Policy and Procedures

Assessment

ACGME General Competencies

The 1999 ACGME Outcome Project introduced six domains on which residency programs would focus to improve education and assessment - Patient Care, Medical Knowledge, Professionalism, Systems-based Practice, Practice-based Learning and Improvement and Interpersonal and Communications Skills. Objective assessments of the six core competency areas are mapped to the Family Medicine milestones provided by the ACGME, as a progressive assessment of resident performance.

Currently, each program is expected to demonstrate assessment tools providing valid evidence that its residents are achieving these competency-based objectives and that the program is effective in preparing residents for practice.

Competency Description

Patient Care
Ability to provide compassionate, appropriate and effective patient care for promotion of health, prevention of illness, treatment of disease and end-of-life care. Residents are expected to:

  • Communicate effectively and demonstrate caring and respectful behavior when interacting with patients and their families
  • Gather essential and accurate information about their patients
  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment
  • Develop and carry out patient management plans
  • Counsel and educate patients and their families
  • Use information technology to support patient care decisions and patient education
  • Perform all medical and invasive procedures considered essential for the area of practice competently
  • Provide health care services aimed at maintaining health or preventing health problems
  • Work with health care professionals, including those from other disciplines, to provide patient-focused care

Medical Knowledge
Knowledge of established and evolving biomedical, clinical and social sciences, as well as application of this knowledge to patient care and education of others. Residents are expected to:

  • Demonstrate an investigatory and analytic approach to clinical situations
  • Know and apply the basic and clinical sciences appropriate to their discipline

Practice-Based Learning and Improvement
Ability to use scientific methods and evidence to investigate, evaluate and improve patient care practices. Residents are expected to:

  • Analyze practice experience and perform practice-based improvement activities using a systematic methodology
  • Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems
  • Obtain and use information about their own population of patients and the larger population from which their patients are drawn
  • Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
  • Use information technology to manage information, access online medical information and support their own education
  • Facilitate the learning of students and other healthcare professionals

Interpersonal and Communication Skills
Demonstration of interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. Residents are expected to:

  • Create and sustain a therapeutic and ethical relationship with patients
  • Use listening skills and elicit and provide information using nonverbal, explanatory, questioning and writing skills
  • Work effectively with others as a member or leader of a health care team or other professional group

Professionalism
Residents must demonstrate behavior that reflects a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, profession and society. Residents are expected to:

  • Demonstrate respect, compassion and integrity
  • Demonstrate a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession
  • Demonstrate a commitment to excellence and ongoing professional development
  • Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality of patient information, informed consent and business practices
  • Demonstrate sensitivity and responsiveness to patients' culture, age, gender and disabilities

Systems-Based Practice
Demonstration of an understanding of context and delivery systems in which health care is provided, and the ability to apply this to optimize health care. Residents are expected to:

  • Understand how their patient care and other professional practices affect other health care professionals, the healthcare organization and the larger society, as well as how these elements of the system affect their own practice
  • Know how types of medical practice and delivery systems differ, including methods of controlling health care costs and allocating resources
  • Practice cost-effective health care and resource allocation that does not compromise quality of care
  • Advocate for quality patient care and assist patients in dealing with system complexities
  • Know how to partner with health care managers and health care providers to assess, coordinate and improve health care and know how these activities can affect system performance

Evaluation

Overview
The Family Medicine Residency Program is committed to early, continuing, progressive evaluation of resident competencies using a framework of developmental steps that relies upon clinical faculty to collect data, supplemented by academic faculty members' own observations, while charging academic faculty with the responsibility of evaluation through the Clinical Competency Committee.

The milestone evaluation is explicit and understanding the developmental stages is stressed during residents' orientation, and is also available online at the residency program's website and at E-value.net.

Methodology
The program provides objective assessments of competence in patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice based on the "milestones" through multiple forms of evaluation. On-line data collection instruments further map the evaluations to the milestones to simplify clinical faculty data collection and improve consistency. These completed evaluations are available online to residents. The use allows each resident to measure personal strengths and weaknesses together with indicating a path toward remediation or advancement. In addition, assessment includes direct observation of resident patient encounters, six observations in PGY I, four in PGY II, and three in PGY III.

Process
An early evaluation of all incoming residents is carried out to assess performance within the six-core competency areas. This evaluation involves core faculty, select behavioral science faculty and nursing, together with self-evaluation by the resident. A simulated patient may be used, using a presentation of sufficient complexity to permit recognition of more advanced skills, and using the observation capabilities of the simulation laboratory of the School of Medicine and Health Sciences. Upon successful completion of orientation, the resident will progress into the core curriculum. Evaluation forms assessing the six core competencies as well as skill sets identified on the milestones will be completed by appropriate personnel (i.e. physicians, nursing staff, etc.) at the completion of each scheduled rotation. Separately, the educational experience is evaluated by the resident. Resident will be further evaluated by peers, residency clinic nursing staff, patients, and additional members of the healthcare team throughout all years of training. Additionally, self-evaluation is encouraged as a continuous process throughout training to foster the development of skills necessary to become a family physician. This form of evaluation requires maturation throughout training and, while felt to be a daily exercise, will also be formally completed at least twice yearly at required resident evaluation meetings with a core faculty member. All evaluations are maintained within the resident’s written file as well as through an online secure database that is accessible for review. Evaluations are reviewed by the Clinical Competency Committee to document progressive resident performance through the utilization of family medicine specific milestones. Evaluations and milestone assessment will be reviewed with the resident at least twice yearly at required resident evaluation meetings. Resident evaluation meeting schedule is as follows: PGY I - every three months, PGY II and PGY III - every six months, and prior remediation - every three months.

Performance Improvement
Formative evaluations, sentinel or “near-miss” event, concern from teaching faculty, peers, nursing staff or patients, regarding resident’s performance, and/or inadequate performance in general measures (In-training Exam, Boards) will be used to identify possible resident deficiency in the core competencies. If a concern is identified, the resident will be referred to the Resident Progress Committee (RPC). If a deficiency is noted in one of the competency areas, it will be stated explicitly and focused correction implemented. An academic action plan will be initiated and reviewed until appropriate advancement in the core competencies is obtained. A written record of the academic action plan will be completed and signed by the RPC chair and resident. An initial period of one to three months for correction of deficiencies, at the discretion of the RPC, will be allotted.

At the discretion of the faculty, and provided that progress has been demonstrated, one further period of remediation not to exceed three months may be provided. Failure to reach explicit goals at that stage is considered academic failure and dismissal proceedings may be initiated.

On any occasion when action that could affect a resident's academic standing is contemplated, discussed, or implemented, an academic action plan will be placed in the resident's academic record. Further, such discussion will be noted in the minutes of the faculty meeting and that minute will be reviewed and approved or amended by the faculty no later than the following faculty meeting.

A blank copy of the academic action plan is available for review at gfresidency.com as well as in this document following description of residency requirements.

Professionalism
Residents are understandably focused on content and breaches of professionalism may not be recognized. However, professional breaches may escalate. Consequently, questionable breaches of professionalism are reviewed by faculty on a monthly basis. Such breaches may include, but are not limited to:

Unpunctuality - this is inefficient, disruptive to clinical services, and discourteous to patients and clinical faculty who may have made special preparation to teach;
Failure to report duty hours in a timely fashion;
Failure to complete clinical records, including progress notes and discharge summaries, in a timely fashion;
Unusual patterns of sick leave; Repeated rescheduling of clinic appointments.
If a suspected lapse of professionalism occurs, it will be referred to the RPC.

Program Director's Final Evaluation

Towards the completion of training, the resident will meet with the program director for a summative evaluation. It is a review of the resident's performance throughout residency. Family medicine specific milestones will be used as one of the tools to ensure that the resident is able to practice core professional activities without supervision upon completion of the program. This written evaluation will be part of the resident's permanent record, maintained by Altru Health System, and accessible for review by the resident.

In training Exam

The American Board of Family Medicine In-Training Examination is a cognitive examination given annually in the last week of October. All residents are released from other responsibilities in order to be present for the examination. The examinations are scored by the Board and the results reported to the Program Director.

The In-Training Examination is similar in emphasis and format to the Certification Examination. It consists of items written to test core knowledge and patient management skills in eight major areas: Internal Medicine, Surgery, Obstetrics, Community Medicine, Pediatrics, Psychiatry and Behavioral Sciences, Geriatrics and Gynecology. Physicians who write the test items, as well as the members of the special committee who review them, include both practicing clinicians and teachers in Family Medicine residency programs.

The Program Director and faculty will review both current and past test results to determine if a resident is demonstrating improvement on successive year’s results and to ensure that a resident is ready for the Certification Examination at the end of his/her residency training.

As a consequence of the above, together with the Program's commitment to the idea of life-long learning, the Program specifies the following:

  • Using the Bayesian score predictor provided with the In-training Examination, residents are expected to score at a level that is equal to or greater than 90.0% prediction is passing the certification exam.

  • Failure to score above this benchmark requires additional coursework.

  • Residents scoring under this benchmark are required to complete the Core Content examination monthly (when available). The test booklet and answer booklet will be provided to the resident prior to the examination time. The exam will be held on the first Wednesday of every available month at noon at the Family Medicine Residency Conference room. If a resident is unable to attend at the scheduled time, he/she must make arrangements with the residency program coordinator to take the examination within a week of the scheduled time.

  • In addition, residents in their third year of post-graduate training scoring under the benchmark are also required to complete a board review course. This is an independent study program. The residency program will provide the board review course materials. The resident may choose to use their CME money to attend a live Board Review course which would also satisfy the remediation requirement.
  • Residents will be notified via in person and through a signed letter if they are required to complete additional coursework as described above.
  • If a resident is unable to be present for the In-Training Examination, he/she must receive permission from the Program prior to the date of the exam to be granted an excused absence. Residents in the first two years of training, who were unable to take the exam and provided an excused absence, will be enrolled in the remediation program automatically for the academic year. If a third-year resident is unable to take the examination and has an excused absence, they will be provided the option to take the examination at a later date under the supervision of the program. The examination will be hand scored by the Program and a Bayesian score predictor result will be provided to the resident. If the resident scored 90.0% or above, they will not be required to complete a board review course.

Patient Handoff Policy

The Family Medicine Residency recognizes handoffs during hospitalization from one provider to another as critical transitions in patient care. Poor handoffs have been implicated as a source of adverse events. Further, the reduction in resident work hours by the Accreditation Council for Graduate Medical Education (ACGME) has resulted in a greater number of handoffs and the need for greater scrutiny.

To ensure patient safety and effective handoffs, the Residency endorses the recommendations of Arora et al, 2009. At any time a resident is required to transfer patient care, that resident is expected to provide an effective handoff including interactive communication, up-to-date information with identification of issues requiring further evaluation, relevant historical factors, and anticipated changes to patient status. This should occur without significant interruptions. To that end, the following procedure for residents making patient handoffs on the Family Practice Teaching Service (FPTS) is used:

  • There is dedicated time for verbal exchange of information in morning and evening “sign out rounds”. Residents on the FPTS are required to report for morning rounds and are blocked from the outpatient clinic at the end of the day to provide adequate time to complete handoffs.
  • The chief resident trains and evaluates incoming residents in handoff expectations. Handoffs during evening rounds will also be supervised by core faculty members intermittently through the year and will be recorded in faculty meeting minutes.
  • The verbal exchange of information is interactive, giving priority to sicker patients, with insight on what to expect or do given during the verbal exchange.
  • All patients that are handed off will be included on the patient list.

Procedure Documentation

Family Medicine residents have the opportunity to perform many procedures in both the inpatient and outpatient setting on a number of rotations throughout the course of training. Each resident will need to track and record all procedures on the current database program. A printed document of procedural data can be generated and downloaded from this database. It is the resident’s responsibility to record and maintain the procedure log. This log book will be the basis for whether or not a resident is given hospital privileges to perform procedures upon graduation.

A database of resident’s clinical and procedural experience, both in the hospital and in the ambulatory settings is maintained. Most privileges are now granted on an experiential basis, so it is essential that this database is maintained accurately, and kept current. While it is the program’s responsibility to make such a system available, it is the resident’s responsibility to utilize it and enter their procedure activities on the computer.

Procedures are an important part of family medicine. Reductionism in the practice of medicine frequently "streamlines" procedures that could be easily performed in the office to a custom-built center, which is almost invariably more expensive, and less convenient to the patient, than an office setting. Notwithstanding, the procedures that a resident should hope to master will inevitably be directed by that resident's eventual practice site and the needs of his/her patient population. As far as the teaching of procedural skills during residency is concerned, the Program divides them into core, graduation requirement, and elective. A procedural elective is available.

Residents are required to log all procedures, using the database supplied through E-value. Each procedure has a “Basic Skills Qualification” describing the procedure and an assessment form to verify procedure competency. “Basic Skills Qualifications” are available on E-Value or below. Prior to seeking BSQ certification, a resident should be confident in their skills. The “Basic Skills Qualification” is printed and given to the supervising physician, whereafter, the resident performs the procedure under direct observation of the supervising physician. The competency assessment is completed by the supervising physician with their signature and given back to the resident. The resident then returns the competency assessment to the Academic Coordinator.

Basic Skills Qualifications

1. Abscess Incision and Draining
2. Amniotomy
3. Anoscopy
4. Basic OB Ultrasound
5. Circumcision
6. Colposcopy with Biopsy
7. Cryotherapy
8. EKG
9. EKG Reading
10. Endometrial Biopsy
11. Endotracheal Intubation
12. FAST Exam
13. Fetal Scalp Electrode (FSE) Placement
14. Fluorescein Eye Exam
15. Ingrown Toenail Removal
16. Injury Management
17. Intrauterine Pressure Catheter (IUPC)
18. IUD Insertion
19. Large Joint Arthrocentesis/Injection – Knee
20. Large Joint Arthrocentesis/Injection – Shoulder
21. Lumbar Puncture
22. Musculoskeletal Ultrasound I (Basic)
23. Musculoskeletal Ultrasound II (Intermediate)
24. Musculoskeletal Ultrasound III (Advanced)
25. Musculoskeletal Ultrasound – Ankle
26. Musculoskeletal Ultrasound – Elbow
27. Musculoskeletal Ultrasound – Hip
28. Musculoskeletal Ultrasound – Knee
29. Musculoskeletal Ultrasound – Shoulder
30. Musculoskeletal Ultrasound – Venous Access
31. Musculoskeletal Ultrasound – Wrist
32. Nexplanon (etonogestrel implant) Insertion
33. Office Spirometry
34. Perineal Laceration Repair
35. Punch Biopsy/Shave Biopsy/Excisional Biopsy
36. Slit Lamp Exam
37. Splinting and Casting
38. Stress Testing
39. Team Travel
40. Vasectomy
41. Wound and Laceration Repair

Residency Supervision Policy

The faculty is committed to supervision commensurate with resident competency and complexity of care while the educational curriculum and faculty and call schedules are designed to ensure such supervision. Progressive increase in resident responsibility with independence is provided individually on the basis of expertise in the six ACGME core competencies with incorporation of the family medicine specific milestones and determined by multiple evaluation modalities. Notwithstanding, patient care complexity may always exceed resident capability and should be recognized.

General Supervision Policy

  1. In each patient assignment, the resident will identify the practitioner ultimately responsible for the patient’s care
  2. That practitioner will be appropriately credentialed for his/her area of expertise.
  3. The resident will introduce himself/herself at the beginning of each patient encounter and inform the patient of his/her role in the healthcare team.

Level of Supervision

  1. Family Medicine Residency Clinic Supervision
    1. Faculty Availability
      1. Faculty supervision is mandated whenever a resident is involved in patient care.
      2. The minimum ratio of faculty to residents actively involved in patient care is 1:4.
      3. Supervising faculty physicians are free from responsibilities that might prevent immediate availability.
      4. Regardless of a resident’s assigned degree of independence, the faculty physician may obtain further history or perform a focused physical examination if either determines additional evaluation is necessary.
    2. PGY-1 residents or upper-level residents who are transferring into the Program will be directly observed. This observation may be supplemented with patient module(s) in the simulation lab. Evaluation will be based upon the six core competencies mapped to appropriate milestones. Evaluations will be reviewed by the Clinical Competency Committee to permit advancement to indirect supervision with direct supervision immediately available within an outpatient setting.
    3. Residents will precept all Medicare patients.
    4. Clinic procedures will have direct supervision until the resident is considered competent to perform the procedure with ‘indirect supervision with direct supervision immediately available’, as a result of faculty evaluation of skill and experience.
  2. Nursing Home Supervision
    1. A nursing home patient assigned to a resident will have an identifiable attending physician ultimately responsible for the patient’s care though the resident is expected to function as an important member of a patient’s healthcare team.
    2. Residents will see assigned nursing home patients monthly with documentation in the electronic medical record which will be reviewed by the patient’s attending physician.
    3. PGY-1 residents are assigned one nursing home patient and are not permitted to write orders without discussion with the patient’s attending physician.
    4. PGY-2 and PGY-3 residents are assigned two nursing home patients and provide continuity of care as long as the patient remains in the nursing home. Such residents are permitted to write orders as their documented competency permits, though any major change in patient’s status is required to be discussed with the attending physician.
  3. Hospital Supervision
    1. Specialty Rotations
      1. Specialty rotations will be directly supervised by the physician preceptor or physician group (i.e. pediatricians for pediatrics) for the rotation.
    2. Family Medicine Teaching Service
      1. Each patient on the teaching service will have an identifiable attending physician ultimately responsible for the patient’s care.
      2. PGY-1 resident is directly supervised while involved in patient care by a family medicine physician or senior resident who has previously qualified to function in a supervisory role. (see stated requirements)
        1. Graded and progressive responsibility is encouraged and ‘indirect supervision with direct supervision immediately available’ is permitted for PGY-1 residents after thorough review of performance and evaluations at CCC meetings. Advancement will be documented in meeting minutes in addition to documentation within the resident file.
      3. Prior to completion of the first year of training, in preparation for advancement to PGY-2 level of training, all evaluations will be reviewed by the Clinical Competency Committee to determine if the resident has performed satisfactorily to permit ‘indirect supervision with direct supervision available’. Appropriate documentation will be provided in the resident’s file prior to advancement to the second year of training.
      4. PGY 3 residents serve as chief resident on the teaching service with responsibility for assisting in supervision of residents, medical students, educational opportunities and management of service.
      5. Residents at all levels of training and independence are required to directly communicate with the attending physician any major change in patient’s clinical status, transfer of care to a higher level of service (ICU, etc) or initiating end-of-life orders.
  1. Obstetrics
    1. Residents provide continuity of obstetrical care, including prenatal, antenatal and postnatal care, at the Family Medicine Residency Center.
      1. All residents, regardless of level, require preceptor approval of an initial obstetrical visit, intended induction of labor, or any time a pregnancy is deemed to have deviated from normal.
      2. Preceptor approval is required at 28 and 36 weeks gestation.
      3. A resident is required to be present on the labor floor while the patient is in labor. A patient of the Family Medicine Residency Center will be supervised by the patient’s attending physician but if the primary physician is a resident, then the attending physician will be the second preceptor on duty during the day or the family medicine department physician on call for labor and delivery after clinic hours. The minimum supervision required is defined below.
    1. Supervision of Labor and Delivery
      1. All patients on the labor floor will have an easily identifiable attending physician, either a member of the OB/GYN department or a family physician with obstetrical privileges.
      2. Direct supervision for residents at all levels of training is required at the time of delivery, for the third stage of labor, as well as at the discretion of the attending physician depending on the resident’s experience and/or complexity of care required to manage the labor.
      3. Circumstances requiring direct notification of the attending physician, include but not limited to: pregnancy-related complications (i.e. pre-eclampsia, HELLP syndrome); non-reassuring maternal or fetal status; prior to initiating augmentation for labor dystocia; and postpartum hemorrhage
      4. In-house supervision is available at all times for a PGY-1 resident by either the attending physician, OB fellow, or a senior resident. Senior residents are permitted to function in a supervisory role by successful completion of prior obstetrical rotations during the first year of training.

Rotations

Residency guides the transformation of medical student to independent practitioner. It requires longitudinally-concentrated effort on the part of the resident whose essential learning activity is interaction with patients under the guidance and supervision of faculty members. As experience is gained and growth demonstrated, roles are assumed that permit the exercise of skills with greater independence. This concept - graded and progressive responsibility - is a tenent of the Accreditation Council for Graduate Medical Education (ACGME). The ACGME "Milestones" are used as a tool to ensure residents are able to practice core professional activities upon graduation. Residents who have not satisfied the Program's requirements for advancement to indirect supervision as defined by the ACGME will not undertake any patient activity leading to change of status, acuity, or management, without the physical presence of an appropriately qualified physician. However, residents will not interpret this in such fashion to curtail legitimate learning. All residents are encouraged to carry out whatever activities are necessary to strengthen history taking and physical examination skills, together with improving rapport with patients and their families, with whatever frequency the resident deems necessary. In the maturation of those skills, there is no substitute for patient contact.

Work Hour Policy

General
The residency program complies with ACGME work hour policies. Compliance is monitored by the duty hours log maintained in the electronic database at E-value.net. This database is reviewed regularly and anomalous entries and discrepancies challenged and explained. An administrative assistant and designated faculty member have oversight responsibility. In addition, a hard copy of the work hours log is reviewed by all faculty on a monthly basis.

Fatigue and sleep deprivation
There is required attendance at a presentation on fatigue and sleep deprivation by a sleep disorder specialist. Attendance at the sleep disorder clinic is also part of the required behavioral science rotation. The resident pool provides sufficient redundancy to allow call substitution and recovery time in the event of a fatigued or indisposed resident.

Transfer of patient supervision
Errors of omission and commission during patient care "handoffs" present a significant threat to patient safety. Adequate, protected, time is provided for the hand over of care, twice daily, at the change of shifts. Patient status is updated and outstanding studies and continuing therapies are reviewed, with particular emphasis on the critically ill, unstable, and those needing further evaluation.

Accommodation and subsistence
Residents are provided with food service, a study area with electronic database connectivity, and a private sleeping area, the latter separated from patient care areas.

Work Hour Regulations:

  • First-year residents will not work more than 16 hours on single or combined shifts and each 16-hour shift will be followed by a ten-hour break before other assigned duties or responsibilities.
  • Second and third-year residents may work 24-hour shifts and such shifts will be followed by fourteen hours free from assigned duties or responsibilities.
  • All residents must have one 24-hour period free from assigned "in hospital" duties and responsibilities, and be absent from the hospital, every seven days, averaged over a four-week period.
  • No resident will work more than 80 hours per week averaged over a four-week period.
  • At home call will not average more than every third night over a four-week period.
  • Onerous activity resulting from such call will require relief from responsibilities.
  • All of the foregoing is monitored through E-value and the timely entering of data is a resident professional responsibility.
  • Failure to record accurate duty hours through E-value within seven days will result in a verbal and email warning. An additional day of call will be assigned to the resident for each day that the resident fails to record duty hours beginning at 10 days of deficiency.
  • Certain exceptions to the work hour regulations are recognized for infrequent and extenuating circumstances, such as continuity of care for a severely ill or unstable patient, academic importance of an event, continuity of care of an obstetrical patient, or humanistic attention to the needs of a patient or family.
  • The decision to violate a work hour regulation is at the sole discretion of the resident.
  • Care of all other patients will be handed over to the appropriate team once the resident is in violation of a work hour regulation.
  • The resident must properly document in E-value the rationale for any work hour violation.
  • The violation will be reviewed by an appointed faculty member, discussed with the resident, and appropriate faculty documentation in E-value will be completed.
  • The resident will also be provided a mandated rest period following the work hour violation, as appropriate for the type of violation

Scholarly Activity

ACGME

  • The curriculum must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care.
  • Residents should participate in scholarly activity.
  • Residents should complete two scholarly activities, at least one of which should be a quality improvement project.
  • The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.

(ACGME Program Requirements for Family Medicine, IV, B)

Residency Program

  • Residents are instructed in literature appraisal skills and then encouraged to develop and evaluate them at journal club, with the completion of scholarly activities, and on clinical rotations.
  • Each resident is required to complete at least two scholarly activities throughout three years of residency training.
  • Each resident is required to the primary presenter of an internal medicine topic of his/her choice as part of the Internal Medicine lecture series at Altru Health System. Each presentation will meet criteria to be eligible for granting of CME credit for physicians in attendance and will adhere to guidelines necessary to qualify as such activity.
  • A second project will include completion of a Part IV quality improvement module through the ABFM which is required for advancement from PGY II to PGY III.
  • Additional scholarly activities are encouraged.
  • All necessary support from the Health System will be provided to allow successful and meaningful completion of the scholarly activities.
  • Scholarly activity will be overseen by the Director of Scholarly Activity as appointed by the Program Director.

Conferences

  • Conferences occur Monday, Tuesday, Thursday, and Friday at the FMR clinic.
  • Topic matter reflects the needs of the program and residents.
  • Presenters include core/community faculty, residents, and outside presenters with subject matter relevant to the program and residents.
  • The fourth Tuesday of the month is "chief conference," followed by an afternoon of resident education.
  • Wednesday Altru hospital conference is available to all physicians, including residents. The subject matter is determined by Altru's Education Committee.
  • Lunch is provided for all conferences sponsored by the residency program. If the conference is canceled, no meal is provided. Altru provides lunch during the Wednesday Altru conference.