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Medical Knowledge Competency at Altoona Family Physicians Family Medicine and Osteopathic Family Practice Residency The medical knowledge competency encompasses teaching, evaluating and remediating as needed established and evolving biomedical, clinical and cognate (e.g. epidemiologic and social-behavioral) sciences and the application of this knowledge to patient care. ACGME TOOLBOX Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiologic and social-behavioral sciences, as well as the application of this knowledge to patient care. Common Program Requirements Compliance for this requirement will be demonstrated by written didactic curriculum, lecture schedule, and reading assignments. Altoona Family Physicians Medical Knowledge Competency “Building the Framework” for a Successful Career! Altoona Family Physicians strives to provide a framework of personal medical knowledge that the resident physician can use to “build” upon throughout his or her career. The “building plan” is determined by the assessment program in place throughout the curriculum with pretests and posttests in all the major knowledge areas of family medicine as chosen by the Family Practice Essentials editors. The “tools” the resident chooses are determined by the “Learning Styles Assessment Survey” and meetings with the resident’s advisor. Our “blueprint” is the Family Practice Essentials reading program. The “home owner’s insurance” is purchased by the resident as he or she participates in the Critical Appraisal Curriculum and Practice Based Learning Curriculum and by discussing their lifetime adult learning goals, objectives, methods and progress with his or her advisor. In this way, residents not only have the “foundation” of a knowledge base before graduation, but the ability to assess the best “power tools” to help them maintain their medical knowledge home and keep it growing and in “good maintenance and home improvement” through out his or her career. Medical Knowledge Competency Curriculum Goals and Objectives Goal 1. The resident will learn a variety of methods and approaches to acquire medical knowledge during residency and throughout his or her medical career. The program will help the resident determine a combination of lectures or course attendance, question and answer study programs, video/audio, computer based resources and journals that would best suit their needs and affinities. Objective 1. The resident will attend 75 percent or greater of all lunch didactic conferences and report attendance and evaluation on their conference schedule which will be tabulated by administrative staff, reviewed by the Associate Director, and reported to faculty advisors prior to all resident evaluations. Goal 2. Didactic conference Patient Care Competency goals Conferences will help the learner expand their clinical knowledge and give a framework of important topics in family medicine that should be mastered. They will concentrate on all the major disciplines in family medicine including but not limited to Inpatient Family Medicine, Care of the Adult patient, Care of Women and Children and Care of the Elderly. They will also focus on Community Medicine, Emergency Medicine, Behavioral Medicine and Communication Skills. The conferences should help the resident acquire knowledge, analyze it and apply it to achieve competency in clinical Patient Care. Objective 1.Speakers will be encouraged to utilize whenever possible a case based format, clear goals and objectives and a question or activity to help the resident see where the information can be applied in his or her Patient Care. Objective 2. Faculty will strive to provide a framework for the knowledge that a resident will need to achieve competency in Medical Knowledge and Patient Care. Conferences will relate appropriate and effective treatments of health problems and promotion of health enhancing competency in Patient Care. Objective 3. Systems-based Practice competency will be part of didactic conferences as speakers are encouraged to incorporate cost to society and our health care system and patients of recommended medical interventions and therapies. The risks and benefits of therapies and interventions as well as patient safety will be discussed whenever appropriate to the conference topics. Goal 3. The faculty shall strive to incorporate other competencies in didactic lectures. Practice-based Learning and Improvement shall be part of Medical Knowledge competency as residents utilize intraining exams, pre-test and post test activities in Family Medicine Essentials course work and on rotations to help the resident measure his or her strengths and limits in knowledge and expertise, and choose with his or her faculty advisor areas to concentrate on and methods to utilize to improve medical knowledge competency such as reading and multimedia educational programs, web based learning and choices of electives. The resident will locate answers to clinical problems in real time strengthening their competence in Practiced Based Learning by utilizing web based evidence sources such as Up-to-date, Cochrane Data Base, Medline as measured by his or her ability to answer clinical questions as they arise in the hospital and family practice center setting. This will be demonstrated on rounds, didactic conferences, in APF and WBG precepting and measured by attending and peer evaluations. Goal 4. The residency will try to incorporate learning strategies to optimize didactic experiences to enhance Medical Knowledge Competency. The faculty, residents shall be instructed and all guest speakers given an information sheet that requests that all didactic conference have clearly stated goals and objectives. There should also be an effort to base the talk around a clinical case scenario whenever possible. Questions can be used by faculty or presenter to assess competence and integration of material. Faculty can increase competency in Systems Based Practice by asking residents to look at how our local hospital and healthcare system utilize current medical practices as presented in lunch conferences. Knowledge base can be assessed by asking questions that go beyond regurgitating facts and require higher order thinking. For example learners can be asked to compare and contrast the signs and symptoms of a two diseases and then choose the signs or symptoms that are pathognomonic for one disease of the pair. When teaching principles in medicine, faculty can ask the resident to predict outcomes and apply the concept in a clinical scenario to ensure understanding and retention of the concept. Objective 1. The resident will complete a learning style inventory test during orientation. Application of this information will be discussed with the residents as a group during orientation. The resident shall discuss with his or her faculty advisor his learning style and self study habits at each quarterly evaluation. The faculty advisor will provide and encouragement and support. Together they will set time goals for reading and study that work for that particular resident keeping in mind work life issues and learning styles. Progress in this area will be recorded on evaluation worksheets. Objective 2. The resident will choose with faculty advisor guidance CME activities that suit their learning styles and can be continued after graduation. These will include but not be limited to courses offered by the American Academy of Family Physicians, American College of Osteopathic Family Physicians, Altoona Regional Healthcare System, and American College of Physicians. Residents will be made aware of home study such as Core Content of Family Medicine and AAFP home study program, audio options and web based CME such as Uptodate.com. and Info Poems. They will have guidance in spending their CME time and money in ways that best suit them as a learner that can continue after graduation. These goals will be set at evaluations and measured by attendance and self reported progress to faculty advisors and recorded on evaluation worksheets. Objective 3. The resident will participate in Core Content of Family Medicine conferences, record their attendance on their schedules and Dr. Sweeney will measure their ability to answer programmed questions at the time of conference. She will report at faculty meeting any perceived difficulties in reasoning through test questions so advisors can assist the residents. Objective 4. The first year resident will prepare for ALSO, NRP, ACLS, ATLS courses during orientation and PGY and OGME 1 years. They will complete the courses successfully as measured by passing all clinical scenarios and post tests. Objective 5. The second and third year residents shall maintain the above certifications and success will be measured by passing all clinical scenarios and post tests. This is tracked and recorded in the resident file. Objective 6. The second and third year residents will locate, appraise and assimilated evidence from scientific studies and present this information in a formal senior talk with power point, handout and bibliography once a year. One year the topic will be an obstetrics or pediatrics topic and the other year internal medicine or adult medicine topic. The resident will pick a faculty advisor for guidance and have the topic approved by Dr. Sweeney. Formative feedback will be gathered by attending faculty evaluation and reviewed with the residents at his or her quarterly evaluation by his or her advisor. This will also measure Professionalism Competency as the resident will be required to give at the talk in the fashion of grand rounds. Interpersonal and Communication Skills and formal teaching to peers, Practiced Based Learning Improvement, is measured by faculty presentation evaluation forms. Goal 5. The resident will learn ways to analyze medical knowledge and increase Practice Based Learning Competency. Objective 1. All residents shall attend and participate in Critical Appraisal Course as part of the didactic lecture curriculum. They will learn the fundamentals of evidence based medicine and analyzing the medical literature as measured by their improvement on the pretest and post test. The resident will present one journal article twice a year at Family Practice Rounds evaluated by faculty and residents in attendance. Goal 6. The curriculum of family medicine and osteopathic family practice will be presented and experienced by residents in a variety of modalities. This will enhance learning for adults with different strengths and learning styles. Objective 1. The faculty will provide and model clinical teaching in the outpatient office as preceptors, in the hospital as attendings on the medical, obstetrics, pediatric, nursery floors, ER and ICU. This will be measured by feedback from residents on faculty evaluations on individual rotations and yearly faculty evaluations. Objective 2. Second and third year residents will progressively assume more duties for clinical teaching as part of the Practice Based Learning Competency as they demonstrate their clinical knowledge and skills to other residents and medical students. This will be measured and feedback provided by faculty and peer evaluations. Objective 3. The associate director/Osteopathic Family Practice Director will plan didactic lunch conferences to incorporate the breadth and variety of family medicine. Outcomes will be measure by twice a year feedback conferences where residents directly give feedback as to the utility of sessions. Residents are also encouraged to utilize email to suggest conference topics and provide feedback. Residents will also provide written feedback on didactic lectures on the conference schedule with completion measured by administrative residency personnel, tabulation and adjustments made by the director. Goal 7. The program directors will organize extended seminars to cover procedures and topics as seen necessary. Examples are:
Practice Management Course
Procedural Workshops Osteopathic Manipulation Day
Arthrocentesis and Major Joint injections
Breast Exam- Future topic Skin biopsy
Colposcopy, Cryotherapy of the cervix, Pap Smears, Endometrial Biopsy, Endocervical curettage
Goal 8. The residency shall provide group study experiences to enhance learning through discussions and sharing Family Medicine Rounds
Core Content Family Medicine
Problem Based Small Group Learning
Goal 9. The residency shall cultivate, create and collect methodologies to pre-test knowledge of residents before rotations and provide post-tests to help gauge progress towards medical knowledge competency Objective 1. The resident shall take pretests as designated from the AAFP Home study Monograph series on the following schedule. An updated CDROM of Family Medicine Essentials will be provided each academic year. This program covers all major topics in family medicine over a 6 year cycle, and is an excellent source for pre-testing knowledge over the breadth of family medicine. The resident will self score this assessment, turn in test sheets to administrative assistants for tracking and use it to direct reading of the monograph or other sources. Post-tests may be taken at any time. If a score of 100% is achieved on the pretest and posttest no further reading of the Monograph is required unless desired. If less than this score is achieved, residents are to study the Home Study Monograph as assigned until 100% is achieved. These answer sheets will sent by handed in to Cindy Fickes for inclusion in resident portfolios. She will track resident progress and report it to resident advisors prior to evaluations. Completion of all assigned pre and post tests is necessary for promotion to the next year of residency. Each resident will receive a CD ROM yearly and be required to take the following pre and post tests on the following rotations. Assignments will be updated each March when a new CDROM is available. This program was chosen for the following reasons: 1. The topics covered encompass those usually queried in the Board of Family Medicine and Osteopathic Family Practice Board Examinations. 2. Residents can assess their knowledge of the topic by taking pretest and post tests prior to reading the monograph. . Residents should read the monograph and then retake the pre and post test until 100% scoring is reached. If the resident achieves 100% immediately, he or she can elect to choose more in-depth reading on the same topic under the guidance of their advisor. The resident may choose articles on this topic out of the current literature critically appraise the information and present it at Family Medicine Rounds to other residents to show how to apply the Medical Knowledge to improve Patient Care. In this way learners should be able to tailor their reading program to their personal needs and strengths. The required tests and monograph resources are: First Year Curriculum
Second Year Curriculum
Third Year Curriculum
Objective 2. Medical knowledge will also be measured through the in-training exams with review of each resident’s strengths and weaknesses at faculty meeting and advisor evaluations. Study programs will be addressed by advisors in keeping with learning strengths, styles and needs assessment from in-training exams. Goal 9. The resident will participate in Journal club and the Critical Appraisal Course/ Curriculum as they are essential to our Medical Knowledge competency. Objective 1. Each resident will take pre and post tests for the Critical Appraisal Curriculum and mastery will be measured by faculty evaluation of the resident’s ability to present two articles at journal club yearly.
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