Enhanced Skills Program: Hospital Medicine Goals and Objectives General Internist Attending

Goals and Objectives: PGY-3 FM-Academic Hospital Medicine
UHN Hospitalist Team

1. Medical Expert

By the end of the rotation the resident will:

• Independently triage patients for medical admissions in the emergency department
• Recognize when to involve the Intensive Care Unit early in a medical admission
• Produce focused admission assessment and management plans for complex medical patients
• Develop and refine an approach to common general medical conditions requiring hospitalization (the following is a guideline and is not exhaustive):
  • Cardiovascular: Angina, heart failure, acute coronary syndrome, arrhythmias, hypertension, hyperlipidemia, syncope
  • Dermatology: common inpatient problems, drug reactions
  • Endocrinology: diabetes, thyroid disorders, lipid disorders, osteoporosis
  • Gastrointestinal: GI bleeding, diarrhea, constipation, acute/chronic liver disease, abdominal pain
  • Geriatric: dementia, delirium, recurrent falls, weight loss, polypharmacy, urinary incontinence, chronic pain, decubitus ulcers
  • Hematology: anemia, coagulation disorders, cytopenias, lymphadenopathy
  • Infectious Disease: acute infectious illness (sepsis, meningitis, encephalitis, pneumonia, endocarditis, gastroenteritis, cellulitis, urinary tract infection, pyelonephritis), tuberculosis
  • Neurology: headache, seizure, stroke, vertigo, syncope, movement disorders
  • Nephrology: acute kidney insufficiency, chronic renal insufficiency, electrolyte disorders, acid-base disorders
  • Oncology: mass NYD, appropriate screening tests
  • Palliative: end of life care, symptoms control
  • Respiratory: obstructive airway disease, pleural effusion, infections, interstitial lung disease, malignant disease, thromboembolic disease
  • Rheumatologic: acute/chronic monoarthritis and polyarthritis, vasculitis
• Make appropriate use of antibiotics/antibiotic stewardship
• Recognize disease presentations that deviate from common patterns and require complex decision making
• Modify differential diagnosis and care plan based on the patient’s clinical course and available investigations, in the context of patient centered care
• Correctly interpret laboratory tests, chest radiographs, ABGs and ECGs
• Demonstrate familiarity and intermediate competence in procedures, including but not limited to arterial puncture for blood gas, joint aspiration/injection, nasogastric tube insertion, paracentesis, thoracentesis, lumbar puncture
• Manage, with minimal supervision, general medical patients with a broad spectrum of clinical disorders

2. Communicator

By the end of the rotation the resident will:

• Demonstrate an organized approach of gathering historical information from patients and their family
• Ensure patient centered communication regarding diagnosis, prognosis, medical status and treatment options occur with patients and their families
• Appropriately counsel patients about benefits and risks of in hospital tests and procedures
• Participate inpatient handover to on-call staff/residents, outlining patient status and potential areas of medical concern

3. Collaborator

By the end of the rotation the resident will:

• Demonstrate strong and effective working relationships with allied health staff and physician colleagues
• Utilize consultation with other services appropriately and effectively, and judiciously puts into practice their recommendations
• Collaborate effectively with medical and allied health team members to ensure comprehensive, efficient and safe discharge planning occurs
• Collaborates with community agencies and other professionals.

4. Manager/Leader

By the end of the rotation the resident will:

• Demonstrate time management skills to reflect and balance priorities of patient care, outpatient practices, academic demands and sustainable practice/personal life
• Balance and prioritize competing demands in order to successfully manage patients on inpatient wards simultaneously with managing emergency department and/or outpatient care

5. Health Advocate

• Assess, individualize and respond to inpatients health concerns using a biopsychosocial model
• Mentor advocacy to team members throughout inpatient admission and through planning outpatient discharge plans
• Minimize unnecessary test, procedures and therapies

6. Scholar

By the end of the rotation the resident will:

• Maintain and enhance professional activities through ongoing learning
• Clinically appraises medicalliterature
• Use medical literature to complement team discussions and teaching

7. Professional

By the end of the rotation the resident will:

• Recognize the scope of his/her abilities and ask for supervision and assistance
• appropriately
• Maintain appropriate professional relationships with patients and families
• Ensure confidentiality