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Internal Medicine
Evaluation of the ACGME Competencies
Systems-Based Learning
This domain of medical performance includes the degree to which trainees utilize various medical/social systems to complement care of patients' organic problems. It also examines the degree to which they use resources appropriately and efficiently, functioning in a way to enhance the quality of care of their patients (and the system as a whole).
1. Discharge Planning Rounds - All interns on the Wards services meet with discharge planners twice each week to discuss disposition issues on their panel of in-patients. In this manner, they are educated about outpatient services, and how to actuate them for their patients to optimize the chances of success upon discharge. The program emphasizes that physicians must provide more than just care of organic problems. Rather they must learn to integrate knowledge of each patients' diseases and enhance their outpatient milieu and follow-up care to reduce the likelihood of recurrent hospitalizations. Behavior modification modalities and multi-disciplinary interventions arranged prior to discharge are reviewed and emphasized. Trainees are evaluated by the discharge planners/social workers regarding their facility in dealing with these issues.
2. Quality-Assurance/Errors Management - Trainees must learn that they are part of a much bigger healthcare system that monitors quality of care and medical errors. Accordingly, a combined practice- and systems-based learning exercise is performed by PGY-2's, and includes 3 sessions spent at hospital quality management meetings. Trainees read several chapters from the Institute of Medicine work on improving quality and reducing errors, and complete a short quiz. These materials can be obtained in the Department of Medicine Program Director's office. Trainees have learned real lessons from these sessions - some of have gone on to report their own errors or errors they have witnessed to enhance the quality of care of patients.
3. Errors-Management Exercise - All trainees are encouraged to identify one error they have either witnessed or made themselves. They should research the error in the medical literature, examine its "root cause" and devise a solution to be refined and implemented by hospital quality officials.
4. Systems-based Learning Curriculum - Dr. Robert Bernasek has spear-headed an effort to create a curriculum to include: a. office management skills, b. billing codes, c. use of protocols to maximize outcomes, minimize costs, d. efficient use of hospital resources. Although the curriculum is still in development, it is rapidly being integrated into Morning Report Discussions and noon conference lectures.
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A summary of all six ACGME competencies may be downloaded from the following link.
NOTE: These documents are in Adobe Acrobat® (PDF) format. If you are unable to open them, please download and install Acrobat Reader by clicking on the following button.
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