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                     CURRICULUM

INTERNAL MEDICINE RESIDENCY PROGRAM

 

The general goals of the Department of Internal Medicine and its residency programs are:

1. To foster excellence in medical education and practice at all levels of training and experience.

2. To care for our patients with respect and compassion in a setting in which they benefit from the application of medical and scientific advances.

3. To develop leaders in medicine.

4. To foster a love for learning, scholarship and research.

The specific goals of the residency programs are:

1. To prepare residents to become independent practitioners of General Internal Medicine who are skilled in providing inpatient and outpatient primary care as well as consultative support for family physicians, surgeons, psychiatrists, gynecologists, and other physicians

2. To provide the educational background for entry into sub-specialty or research training programs.

OBJECTIVES

The objectives of the program are:

* To teach by example and supervised practice the following clinical and personal skill.

o Leadership

o Compassionate and ethical physician-patient interactions

o Composition of the medical history

o The medical interview

o Physical examination

o Differential diagnosis

o Rational and cost-effective use of diagnostic tests

o Evidence based diagnosis

o Evidence based decision making in patient management

o Rational, cost effective use of therapeutic agents

o Preparation of an appropriate comprehensive data base for each patient

                 o Preparation of meaningful summary of each patient's data base, diagnoses,management,

                   and course  to use as a discharge summary, transfer note, referral letter, consultation .              

 

      * To provide supervised inpatient, outpatient (ambulatory) and consultative services that prepares  

        the resident for independent diagnosis and management of patients with the broad spectrum of  

        diseases

         encountered by the general internist, including those with the following subspecialty interests:

 

o Adolescent Medicine

o Cardiology

o Critical Care Medicine

o Dermatology

o Endocrinology and Metabolism

o Emergency Medicine

o Gastroenterology

o General Internal Medicine

o Geriatric Medicine

o Health care Ethics

o Hematology

o Infectious Diseases

o Immunology

o Nephrology

o Neurology

o Nuclear Medicine

o Nutrition

o Oncology

o Pulmonology

o Psychosocial Medicine

o Rheumatology

o Sexual Dysfunction

o Substance Abuse

 

    * To encourage residents to participate electively in subspecialty practices with the following three additional  

       objective:

1.  To teach by example and supervised practice the art of providing consultative support for other physicians.

2.  To increase experience in an ambulatory care setting.

3. To cover through patient evaluation, case presentation, conferences, rounds, and informal discussions the diseases and areas of research appropriate to the subspecialties.

 

ASSIGNMENTS

 

YEAR ONE

General Internal Medicine in patient service (includes 4 weeks of vacations)

o 4 months in General Ward (San Juan City Hospital)

o 1.5 months in Emergency Room (San Juan City Hospital)

o 2 months in Intensive Care Unit (San Juan City Hospital)

o 1 month in Elective Rotation (San Juan City Hospital)

o Ambulatory care, residents attend to internal medicine follow up clinics once a week at San    

   Juan City Hospital.

 o 1 month hematology / oncology ward

 

In the first year the resident functions as a primary physician, providing the initial evaluation, management plan, and prescriptions of orders.   At the San Juan City Department of Medicine as well as the others affiliated institutions, the residents discharge their patients to their own continuity practices or depending on the patient's need to: extended care facilities, convalescent homes, home care programs, extended care units, the vocational and rehabilitation center, drug addiction programs and psychiatric care units.

Every patient encountered, whether inpatient or ambulatory is closely supervised by a faculty member.  In addition an upper level resident is involved in many patients encounter, providing assistance and supervision to the first year resident. A General Medicine Inpatient Team is staffed by one attending physician, two PGY-I, one PGY-II, some months by seniors medical students or a Transitional Resident.

As first year residents they are on calls every four (4) night. An intensive care unit team consists of an attending physician, one PGY-II and two PGY-I.  Each resident has one day-off per week.


 

UPPER LEVEL RESIDENTS

A) The second year resident is the admitting officer, serves as a tea leader, with responsibilities of teaching and supervising the first year residents as well as students on his/her team.

 When the team is on call, the resident is responsible for evaluation and admission of   patients from both Emergency Rooms.

The second year resident on duty has availability for assistance and advice from the attending physician on call, the Chief Resident, and from a fellow of on Hematology/Oncology call

Assignment

* 5 months in General Ward (San Juan City Hospital)

* 2 month in Critical Care Medicine (San Juan City Hospital)

* 1 month in Cardiology (San Juan City Hospital)

* 1 month in Neurology (San Juan City Hospital)

* 1 month in Emergency Room (San Juan City Hospital)

 * Vacation 4 weeks

                   o  Ambulatory Care, residents have a follow up clinic once a week at San

Juan City Hospital.

o The Second year resident attend to one preadmission clinic weekly, and perform medical evaluations and make appropriate recommendations in patients that usually are candidates for some type of surgery. They are advised and supervised by an attending physician in charge of ambulatory clinic.

B)  The third year resident has the greatest degree of responsibility and independence, he/she is also expected to serve as a team leader for each assignment. The PGY-III residents deliver total medical care during their rotations through the various subspecialty inpatient services and subspecialty clinics.    Depending on subspecialty, these clinics may take place weekly or biweekly. The residents continue to attend their follow up clinics for the whole year. Also they participate in special clinics such as complicated OB-Gyn Clinics. When the third year resident is on call, he/she is responsible for the entire Coronary Care Unit, and has assistance and advice of a faculty cardiologist on call. The OPD rotation includes Dermatology, Ophthalmology, ENT, Orthopedic. The PGY-III attends one of the CDT's three days a week during four week period. They are the first contact for the evaluation and treatment of these patients under attending supervision.

 

       * To encourage an understanding of the operation and management of health care delivery systems by involving the residents in multiple systems including:

1. Tertiary Hospital Practice

a. San Juan City - Carolina

b. University of Puerto Rico Hospital

2. Ambulatory Care Practice

3. Diagnostic and Treatment Center

4. Home Care, Antillas Medical Complex (long term care facility)

     * To encourage residents and staff members participation in clinical research

    * To participate in the form provided by the UPR School of Medicine and UPR School of Public Health, about the practice of medicine, health care economics, medical ethics, and health care public policy issues including access to medical care, distribution of medical manpower, reimbursement for medical care and medical education.

ASSIGMENT

 * Cardiology

1 month at San Juan City Hospital

* Consultation

1 month at San Juan City Hospital

* Endocrinology / Dermatology     

      1 month at San Juan City Hospital

* Gastroenterology

1 month at San Juan City Hospital

* Geriatric

1 month at School of Medicine UPR

* Infectious Disease / Physical Medicine and Rehabilitation

      1 month at San Juan City Hospital

* Nephrology

1 month at San Juan City Hospital

* Radiology / Ophthalmology

1 month at San Juan City Hospital

* OPD / Adolescent

1 month at San Juan City Hospital

* Pneumology

1 month at San Juan City Hospital

* Rheumatology / ENT

1 month at San Juan City Hospital

* Vacation 1 month

During each rotation residents will do working rounds daily and teaching rounds three times per week with their attending.This is complemented with our daily conference schedule were we cover most topics relevant to the General Internal Medicine practice, and its subspecialties.

 

 
 

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