Corry Memorial Hospital Internal Medicine Residency Program

Overall Educational Goals and Objectives

Corry Memorial Hospital Internal Medicine Residency Program Overview of Goals and Objectives

The Corry Memorial Hospital Internal Medicine Residency Program offers a 36-month, rural community-based, Accreditation Council for Graduate Medical Education (ACGME) accredited program, designed to train knowledgeable, compassionate and efficient internists consistent with the definition developed by the Review Committee as follows:

Internists are specialists who care for adult patients through comprehensive, clinical problem solving. They integrate the history, physical examination, and all available data to deliver, direct, and coordinate care across varied clinical settings, both in person and remotely through telemedicine.
Internists are diagnosticians who manage the care of patients who present with undifferentiated, complex illnesses, and comorbidities; promote health and health equity in communities; collaborate with colleagues; and lead, mentor, and serve multidisciplinary teams.
Internists integrate care across organ systems and disease processes throughout the adult lifespan. They are expert communicators, creative and adaptable to the changing needs of patients and the health care environment. They advocate for their patients within the health care system to achieve the patient’s and family’s care goals.
Internists embrace lifelong learning and the privilege and responsibility of educating patients, populations, and other health professionals. The discipline is characterized by a compassionate, cognitive, scholarly, relationship-oriented approach to comprehensive patient care. The successful, fulfilled internist maintains this core function and these core values.
Internists find meaning and purpose in caring for individual patients with increased efficiency through well-functioning teams, and are equipped and trained to manage change effectively and lead those teams. They understand and manage the business of medicine to optimize cost-conscious care for their patients. They apply data management science to population and patient applications and help solve the clinical problems of their patients and their community.
Internists communicate fluently and are able to educate and clearly explain complex data and concepts to all audiences, especially patients. They collaborate with patients to implement health care ethics in all aspects of their care.
Internists display emotional intelligence in their relationships with colleagues, team members, and patients, maximizing both their own and their teams’ wellbeing. They are dedicated professionals who have the knowledge, skills, and attitudes to effectively use all available resources, and bring intellectual curiosity and human warmth to their patients and community.¹

While our program will focus on the delivery of healthcare within a rural community-based system, our curriculum is designed to train future internists who are able to practice in any environment.

¹ https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2023.pdf Accessed 6/4/2023

MISSION STATEMENT

The mission of Corry Memorial Hospital Internal Medicine Residency Program is to train the next generation of physicians in rural internal medicine who are well prepared to practice competently and independently through a residency program of excellence in education, research, clinical care, and community service to improve the health of rural communities.

PROGRAM AIMS

Corry Memorial Hospital is committed to providing the necessary financial support for administrative, education, and clinical resources, including personnel for the success of the Internal Medicine Residency Program.
The Internal Medicine Residency Program aims to train physicians who are actively engaged in the teaching of medical student and residents throughout their career.
The Internal Medicine Residency Program aims to retain graduating residents to practice in the community in which they trained and to encourage participation in a graduate medical education program as members of the faculty.
The Internal Medicine Residency Program aims to contribute to the growing body of literature through research.
The Internal Medicine Residency Program aims to train physicians on the complexity of healthcare delivery in a rural community setting and value the services and expertise of all members of our healthcare team.

GOALS AND OBJECTIVES

The ACGME has established six core competencies that must be integrated into the Internal Medicine educational curriculum. The competency-based goals and objective of each post graduate year are listed below and organized to demonstrate the expected learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.

Medical Knowledge (MK)

Overall Goals

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, including scientific inquiry, as well as the application of this knowledge to patient care.
Residents must demonstrate a level of expertise in the knowledge of the broad spectrum of clinical disorders seen by an internist including:
1. the internal medicine subspecialties,
2. the multidisciplinary subspecialties of geriatric medicine, hospice and palliative medicine and addiction medicine, and neurology
Residents must demonstrate sufficient knowledge in the following areas:
1. evaluation of patients with an undiagnosed and undifferentiated presentation
2. pharmacotherapeutic and non-pharmacotherapeutic treatment of the broad spectrum of medical conditions and clinical disorders managed by internists
3. provision of preventive care
4. interpretation of clinical tests and images
5. recognition and initial management of urgent medical problems
6. application of technology appropriate for the clinical context, including evolving techniques

Objectives per Post-Graduate Training Year

PGY-1

Explains the scientific knowledge (e.g., physiology, social sciences, mechanism of disease) for normal function and common medical conditions
Explains the scientific basis for common therapies
Explains the rationale, risks, and benefits for common diagnostic testing
Interprets results of common diagnostic tests

PGY-2

Explains the scientific knowledge for complex medical conditions
Explains the indications, contraindications, risks, and benefits of common therapies
Explains the rationale, risks, and benefits for complex diagnostic testing
Interprets complex diagnostic data

PGY-3

Integrates scientific knowledge to address comorbid conditions within the context of multisystem disease
Integrates knowledge of therapeutic options in patients with comorbid conditions, multisystem disease, or uncertain diagnosis
Integrates value and test characteristics of various diagnostic strategies in patients with common diseases
Integrates complex diagnostic data accurately to reach high-probability diagnoses

Graduate

Integrates scientific knowledge to address uncommon, atypical, or complex comorbid conditions within the context of multisystem disease
Integrates knowledge of therapeutic options within the clinical and psychosocial context of the patient to formulate treatment options
Integrates value and test characteristics of various diagnostic strategies in patients with comorbid conditions or multisystem disease
Anticipates and accounts for limitations when interpreting diagnostic data

Patient Care (PC)

Overall Goals

Residents must be able to provide patient care that is patient- and family-centered, compassionate, equitable, appropriate, and effective for the treatment of health problems and the promotion of health.
Residents must demonstrate the ability to manage the care of patients:
1. using clinical skills of interviewing and physical examination
2. in a variety of roles within a health system with progressive responsibility, including serving as the direct provider, a member, or leader of an interprofessional team of providers; as a consultant to other physicians; and as a teacher to the patient, the patient’s family, and other health care workers
3. including the prevention, counseling, detection, diagnosis, and treatment of adult diseases
4. in a variety of health care settings, including the inpatient ward, critical care units, and various ambulatory settings
5. for whom they have limited or no physical contact, through the use of telemedicine
6. in the subspecialties of internal medicine
7. using population-based data
8. using critical thinking and evidence-based tools
Residents must be able to perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.
Residents must demonstrate the ability to:
1. use and/or perform point-of-care laboratory, diagnostic, and/or imaging studies relevant to the care of the patient
2. perform diagnostic and therapeutic procedures relevant to their specific career paths; and,
3. treat their patients’ conditions with practices that are patient-centered, safe, scientifically based, effective, timely, and cost effective
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Objectives per Post-Graduate Training Year

PGY-1

Elicits and reports a comprehensive history for common patient presentations, with guidance
Seeks data from secondary sources, with guidance
Performs a general physical examination while attending to patient comfort and safety
Identifies common abnormal findings
Organizes and accurately summarizes information obtained from the patient evaluation to develop a clinical impression
Formulates management plans for common conditions, with guidance
Identifies opportunities to maintain and promote health
Formulates management plans for a common chronic condition, with guidance
Formulates management plans for acute common conditions, with guidance
Uses electronic health record (EHR) for routine patient care activities
Identifies the required components for a telehealth visit

PGY-2

Elicits and concisely reports a hypothesis-driven patient history for common patient presentations
Independently obtains data from secondary sources
Performs a hypothesis-driven physical examination for a common patient presentation
Interprets common abnormal findings
Integrates information from all sources to develop a basic differential diagnosis for common patient presentations
Identifies clinical reasoning errors within patient care, with guidance
Develops and implements management plans for common conditions, recognizing acuity, and modifies based on the clinical course
Develops and implements management plans to maintain and promote health, with guidance
Develops and implements management plans to maintain and promote health
Develops and implements management plans for common chronic conditions
Develops and implements management plans for common acute conditions
Expands use of EHR to include and reconcile secondary data sources in patient care activities
Performs assigned telehealth visits using approved technology

PGY-3

Elicits and concisely reports a hypothesis-driven patient history for complex patient presentations
Reconciles current data with secondary sources
Performs a hypothesis-driven physical examination for a complex patient presentation
Identifies and interprets uncommon and complex abnormal findings
Develops a thorough and prioritized differential diagnosis for common patient presentations
Retrospectively applies clinical reasoning principles to identify errors
Develops and implements value-based (high value) management plans for patients with multisystem disease and comorbid conditions; modifies based on the clinical course
Independently develops and implements plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
Develops and implements plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
Develops and implements management plans for multiple chronic conditions
Develops and implements an initial management plan for patients with urgent or emergent conditions in the setting of chronic comorbidities
Effectively uses EHR capabilities in managing acute and chronic care of patients
Identifies clinical situations that can be managed through a telehealth visit

Graduate

Efficiently elicits and concisely reports a patient history, incorporating pertinent psychosocial and other determinants of health
Uses history and secondary data to guide the need for further diagnostic testing
Uses advanced maneuvers to elicit subtle findings
Integrates subtle physical examination findings to guide diagnosis and management
Develops prioritized differential diagnoses in complex patient presentations and incorporates subtle, unusual, or conflicting findings
Continually re-appraises one’s own clinical reasoning to improve patient care in real time
Uses shared decision making to develop and implement value-based (high value) comprehensive management plans for patients with comorbid and multisystem disease, including those patients requiring critical care
Independently develops and implements comprehensive plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
Develops and implements value-based (high-value) comprehensive plans to maintain and promote health
Develops and implements value-based (high value) comprehensive management plans for multiple chronic conditions, incorporating pertinent psychosocial and other determinants of health
Develops and implements value-based (high value) management plans for patients with acute conditions
Uses EHR to facilitate achievement of quality targets for patient panels
Integrates telehealth effectively into clinical practice for the management of acute and chronic illness

Practice Based Learning and Improvement (PBLI)

Overall Goals

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.
Residents must demonstrate competence in:
1. identifying strengths, deficiencies, and limits in one’s knowledge and expertise
2. setting learning and improvement goals
3. identifying and performing appropriate learning activities
4. systematically analyzing practice using quality improvement methods, including activities aimed at reducing health care disparities, and implementing changes with the goal of practice improvement
5. incorporating feedback and formative evaluation into daily practice
6. locating, appraising, and assimilating evidence from scientific studies related to their patients’ health problems

Objectives per Post-Graduate Training Year

PGY-1

Demonstrates how to access, categorize, and analyze clinical evidence, with guidance
Accepts responsibility for personal and professional development by establishing goals
Identifies the factors that contribute to gap(s) between ideal and actual performance, with guidance

PGY-2

Articulates clinical questions and elicits patient preferences and values to guide evidence-based care
Demonstrates openness to performance data (feedback and other input) to inform goals
Analyzes and reflects on the factors which contribute to gap(s) between ideal and actual performance, with guidance
Actively seeks opportunities to improve

PGY-3

Critically appraises and applies the best available evidence, integrated with patient preference, to the care of complex patients
Seeks performance data episodically, with adaptability, and humility
Institutes behavioral change(s) to narrow the gap(s) between ideal and actual performance
Designs and implements an individualized learning plan, with prompting

Graduate

Applies evidence, even in the face of uncertainty and conflicting evidence, to guide care, tailored to the individual patient
Seeks performance data consistently with adaptability, and humility
Challenges one’s own assumptions and considers alternatives in narrowing the gap(s) between ideal and actual performance
Independently creates and implements an individualized learning plan

Systems Based Practice (SBP)

Overall Goals

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, including the structural and social determinants of health, as well as the ability to call effectively on other resources to provide optimal health care.
Residents must demonstrate competence in:
1. working effectively in various health care delivery settings and systems relevant to their clinical specialty
2. coordinating patient care across the health care continuum and beyond as relevant to their clinical specialty
3. advocating for quality patient care and optimal patient care systems
4. participating in identifying system errors and implementing potential systems solutions
5. incorporating considerations of value, equity, cost awareness, delivery and payment, and risk-benefit analysis in patient and/or population-based care as appropriate
6. understanding health care finances and its impact on individual patients’ health decisions
7. using tools and techniques that promote patient safety and disclosure of patient safety events (real or simulated)
Residents must learn to advocate for patients within the health care system to achieve the patient’s and patient’s family’s care goals, including, when appropriate, end-of-life goals.

Objectives per Post-Graduate Training Year

PGY-1

Demonstrates knowledge of common patient safety events
Demonstrates knowledge of how to report patient safety events
Demonstrates knowledge of basic quality improvement methodologies and metrics
Demonstrates knowledge of care coordination
Identifies key elements for safe and effective transitions of care and hand-offs
Demonstrates knowledge of population and community health needs and disparities
Identifies key components of the health care system
Describes basic health payment systems

PGY-2

Identifies system factors that lead to patient safety events
Reports patient safety events through institutional reporting systems (actual or simulated)
Describes local quality improvement initiatives
Coordinates care of patients by effectively engaging interprofessional teams in routine clinical situations
Performs safe and effective transitions of care/hand-offs in routine clinical situations
Identifies specific population and community health needs and inequities for the local population
Describes how components of a complex health care system are interrelated, and how this impacts patient care
Delivers care with consideration of each patient’s payment model

PGY-3

Contributes to the analysis of patient safety events (simulated or actual)
Participates in disclosure of patient safety events to patients and families (simulated or actual)
Contributes to local quality improvement initiatives
Coordinates care of patients by effectively engaging interprofessional teams in complex clinical situations
Performs safe and effective transitions of care/hand-offs in complex clinical situations
Uses local resources effectively to meet the needs of a patient population and community
Discusses how individual practice affects the regional and national health care system
Engages with patients in shared decision making, informed by each patient’s payment models

Graduate

Conducts analysis of patient safety events and offers error prevention strategies (simulated or actual)
Discloses patient safety events to patients and families (simulated or actual)
Demonstrates the skills required to identify, develop, implement, and analyze a quality improvement project
Models effective coordination of patient-centered care among different disciplines and specialties
Models and advocates for safe and effective transitions of care/hand-offs within and across health care delivery systems, including outpatient settings
Participates in changing and adapting practice to provide for the needs of specific populations
Manages various components of the complex health care system to provide efficient and effective patient care
Advocates for patient care needs with consideration of the limitations of each patient’s payment model

Professionalism (P)

Overall Goals

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles.
Residents must demonstrate competence in:
1. compassion, integrity, and respect for others
2. responsiveness to patient needs that supersedes self-interest
3. cultural humility
4. respect for patient privacy and autonomy
5. accountability to patients, society, and the profession
6. respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation
7. ability to recognize and develop a plan for one’s own personal and professional well-being
8. appropriately disclosing and addressing conflict or duality of interest

Objectives per Post-Graduate Training Year

PGY-1

Demonstrates professional behavior in routine situations
Demonstrates knowledge of basic ethical principles
Performs administrative tasks and patient care responsibilities, with prompting
Recognizes the importance of getting help when needed to address personal and professional well-being

PGY-2

Identifies potential triggers for professionalism lapses and accepts responsibility for one’s own professionalism lapses
Applies basic principles to address straightforward ethical situations
Performs administrative tasks and patient care responsibilities in a timely manner in routine situations
Lists resources to support personal and professional well-being
Recognizes that institutional factors affect well-being

PGY-3

Demonstrates a pattern of professional behavior in complex or stressful situations
Analyzes complex situations using ethical principles and identifies the need to seek help in addressing complex ethical situations
Performs administrative tasks and patient care responsibilities in a timely manner in complex or stressful situations
With prompting, reflects on how personal and professional well-being may impact one’s clinical practice
Describes institutional factors that affect well-being

Graduate

Recognizes situations that may trigger professionalism lapses and intervenes to prevent lapses in oneself and others
Analyzes complex situations and engages with appropriate resources for managing and addressing ethical dilemmas as needed
Proactively implements strategies to ensure that the needs of patients, teams, and systems are met
Reflects on actions in real time to proactively respond to the inherent emotional challenges of physician work
Suggests potential solutions to institutional factors that affect well-being

Interpersonal and Communication Skills (ICS)

Overall Goals

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Residents must demonstrate competence in:
1. communicating effectively with patients and patients’ families, as appropriate, across a broad range of socioeconomic circumstances, cultural backgrounds, and language capabilities, learning to engage interpretive services as required to provide appropriate care to each patient
2. communicating effectively with physicians, other health professionals, and health-related agencies
3. working effectively as a member or leader of a health care team or other professional group
4. educating patients, patients’ families, students, other residents, and other health professionals
5. acting in a consultative role to other physicians and health professionals
6. maintaining comprehensive, timely, and legible health care records
Residents must learn to communicate with patients and patients’ families to partner with them to assess their care goals, including, when appropriate, end-of life goals.

Objectives per Post-Graduate Training Year

PGY-1

Uses language and non-verbal behavior to demonstrate respect and establish rapport
Respectfully requests and responds to a consultation
Uses verbal and non-verbal communication that values all members of the interprofessional team
Accurately documents comprehensive and current information
Communicates using formats specified by institutional policy to safeguard patient personal health information

PGY-2

Establishes and maintains a therapeutic relationship using effective communication behaviors in straightforward encounters
Identifies common barriers to effective communication
Clearly and concisely requests and responds to a consultation
Communicates information, including basic feedback with all interprofessional team members
Documents clinical encounter, including reasoning, through organized notes
Selects direct (e.g., telephone, in-person) and indirect (e.g., progress notes, text messages) forms of communication based on context, with assistance

PGY-3

Establishes and maintains a therapeutic relationship using effective communication behaviors in challenging patient encounters
Identifies complex barriers to effective communication, including personal bias
Checks own and others’ understanding of recommendations when providing or receiving consultation
Facilitates interprofessional team communication to reconcile conflict and provides difficult feedback
Documents clinical encounter through concise and thorough notes
Appropriately selects direct and indirect forms of communication based on context

Graduate

Establishes and maintains therapeutic relationships using shared decision making, regardless of complexity
Mitigates communication barriers
Coordinates recommendations from different consultants to optimize patient care
Adapts communication style to fit interprofessional team needs and maximizes impact of feedback to the team
Documents clinical encounter clearly, concisely, timely, and in an organized form, including anticipatory guidance
Models effective written and verbal communication

INCORPORATING CORE COMPETENCIES INTO TEACHING AND ASSESSMENT

The general didactic program incorporates various modalities, including regularly scheduled conferences, lectures, board review, web-based modules, interactive videoconferences, simulation activities, clinical didactics, case presentations, journal club, and workshops that are accessible by electronic means if a resident is unable to attend. Formal lectures are provided by different specialists that incorporate a broad range of inpatient and outpatient clinical experiences in the management of patients with a wide spectrum of health problems.

Each resident’s performance is measured by the program’s evaluation system, which incorporates feedback from faculty, staff, attending physicians, patients and peers into monthly, quarterly, semi-annual and yearly assessments. Each resident will meet with their preceptor midway through each rotation to discuss progress and opportunities for improvement, followed by a formal, written evaluation conducted at the end of each rotation. There will be formal, semi-annual assessments performed by the Clinical Competency Committee utilizing the internal medicine milestones.

Common Teaching and Assessment Methods for the Six Core Competencies

Core Competency	Teaching Modality	Assessment Method
Patient Care (PC)	Teaching Rounds Conference/Lectures Continuity Practice Physician as educator Interaction with physician mentor Clinical Simulator Sessions	Direct observation Rating scales/evaluation forms Audit of clinical practice Faculty assessment Chart Reviews Participation in didactics
Medical Knowledge (MK)	Clinical teaching Lectures/conferences Independent study Teaching rounds Function as educator Board Review Clinical Simulator Sessions	In-training examinations Oral questioning methods Direct observation Faculty assessment Chart Reviews Participation in didactics
Practice-Based Learning & Improvement (PBLI)	Clinical teaching Journal Club Independent study Interaction with physician mentor Physician as Educator Lectures/Conferences Performance Improvement Project Simulation activities	Audit of clinical practice Evidence-based medicine logs Rating scales/evaluation forms Reflective practice rubrics Participation in QAPI trainings and committee functions
Interpersonal & Communication Skills (ICS)	Clinical teaching Interaction with physician mentor Transition and transfer of care instruction Physician as educator Simulation activities	Multi-source feedback Patient surveys Direct observation
Professionalism (P)	Clinical teaching Interaction with physician mentor Lectures/Conferences Simulation activities	Multi-source feedback Patient surveys Direct observation
System-Based Practice (SBP)	Clinical teaching Independent study Lectures/Conferences Performance Improvement Project Simulation activities	Audit of clinical practice Multi-source feedback Rating scales/evaluation forms Participation in QAPI trainings and committee functions