other providers who refer patients to the Community Clinic both as the primary provider and as the consulting pediatrician. • Demonstrate knowledge of key aspects of outpatient health care systems including cost control, billing and reimbursement in the Community Clinic. /home/pptfactory/temp/20101018124713/evaluation4196.doc
  22. 22. evaluation4196.doc Page 22 LBJ/OBSTETRICS, GYNECOLOGY & REPRODUCTIVE SCIENCES Goals and Objectives for the Transitional Year Resident Provided below is a list of objectives and goals for transitional year residents on the LBJ Ob/Gyn services. This list is meant to provide direction for their study. In most cases, the greater the duration of their time spent on this service, the greater the likelihood they will achieve these objectives. Gynecology: Competency-Based Knowledge Objectives Perform an efficient and complete gynecological assessment, including an accurate history and physical examination. Outline the evaluative process and treatment for gynecologic problems such as: • pelvic masses; • early pregnancy problems such as ectopic pregnancies and miscarriages; • infections including all common STDs, and vaginitis; • gynecologic cancer screening; • abnormal uterine bleeding; • urinary incontinence and pelvic floor dysfunction Describe the mechanisms of action, fertility rates, benefits and risks of all common contraceptive measures and be able to counsel patients who desire to delay or end their reproductive function. Gynecology: Competency-Based Performance Objectives Perform pelvic examinations, only initially under direct supervision: • Part of every woman's general physical examination • Required for patient to be evaluated for abdominal or pelvic symptoms • Critical for patients who must undergo abdominal or pelvic surgery Obstetrics: Competency-Based Knowledge Objectives Describe the process for diagnosing and managing common obstetrical conditions and situations such as: term labor premature labor diabetes postpartum infection abnormal fetal presentation abnormal labor shoulder dystocia lactation antepartum hemorrhage postpartum hemorrhage intrapartum intraamniotic infection preeclampsia ruptured amniotic membranes, both term and preterm Obstetrics: Competency-Based Performance Objectives • Diagnose pregnancy, utilizing • History: include menstrual history and symptoms of early pregnancy /home/pptfactory/temp/20101018124713/evaluation4196.doc
  23. 23. evaluation4196.doc Page 23 • Physical examination: expected changes in the uterine cervix and corpus • Laboratory tests for pregnancy • Diagnose and evaluate a woman whose chief complaint is labor including the appropriate intrapartum laboratory assessment and counseling. • Deliver a baby during an uncomplicated delivery • Initially manage postpartum hemorrhage while obtaining more experienced assistance. • Perform prenatal screening assessment and counseling during all trimesters of pregnancy and recognize the following things: • Fetal heart beat by the fetoscope • The fetal position by the Leopold maneuvers • Palpation of fetal movements • Palpation of enlarged uterus, fundal height, softening of the cervix OB-GYN Ambulatory Since the OB/GYN schedule blends ambulatory with OB and GYN responsibilities, the ambulatory goals and objectives are contained within those previously listed. The resident can expect to spend 1.5 days per week in ambulatory care. Residents Responsibilities for Direct Patient Care, Decision Making, Planning, Record Keeping, Order Writing and Continuing Management of Patients Residents share duties with categorical PGY-1 OB-GYN residents. These duties include diagnosis of labor, techniques of delivery, pre- and post-op care and outpatient care with an emphasis on return OB visits and well- woman exams. Residents are responsible for completing a history and physical, writing daily progress notes, orders and plan of management, all with appropriate supervision. Supervision Residents in the clinic and L&D see patients first and present to an upper level resident (or faculty) from the LBJ OB-GYN service. In addition there is a faculty member from the OBGYN service in the hospital 24 hours a day seven days a week to provide consultation and supervision. /home/pptfactory/temp/20101018124713/evaluation4196.doc

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