WARDS

Essentials for the Wards Rotation:

• Admission Note essentials
• Progress Note essentials
• Discharge Summary essentials
• Physical exam essentials:
  • Cardiac exam
  • Neck vein exam
  • Respiratory exam
  • Abdominal exam
  • Lymph node exam

Ward competency-based goals and objectives

The development of the competencies is an ongoing process in the growth of a physician in training. There are milestones in each year of training which must be accomplished in order to successfully progress through the program. The expected goals for internal medicine wards for each year of training are outlined below. Many of the skills overlap different competencies. Although each individual may grow at his or her own rate, these milestones should be looked upon as evolving and becoming more refined through each year of training.

PGY 1

	Educational objectives	Assessment method
Patient Care	1) Perform thorough history and physicals 2) Synthesize data into an appropriate problem list and differential diagnosis. This should become more refined and pertinent throughout the year. 3) Formulate diagnostic and therapeutic plan with some supervision. 4) Develop an understanding of problems requiring immediate attention and those that can be worked up as an outpatient. 4) Present the H and P at attending rounds and in succinct and organized manner.	1) Global faculty assessment 2) Peer evaluation 3) Direct faculty bedside observation 4) Video taped physical exam 5) H&P and progress note expectations review and performance evaluation and feedback 6) CEX on history taking skills 7) CEX on “essentials of patient care encounters” 8) Faculty inpatient chart review
Medical Knowledge	1) Have a basic knowledge of pathophysiology that grows. 2) Develop solid working knowledge base of common clinical problems 3) Regularly attend conferences 4) Show commitment to ongoing learning by reading, investigating, and asking questions.	1) Global faculty assessment 2) Peer evaluation 3) Exam skills expectation review and assessment of select systems 4) EKG exam
Practice-Based Learning and Improvement	1) Begin to recognize common errors and develop a willingness to learn from them. 2) Demonstrate insight into knowledge deficiencies and limitations. 3) Use information technology to answer clinical questions.	1) Global faculty assessment 2) Peer evaluation 3) Inpatient chart review with staff 4) Review of all deaths on service with attending staff
Interpersonal and Communication Skills	1) Develop strong electronic documentation skills and continue refining them throughout the year. 2) Learn to present a case accurately and succinctly 3) Demonstrate caring and respectful behavior for all patients and staff.	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey
Professionalism	1) Demonstrate respect and compassion for all patients, families, and staff. 2) Demonstrate commitment to ethical issues 3) Show willingness to aid in covering other shifts when needed.	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey
Systems-Based Practice	Develop a basic knowledge of practice and delivery systems, including a willingness to collaborate with social workers, nursing staff, pharmacists and other ancillary staff.	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey

PGY 2

	Educational objectives	Assessment method
Patient Care	1) Supervise junior residents and students, and coordinate patient care among all members of the health care team. 2) Formulate therapeutic and diagnostic plan independently, and be willing to modify them with staff input. 3) Anticipate and plan for diagnostic and therapeutic steps beyond immediate actions. 4) Use information technology extensively to support patient care decisions. This includes electronic references and hand-held technology. 5) Develop excellent skills in navigating, using, and teaching of the electronic medical record. 6) Perform and eventually demonstrate (where appropriate) bedside procedures. 7) Develop increasing efficiency and ability to prioritize patients and medical issues. 8) Learn methods of teaching other residents, students, other care providers, and patients (and their families) about medical problems, prognosis, and treatment	1) Global faculty assessment 2) Peer evaluation 3) Direct faculty bedside observation 4) Discharge summary and progress note expectations review and performance evaluation and feedback 5) Faculty inpatient chart review 6) Family conference CEX 7) Student evaluations
Medical Knowledge	1) Develop deeper understanding of disease states, including less common diseases. 2) Develop a basic and growing ability to read and interpret medical literature. 3) Be willing to share knowledge readily in group discussions. 4) Regularly attend conferences and participate willingly.	1) Global faculty assessment 2) Peer evaluation 3) Heart sounds exam 4) In-training exam
Practice-Based Learning and Improvement	1) Facilitate the learning of others 2) Gain competence in bedside medicine and teaching of it. 3) Use literature and information technology extensively to answer clinical questions. Consult with the primary literature regularly.	1) Global faculty assessment 2) Peer evaluation 3) Inpatient chart review with staff 4) Review of all deaths on service with attending staff
Interpersonal and Communication Skills	1) Create and sustain a therapeutic relationship with patients, and model this to junior residents and students. 2) Obtain the skills necessary to present topics informally and formally to a group 3) Demonstrate excellent presentation skills in attending rounds, showing enthusiasm for expanding and sharing knowledge. 4) Demonstrate the ability to teach others, including patients, about medical problems	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey 4) Student evaluation
Professionalism	1) Manage and direct a health care team 2) Develop conflict management skills 3) Work with consultants and other health care teams in a collaborative, respectful fashion. 4) Demonstrate cooperative and willing behavior during assignment of patients by chief residents.	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey
Systems-Based Practice	1) Work with ancillary team members (discharge planners, home care, and case managers) to provide for high quality, cost effective health care. 2) Understand ways to most effectively utilize the above components in the system of care to optimize patient care. 3) Develop a robust understanding of clinical practice guidelines, while recognizing their limitations.	1) Global faculty assessment 2) Peer evaluation 3) Social worker survey