III. Graded Responsibility

The Berkshire Medical Center Internal Medicine Residency requires that trainees reach different levels of competency for each year of training. The general competencies expected by each post graduate year level are laid out below. Individual components of the curriculum including the Wards and ICU have added additional expectations within their respective curricula. Evaluation of competency is determined by the Program Director in conjunction with the Clinical Competency Committee. Residents may appeal decisions (see Appendix B, Housestaff Personnel Policies). Ramification and consequences of unsatisfactory performance, in any area, will be decided upon by the Program Director in conjunction with the Clinical Competency Committee (where appropriate) and subject to the Berkshire Medical Center OGME Housestaff Personnel Policies.

III.A. Post Graduate Year One (PG1, R1, Intern)

III.A.1. Satisfactory completion of the PG1 year requires demonstrated success in areas of patient care, leadership, teaching and administration with a focus on, but not limited, to the following:

  • Caring for patients in both inpatient and ambulatory settings and understand the principles of care in each setting
  • Demonstrating an understanding of other Medical/Surgical specialties
  • Developing effective stress management techniques
  • Developing therapeutic relationships with patients and their families
  • Formulating appropriate differential diagnosis and plan
  • Gaining familiarity with evidence based medicine guidelines and resources
  • Integration into the full healthcare team
  • Obtaining clinical data through use of the history/physical exam and other appropriate sources
  • Performing, with supervision, various invasive procedures such as abdominal paracentesis, arterial puncture, arthrocentesis, central venous line placement, lumbar puncture, nasogastric intubation, pap smear, cervical culture, and thoracentesis
  • Understanding the basic pathophysiology of disease and how it relates to the clinical presentation, progression, and treatment of the patient
  • Understanding the indications, complications, and contraindications for various invasive procedures

III.A.2. Responsibilities / learning opportunities given to interns to help achieve above goals (III.A.1.) include, but are not limited to, the following (the major competencies being developed and assessed are listed in parentheses):

  • Attend mandatory conferences, including all GME core curriculum conferences. (MK, PBLI, P, SBP)
  • Demonstrates knowledge of his/her own limitations and effectively/appropriately asks for help and guidance (PBLI, MK)
  • Participates in Ambulatory elective specifically designed to include exposure to specialties of ENT, Ophthalmology, Orthopedics, Physiatry, Psychiatry, Podiatry, Dermatology, and HIV (MK, SBP)
  • Participates in hospital committees (SBP)
  • Participates and is present (when able) for procedures occurring for patients under his/her care (MK, P, PBLI)
  • Presenter of cases at Interns Report (ICS, MK, PBLI, SBP)
  • Primary contact for nursing, case management and ancillary services for patients under his/her care (SBP, P, ICS)
  • Primary historian for inpatient admissions to his/her service for patients under his/her care (PC, ICS)
  • Primary ordering physician for patients under his/her care (MK, PC, PBLI, SBP)
  • Primary planner and presenter of initial differential diagnoses for his/her patients (MK, PBLI)
  • Primary planner and presenter of resource utilization for patients under his/her care (PC, MK, SBP,)
  • Primary reporter and interpreter of data that returns for patients under his/her care (PC, MK, PBLI)
  • Responsible for developing and maintaining an Ambulatory patient panel (PC, MK, P)
  • Responsible for initiating discharge planning and performing the majority of discharge summaries (PC, ICS, SBP)

III.A.3. Assessment tools: Please see Roman Numeral IV

III.B. Post Graduate Year Two (PG2, R2, Resident)

III.B.1.Satisfactory completion of the PG2 year requires demonstration of increased sophistication and proficiency in all the areas expected of PG1 (See III.A.1) and demonstrated success and competency in the following areas:

  • Effective scholarly presentation
  • Increased knowledge as demonstrated by a minimum pass rate of 70% in monthly knowledge assessment exams
  • Knowledge of Geriatrics
  • Leading a healthcare team which may include interns, students and other healthcare disciplines
  • Performing, with supervision, and teaching various invasive procedures including, but not limited to, abdominal paracentesis, arterial puncture, arthrocentesis, central venous line placement, lumbar puncture, nasogastric intubation, pap smear, cervical culture, and thoracentesis
  • Teaching skills in a few settings at a basic level in area of patient management
  • Understanding the basic principles of managed care and office based practice
  • Understanding the principles of literature review and evidence based medicine
  • Understanding the role of the Internal Medicine service to the greater hospital community

III.B.2. Responsibilities/learning opportunities given to PG2s to help achieve above goals (III.B.1.) include, but are not limited to, the following (the major competencies being developed and assessed are listed in parentheses):

  • Attendance and presentation at Multidisciplinary Rounds (SBP, PBLI, MK)
  • Attendance at mandatory conferences, including all GME core curriculum conferences (MK, PBLI, P, SBP)
  • Direct supervision of all admissions on his/her service (PC, ICS, MK, PBLI, P)
  • Direct supervision of all plans & orders written on his/her service (PC, MK, ICS, PBLI, P)
  • Direct supervision of work rounds / pre-rounds (ICS, SBP)
  • Geriatric Elective (SBP, MK, SBP, PC, PBLI, P)
  • Interact with healthcare team
  • Make initial differential diagnosis
  • Manage stress
  • Medical Consultation Rotation (SBP, MK, ICS, PC)
  • Monthly medical knowledge test score > 70% (MK, P)
  • Participates in Ambulatory curriculum designed to include exposure to a range of primary care practices (SBP)
  • Participation in hospital committees (SBP)
  • Presentation at Resident Multidisciplinary Performance Improvement Conference (SBP, PBLI, MK, P, PC, ICS)
  • Presentation of cases and didactics at Morning Report (ICS, MK, PBLI, SBP)
  • Presenter at Journal Club (SBP, PBLI, PC, MK, IC)
  • Primary teacher of intern and students as they learn to (ICS, MK, P, SBP):
  • Report history
  • Write orders

III.B.3. Assessment tools: Please see Roman Numeral IV

III.C. Post Graduate Year Three (PG3, R3, Resident)

III.C.1.Satisfactory completion of the PG3 year requires demonstration of increased sophistication and proficiency in all the areas expected of PG2s (See III.B.1) and demonstrated competency and success in the following areas:

  • Demonstration of increased knowledge as demonstrated by a minimum pass rate of 75% in monthly knowledge assessment exams
  • Demonstration of sophisticated scholarly presentation
  • Increasing knowledge of Geriatrics and the special needs of that population
  • Independently creating full assessment/plans and making complex medical decisions prior to seeking attending feedback
  • Leading a healthcare team which may include PG2s, interns, students and other healthcare disciplines
  • Providing Internal Medicine expertise and services to the greater hospital community and other services
  • Teaching in many different settings and at varying levels of complexity
  • Teaching various invasive procedures including, but not limited to, abdominal paracentesis, arterial puncture, arthrocentesis, central venous line placement, lumbar puncture, nasogastric intubation, pap smear, cervical culture, and thoracentesis
  • Understanding the principles of literature review and evidence based medicine and be facile in applying those principals to direct patient care

III.C.2.Responsibilities and learning opportunities given to PG3s to help achieve above goals (III.B.2.) include, but are not limited, to the following (the major competencies being developed and assessed are listed in parentheses). Major differences in responsibilities between PG2 and PG3 are italicized.

  • 3rd year Geriatric Elective (SBP, MK, SBP, PC, PBLI, P)
  • Ambulatory curriculum to include exposure to a range of primary care practices (SBP)
  • Attendance and presentation at Multidisciplinary Rounds (SBP, PBLI, MK)
  • Attendance at mandatory conferences, including all GME core curriculum conferences (MK, PBLI, P, SBP)
  • Direct supervision of all admissions on his/her service (PC, ICS, MK, PBLI, P)
  • Direct supervision of all plans & orders written by his/her service (PC, MK, ICS, PBLI, P)
  • Direct supervision of work rounds/pre-rounds (ICS, SBP)
  • Learn report history
  • Learn to interact with healthcare team
  • Learn to manage stress
  • Learn to write orders
  • Make initial differential diagnosis
  • Medical Consultation rotation (SBP, MK, ICS, PC)
  • Monthly medical knowledge test score > 75% (MK, P)
  • Participates and teaches at orientation of new interns
  • Participation in hospital committees (SBP)
  • Presentation of sophisticated cases and didactics at Morning Report (ICS, MK, PBLI, SBP)
  • Presenter at Senior Didactic (SBP, PBLI, PC, MK, IC)
  • Responsible for oversight of PG1&2 and coordination of care in the ICU
  • Sophisticated Presentation and follow up at Resident Morbidity and Mortality (Multidisciplinary Quality Improvement) (SBP, PBLI, MK, P, PC, ICS)
  • Sophisticated teaching of intern and students as they learn to care for patients (ICS, MK, P, SBP)

III.C.3. Assessment tools: Please see Roman Numeral IV