University of Alberta Hospital (UAH)

• MED GIM CTU JUNIOR Orientation

During this rotation, residents should develop an approach to the following conditions:

• Congestive Heart Failure

• Pneumonia

• Delirium

• Hypo/hypernatremia

• CVT/PE

• Urosepsis

• COPD Exacerbation

• Diabetic Ketoacidosis

• Drug Overdose

By the end of this rotation, residents will be graded as “progressing as expected” in each of the following and in the Global Rating.  The expected level of performance in the PGY1 year is Interpreter level (See Program Information - Overall Goals and Objectives).

1. Medical Expert

• Data Collection and Clinical Reasoning: The resident appropriately collects and synthesizes clinical information to formulate a primary diagnosis and appropriate differential diagnosis.

• Clinical Decision Making: The resident is able to make appropriate and cost-effective investigation and management decisions based on the context of the case and best available evidence.

2. Communicator

• Patient and Family Communication: The resident communicates with and about patients and family in a patient-centered manner.

• Documentation and Verbal Presentation: The resident appropriately documents and verbally presents cases for new admissions, progress notes, handover of care, and discharge summaries (succinctly organized, prioritized, summarized).

3. Collaborator

• Interdisciplinary Team: The resident works well in a team, shares work, and interacts with allied healthcare providers and other consultants effectively.

4. Leader

• Efficiency: The resident prioritizes tasks and manages time effectively.

5. Health Advocate

• Patient Advocacy: The resident advocates for patients by obtaining/expediting investigations, consults, or access to other resources during inpatient care or during transition to the outpatient setting.

6. Scholar

• Personal and Team-based Learning:  The resident demonstrates an effective personal learning strategy (reading around cases, appropriate use of resources) and shares knowledge with other team members.

7. Professional

• Scope of Practice:  The resident is trustworthy and responsible, knows limitations (asks for help appropriately), and responds well to feedback.

Assessment

We use the following In-Training Evaluation Report (ITER):

• Medicine Junior

Entrustable Professional Activities (EPAs)

This rotation may be done during Transition to Discipline or Foundations. If done during Transition to Discipline (July and August of R1) this is an ideal learning environment for the following EPAs:

• TD1: Performing histories and physical exams, documenting and presenting findings, across clinical settings for initial and subsequent care

• TD2: Identifying and assessing unstable patients, providing initial management, and obtaining help

• TD3: Performing the basic procedures of internal medicine

If done during Foundations (September and onward during R1) this is an ideal learning environment for the following EPAs:

• FD1: Assessing, diagnosing, and initiating management for patients with common acute medical presentations in acute care settings

• FD2: Managing patients admitted to acute care settings with common medical problems and advancing their care plans

• FD3: Consulting specialists and other health professionals, synthesizing recommendations, and integrating these into the care plan

• FD4: Formulating, communicating, and implementing discharge plans for patients with common medical conditions from acute care settings

• FD5: Assessing and providing targeted treatment for unstable patients and consulting as needed

• FD6: Discussing and establishing patients’ goals of care

• FD7: Identifying personal learning needs while caring for patients and addressing those needs 

In addition to the above, residents can also be observed performing a variety of procedures with assessment and logging part of:

• CD5: Performing the procedures of Internal Medicine

Principal Teaching Physician-PGME

Dr. Clarissa Agusto

cagusto@ualberta.ca 

Medical Education Program Coordinator

 medngim@ualberta.ca

• ED CONSULTS JUNIOR Orientation

• ED CONSULTS SENIOR Orientation

• Pharmacy Technician Shift ED Orientation

During this rotation, residents should develop an approach to the following conditions:

• Congestive Heart Failure

• Pneumonia

• Delirium

• Hypo / hypernatremia

• DVT / PE

• Urosepsis

• COPD Exacerbation

• Diabetic keto acidosis

• Drug overdose 

By the end of this rotation, residents will be graded as “progressing as expected” in each of the following and in the Global Rating.  The expected level of performance in the PGY1 year is Interpreter level (See Program Information - Overall Goals and Objectives).

1. Medical Expert

• Data Collection and Clinical Reasoning: The resident appropriately collects and synthesizes clinical information to formulate a primary diagnosis and appropriate differential.

• Clinical Decision Making - Stable Patients: The resident is able to make appropriate and cost-effective investigation and management decisions for common, acutely unwell but stable patients based on the context of the case and best available evidence.

• Clinical Decision Making - Unstable Patients: The resident is able assess and manage acutely unstable patients.

2. Communicator

• Patient and Family Communication: The resident communicates with and about patients and family in a patient-centered manner.

• Documentation and Verbal Presentation: The resident appropriately documents and presents cases for new consults, progress notes, and handover of care (succinctly organized, prioritized, summarized).

3. Collaborator

• Interdisciplinary Team: The resident works well in a team, shares work, and interacts with emergency physicians, nurses and other healthcare providers effectively.

4. Leader

• Efficiency: The resident prioritizes tasks and manages time effectively.

5. Scholar

• Personal and Team-based Learning:  The resident demonstrates an effective personal learning strategy (reading around cases, appropriate use of resources) and shares knowledge with other team members.

6. Professional

• Scope of Practice:  The resident is trustworthy and responsible, knows limitations (asks for help appropriately), and responds well to feedback.

Assessment

We use the following In-Training Evaluation Report (ITER):

• ED Consults

Entrustable Professional Activities (EPAs)

This rotation is done during Core of the Discipline and is an ideal learning environment for the following EPAs:

Daytime Shifts

• CD1: Assessing, diagnosing and managing patients with complex or atypical acute medical presentations

• CD4: Assessing, resuscitating, and managing unstable and critically ill patients

  • Form 1: Direct or Indirect Observation of approach to condition

  • Form 2: Multisource Feedback regarding Interprofessional care

• CD5:Performing the procedures of Internal Medicine

  • E.g. Central Lines, Joint arthrocentesis, Lumbar puncture, Paracentesis, Thoracentesis

• CD6: Assessing capacity for medical decision-making

• CD7: Discussing serious and/or complex aspects of care with patients, families, and caregivers

  • Breaking Bad News, Futility of Care

• CD8: Caring for patients who have experienced a patient safety incident (adverse event)

• TP3: Assessing and managing patients in whom there is uncertainty in diagnosis and/or treatment

Evening shifts

• CD End of Shift Review with GIM Fellow / Attending if review is over the phone: This one is not specifically linked to an EPA but is an expectation of our program to have this filled out after most shifts.

Principal Teaching Physician-PGME

Dr. Clarissa Agusto

cagusto@ualberta.ca 

Medical Education Program Coordinator

 medngim@ualberta.ca

The objective of this rotation is to develop an approach to:

• Congestive Heart Failure

• Pneumonia

• Delirium

• Hypo / hypernatremia

• DVT / PE

• Urosepsis

• COPD Exacerbation

• Diabetic keto acidosis

• Drug overdose 

By the end of this rotation, residents will be graded as “progressing as expected” in each of the following and in the Global Rating.  The expected level of performance in the PGY1 year is Interpreter level (See Program Information - Overall Goals and Objectives).

1. Medical Expert

• Data Collection and Clinical Reasoning: The resident appropriately collects and synthesizes clinical information to formulate a primary diagnosis and appropriate differential.

• Clinical Decision Making - Stable Patients: The resident is able to make appropriate and cost-effective investigation and management decisions for common, acutely unwell but stable patients based on the context of the case and best available evidence.

• Clinical Decision Making - Unstable Patients: The resident is able assess and manage acutely unstable patients.

2. Communicator

• Patient and Family Communication: The resident communicates with and about patients and family in a patient-centered manner.

• Documentation and Verbal Presentation: The resident appropriately documents and presents cases for new consults, progress notes, and handover of care (succinctly organized, prioritized, summarized).

3. Collaborator

• Interdisciplinary Team: The resident works well in a team, shares work, and interacts with emergency physicians, nurses and other healthcare providers effectively.

4. Leader

• Efficiency: The resident prioritizes tasks and manages time effectively.

5. Scholar

• Personal and Team-based Learning:  The resident demonstrates an effective personal learning strategy (reading around cases, appropriate use of resources) and shares knowledge with other team members.

6. Professional

• Scope of Practice:  The resident is trustworthy and responsible, knows limitations (asks for help appropriately), and responds well to feedback.

Assessment

We use the following In-Training Evaluation Report (ITER):

• Night Float

Entrustable Professional Activities (EPAs)

This rotation is done during Core of the Discipline and is an ideal learning environment for the following EPAs:

• CD1: Assessing, diagnosing and managing patients with complex or atypical acute medical presentations

• CD4: Assessing, resuscitating, and managing unstable and critically ill patients

• TP3: Assessing and managing patients in whom there is uncertainty in diagnosis and/or treatment

Principal Teaching Physician-PGME

Dr. Clarissa Agusto

cagusto@ualberta.ca 

Medical Education Program Coordinator

 medngim@ualberta.ca

• WARDS CONSULTS Orientation

During this rotation, residents should develop an approach to the following:

1) Internal Medicine conditions such as:

• Anemia

• Chest pain

• Congestive Heart Failure / Edema

• Dizziness/Syncope

• Dyspnea

• Fatigue

• Hypertension

• Weight loss

2) Perioperative Medicine including:

• Perioperative Anticoagulation Management

• Perioperative Cardiovascular Risk Assessment and Management

• Perioperative Diabetes Management

• Perioperative Hypertension Management

• Perioperative Medication Management

• Perioperative Pulmonary Risk Assessment and Management

• Perioperative Venous Thromboembolism Prevention

3) Providing consultation to other services such as:

• Family Medicine

• Neurology

• Psychiatry

• Surgery

By the end of this rotation, residents will be graded as “progressing as expected” in each of the following and in the Global Rating.  The expected level of performance in the PGY1 year is Interpreter level (See Program Information - Overall Goals and Objectives).

1. Medical Expert

• Data Collection and Clinical Reasoning: The resident appropriately collects and synthesizes clinical information to formulate a primary diagnosis and appropriate differential.

• Clinical Decision Making: The resident is able to make appropriate and cost-effective investigation and management decisions based on the context of the case and best available evidence.

2. Communicator

• Patient and Family Communication: The resident communicates with and about patients and family in a patient-centred manner.

• Documentation and Verbal Presentation: The resident appropriately documents and presents cases for new consults, progress notes, and handover of care (succinctly organized, prioritized, summarized) including answering the question asked by the referring service.

3. Collaborator

• Interdisciplinary Team: The resident works well in a team, shares work, and interacts with referring physician and other healthcare providers effectively.

4. Leader

• Efficiency: The resident prioritizes tasks and manages time effectively.

5. Health Advocate

• Patient Advocacy: The resident addresses disease prevention, risk factor reduction, and health surveillance when indicated.

6. Scholar

• Personal and Team-based Learning:  The resident demonstrates an effective personal learning strategy (reading around cases, appropriate use of resources) and shares knowledge with other team members.

7. Professional

• Scope of Practice: The resident is trustworthy and responsible, knows limitations (asks for help appropriately), and responds well to feedback.

Assessment

We use the following In-Training Evaluation Report (ITER):

• UAC/PAC/Ward Consults

Entrustable Professional Activities (EPAs)

This rotation is done during Core of the Discipline and is an ideal learning environment for the following EPAs:

• CD1: Assessing, diagnosing and managing patients with complex or atypical acute medical presentations

• CD2: Assessing, diagnosing, and managing patients with complex chronic diseases

• CD3: Providing internal medicine consultation to other clinical services

• CD7: Discussing serious and/or complex aspects of care with patients, families, and caregivers

  • Breaking Bad News

• CD10: Implementing health promotion strategies in patients with or at risk for disease

  • e.g. Diabetes counselling, Vascular risk reduction, Smoking cessation in Asthma/COPD

Principal Teaching Physician-PGME

Dr. Clarissa Agusto

cagusto@ualberta.ca 

Medical Education Program Coordinator

 medngim@ualberta.ca

• MED GIM CTU SENIOR Orientation

During this rotation, residents should develop an approach to the following conditions:

• Congestive Heart Failure

• Pneumonia

• Delirium

• Hypo / hypernatremia

• DVT / PE

• Urosepsis

• COPD Exacerbation

• Diabetic keto acidosis

• Drug overdose 

By the end of this rotation, residents will be graded as “progressing as expected” in each of the following and in the Global Rating.  The expected level of performance in the PGY1 year is Interpreter level (See Program Information - Overall goals and objectives).

1. Medical Expert

• Clinical Decision Making:  The resident is able to make appropriate and cost-effective investigation and management decisions based on the context of the case and best available evidence.

2. Communicator

• Patient and Family Communication:  The resident communicates with and about patients and family in a patient-centred manner.

• Documentation and Verbal Presentation:  The resident appropriately documents and presents cases for progress notes, handover of care, and discharge summaries.

3. Collaborator

• Interdisciplinary Team:  The resident works well in a team, interacts with allied healthcare providers and other consultants effectively.

4. Leader

• Managing Team:  The resident manages the team efficiently, delegates and prioritizes tasks, and manages time effectively.

• Teaching and Supervising Learners:  The resident teaches, gives feedback to, and assesses junior trainees effectively.

5. Health Advocate

• Patient Advocacy:  The resident advocates for patients by obtaining/expediting investigations, consults, or access to other resources during inpatient care or during transition to the outpatient setting.

6. Scholar

• Personal and Team-based Learning:  The resident demonstrates an effective personal learning strategy (reading around cases, appropriate use of resources) and shares knowledge with other team members.

7. Professional

• Scope of Practice:  The resident is trustworthy and responsible, knows limitations (asks for help appropriately), and responds well to feedback.

Assessment

We use the following In-Training Evaluation Report (ITER):

• Medicine Senior

Entrustable Professional Activities (EPAs)

This rotation is done during Core of the Discipline and is an ideal learning environment for the following EPAs:

• CD1: Assessing, diagnosing and managing patients with complex or atypical acute medical presentations

• CD2: Assessing, diagnosing, and managing patients with complex chronic diseases

• CD4: Assessing, resuscitating, and managing unstable and critically ill patients

• CD5: Performing the procedures of Internal Medicine

  • E.g. Central Lines, Joint arthrocentesis, Lumbar puncture, Paracentesis, Thoracentesis

• CD6: Assessing capacity for medical decision-making

• CD7: Discussing serious and/or complex aspects of care with patients, families, and caregivers

  • futility of care; breaking bad news;

  • discharge related discussion;

  • conflicting recommendations of consultants

• CD8: Caring for patients who have experienced a patient safety incident (adverse event)

• CD9: Caring for patients at the end of life

• CD11: Teaching and assessing junior learners through supervised delivery of clinical care

Although this rotation is done during Core, this is also a good environment to get the following Transition to Practice EPAs:

• TP1: Managing an inpatient medical service 

• TP3: Assessing and managing patients in whom there is uncertainty in diagnosis and/or treatment

• TP5: Initiating and facilitating transfers of care through the health care system

• TP6: Working with other physicians and healthcare professionals to develop collaborative patient care plans

Principal Teaching Physician-PGME

Dr. Clarissa Agusto

cagusto@ualberta.ca 

Medical Education Program Coordinator

 medngim@ualberta.ca