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  1. 1. INTERNAL MEDICINE GOALS: Emergency medicine residents on internal medicine rotations should focus on: 1. Developing a systemic evaluation of patients presenting to the emergency department with medical complaints. 2. Understand the pathophysiology, presentation, evaluation, and treatment of diseases related to the GI tract, respiratory system, hematology system, hyper- and hypofunction of the immune system, infectious disorders, renal system, endocrine and metabolic systems, and nervous system. 3. Understanding the unique aspects of medical practice and the role of various medical specialists in the inpatient and outpatient care of emergency medicine patients. OBJECTIVES: Upon completion of the rotation, residents should be able to: Medical Expert GENERAL SKILLS 1. Conduct an efficient and effective history and physical examination for all medical patients under their care. 2. Based on the history, do an immediate assessment and initial stabilization, followed by a complete directed examination. 3. Combine the knowledge from the objectives below with the history and physical exam to develop an appropriate differential diagnosis, investigation, treatment and disposition plan for medical patients. RESPIRATORY 1. Describe the etiology, presentation, evaluation, and disposition of patients with infections of the respiratory system, acute and chronic airway disease, pulmonary embolism, chest masses, granulomatous disease, and systemic processes affecting the pulmonary system (e.g. cystic fibrosis). 2. Discuss the contraindications for, indications for, complications of, and perform: thoracentesis. GASTROENTEROLOGY 1. Describe the etiology, presentation, evaluation, and disposition of patients with esophageal problems, severe malnutrition, diarrhea, gallbladder and liver disorders including hepatitis, jaundice and cirrhosis, inflammatory and irritative bowel disease, and gastrointestinal bleeding. 2. Discuss the contraindications for, indications for, complications of, and perform: nasogastric tube insertion, anoscopy, rigid sigmoidoscopy, and paracentesis.
  2. 2. HEMATOLOGY/ONCOLOGY 1. Describe the etiology, presentation, evaluation, and disposition of patients with anemia, bleeding disorders, sickle cell disease, platelet disorders, solid tumours, tumours of the lymphatic system and hematopoeitic sustem. 2. Describe and manage the common oncologic emergencies such as febrile neutropenia, spinal cord compression, hypercalcemia and superior vena cava syndrome. AUTOIMMUNE & INFECTIOUS DISEASE 1. Demonstrate familiarity with the mechanism and manifestations of immune compromise, including that caused by infection with HIV and differentiate non-AIDS causes of immune hypofunction. 2. Describe the etiology, presentation, evaluation, and disposition of patients with rheumatologic and autoimmune diseases, hypersensitivity reactions including transplant rejection, and abnormalities of the lymphatic system. 3. Discuss the manifestations of, treatment of, appropriate disposition for, and immunization (when appropriate) of patients with viral infections and bacterial infections 4. Demonstrate knowledge of the time course, vectors, and treatment of the more common protozoal diseases and rickettsial diseases. 5. Know the characteristics of sepsis in different age groups. NEPHROLOGY ,ACID-BASE DISORDERS & THE ENDOCRINE SYSTEM 1. Describe the etiology, presentation, evaluation, and disposition of patients with glomerular disorders acid/base disorders fluid and electrolyte abnormalities glucose metabolism, and endocrine abnormalities. 2. Discuss the common causes, metabolic manifestations, treatment (including dialysis) and disposition of patients with renal failure. NEUROLOGY 1. Describe the etiology, presentation, evaluation, and disposition of patients with seizures, acute nervous system deficits, strokes, systemic nervous system disorders (such as Guillian-Barre, and myasthenia gravis), headache, and movement disorders. 2. Discuss the contraindications for, indications for, complications of, and perform: lumbar puncture. GERIATRICS 1. Describe the changes in anatomy, physiology, pharmacology, and psychology that occur with aging. 2. Perform a formal mental status exam for the elderly patient in the emergency department environment. 3. Assess decision making capacity in the elderly; discuss the types and meaning of advance directives. 4. Discuss which common diseases (appendicitis, myocardial infarction, etc.) present with atypical signs and symptoms in the elderly. 5. Perform functional assessments evaluating activities of daily living (ADL) of elderly patients in an emergency department setting. 6. Define and diagnose dementia and delirium in elderly patients. 7. Discuss the management of elderly patients who present with polypharmacy. 8. Demonstrate the ability to detect and manage elder mistreatment, including physical abuse, sexual assault, physical neglect, and psychological abuse and neglect.
  3. 3. Communicator 1. Converse effectively and sensitively with medical patients and their families. 2. Be able to discuss relevant issues around interventions. 3. Demonstrate knowledge of the health care consent act. 4. Demonstrate ability to deliver bad news effectively with compassion and sensitivity. 5. Demonstrate sensitivity to the needs of elderly patients and respect for their ability to make decisions. 6. Maintain appropriate documentation of progress and treatment decisions. 7. Communicate efficiently and effectively with all members of the health care team. 8. Participate meaningfully and lend expertise to family and case management meetings. Collaborator 1. Act as chief care-giver (under supervision) and communicate with the patient, family, family physician, consultants, other health care professionals and social agencies. 2. Communicate and coordinate with the health care team both short and long term therapeutic decisions regarding patient care. 3. Detail the proper and appropriate transfer of patients from one health care setting to another including listing of issues of patient transfer, transfer of medical documents and medical legal concerns. 4. Demonstrate ability to work effectively as part of a health care team in the inpatient setting. 5. Demonstrate an understanding of the roles of various participants in inpatient care. Manager 1. Coordinate care for patients, including the appropriate utilization of consultant specialists and community resources. 2. Manage time efficiently. 3. Identify medico-legal risks and take steps to address them. 4. Learn the ethical principles involved in medical decision-making with regard to advance directives and life sustaining treatment. 5. Assume a leadership role in the care of the medical patient. Health Advocate 1. Demonstrate an understanding of the determinants of health affecting medical patients and their families. 2. Act as an advocate for the individual patient and affected populations. 3. Demonstrate knowledge of routine preventive health initiatives such as prevention of falls in the elderly. 4. Understand societal biases regarding aging in the context of the emergency health care system. 5. Learn the concept of functional status as the interaction of age, disease, and environment.
  4. 4. Scholar 1. Demonstrate ability to critically evaluate the literature as it pertains to care of the medical patient. 2. Demonstrate inquisitiveness around clinical cases. 3. Demonstrate ability to apply the principles of evidence-based medicine. Professional 1. Adhere to the code of ethics of the CMA and the institution. 2. Treat patients and colleagues with respect. 3. Self-evaluate, demonstrating insight into strengths and weaknesses 4. Demonstrate commitment to life-long learning 5. Be reliable, responsible and accountable for his/her actions and for patient care. Evaluation Resident performance is reviewed by the attending Internist and/or Service Chief. Verbal feedback will be provided at least monthly by the Preceptor. An ITER (In Training Evaluation Report) will be completed at the conclusion of the one month training period. The ITER should be reviewed and signed by the resident and returned to the office of the Residency Program Director with a completed Procedures Record and Rotation Evaluation Form.