kING SAUD UNIVERSITy
COLLEGE OF MEDICINE
DEPARTMENT OF MEDICINE
INTERNAL MEDICINE RESIDENCY PROGRAM
King saud residency program
curriculum, PROTOCOLS and policies
OCTOBER 2007
INTERNAL MEDICINE RESIDENCY
TABLE OF CONTENTS
Table of Contents iv
Introduction 1
Definition and Description 2
General Goals and Objectives of the Residency Program 3
Curriculum Structure 5
Rotation Schedules 8
Program Goals by Year of Training 9
Procedure Log Book 11
Research Elective 12
Resident’s Benificiary 13
Specific Rotation Objectives
Anesthesia 14
Cardiology and Coronary Care unit 16
Emergency Medicine 19
Endocrinology 22
Gastroenterology 27
Haematology & Oncology 35
Infectious Disease 39
Intensive Care Unit 42
Nephrology 45
Neurology 52
Pulmonology 54
Radiology 58
Rheumatology 60
On-Calls Policies and RespoNsibilities 64
Vacation and LeavePolicy 66
Resident’s Day Activity 2007 – 2008 67
Internal Medicine Academic Activities 70
Performance and Evaluation Process 77
i
INTRODUCTION
Internal Medicine Residency Program, College of Medicine, in King Saud University is structured to provide a comprehensive core curriculum in internal medicine. This is accomplished through supervised daily patient care activities as well as other educational activities.
The residency program is structured to ensure that each resident has the opportunity to acquire the knowledge, clinical skills, interpersonal skills, professional attitudes and behaviors, and experience required to become an outstanding general internist or subspecialist.
For each required and elective rotation, the curriculum defines the educational purpose, training objectives, principal teaching methods, educational content, educational methods, and evaluation methods.
The curriculum covers the full range of general internal medicine and all subspecialties. It also provides an educational framework for clinical experiences in the related specialties of dermatology, neurology and diagnostics medical specialties.
OVERVIEW GOALS:
· Provide the educational and academic environment, formal and informal instruction, and clinical material necessary to train physicians for the practice of internal medicine or for subspecialty fellowship training.
· The R1 year focuses on fundamentals of differential diagnosis and clinical problem solving. Residents in the first year master the techniques of history taking and physical examination, gain expertise in the care of patients in a variety of inpatient and ambulatory settings and develop competence in procedural skills. At the conclusion of the R1 year, residents are prepared to assume responsibility for supervising patient care. In addition to rotations on the medical floors and intensive and coronary care units, residents have an opportunity to rotate in emergency medicine
· From the second (R2) year of core training, residents continue to evolve on the clinical teaching units in a progressively more seniorrole. They are expected to continue to broaden their knowledge base, develop teaching skills and acquire consultancy skills.
· In the Third (R3) and Fourth (R4) year of training the resident will be exposed to more medical problems ( medical condition of pregnancy, preoperative care, critical care, procedural skills, non-invasive cardiology) and they will be involved with other multidisciplinary specialties and he/she will be encourage to participate in research project. They will participate actively in academic activities and will beencouraged to develop special areas of interest. In general the fourth year resident will have more senior and supervisor role and to act as co-consultant level in decision making and patient care.
· Throughoutthe core training years a minimum of one half day a week is spent in anambulatory care setting under the supervision of faculty staff member. Daily and weekly lectures, conferences and workshops form anintegral part of the teaching program. In-training evaluations are completed for every rotation andcomposite reports are prepared every six months. Residents are encouraged to review and discuss these with theattending physician supervisor and the program director.
DEFINITION AND DESCRIPTION
This section defines the terms used throughout the present document.
Residency Program: King Saud Residency Program of Internal Medicine, College of Medicine, King Saud University
Academic Year: The academic year commences October 1 and finish on September 30. Occasionally the resident may be out of phase (e.g.: starting date other than Oct 1st)
Block: a block is 4-weeks duration. There are 13 blocks in the academic year.
Rotation: a rotation referred to the content of the experience, and it may be of any duration or more than one block (one block minimum to 3 blocks maximum)
Medicine Postgraduate Office (MPO): it is an office primarily focused on providing information, services, and support to residents, chief residence and residency program.
Resident: all resident approved and registered by Post Graduate Medical Education (PGME) in KSU or/and Saudi Council of Health Specialties (SCHS)
Chief Resident: Senior resident that act as coordination of organizing academic activities, on-call schedules and annual leaves for residents
Residency Unit Supervisor (RUS): Nominated by the unit to orient the residents to the unit, organize and supervise teaching activity and communicate and report to the program director any concerns or resident misbehavior.
Departmental Residency Committee (DRC): committee chaired by program director and consists of deputy program director, two consultant and chief resident.
Departmental Residency Committee
· Dr Abdulkareem Al Suwaida Committee Chairman
· Dr Ahmed Hersi Program Director
· Dr Ahmed Al Sagheir Deputy Program Director
· Dr Fahad Al Majed Member
· Dr Abdulrahman Al Arfaj Member
· Dr Nahla Azzam Member
· Dr Aamer Aleem Member
· Dr Mohammad Al Khowaiter Member (non-voting)
general Goals and objectives of the residency program
Goal I
Residents must demonstrate the ability to provide patient-centered care that is appropriate, compassionate and effective for treatment of health problems and the promotion of health.
Objectives:
· Residents will gather essential and accurate information by performing complete and clinically-relevant history and physical exam.
· Residents will understand how to order and interpret appropriate diagnostic tests.
· Residents will make diagnostic and treatment decisions by analyzing and synthesizing information.
· Residents will understand the limits of their knowledge and expertise.
· Residents will develop and carry out care plans.
· Residents will perform procedures competently.
· Residents will effectively counsel patients and families.
· Residents will use consultants and referrals appropriately.
Goal II
Residents will investigate and evaluate their patient care practices, evaluate and use current medical information and scientific evidence for patient care.
Objectives:
· Residents will demonstrate mastery of core basic and clinical science necessary to internal medicine practice.
· Residents will be able to access information and evaluate the medical literature.
· Residents must demonstrate habits consistent with life-long learning.
· The resident will exhibit evidence of self-evaluation.
· The resident will use feedback to improve practice.
· The resident will apply these processes to improve patient care.
· The resident will participate in the education of patients, families, students, residents, and other health professionals.
Goal III
Residents must demonstrate interpersonal and communication skills that result in effective information exchange, and collaboration with patients, families, and health professionals.
Objectives:
· Residents will demonstrate the ability to develop highly effective therapeutic relationships with patients and families.
· Residents will exhibit communication that is characterized by socio-cultural effectiveness.
· Residents will communicate respectfully and effectively with other health professionals.
· Residents will be able to act in a consultative role to other physicians and health professionals.
· Residents will maintain comprehensive, timely, effective and legible medical records.
Goal IV
Residents will demonstrate a commitment to professionalism, ethical behaviour and a commitment to the development of cultural humility.
Objectives:
· The resident demonstrates integrity, honesty and compassion, empathy and altruism.
· The resident acknowledges errors and limitations.
· The resident demonstrates responsibility, accountability, dependability, commitment and encourages continuity of care.
· The resident respects patient and family privacy and autonomy.
· The resident exhibits a commitment to the development of cultural humility.
Goal V
Residents will practice quality health care that is cost-effective and advocates for patients within the health system.
Objectives:
· The resident demonstrates care coordination and a knowledge of medical practice and delivery systems.
· The resident advocates for patients and for populations of patients.
· The resident understands and practices cost-effective health care that does not compromise quality of care.
· The resident understands the quality improvement process and how to work with health care managers and providers to assess, coordinate and improve care.
Curriculum structure
For the resident to reach above objectives the program curriculum is structured to enhance and evaluate the resident in four domains (APPENDIX I):
A. Knowledge
B. Communication
C. Professionalism
D. Scholarship
A. The Knowledge
The curriculum is structured to occur though regular teaching sessions, journal clubs, and most significantly in the patient-care context. The resident should be provided with adequate resources in this context including written and electronic references.
Regular evaluation of a resident's knowledge, skill, and attitudes in this domain are part of the periodic scheme for each clinical rotation. The resident's knowledge and skills in this domain will also be evaluated as part of the annual oral examination, as well as other examinations implemented by the KSU or the SMCHS.
As a result;
· The resident will be able to perform a complete and reliable history and physical examination, recognizing the normal from the abnormal.
· The resident will select appropriate investigations in a logical sequence, recognizing normal from abnormal results, and their significance.
· The resident will formulate a comprehensive problem list, synthesize an effective diagnostic and therapeutic plan, and establish appropriate follow-up.
· The resident will demonstrate effective consultation skills, presenting well-documented assessments and recommendations both verbally and in writing.
· The resident will be knowledgeable in both common and uncommon diseases.
· The resident will demonstrate technical expertise in performing the following procedures while knowing their indications and complications:
ü Central venous catheter insertion
ü Lumbar puncture
ü Peripheral arterial catheter insertion
ü Abdominal paracentesis
ü Endotracheal intubation
ü Thoracentesis
ü Knee joint aspiration
ü Electrocardiographic interpretation
· The resident's knowledge, attitudes, and skills in this context will show appropriate evolution over the four years of training, with appropriate mastery of more advanced concepts and skills in this field as the resident's clinical training progresses.
B. Communication
The curriculum is structured to occur through regular teaching, academic sessions and in the patient-care context through the recognition and application of the principles of verbal and written communication with patients, families, colleagues, and other health-care professionals, and in discussions and presentations with health-care professionals.
Regular evaluation of a resident's knowledge, skill, and attitudes in this domain are part of the periodic evaluation scheme for each clinical rotation. Furthermore, directly observed patient interviews occur on a regular basis as part of the annual practice oral exam.
As a result;
· The resident will be able to establish a therapeutic relationship with patients and families based on trust and respect, recognizing the fundamental importance and benefits of this relationship.
· The resident will be able to obtain and synthesize a relevant history from patients and families, given specific challenges (for example, language or other communication barriers). The relevant history will include not only information about the disease, but also patient beliefs, concerns, and expectations about the illness.
· The resident will be able to listen effectively.
· The resident will be able to discuss appropriate information with patients, families, and the health-care team. Specifically, the resident will be able to communicate in a humane and understandable manner that fosters discussion and promotes patient understanding.
· The resident will recognize the importance of cooperation and communication among health-care providers, and recognize the importance of delivering consistent messages to patients.
· The resident's knowledge, attitudes, and skills in this context will show appropriate evolution over the four years of training, with appropriate mastery of more advanced concepts in communication as the resident's clinical training progresses.
C. Professionalism
The curriculum is structured to occur primarily through the patient-care context. It is in this context that the resident participates in the day-to-day care of in-and out-patients, as a collaborative member of the health-care team whose goal is the provision of optimal patient care, education, and research.
The resident will show professionalism in:
· Punctuality, discipline and reliability
· Integrity, honesty and compassion
· Leadership and management skills
· Attitude toward patient, patient’s family and other health-care providers
· Personal and interpersonal behavior
· Understanding the ethical and medico-legal aspects of health problems
· Implementing the standard of care taking in consideration the patient well-being at all time regardless of cultural or belief diversity.
Regular evaluation of a resident's knowledge, skill, and attitudes in this domain are part of the periodic evaluation scheme for each clinical rotation.
D. Scholarship
The curriculum is structured to occur through regular journal clubs, academic sessions and through the completion of a research project.
· Residents are strongly encouraged to participate in research, and meet with their assigned research coordinators to assist them in this area. Teaching in epidemiology will be arranged in yearly bases in collaboration with department of medical education to improve the resident's knowledge and skills in this area.
· The resident will be encouraged and supported to have regular opportunities to present clinical cases and topic reviews at various clinical meeting.
· The resident will be able to facilitate the learning of patients, students, residents, and other healthcare professionals.
· The resident will contribute to the development of new knowledge.
· The resident will be able to develop and implement a personal continuing education strategy.
· The resident's knowledge, attitudes, and skills in this context will show appropriate evolution over the four years of training, with appropriate mastery of more advanced concepts in clinical epidemiology, teaching, and research as the resident's clinical training progresses.
rotation schedules
- First Year R1 Resident: 13 periods
· 4 weeks Vacation