The Hospital
St. Barnabas Hospital is a 458 bed acute care private community hospital affiliated with the New York College of Osteopathic Medicine’s Educational Consortium (NYCOMEC). St. Barnabas Hospital and NYCOMEC associated for the purpose of establishing a cooperative program of medical education, research and improved medical care.
St. Barnabas Hospital is located in the Belmont or "Little Italy" neighborhood of the Bronx, and this area is a tourist attraction because of the many fine shops, bakeries, and restaurants which it harbors. A few blocks away are Fordham University, the New York Botanical Garden, and the New York Zoological Society ("The Bronx Zoo").
The Hospital sits on several landscaped acres adjacent to the recently constructed St. Barnabas Nursing Home. There is a brand new seven-story Ambulatory Care Center immediately across the street. Other ambulatory care sites include the HIP Southern Center at 149th Street, Union Community Health Care Center (UCHC) located at Valentine Ave, 2021 Grand Concourse Ave, and 470 East Fordham Road. The latter serves as the primary care site for the St. Barnabas Family Practice Residency Program.
The Program
The St. Barnabas Family Practice Residency Training Program is designed to accommodate the individual learning needs of osteopathic physicians, who plan to pursue a career in Family Practice. The residency training focuses on the ambulatory aspects of patient care, prepares residents to take the AOBFP certifying board examination, and accommodates individual practice interests. The resident learns the basis for community oriented primary care.
The Department of Family Practice is responsible for:
(1) Structuring and providing guidance for the overall curriculum, and
(2) Rotations through various affiliated institutions.
To this end, St. Barnabas directs the program, oversees its quality and accreditation status through the American Osteopathic Association (AOA).
The St. Barnabas Family Practice Program located at Union Community Health Care Center at Fordham Plaza has been appointed a New York State Designated Priority Program. In keeping with this appointment, the site and the residency program must comply with many standards which benefit both our patients and our residents. This includes the use of an appointment system that accommodates personal appointments, walk-ins and referrals, allows ample time for exam, treatment and patient education. The program’s continuity site also provides comprehensive coverage that provides prompt telephone access to a clinical staff member on a 24-hour basis, operates 40 hours a week including 8 hours on the weekend, and assigns residents to provide care for a specific panel of patients. In keeping with the goals of the NYS Designed Priority Program, the program tracks patients who are referred, sent to the hospital, and also monitors reports and results of consultations.
Purpose, Goals, and Objectives
Purpose
The purpose of the St. Barnabas Family Practice Residency Program is to provide residents with instruction and training experiences such that they acquire the necessary knowledge and skills to manage the large majority of health problems of the general public. This includes:
Treating the presenting complaint in the context of the patient’s overall health and family problems;
Emphasizing the ambulatory aspect with appropriate attention to the pre-hospitalization, and post- hospitalization planning and implementation;
Identifying the role of the family practitioner in health care delivery with other medical specialists;
Imparting a sense of concern for all aspects of the patient's health;
Providing core curriculum material, yet recognizing the individual interest areas characteristic of family practitioners; and
Managing all aspects of patient care over the course of the residency under supervision of board-certified preceptors in family medicine and by actively interacting with other medical specialists.
Goals
To achieve the purpose of the graduate training program, major goals have been developed to guide the education and training of the residents. The goals include:
To provide properly organized, progressive primary responsibility for the care of patients in a family practice environment under the supervision of attending family practitioners. Emphasis is placed upon the longitudinal approach and the educational aspects of the residency program. In addition, special emphasis is placed on osteopathic concepts, along with the psychological, social and somatic aspects of disease, and procedures commonly emphasized in the practice of osteopathic medicine. This is the holistic model of medicine as seen in the tradition of Hippocrates.
To provide additional experience and responsibility in those branches of medicine, surgery, pediatrics, obstetrics/gynecology, behavioral science and osteopathic principles and practice which are of primary importance to the family practitioner.
To provide the basic requirements for eventual certification in family practice by the American Osteopathic Board of Family Practice.
Objectives
The St. Barnabas Family Practice Residency Program is a comprehensive three year program. As such it meets the following objectives:
1 a. During the training period all basic requirements for AOA certification are met.
b. The three year program is designed to allow for the educational objectives of individual residents in accordance with their needs to develop additional family practice skills. These needs may reflect the
practice standards of the potential community in which the resident intends to work.
2.The program conforms to the standards of the AOA's Committee on Postdoctoral Training as set forth in the Residency Training Requirements of the American Osteopathic Association.
3.In-hospital training includes:
a.The acquisition of specialty knowledge and skills needed to function in the ambulatory setting.
b.The gaining of knowledge and skills needed for inpatient care.
c.The learning of the protocols by which other osteopathic specialists assist in total patient care.
4. Ambulatory Family Practice training includes:
a.Emphasis on osteopathic principles and practices.
b.Provisions for longitudinal patient care.
c.Introduction to outpatient procedures and ambulatory care practice.
d. Provision for the conceptual and practical development of skills in primary care and continuity of patient care.
e.Emphasis on the physician-patient relationship.
f.Introduction of preventive health care delivery.
g. Application of community oriented medicine in total patient care.
h.Evaluation and treatment of outpatient pediatric patients
i. Evaluation and treatment of outpatient GYN patients
5. The program emphasizes the behavioral sciences as well as non-clinical medicine.
a. The acquisition of knowledge and skills in the behavioral sciences (e.g., human development, interviewing and counseling skills, knowledge of psycho-social factors in health and disease, family dynamics, and terminal patient care.)
b. Understanding of areas such as epidemiology, medical ethics, patient education, community and social health services, principles of continuing medical education, and office management and systems.
6. A family practice scientific paper is required to be submitted and approved to complete the program.
Program requirements of the St. Barnabas Family Practice Residency Program address the applicant, the program, the hospital, the program director, and the resident. This section outlines requirements at each of these levels.
The following admission requirements apply to those applicants who desire to be considered as a candidate for the family practice program:
1. The applicant must fulfill the application procedures as follows:
a. Complete the application form either in paper or through the Electronic Residency Application Service(ERAS)..
b. Submit letters of recommendation as requested.
c. Submit copy of college transcript.
d. Submit copy of Board Scores.
e. Arrange for a personal interview with the Program Director, and the Admissions Committee.
2. To become a candidate the applicant must:
a. Be a graduate of an AOA accredited college of osteopathic medicine
b. Be a member in good standing of the American Osteopathic Association.
c. Be eligible for licensure in the state of New York.
d. Be a person of good moral character.
1. Training is provided through in-hospital departments, and the Fordham Plaza Primary Care Center.
2. The St. Barnabas program is conducted at multiple training sites. St. Barnabas hospital offers a program that incorporates all the AOA requirements, but still takes advantage of the uniqueness of training opportunities inherent to the inner city.
St. Barnabas offers a core of required and elective rotations. The following is a Model Sequence for both years of the program:
PGY-2(13 blocks) PGY-3 (13 blocks) Internal Medicine - 3 blocks Internal Medicine - 3 blocks Surgery - 1 block Surgery -1 block Emergency Medicine - 1 block Emergency Medicine - 1 block Obstetrics/Gynecology - 2 blocks Obstetrics/Gynecology - 2 blocks Vacation - 1 block Vacation - 1 block Elective - 2 blocks Elective - 2 blocks ICU - 1 block
During PGY-2 and PGY-3 years, residents are required to continue continuity clinic at Fordham Plaza for 4 sessions a week. The only exceptions include rotation is ICU, outside elective and vacation.
*Behavioral Science and Practice Management are incorporated throughout both years. Residents will see their patients longitudinally during both years of training wherever feasible. The "monthly" designation refers to equivalent time of longitudinal care.
3. The resident is provided with an orderly educational curriculum in each required area of training.
4. The skills necessary for the training of competent family practitioners are emphasized. This includes longitudinal ambulatory patient are in each rotation.
5. The resident is provided with a schedule period for vacation during this year.
All medical subject matter, topic will be discussed in this section for easy reference. Topics inclide:
| Family Practice | ||
| Allergy and Immunology | Cardiology | Critical Care |
| Cultural Competency | Dermatology | Emergency Medicine |
| Endocrinology | ENT | GI |
| Geriatrics | Hem/Onc | Internal Medicine |
| ID | Medical/Ethics | Nephrology |
| Neurology | OB/GYN | OMT |
| Ophthalmology | Orthopedics | Pediatrics |
| Psychiatry | Pulmonology | Radiology |
| Rheumatology | Urology |
Faculty:
Nelson Eng, DO, FACOFP ¨C Director Ext. 6517
The resident shall be able to:
•Elicit an accurate and relevant history.
•Satisfactorily perform a complete or limited (based on the patient’s chief complaint) physical examination.
•Accurately diagnose patients presenting with signs and symptoms of gynecologic, obstetrical, proctologic, urinary, cardiovascular, pulmonary, hematologic, oncologic, endocrine, neurologic, dermatologic, rheumatologic, musculoskeletal, otorhinolaryngologic, podiatric, gastrointestinal, psychiatric, pediatric, and neonatal disease entities. (See specific diagnostic objectives for each of these clinical areas as applicable to a family practice.)
•Demonstrate the proper management of patients with problems in the aforementioned areas. (See special management objectives for each area.)
•Understand the importance of implementing a holistic approach in a family practice. Elicit
•Understand the significance of the family unit.
•Understand the significant role the physician plays as the primary care provider in:
°Evaluating a patient's total health care needs.
°Providing overall control of health care visits.
°Providing continuity of care.
°Evaluating health care costs in respect to cost containment.
•Use current medical knowledge to identify, evaluate and minimize risks for patients and family.
•Balance potential benefits, costs and resources in determining appropriate interventions.
•Understand the relevance of the interaction of biological, psychological, and sociological components when dealing with a patient and his/her support group (family).
•Understand (in reference to above) the differences between the ˇ°biopsychosocialˇ± model vs. the ˇ°biomedicalˇ± model.
•Understand the importance of providing health care to all members of the family regardless of age or presenting complaints.
•Apply the musculoskeletal component of the osteopathic concept as related to the patients off all ages.
•The resident shall be familiar with:
°Modified POMR.
°Chart entries in the S.O.A.P. format.
°The business aspects of family practice.
°Financial management.
°Personnel management.
°Record keeping.
°Costs of setting up a practice.
°Attaining supplies and equipment.
°Insurances/billing.
°Scheduling.
°Group vs. solo vs. partnership practices.
•The resident shall be able to actively take part in:
°Preventive health care and patient education.
°Patient counseling.
°Health maintenance.
•The resident shall be able to:
°Demonstrate competence in academic family medicine:
°Teach (clinical/didactic).
°Perform research design including evaluations of research findings.
°Give professional case presentations.
°Write reports of publishable quality.
•The resident shall:
°Be familiar with community referrals services°Be familiar with the use of allied health professionals as an integral part of medical care.
°Appropriately consult with, or refer patients to, specialty or subspecialty physicians when medical problems arises that is out of the scope of family practice.
Residents are required to:
Read:
1. Appropriate chapters from Taylor’s Family Practice Textbook.
Attend: All family practice conferences and lectures.
Faculty:
Haeyoung hwang, MD ¨C Director Ext. 6625
The resident shall be able to:
•Diagnose and manage anaphylaxis
•Diagnose and manage hives
•Diagnose and manage desensitization
Residents are required to:
Read:
1. Appropriate chapters from Harrison's Internal Medicine.
2. Appropriate chapters from Taylor’s Family Practice Textbook.
Attend: Conferences by Dr. Hwang.
Faculty:
Malconlm Philips,MD –Director of Medicine Ext. 6205
Rubin Silverman, MD – Director of Cardiology
Frank Iacovone Jr., MD – Director of Interventional Cardiology
Schedule:
Daily Schedule begins at 8 am in the cardiac cath. Lab
Clinics –1st and 3rd Tuesday AM
1st and 3rd Thursday AM
Conference – 1st Wednesdayof the month
Morning report – once per month
The resident shall be able to:
•Elicit an accurate relevant cardiovascular history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations
°Order appropriate laboratory and X-ray studies, EKG, chest
°X-ray, enzyme levels, holter monitoring, echocardiogram, cineangiography, etc
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of symptoms of disease entities of the cardiovascular system:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the cardiovascular system.
°Order priorities to arrive at a diagnosis
°Perform appropriate diagnosis techniques and procedures.
•Demonstrate the proper patient management:
°Initiate appropriate therapy (which may include a cardiology referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment, and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
°Be familiar with rehabilitation programs, exercise, diet, life stress reduction, etc.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
•Perform those skills and techniques required for ACLS certification
Residents are required to:
Read:
1. Appropriate chapters from Harrison's Internal Medicine.
2. Appropriate chapters from Taylor’s Family Practice Textbook.
3.Read Dubin's or other EKG text.
Attend: All Cardiology related lectures.
Faculty:
Dr. Ronald Ciubotaru - ICU Director Dr. Darryl Adler – Assist.
Director
Dr. Christopher Grantham Dr. Robert Menkel
Dr. Laurence Miller Dr. Richard Stumacher
Dr. Vanita Gupta Dr. Adey Tsegaye
Schedule:
Each month the housestaff will be divided into 3 teams. During weekdays one team will be short call working 7:45 AM –4:00 PM, a second team will be long call working 7:45 AM- 8:00 PM, the third team will be the night shift working 8:00 PM to 8:00 AM the following day. On weekends shifts will be 24 hours long.The ICU is divided into three “districts” each team will have houseofficers distributed in the three districts. There will be an ICU attending assigned to each district and there will be daily rounds beginning at 8:15 AM. As well there will be sign out rounds at 3:30 PM.
Overview:
Residents, interns, or students participating in this rotation will be expected to learn and practice diagnostic and therapeutic methods of critical care medicine, within a multidisciplinary ICU team. They will be responsible for evaluating and treating inpatients with medical and surgical problems, under the supervision of the intensive care attendings.
The resident shall be able to:
•Developing a logical and timely approach to clinical problems in critical care medicine, while treating patients and their families with respect, empathy, and ethics.
•Understanding indications for, and the interpretation of, diagnostic methods used in critical care medicine, such as arterial blood gases, hemodynamic measurements, radiographic studies, electrocardiography, echocardiography, and pulmonary mechanics.
•Acquiring skill in performing basic procedures in critical care medicine, as well as becoming familiar with more advanced procedures.
•Learning to interact professionally with members of allied services essential to the successful care of the critically ill such as other subspecialists, nurses, respiratory therapists, pharmacists, chaplains, social workers, and others.
Principal Teaching and Learning Activities:
Direct Patient Care (DPC): Residents and students will often perform the initial evaluation of a critically ill patient transferred to the ICU from various settings, e.g. the Emergency Department, inpatient floors, and the operating room. The housestaff team will be responsible for assessing the patient, identifying and prioritizing critical problems, and deriving a plan for management. Appropriate documentation of the evaluation and plan is required, both to aid in the attendings’ evaluation of the housestaff’s performance, as well as to communicate findings to other members of the ICU team. Thorough, timely, and reliable implementation of the plan is also expected. Since patients who are critically ill often cannot themselves participate in their own care, the ICU team will also be responsible for interacting with patients’ families .
Attending Teaching Rounds (ATR): Daily rounds will be conducted by Critical Care Attendings. These cases will serve as springboards for the discussion of many topics in critical care medicine, including cardiac, pulmonary, neurologic, metabolic, renal, gastrointestinal, hepatic, neoplastic, hematologic, and endocrine emergencies involved in the care of postsurgical and trauma cases as well. Review of relevant x-ray studies, lab studies, hemodynamic measurements, and other diagnostic modalities will be included in rounds. Ventilator management will also be taught at the bedside.
Procedure Experience (PE): Residents are strongly encouraged to personally perform basic procedures such as central venous and arterial line placement, Swan-Ganz catheterization, endotracheal intubation, arterial blood sampling, thoracentesis, chest tube placement, etc. All such procedures are done under the personal supervision of the Attending. Emphasis will be placed in understanding proper technique, such as sterile prep, local anesthesia, and knowledge of anatomy. If the resident needs credentialing in a particular procedure, the ICU attending will make every possible effort to ensure the resident’s success. Procedures done by the resident will be documented in the chart. Residents and students may also attend more advanced procedures done in the ICU, such as transesophageal echocardiography, electrical cardioversion, bronchoscopy, and gastrointestinal endoscopy.
Didactic Presentation (DP): Residents and students may be asked by the Attending to give a didactic presentation on a relevant article or topic on any aspect of critical care medicine. This mainly serves as an opportunity to demonstrate knowledge of available literature databases, ability to organize and critique evidence, and facility with communication.
Team 1 (T1): The members of the ICU team will be the first responders to cardiopulmonary arrests in the hospital. As such housestaff and students will have real time experience in how to provide appropriate ACLS care.
Residents are required to:
Read:
1.Pulmonary/Critical Care MKSAP
2.Cecil (via Merck Medicus): http://www.merckmedicus.com
3.UpToDate: http://www.utdol.com
4.Critical Care Medicine - Parrillo/Dellinger
5.Intensive Care Medicine - Irwin/Rippe
6.The ICU Book – Marino
7.Reference to be posted on the ICU website
Attend: All ICU lectures.
Faculty:
Dr. Elena Padilla Ext. 6205
Dr. Nelson Eng, D.O., FACOFP Ext. 6517
Each year, residents complete approximately eight hours of instruction in cultural competency. The main speakers are Dr. Nelson Eng and Dr. Elena Padilla, Scholar-In-Residence .
By the end of this curriculum, residents will know :
•Definition of the culturally competent physician
•Strategies to optimize the use of an interprete
•Usefulness of Kleinman's "explanatory model
•How to elicit the patient's "explanatory model" indirectly.
•The usefulness of the "social context"
•CLAS standards
Residents are required to:
Read:
1. Judy Ann Bigby’s text on cultural competency .
View:
1. Videotaped vignettes from AmericanAcademy of Family Practice
Attend: Cultural Competency core conferences.
Faculty:
Charles GropperM.D. Ext– 6205
Schedule:
Dermatology Clinic from 8:30 am – noon 5th floor of the SBHClinicBuilding
The resident shall be able to:
•Elicit an accurate relevant dermatologic history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations (patterns of distributions, etc.).
°Order appropriate laboratory and X-ray studies (KOH preps, tzcank smears, etc.).
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of disease entities of the integument systems:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the integumentary systems:
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include dermatologic referral).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
°Perform basic surgical skills: suturing, suture removal, wart removal, skin biopsies, l+D.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.Stamford On Line: http://www.telemedicine.org/stamford.htm
6.Johns Hopkins: http://dermatlas.med.jhmi.edu/derm/
7.Iowa: http://tray.dermatology.uiowa.edu/ImageBase.html
8.Harvard’s Carl J. Shapiro Derm Case Studies: http://research.caregroup.org/VPtutorials/DERM_dswmedia/initDerm.htm
9.Federman on coetaneous signs of malignancy: http://www.postgradmed.com/issues/2004/01_04/federman.htm
Attend: All Dermatology related lectures
Faculty: Ext. 6103
Ernest Patti, D.O., – Director
Juan Acosta, D.O., – Residency Director
Daily schedule: Assigned each rotation
The resident shall be able to:
•Elicit an accurate relevant history
•Satisfactorily perform a complete or limited physical examination:
°Order appropriate laboratory and X-ray examinations.
•Accurately diagnose patients in an emergency setting:
°Perform diagnostic techniques and procedures.
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
°Order priorities to arrive at the diagnosis.
•Demonstrate proper patient management:
°Evaluate risks of alternative treatments.
°Initiate appropriate therapy.
°Recognize and evaluate effectiveness of the therapy chosen.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Demonstrate knowledge and skills of airway maintenance.
°Demonstrate knowledge and skills of cardiopulmonary resuscitation (ACLS Certification).
°Perform surgical skills such as repair of lacerations and removal of foreign bodies.
°Obtain vascular access (e.g., by IV catheter, IV cut down, and IV and IA needle).
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Related Topics in Rosen’s Emergency Medicine
4.Cecil (via Merck Medicus): http://www.merckmedicus.com
5.Up-To-Date http://www.utdol.com
6.ER Medicine: http://www.emedmag.com/html/cur/cov/cov.asp
View:
1. NEJM Videos in Clinical Medicine (procedures):
http://content.nejm.org/misc/videos.shtml?ssource=recentVideos
Attend: All lectures
Faculty:
Director - James Hellerman, MD Ext. 6205
Schedule:
Monday afternoon: Endocrine private practice at Bronx Park Suite 302 (822-1515)
Thursday AM: Medical Grand Rounds
Thursday PM: Endocrine Clinic 5th Floor
The resident shall be able to:
•Elicit an accurate relevant history as related to endocrinology.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of disease entities of major organ systems:
°Achieve knowledge in the diagnosis of disease of functional or organic origin of endocrine organs and systemic effects.
Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include an endocrinology referral or consult).
°Recognize and evaluate the effective treatments.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications
°Attain vascular access.
°Perform basic surgical skills – FNA
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
Faculty: Ext. 6202
Dr. Michael Burnett
Dr. Sheila Apicella
Schedule:
ENT Clinic is open to residents on
Thursday mornings from 9:00 - 12:00, please contact regarding other clinic days
The resident shall be able to:
•Elicit an accurate relevant surgical history as related to Otorhinolaryngology
•Satisfactorily perform a complete or limited physical examination:
°Perform and orthopedic examination of specific joints:
°Cervical spine, shoulder, elbow, wrist and hand, lumbosacral spine, hip, knee, ankle and foot.
°Order appropriate laboratory and X-ray examination
°Be familiar with anatomic and physiologic correlations.
•Accurately diagnose those patients presenting with signs and symptoms requiring surgical attention:
°Achieve knowledge in the diagnosis of disease of functional or organic origin.
°Order priorities to arrive at a diagnosis.
°Differentiate between those problems requiring immediate surgical intervention and other non-emergency situations.
•Demonstrate proper patient management:
°Design suitable management plans.
°Recognize the situations that require patient referral.
°Communicate findings, management plan, and prognosis to the patient and/or family.
°Accurately communicate the associated risks and benefits of surgical procedure, including anesthesia (informed consent).
°Evaluate the risks and/or benefits of alternative procedures.
°Give reassurance and provide appropriate patient and/or family counseling when necessary.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Perform surgical skills such as suturing, handling of instruments, removal of sutures, etc.
°Demonstrate sterile surgical techniques.
°Demonstrate proper bandaging techniques.
°Perform such techniques as nasal packing, indirect laryngoscopy, etc.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.SBH On Line References: http://www.teacherweb.com/NY/StBarnabas/Law-PublicPolicy/ent-dt-pwd.htm
6.ENT Online resources: http://www.bcm.edu/oto/othersa2.html
Attend:required ENT Core lectures.
Faculty: Ext. 6205
Dr. Fred FallickDr. Carl Guillaume Dr. Robert Sable
Dr. David Stein Dr. Andrea Culliford Dr. Jeremiah Kurz
Schedule:
Tuesday AM: GI Clinic
Wednesday AM: Liver Clinic
Thursday AM: (after GR) GI Clinic
Liver Pathology: First Wednesday of month
GI Radiology: Last Tuesday of month, 4th floor 4 PM
GI Surgery: Last Thursday of month, Osteo Ed 4th Flr.
GI Journal Club: monthly
GI IM noon time conference: monthly (Core Lecture Series)
All residents are expected to begin their day at 8:30am. On Mondays, Tuesdays and Fridays any undone consults remaining in the consult box outside of the GI office on the 7th floor are to be picked up. Once the patient has been evaluated and examined, the GI attending should be paged to review the case and formulate an assessment and management plan. If there are not any consults pending then residents are expected to report to the endoscopy suite on the 5th floor.
The resident shall be able to:
•Elicit an accurate relevant history as related to GI system
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
°Accurately interpret laboratory and X-ray results.
°Perform or assist with procedures such as anoscopy, sigmoidoscopy, endoscopy, and paracentesis.
•Accurately diagnose patients with signs and symptoms of disease entities of gastrointestinal system:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the gastrointestinal system.
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include Gastroenterology referral).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications
°Attain vascular access.
°Be familiar with the insertion and uses of various tubes (NG, Salem Sump, Miller-Abbott, Sengstaken-Blakemore).
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
Specialty Texts:
1.Sleisenger and Fordtran's Gastrointestinal and Liver Disease
2.Yamada's Textbook of Gastroenterology
3.Schiff's Diseases of the Liver
Attend:Clinics and lectures as above
Faculty: Ext. 6205,6517
Dr. Joel Sender Dr. Robert Sable Dr. Shaparak Motjabi
Dr. Brian Delaney Dr. Edgar Pimentel Dr. Galina Bendich
The resident shall be able to:
•Elicit an accurate history the geriatric patient
•Satisfactorily perform a complete or limited physical examination of the geriatric patient.
•Understand the normal physiologic process of aging.
•Recognize the special problems of the elderly patient.
•Understand the different interactions of biological, psychological and sociological components when dealing with the elderly patient and his/her patient and his/her support group (family).
•Balance potential benefits, cost and resources in determining appropriate intervention.
•Understand the legal and ethical considerations in areas such as the “Right to Die” or “A Living Will”.
•Principles of the geriatric interview including MSE
•Geriatric assessment including common problems
•Geriatric rehabilitation
•Geriatric prescription writing
•Specific geriatric topics (hip fracture, overactive bladder, behavior disturbances, osteoporosis, low back pain, capacity for decision making, dementia evaluation, delirium, feeding tubes, weight loss, depression, failure to thrive, orthostatic BP changes, pneumonia.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
Faculty: Ext. 6205
Dr. Simeon SchwartzDr. Stuart FeldmanDr. Wanda Noguera
Schedule:
H-O Clinic 8:30 am - 12:00 Mon, Tues, Wed, Thur
Radiation Onc Clinic Fri AM with Dr. Adler
Tues Noon - Tumor Board (except 2nd Tues of month)
The elective is structured to provide residents with active experience in the management of patients with hematological/oncological disorders. The structure of the rotation includes hospital consultations, care of patients in clinic and outpatient setting, preparation of material for hospital-wide conferences, and setting independent goals for review of the literature and acquiring approved database of knowledge in Hematology/Oncology. The elective is a full-time commitment with attending rounds four days a week. On the first day of the rotation, the orientation will include review of the schedule, and review of resident responsibilities During the elective, the residents will divide amongst the various members of the team, consults that are called in. These consults are called into the Department of Medicine and the residents are required to check with the Department of Medicine, two or three times daily, to look for any new consultations. When consults are called in, they require a comprehensive evaluation of the patient. This includes a written history and physical, the elements of which should include an appropriate sub-specialty history of the present illness, notations for past medical and surgical histories, current medications, allergies, social history, and a comprehensive review of systems spelled out. A complete physical examination, including a neurological examination and a complete rectal examination, is part of a comprehensive Hematology/Oncology Physical including a stool for occult blood.
Any hematology case should have a peripheral blood smear made and stained. It should be in the possession of the resident at the time the case is presented. If the residents are not familiar with preparing peripheral blood smears, they should contact the supervisor in the Hematology Lab for personal instruction. The resident is expected to review all radiological studies with either a resident in Radiology, or an Attending Radiologist, as part of the evaluation of the patient. Both current and previous histology should be reviewed with an attending pathologist. The conclusions of the consultation, as well as the recommendations, will be written only by the attending after the case is presented, and the patient examined by the attending. It is best that each resident take one or two consultations a day, as opposed to one resident being assigned to all of the consults for a given day. The residents on the Hematology/Oncology Rotation are responsible for reviewing transfusions that do not meet the guidelines. This is part of an educational program in understanding the importance and implications and Transfusion Medicine. The forms for review are available on a daily basis in the Blood Bank. The resident will devise a schedule to be certain that one resident goes every day to pick up the information. This will be reviewed with Dr. Noguera on Mondays and Dr. Feldman on Thursdays.
Attending Rounds occur on Monday starting at 8:00 a.m., Tuesday at 8:00 a.m., Wednesday at 8:00 a.m., and Thursday at 9:00 immediately following Grand Rounds. On Fridays, the residents will see consults and then report to Dr. Adler in the basement of the clinic building for Introduction to Radiation Oncology. On the last Friday of the month, the residents will joinDr. Feldman at the Surgical Tumor Board at 8:OO AM in the Breaker Board Room. Residents will be responsible for PowerPoint presentations (utilizing PowerPoint templates) of patients chosen to be discussed at the Hematology-Oncology Tumor Boards which are scheduled on Tuesdays at 12 noon. When a resident is unable to attend rounds for that day, they need to contact the attending and explain the reasons for their absence. At the conclusion of the rotation, Drs. Feldman and Dr. Noguera are interested in a personal interview with each resident to discuss their accomplishments during the month, as well as suggestions for improvement of the rotation. At this time, the residents will receive feedback concerning their performance and evaluation forms will be completed simultaneously. In order to pass this rotation you have to work up cases.
For example: If you have a patient with CML, go to UpToDate.com to read about the diagnosis and management of CML. Other websites, which may be consulted, include PDQ on the cancer.gov site and the treatment guidelines on the NCCN.org site. You should follow this protocol for all the cases in Hematology & Oncology rotation.
The resident shall be able to:
•Elicit an accurate relevant hematologic/oncologic history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
Accurately interpret laboratory and X-ray results.
°Demonstrate familiarity with cancer screening techniques.
•Accurately diagnose patients presenting with signs and symptoms of hematologic or oncologic disease entities:
Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
Order priorities to arrive at a diagnosis.
Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include an oncology or hematology referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatments.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
°Demonstrate sensitivity and psychological needs of the cancer patient and their family (especially when dealing with a dying patient).
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications (chemotherapy regimens).
°Attain vascular access.
°Be familiar with various methods of alleviating protracted pain.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.NCI: http://www.cancer.gov/
6.NCI-Trials: http://www.cancer.gov/clinicaltrials/
Attend:Clinics and lectures as above
Faculty:
Dr. Judith Berger, Chief of ID, Beeper **000
Dr. Victoria Bengualid, Attending in ID, Faculty Advisor in Research, Beeper **612
Dr. Michelle Dahdouh, Attending in ID, Beeper **329
Dr. Carol Epstein, Attending in ID, Beeper **521
You will report to 7th Floor Department of Medicine from Monday to Friday at 9 AM except Wednesday when youwill report to 4th Floor DAC clinic at St. Barnabas Hospital Ambulatory Center at 9 AM.
Introduction
Welcome to the Infectious Diseases Elective. As part of the rotation, you will be expected to participate in the Inpatient consultation service and our HIV DAC ambulatory clinic.
Residents and students on service will be expected to perform thorough infectious diseases evaluation of patients in the hospital, perform thorough HIV outpatient primary care at DAC clinic, attend conferences and lectures, and complete outside reading and self-study. You will also have the opportunity to participate in ongoing research projects in Infectious Diseases if you wish. During the rotation, you will become knowledgeable and proficient in treating infections in general medicine, emergency room, geriatric, hematology oncology, intensive care, OB/GYN, surgical, trauma, HIV patients, and HIV outpatient primary care.
At the beginning of the rotation, you will be given a packet including up to date St. Barnabas Hospital/ Nursing home antibiogram, empiric antimicrobial therapy guide, and state of the art Infectious Disease articles. There will be an ID quiz available on line. Please complete the quiz by the end of the rotation as part of your evaluation. During the rotation, we will give you feedback on your performance and at the end we will fill out an evaluation on your performance according to ABIM guidelines. If you are having any problems, please alert us as soon as possible to try to remedy the situation. Included in the packet, there will be an evaluation of the elective for you to fill out and return to us. Please let us know what you like and dislike about the rotation. All feedback is welcome.
Schedule:
Grand Rounds: Outside speakers on various ID topics and CPCs on ID cases.
Morning Report: Inpatient cases with ID issues discussed with Attending.
DAC & ID Conference: Outside speakers include topics such as Resistant Organisms and New Antibiotics, HIV Resistance and New Treatment, Metabolic Complications of HIV and HAART, HIV Updates, etc.
Noon Conference includes lectures given by our faculty: Acute HIV Infection, Opportunistic Infections, What is HAART and When To Start, HIV Resistance and Resistance Testing, HIV and Pregnancy, Complications of HAART Therapy, HIV Jeopardy, HIV path physiology, virology and HAART class targets, Post exposure Prophylaxis, ID Jeopardy, Travel Medicine, Empiric Antibiotic Coverage, Resistant Bacteria, Community acquired Pneumonia, Bioterrorism, Meningitis, Mycobacteria, Soft Tissue Infections, Necrotizing Fasciitis, Osteomyelitis, Central Venous Line Infections.
Suggested Resources: Residents and students have access to Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Harrison’s Principles of Internal Medicine, The Sanford Guide to Antimicrobial Therapy, The Sanford Guide to HIV/AIDS Therapy, St. Barnabas Hospital Intranet Library On Line, Up To Date, Medscape, and medical journals through St. Barnabas Medical Library located on the 5th Floor Braker Building.
Internet sites on HIV topics:
1.International AIDS Society- USA at http://www.iasusa.org
2.AIDS Info at http://www.aidsinfo.nih.gov
3.The American Academy of HIV Medicine at http://www.aahivm.org
4.HIV Drug Resistance Database at http://www.hivdb.stanford.edu
5.AIDS Research at http://www.amfAR.org
6.HIV Clinical Resource ¨C NYSDOH AIDS Institute at http://www.hivguidelines.org
7.John Hopkins POC-IT ¨C HIV Guide at http://www.hopkins-hivguide.org
8.John Hopkins AIDS Service at http://www.hopkins-aids.edu
Internet sites on Infectious Diseases topics:
1.International AIDS Society- USA at Emerging Infectious Diseases Links at http://www.cdc.gov/ncidod/id_links.htm
2.Infectious Diseases Society at http://www.idsociety.org
3.CDC and Bioterrorism at http://www.bt.cdc.gov/agent/agentlist.asp
4.CDC and Travel Medicine at http://www.cdc.gov/travel
5.John Hopkins Infectious Diseases Antibiotic Guide at http://www.hopkins-abxguide.org
6.BMJ on Handwashing: http://bmj.bmjjournals.com/cgi/content/full/325/7360/396/a
7.Appropriate chapters from Harrison’s Internal Medicine
8.Appropriate chapters from Taylor’s Family Practice Textbook.
9.Cecil (via Merck Medicus): http://www.merckmedicus.com
Attend:All related lectures
Faculty: Ext. 6205
Dr. Richard Stumacher
Dr. James Croll
Medical Ethics (a component of Professionalism) is taught as a series of didactic lectures, part of the required Core Conferences.
The resident shall be able to:
•When to request an ethics consultation
•Importance of confidentiality
•Ethical aspects of informed consent
•Issues related to organ donation
•Appropriate boundaries between physician & patient
•If and when it is appropriate to disclose errors
•If and when to accept gifts from patients
Residents are required to:
Read:
1.“Ethical Choices - case studies for medical practice” edited by Lois Snyder (available in our library or from the ACP).
2.“Ethics Overview” by Dr. Christine Cassel (see SBH links, below)
3.Cecil (via Merck Medicus): Ethical Patient Care: a casebook for geriatric healthcare teams- Chapter 1 by Dr. Christine Cassel (see SBH links, below)
Review:
1.Up-To-Date The ACP Ethics Manual (see SBH links, below)
Attend: Required Core Lectures on Medical Ethics.
Faculty: Ext. 6205
Dr. A. Ahmed **90*
Dr. J. Croll **330
Dr. M. Henriquez
Schedule
In the morning, residents should visit 5N to check for
HD admissions.
The 2nd and 4th Tuesdays Mornings attend Nephrology clinic
The resident shall be able to:
•Interpret a chemical and microscopic U/A.
•Assess renal function by:
°MDRD equation
°Cockcroft Gault equation
°UA
°Sonogram
°24 hour urine collection
•Diagnose the different stages of CRF
•Acute renal failure
•Evaluate for obstruction
•Diabetic nephropathy
•Acid-base disorders
•Electrolyte disorders
•Hypertension
•Evaluate glomerular disease
•Indications for renal biopsy
•Indications for renal replacement therapy
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.Nephron Web site: http://Nephron.com
6.Brigham & Women’s Nephrology Round: http://www.nephrologyrounds.org
7.NEJM Kidney Collection: http://content.nejm.org/cgi/collection/kidney_disease
8.UTAH: The UA http://www-medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html
Faculty: Ext. 6205
Dr. Scott Segan
Dr. Lorenzo Freddo
The resident shall be able to:
•Elicit an accurate relevant neurological history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies including EEG’s, CT scans and angiography.
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of disease entities of the nervous systems:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the central and peripheral nervous systems.
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include neurologic referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
°Perform a lumbar puncture.
Residents are required to:
Reading:
The following are available in the St. Barnabas Hospital library:
1.Adams RD, Victor M. Principles of Neurology, 5th edition. McGraw-Hill Inc. New York 1993.
2.Walton J (ed.). Brain’s Diseases of the Nervous System, 10th edition. OxfordUniversity Press, Oxford 1993.
3.Barnett HJM, Morh JP, Stein BM, Yatsu F. Stroke: pathophysiology, diagnosis and management, 2nd edition. Churchill Livingstone, New York 1992.
Extensive material is available on the World Wide Web See our list of Neurology Links for further resources Handouts and other goodies are available at
SBH Neuro MedEd site, open or download handouts and other goodies
Faculty: Phone: 631-9300 or OB/GYN office
Dr. Mark Rosing
Dr. Mary Gratch
Schedule:
Please note the schedule posted on the OB/GYN floor on 1 North or contact the office
The resident shall be able to:
•Elicit an accurate relevant history.
•Satisfactorily perform a complete or limited physical examination:
°Know patterns of normal growth and development and recognize variations.
°Understand the physiology of menstruation, conception, pregnancy, and menopause.
°Perform a thorough and accurate pelvic examination.
°Exhibit sensitivity to, and consideration for, patient’s comfort and emotional state.
°Order and interpret appropriate procedures, laboratory, and radiological tests.
•Accurately diagnose those patients presenting with signs and symptoms of gynecologic and obstetrical disease entities:
°Know the signs and symptoms of gynecologic infections and neoplasms of obstetric complications.
°Implement a pregnancy risk assessment.
°Evaluate pelvic adequacy, fetal maturity, and feto-placental adequacy.
•Demonstrate proper patient management:
°Possess skill and experience in counseling and/or referral, especially for sexual assaults, problem pregnancy, abortions, and pregnancy loss.
°Uncomplicated labor and delivery.
°Sexual counseling
°Provide the patient with an adequate understandable description of the diagnosis, treatment, and prognosis.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know the indications and contraindications for infertility workup, gynecologic surgery, Caesarian deliveries, and induced abortions.
°Manage prenatal care and postpartum care.
°Develop a suitable treatment plan.
°Possess needed technical skills (e.g. biopsy, cryosurgery, IUD insertion).
•Know indications and contraindications for us of various medications
Residents are required to:
Read:
1.Appropriate chapters from Taylor’s Family Practice Textbook.
2.Up-To-Date http://www.utdol.com
3.Nephron Web site: St. Barnabas On Line GYN Curriculum:http://www.teacherweb.com/NY/StBarnabas/Law-PublicPolicy/GYN-dt-pwd.htm
Attend: All related lectures and rounds
Faculty: Ext. 6517
Dr. Hugh Ettlinger - Director
Schedule:
Please contact the current chief resident for a full clinic and lecture schedule
OSTEOPATHIC STRUCTURAL EXAMINATION AND TREATMENT
The resident shall be able to:
• Elicit an accurate relevant structural history.
• Satisfactorily perform patients with structural problems in any of the following are:
°The scanning portion of a structural examination.
°The screening portion of a structural examination.
• Accurately diagnose patients with structural problems in any of the following areas:
°Cervical
°Lumbar
°Thoracic
°Pelvis/sacrum
°Upper and lower extremities
• Achieve knowledge in the diagnosis of disease of functional or organic origin in the musculoskeletal system.
• Order priorities to arrive at a diagnosis.
• Demonstrate proper patient management:
• Initiate appropriate management (which may include referrals).
• Provide the patient with an adequate, understandable description of the diagnosis, treatment, and prognosis of a structural problem
• Evaluate and recognize the effectiveness of manipulative therapy.
• Demonstrate the ability to select and employ the proper treatment modalities.
• Correct structural problems in the aforementioned areas suing the following techniques:
°Muscle energy
°Functional
°Soft tissue
°Thrust (high velocity/low amplitude)
Residents are required to:
Read :
1.An Osteopathic Approach to Diagnosis and Treatment
2.DiGiovanna and Schiowitz
3.Other reading material provided by the department
Attend : All lectures and appropriate clinics
Faculty: Ext. 6202
Dr. E. Gonzalez
Schedule:
Please see Dr. Gonzalez regarding your schedule
Residents have the opportunity to work with Dr. Gonzalez as part of the "Office Practice" Rotation. It is important to arrive at the Ophthalmology Clinic no later than Noon on the days you are assigned. Dr. Gonzalez has a series of tapes/slides which he is please to have you review, in addition to attending his noon-time conferences and Grand Rounds.
The resident shall be able to:
• Dr. Gonzalez gives talks on the following topics:
° Introduction to the basic eye examination
° Red eye & ocular manifestations of systemic diseases
° Ocular emergencies
° Glaucoma
° Opportunistic infections (e.g.,cmv, toxo, herpes)
° intro to basic eye exam
• During your exposure to ophthalmology you should become familiar with
° Use of the hand held ophthalmoscope
° Shiotz tonometrymaster of 1. slit lamp
° Slit lamp
• Before the end of the rotation, you must complete the three quizzes which are available
elsewhere.
Residents are required to:
Read :
1.Appropriate chapters from Taylor 's Family Practice Textbook.
Attend:
All clinics and lectures as above
Faculty:
Dr. Mark Silverman
Dr. Stuart Remer
Please contact the Ortho PA - regarding the rotation via operator
Schedule:
Clinics held daily at SBH clinic 1 st floor in the AM
The resident shall be able to:
• Elicit an accurate relevant orthopedic history.
• Satisfactorily perform a complete or limited physical examination:
° Perform and orthopedic examination of specific joints:
°Cervical spine, shoulder, elbow, wrist and hand, lumbosacral spine, hip, knee, ankle and foot.
° Order appropriate laboratory and X-ray examination
° Be familiar with normal deviation for sex and age.
• Accurately diagnose patients presenting with signs and symptoms of orthopedic disease entities:
° Achieve knowledge in the diagnosis of disease of functional or organic origin in the musculoskeletal system.
° Order priorities to arrive at a diagnosis.
° Recognize simple fractures from those fractures requiring orthopedic management.
• Demonstrate proper patient management:
° Initiate appropriate management (which may include orthopedic referral).
° Provide the patient with an adequate understandable description of the diagnosis, treatment, and prognosis of an orthopedic problem.
° Evaluate and recognize the effectiveness of orthopedic therapy.
• Demonstrate the ability to select and employ the proper treatment modalities:
° Initiate appropriate treatment.
° Be capable of adequately performing simple fracture reduction, casting, splinting and bracing, orthocentesis and musculoskelatal injections.
° Know indications and contraindications for use of various medications.
Residents are required to:
Read :
1.Appropriate chapters from Taylor 's Family Practice Textbook.
Suggested:
1. Walter B. Gree, MD Editor of the American Academy of Orthopedic Surgeons
2. American Academy of Pediatrics "Essentials of Musculoskeletal Care" 2nd ed
Attend: Clinics and lectures
Faculty: Ext. 6440
Dr. David Rubin ¨C Chair
Dr. David Listman
The resident shall be able to:
• Elicit an accurate relevant history.
• Satisfactorily perform a complete or limited physical examination:
° Place a patient at ease while performing a complete physical examination:
° Order appropriate laboratory and X-ray test.
° Interpret pediatric laboratory and X-ray results.
° Know growth and development parameters of pediatric patients.
° Recognize signs of child abuse and neglect.
• Accurately diagnose those patients presenting with signs and symptoms of pediatric disease entities:
° Understand nutritional assessment of pediatric patients
° Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
° Order priorities to arrive at a diagnosis.
• Demonstrate proper patient management:
° Design suitable management plans.
° Communicate findings, management plan, and prognosis to the patient and/or family.
° Give reassurance and provide appropriate patient and/or family counseling when necessary.
° Understand management and care of the healthy child, ambulatory and hospital care of the sick child.
° Know and carry out the immunization schedule.
° Be knowledgeable in counseling skills for behavioral problems accompanying growth and development.
• Demonstrate the ability to select and employ the proper treatment modalities:
° Be familiar with appropriate pediatric medications.
° Know age-appropriate pediatric dosages
Residents are required to:
Read :
1. Appropriate chapters in Taylor 's Text
2. Nelson's Pediatrics
Faculty: Ext. 6202
Dr. Gregg Schiffhauer
Dr. John Burgess (Dept. Director)
Schedule :
Residents should arrive in the Psychiatry ED on Monday 9 AM for assignments with Dr. Schiffhauer
The resident will be able to:
• Screen for, diagnose depression and initiate therapy.
• Recognize patients at risk for suicide and intervene appropriately.
• Diagnose and initiate treatment for anxiety when appropriate.
• Diagnose PTSD
• Diagnose OCD
• Recognize and treat medical problems known to occur with psychiatric medications, including hypothyroidism, hypocalcemia, DI, DM, hyperprolactinemia.
ST.BARNABAS FAMILY PRACTICE RESIDENCY PROGRAM BEHAVIORAL SCIENCE CURRICULUM
Behavioral science is viewed as an integral part of the educational process cutting across all rotations of the residency program. The general goals of the Behavioral Science Curriculum are to:
1. Foster an appreciation of the biopsychosocial approach to health and illness.
2. Provide residents with knowledge and skills necessary to incorporate Behavioral Science in Family Practice.
3. Enhance the communication and interviewing skills of Family Practice Residents.
The Behavioral Science Curriculum is implemented through several modalities:
1. Didactic Lectures
2. Workshops/Demonstrations
3. One-to-One Feedback
The delivery system varies according to the specific topic and residents' needs. For example, a formal syllabus with accompanying slides was developed for such topics as "Anxiety Disorders in Primary Care" and "Mood Disorders in Primary Care." (Additional topics are in development.) Other topics are covered through less formal and more interactive approaches. For example, a workshop approach was utilized for "Biofeedback and Relaxation Therapy", including demonstration of equipment and a small group relaxation exercise.
Finally, one-to-one feedback on medical interviewing is provided by Family Practice Preceptors, based on direct observation of residents' patient interviewing. These observations are conducted in the ambulatory are center at each hospital site. The focus of the feedback is on such aspects of the medical interview as Doctor/Patient Communications, Psychosocial Sensitivity, and Patient Education/Compliance.
The following is a more complete outline on the Communication/Interviewing aspect of the Behavioral Science Curriculum. It is followed by a more comprehensive list of topics targeted for incorporation into the training program at the various hospital sites. Hospital-based faculty are involved in implementing the curriculum through formal and informal mechanisms.
THE MEDICAL INTERVIEW
I. DOCTOR/PATIENT INTERACTION/COMMUNICATION STYLE
A. Rapport (small talk, Comfort seating, etc.)
B. Conveys social support, empathy
C.Sense of confidence (conveying competence, decisiveness)
D. Good use of nonverbal communication (eye contact, posture, sense of “listening”)
E. Use of open-ended questions (to elicit symptoms descriptions, history, etc.)
F. Dealing with angry/hostile patients (being firm, yet supportive)
II. PSYCHOSOCIAL SENSITIVITY
A.Follows questioning pattern to elicit psychosocial profile/state (e.g., lifestyle, occupational factors, family stressors)
B. Identifies somatizers, drug seekers
C. Conveys psychosocial hypothesis to patients (vs. “it's just nerves”)
D. Sensitive to psychological consequences of physical illness (stress on family. Work limitations and “secondary gains”)
E. Refers to mental health professionals, if necessary
III. PATIENT EDUCATION/COMPLIANCE
A. Provides information about disease, behavior changes (diet, smoking)
B. Encourages compliance with medication, diet, etc.
CURRICULUM IN BEHAVIORAL SCIENCE
TOPIC OUTLINE
*1. Anxiety Disorders
*2. Mood Disorders (Depression)
*3. The Suicidal Patient
*4. Humanistic Qualities in the Physician
*5. The Medical interview
*6. Death/Dying
*7. The “Family” in Family Medicine
8. Crisis Counseling
*9. Biofeedback and Relaxation Therapy
*10. Stress Management
*11. Resident Coping vs. Burnout
*12. Patient Adherence
13. Somatoform Disorders
14. Behavioral Pediatrics/Pediatric Psychology
*15. Medical Ethics
16. Cultural/Religious Factors in Health and Disease
17. Psycho-Social Factors in Health and Disease
*18. The Intern/Resident as Teacher
*19. Self-Help/Mutual Support Groups
*20. Substance Abuse
*21. AIDS: Psychosocial Aspects
22. Sleep Disorders
23. Psycho-Social Geriatrics
24. Sexuality
*25. Preventive Medicine/Health Promotion
• Indicates more in depth requirement for integration of this topic at the various hospital sites.
Residents are required to:
Read :
1. Appropriate chapters in Taylor 's Text
2.Massachusetts General Hospital Handbook of General Hospital Psychiatry-5th ed. by Stern, Fricchione, Cassem,Jellinek, Rosenbaum
3. ABC of Alcohol edited by Alex Paton (BMJ)
Attend: A ll lecture and scheduled time
Faculty: Ext. 6205/409-2222(after-hours)
Dr. M. Smina (education coordinator)
Dr. R.Ciubotaru (Division Chief)
Dr. S. Cooper
Dr. J. Sender
Dr. R. Stumacher
Daily schedule, clinic & conferences :
Mondays at 2:30 pm - Pulmonary conference
Last Friday of month, 12:30 Radiology Clinical Case Review
Fridays: Pulmonary-focused Morning Report ( 10:45 am )
Wednesday 1:30 pm , 1st & 3rd, Pulmonary Clinic
The resident shall be able to:
• Elicit an accurate relevant history as related to the respiratory system.
°Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies (chest X-ray, pulmonary function tests, ABGs).
°Accurately interpret laboratory and X-ray results.
• Accurately diagnose patients presenting with signs and symptoms of disease entities of the respiratory system:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the respiratory system.
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
• Demonstrate proper patient management:
°Initiate appropriate therapy (which may include pulmonary medicine referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
• Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
°Perform intubation and thoracentesis.
Residents are required to:
Read :
1.Appropriate chapters from Harrison 's Internal Medicine
2.Appropriate chapters from Taylor 's Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.Interpretation of Pulmonary Function Tests- A Practical Guide 2nd Edition, Hyatt, Scanlon, Nakamura (Lippincott)
6.AFP Spirometry Overview: http://www.aafp.org/afp/20040301/1107.html
7.Flow-Volume Loops: http://www.spirometrie.info/en/quality.html
8.PFTs from Cleveland Clinic: http://www.clevelandclinicmeded.com/diseasemanagement/pulmonary/pft/pft.htm
9.More Cleveland Clinic PFTs: http://www.ccjm.org/pdffiles/Mazzone1003.pdf#search=%22interpretation%20of%20pulmonary%20function%20tests%22
10.Weaning CC: http://www.ccjm.org/pdffiles/Frutos-Vivar503.pdf
11.NEJM Pulmonary Collection: http://content.nejm.org/cgi/collection/pulmonary_disease
12.NEJM Asthma Collection: http://content.nejm.org/cgi/collection/asthma
Faculty: Ext. 6162
Dr. Marie Gade (Department Chair and Education Coordinator)
Schedule:
Please contact the chief resident in regards to daily schedule and lectures
The resident shall be able to:
• Interpret Chest X-ray for:
°CHF
°pneumonia
°pneumothorax
• Interpret flat plate and upright abdominal films for:
° free air
° organomegally
° ascites
° abnormal masses
° calcifications
• CT: routine of brain, chest, abdomen
• MRI: routine of brain, chest, abdomen
• Advantages and disadvantages of different mammography studies
• Bone density interpretation
• Cardiac imaging interpretation
• Bone scan interpretation
• Thyroid scan and sonogram interpretation
Residents are required to :
Review
1. Introduction to Radiology: http://www.virtual.epm.br/material/tis/curr-med/med3/2003/ddi/matdid/cap1.htm
2. MRI Basics: http://www.cis.rit.edu/htbooks/mri/
3. University of Virginia Overview : http://www.med-ed.virginia.edu/courses/rad/
4. Downstate Interactive: http://ect.downstate.edu/courseware/rad-atlas/
5. Radiology Rounds at MD Choice: http://www.mdchoice.com/xray/xr.asp
6. SBH ED Radiology Cases : http://www.sbhemresidency.com/html/radiology.html
7. Yale Online Radiology Resources: http://info.med.yale.edu/intmed/cardio/imaging/contents.html
8.Washington Radiographic Anatomy Review: http://www.rad.washington.edu/RadAnatomy.html
9. Learning Radiology Pulmonary Cases: http://www.learningradiology.com/images/chestimages1/chestgallerypages/index.html
10. MSU CXR Course: http://www.rad.msu.edu/Education/humanmed/im_tutor/default.htm
Faculty: Ext. 6205
Dr. David Engelbrecht (Division Chief and Education Coordinator)
Daily schedule, clinic & conferences:
Monday afternoon
Rheumatology Clinic starting at 1:30 pm and the
Wednesday morning Rheumatology Clinic, starting at 8:30 am
The resident shall be able to:
• Elicit an accurate relevant rheumatologic history.
• Satisfactorily perform a complete or limited physical examination:
° Be familiar with anatomic and physiologic correlations.
° Be familiar with basic immunology including:
• B+T cell type and function
• Macrophage function
• Gell-Coombs classification
• ICx diagnosis
° Be familiar with the inflammatory process, including:
• Polymorphonuclear cells
• Compliment
• Prostaglandin and Leukotrienes
• Lymphokines
• Plasmin, Hagenman Factor and Kinins
° Order appropriate laboratory and X-ray results.
° Accurately interpret laboratory and X-ray results.
• Accurately diagnose patients presenting with signs and symptoms of disease entities of major organ systems as related to Rheumatology:
° Initiate appropriate therapy (which may include rheumatologic referral or consult).
° Recognize and evaluate the effectiveness of the therapy chosen.
° Evaluate the risks of alternative treatment.
° Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
° Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
° Design suitable management plans.
• Demonstrate the ability to select and employ the proper treatment modalities:
° Suturing.
° Suture removal
° Joint aspiration
Residents are required to :
Read :
1.Appropriate chapters from Harrison 's Internal Medicine
2.Cecil (via Merck Medicus): http://www.merckmedicus.com
3.Up-To-Date http://www.utdol.com
4.ˇ°Essential of Musculoskeletal Careˇ± 3rd ed. by Walter B. Greer
5.NEJM Rheumatology Collection: http://content.nejm.org/cgi/collection/rheumatic_disease
6.Clinical Trials at HSS: http://www.hss.edu/Research/Clinical-Trials
Faculty: Ext. 6202
Dr. Stephen DiRusso – Chair
Dr. Michael Weitzen
Schedule:
Please contact the chief resident in regards to the clinical rotation, clinics held in the SBH clinic, Dr. Weitzen also has clinic at Fordham Plaza on Wednesday in the AM.
The resident shall be able to:
• Elicit an accurate relevant surgical history.
• Satisfactorily perform a complete or limited physical examination:
° Preoperatively evaluate and prepare a patient for surgery or anesthesia.
° Order appropriate laboratory and X-ray studies.
° Accurately interpret laboratory and X-ray results.
° Be familiar with anatomic and physiologic correlations.
• Accurately diagnose those patients presenting with signs and symptoms requiring surgical attention:
° Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
° Order priorities to arrive at a diagnosis.
° Differentiate between those problems requiring immediate surgical intervention and other non-emergency situations.
• Demonstrate proper patient management:
° Design suitable management plans.
° Recognize the situations that require patient referral.
° Communicate findings, management plan, and prognosis to the patient and/or family.
° Evaluate the risks and/or benefits of alternative procedures.
° Give reassurance and provide appropriate patient and/or family counseling when necessary.
• Demonstrate the ability to select and employ the proper treatment modalities:
° Perform surgical skills such as suturing, handling of instruments, removal of sutures, etc.
° Attain vascular access.
° Demonstrate sterile surgical techniques.
° Know indications and contraindications for use of various medications.
° Demonstrate proper bandaging techniques.
Residents are required to :
Read :
1.Appropriate chapters from Harrison 's Internal Medicine
Faculty: Ext. 6202
Dr. Danziger
Schedule :
Urology Clinic is held on Monday and Wednesday afternoons,
The resident shall be able to:
• Elicit an accurate relevant urologic history.
• Satisfactorily perform a complete or limited physical examination:
° Preoperatively evaluate and prepare a patient for surgery or anesthesia.
° Order appropriate laboratory and X-ray studies.
° Accurately interpret laboratory and X-ray results.
° Be familiar with anatomic and physiologic correlations.
• Accurately diagnose those patients presenting with signs and symptoms requiring surgical attention:
° Achieve knowledge in the diagnosis of disease of functional or organic origin in the urinary and/or genital system(s).
° Order priorities to arrive at a diagnosis.
° Differentiate between those problems requiring immediate surgical intervention and other non-emergency situations.
• Demonstrate proper patient management:
° Design suitable management plans.
° Recognize the situations that require patient referral.
° Communicate findings, management plan, and prognosis to the patient and/or family.
° Accurately communicate the associated risks and benefits of surgical procedure, including anesthesia (informed consent).
° Evaluate the risks and/or benefits of alternative procedures.
° Give reassurance and provide appropriate patient and/or family counseling when necessary.
• Demonstrate the ability to select and employ the proper treatment modalities:
° Perform surgical skills such as suturing, handling of instruments, removal of sutures, etc.
° Attain vascular access.
° Demonstrate sterile surgical techniques.
° Know indications and contraindications for use of various medications.
° Demonstrate proper bandaging techniques.
Residents are required to :
Read :
1.Appropriate chapters from Harrison 's Internal Medicine
2.Appropriate chapters from Taylor 's Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
Residents will be evaluated after each rotation by individual departments they rotate with, and quarterly by the family practice department. The program stresses the concept of measurable outcomes to document competency over the three-year training period. What is meant by competent? While there are many definitions of competent, the executive director of the ACGME, Dr. David Leach, subscribes to the Dreyfus model, which defines "competent" as a stage along the path to ˇ°mastery".
Using measurable outcomes to document competency is referred to by many as "competency-based education". This logical strategy is predicated on the concept that faculty will tell residents which competencies they need to master; then instruct the residents; then provide formative assessment/feedback ("educational Dx & Rx") to the resident as to how they are doing. And with a boost of encouragement, the resident should be able to demonstrate mastery (well at least competence) of the particular skill.
The Seven General Competencies
It has been mandated that all residency training programs , teach and assess the following seven General Competencies:
1. Medical Knowledge (MK)
2. Patient Care (PC)
3. Interpersonal and Communication Skills (ICS)
4. Professionalism (P)
5. Practice-based Learning and Improvement (PBLI)
6. Systems-based Practice (SBP)
7. Osteopathic Philosophy and Osteopathic Manipulative Medicine (OMM)
1 - MEDICAL KNOWLEDGE
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to:
• Demonstrate an investigatory and analytic thinking approach to clinical situations know and apply the basic and clinically supportive sciences which are appropriate to Family Practice
2 - PATIENT CARE
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. Residents are expected to:
• Communicate effectively and demonstrate caring and respectful behaviors 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 competently all medical and invasive procedures considered essential for the area of practice provide health care services aimed at preventing health problems or maintaining health work with health care professionals, including those from other disciplines, to provide patient-focused care
3 - INTERPERSONAL AND COMMUNICATION SKILLS
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:
• Create and sustain a therapeutic and ethically sound relationship with patients use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills work effectively with others as a member or leader of a health care team or other professional group
4 - PROFESSIONALISM
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business
practices demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities
5 - PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their 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 on-line medical information; and support their own education facilitate the learning of students and other health care professionals
6 - SYSTEMS-BASED PRACTICE
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:
• Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice know how types of medical practice and delivery systems differ from one another, 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
7 - OSTEOPATHIC PHILOSOPHY AND OSTEOPATHIC MANIPULATIVE MEDICINE
Residents must demonstrate and apply knowledge of accepted standards in osteopathic manipulative treatment (OMT) appropriate to Family Practice. The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to lifelong learning and practice habits in osteopathic philosophy and manipulative medicine.
As you can see, the General Competency definitions can appear broad, general, and sometimes difficult to apply to Family Practice. So for the purposes of our Family Practice Residency, we will try to provide clarity by utilizing the components of the seven General Competencies as formulated in the previous section and integrate evaluation tools that are outlined in the following table.
COMPETENCY
ASSESSMENT SKILL
EVALUATION TOOL
1. Patient Care
Goal of rotation
Goals and objectives of rotation
Clinical skills
Precepting sessions
Procedure skills
Procedure logs
Case exposure
Chart Review
Monthly Evaluations/Quarterly Evaluations
2. Medical Knowledge
Medical knowledge
Intraining exam scores/National Boards
Board review class/textbook review
Board Review
Medical knowledge
Chart stimulated recall during precepting sessions
Monthly Evaluations/Quarterly Evaluations
3. Practice Based Learning & Improvement
Learning skills
Scholarly activity
Resident Presentations/portfolios
PBL Exercise
4. Interpersonal Skills and Communication
Communication skills
360 degree Global rating
5. Professionalism
Professional attitudes
360 degree Global rating
Cultural Competence Lectures
6. Systems-Based Practice
Practice knowledge of various medical systems
360 degree global rating
Parent Partners in Health Project
Written Exam (MCQ)
7. Osteopathic Philosophy and Osteopathic Manipulative Treatment
Competent in Osteopathic Manipulative treatment
OMM lecture series
OMM rotations
OMM board review
Monthly/Quarterly Evaluations
To successfully complete the St. Barnabas Family Practice Residency Program, each resident is required to:
1. Demonstrate skill and judgment in performing the procedures acquired during training as demonstrated by the competency based evaluation.
2. Keep log recording each procedure preformed.
a.The log must include all out patient and inpatient procedures assigned.
b.The log must identify cases by hospital case/chart number.
c. The log must be submitted monthly to the hospital to be reviewed by the Program Director and Director of Medical Education.
3. As ability is demonstrated, residents will be afforded opportunity to engage in procedures, under supervision, which will enable them to acquire skill and judgment in various medical fields.
4. The residents will participate in an organized educational program on the staff, intern, and clinical clerk levels.
5. The resident shall notify the assigned physician of any unusual developments in any case.
6. The resident shall review all assigned cases daily and discuss the history and physical examinations with the interns and externs on service.
7. The resident will be responsible for completion of all reading assignments.
8. Each resident shall submit a scientific or research paper suitable for publication, composed under the supervision of the Program Director on a topic relating to family practice.
9. Further resident requirements include:
a.The resident will have quarterly meetings with the Program Director and/or Faculty Advisor.
b.The resident will be responsible for conducting clinical reviews, case presentations, or Journal club presentations as assigned by the clinical service preceptor.
c.The resident will be responsible for teaching interns and medical students whenever requested/assigned.
d.The resident will be "on call" at night and weekends as scheduled by the hospital program director.
e.The resident will be required to participate in relevant educational programs whenever on that particular service.
f.The resident will be required to be certified by American Heart Association in Basic and Advanced Cardiac Life Support.
10. The resident should keep a log of all lectures attended, and presentations made (for future submission to AOA).
11.The resident must keep a list of all procedures performed (by diagnosis), They should indicate whether they were "first assists" or done "under supervision" (for future submission to AOA).
Responsibilities of Residents
By accepting a position in the St. Barnabas Family Practice, the resident agrees to the following responsibilities:
• To demonstrate academic honestly, professional demeanor and ethical behavior with colleagues, staff, patients and the public.
• To strive for the highest ideals of professional conduct.
• To achieve the objectives of the residency training.
• To provide comprehensive and continuous care for the panel of patients assigned from the Family Medicine Clinics.
• To render patients the best possible care.
• To educate patients about health problems and health maintenance.
• To refrain from independent outside practice and consulting during the term of residency
• To maintain satisfactory work records, including logs, evaluations and other required forms.
• To complete study and reading assignments.
• To pursue independent study and develop a research project with subsequent preparation of paper/report suitable for publication.
• To assist in the clinical instruction of medical students.
• To attend all scheduled activities fully prepared and on time.
• To attend all Department of Family Medicine didactic sessions and other meetings recommended by the Supervisor of Training.
• To abide by the rules and regulations of the College, Hospitals, and Clinics.
Ethical Considerations
Family Practice residents of St. Barnabas Hospital are expected to conduct themselves in an ethical and professional manner at all times, especially when representing St. Barnabas in clinical and academic settings. In observing medical ethics, the physician will:
• Give primary concern to the patient's best interest.
• Be available to one's patients at all times or delegate that responsibility to another capable individual.
• Practice within the limits of one's capabilities.
• Maintain strict confidence about patients' situations and respect all confidentiality issues.
• Not indulge in rumored information.
The residents shall respect their patients' rights to privacy. Residents shall refrain from discussing any confidential information outside of clinical settings or in any public areas. Any inquiries from the press, radio or television, regarding patient care, medical issues or related activities, shall be referred to the Supervisor of Training.
The AOA Code of Ethics is the primary guide for the osteopathic profession. Residents should seek growth in all aspects of medical ethics: Sensitivity to issues, conceptual analysis, evaluation of completing claims, and development of a personal philosophy. Resources for such growth include departmental faculty, trainers, hospital chaplains, books and journals, special grand rounds, and seminars. The staff of the General Practice Department will provide scheduled discussions and workshops, and are available for consultation.
No resident shall be coerced, held liable, or discriminated against in any manner, because of a refusal to perform, accommodate, or assist in a procedure, on any sincerely held religious or ethical grounds. This provision shall not be construed to permit abandoning the patient or withholding treatment urgently required for the preservation of the quality of life in any emergency situation.
Legal Considerations
Like any other professional, the resident should be aware of legal issues that may affect his/her practice. Any potential or actual legal difficulty related directly to residency activities should be discussed, as soon as possible, with either the attending preceptor or the Residency Director.
Special Points to note:
- Residents have liability coverage through the hospital for activities assigned as part of the residency. This coverage does not extend to independent outside practice and consulting. If questions, or malpractice problems ever arise, the resident will immediately notify the Attending Preceptor and/or Residency Director. Immediate knowledge and appropriate action has proven to be a very successful deterrent and problem-solving mechanism in early malpractice problems.
Other Considerations
Residents are expected to appear professional on all assignments, especially those involving patient contact. White coats are issued by the hospital and shall be worn over appropriate clothing while on duty. White coats shall be worn over scrub clothes when the residents are outside the surgical or obstetrical suites.
St. Barnabas hospital is committed to the principles of equal opportunity, non-discrimination and affirmative action. Residents shall avoid any discriminatory practices, policies and customs, in their dealings with patients, staff and colleagues.
Patient Care
• Patient scheduling is to be done by the registrars.
• Patients will be encouraged to have appointments.
• Walk-ins and emergency visits will be worked into the scheduled according to medical priority and available time.
• All prescriptions requiring a DEA number or controlled substance number, shall be checked by the physician in charge.
• Patients are not to be taken into the clinic after hours, without supervision by the assigned preceptor.
• All student-patient encounters will be supervised, and all patients will be seen by a resident or other licensed physician before exit.
Records
• A modified POMR, (Problem-Oriented Medical Records) format is to be used on all charts. That is a thorough and complete assessment and plan including health care maintenance.
• Charts should be clear, complete and legible.
• Charts should be maintained in a timely manner.
• All charts will be dated and signed by the resident, and countersigned by the attending physician.
• Verbal orders from attending physicians should be recorded with appropriate notation (date and time).
• Telephone orders shall be recorded with appropriate notation. .
• Staff will periodically update vita statistics on charts.
• Charts will be reviewed in accordance with audit standards of the Quality Assurance committee.
Resident Information
The Attending Preceptor will assign the resident's panel of patients.
If the resident has any medical or procedural questions, the attending physician will be contracted.
The resident shall notify the attending physician of the following occurrences:
• Accidents and emergencies involving a patient
• Sudden change in a patient's condition
• Severe complications
• Severe complications
• Patient dissatisfaction
• Patient self-discharge
The resident may refer patients for consultation with the approval of the attending physician.
Insurance papers, disability certificates, social service forms, etc. are to be signed by the attending physician.
Death certificates are to be signed by the attending physician.
General Information
All support staff will be treated in a professional manner.
Medical equipment is not to be removed without the permission of the Attending Preceptor.
The call schedule shall be followed.
The resident will have a beeper number and home phone number distributed to the Hospital emergency room, admissions office of nursing stations, clinical center, and chief resident.
A modified Problem-Oriented Medical Record format (POMR) is to be used on all charts.
Sign, date and time all progress notes and orders.
Charts are to be cosigned by attending Family Medicine physician.
After-hours patients may be seen in the emergency room.
When admitting a patients to the Hospital, call the admitting office and indicate whether male or female and admitting diagnosis.
Notify attending physician on-call of the patient admission, change of status, and/or transfer or room/ICU.
Admissions orders shall be given upon admission and signed within two hours of admission.
Appropriate lab and x-ray tests are to be ordered and reviewed by the resident.
Daily progress notes shall be recorded on the hospital chart.
The resident will complete discharge summaries at the time of discharge.
Leaves of absence, or change in status of attending physician, shall be recorded on hospital chart.
GENERAL PRACTICE RECORDS
Use a modified Problem-Oriented Medical Record (POMR) format.
Keep charts clear and legible (in acceptable medical terminology)
Include the following minimum content for each visit.
S - Chief Complaints numbered in order
History of Chief Complaint
Onset
Etiology, if known
Previous treatment and response
0 - Physical findings relative to chief complaint, systems aspects involved, including structural aspects
A - Problems and diagnosis, including rule-outs
P - Treatment
-Diagnostic tests (call patient if tests are positive)
-Referrals, if applicable, and reasons
-Follow-up (patient to returnˇ)
-Patient education (example: warnings regarding medication, trial of treatment; if no improvement, next step of tests, etc.)
Keep the following sheets updated:
- Major Problem Sheet
- Temporary Problem Sheet
- Medication Sheet (dosage, dates started/stopped)
LOGBOOK
In addition to the customary clinical record keeping, residents are required to fill out a Patient Visit Log for every patient seen. Any documentation needed by a resident applying for privileges, will come from this file. The logbook will also be used for monitoring workload and improving curriculum.
The resident should be certain to list all diagnoses and procedures performed. Rule-outs and secondary symptoms should not be listed.
The resident will be responsible for correctness and completeness of log information.
On-Call
Residents will be on-call as scheduled for admitting after-hours patients and dealing with problems, which arise with hospitalized patients.
Out-of Town Coverage
During times when one resident is on vacation or out on elective completing residency requirements, another resident is expected to cover on-call requirements.
GRIEVANCE
On occasions, residents may have questions or problems regarding performance of work administration or policies and practices, which are not specifically covered in the Resident Manual, One or more of the following steps, in sequence, may be taken:
Confidential discussion with:
- Immediate clinical preceptor
- Faculty Advisor
- Residency Director
- If the problem is unresolved at the above three steps, there may be a hearing of the entire Family Practice Committee.
ATTENDANCE
Residents are required to promptly attend assigned rotations, clinical sessions, conferences, night or weekend coverage, medical conferences noontime medical lectures and other assignments made by the Program Director.
Excused absences shall be granted for:
- Serious personal illness or injury
- Death in the immediate family
- Special situations given prior approval by the Program Director
In Family Practice clinical assignments, the following additional excused absences may be granted.
A resident who misses one-fourth of more of the sessions in any assignment (e.g. three absences from a rotation scheduled one half-day weekly for a quarter), will be required to make up all the time missed. Residents are encouraged to make up absences even if the limit has not been exceeded. Absences may be made up during elective time, vacation time, or at the end of the year. Any extensive absence (e.g. a whole week) should be made up at the end of the year.
Legal holidays recognized by hospital will be official holidays for this residency. Official holidays include New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas.
On-call during holidays will be shared among the residents as equally as possible; assignments will be designated by negotiations with the residents and the supervisor of training.
St. Barnabas Hospital will establish scale of pay for residents. The St. Barnabas Family Practice residents must receive the same salary and benefits granted to all other residents of that institution.
GRADUATION
A certificate of completion will be issued to each resident who has received recommendation for graduation from the program director. Such recommendation will be based upon satisfactory attendance, examination performance, evaluations from clinical trainers and the Supervisor of Training, and fulfillment of other program requirements.
Before receiving the certificate and final paycheck, the resident shall complete the following
- Assigned dictation and charts for signature
- Patient logs
- Final Activity Log, and Evaluation of Training Program
- Return pager
- Return all other departmental, clinical or hospital property, including keys, library books, linens and scrub suits
- Scholarly Activity
- Documented list of all seminars and medical lectures attended
RESIGNATION
Residents shall give a minimum of 30 days notice of resignation from a training program. All resignations must be submitted to the Residency Director, in writing, and include the reason for leaving the residency.
DISMISSAL FOR CAUSE
The Residency Committee has the right to dismiss, without warning, in cases of unacceptable conduct. Anyone who is dismissed for cause may use the grievance procedure in this manual, for review and final dispensation. Grounds for immediate dismissal include, but are not limited to, the following infractions:
- Inappropriate professional conduct or unethical behavior
- Conduct endangering the life, health or safety of others
- Verbal or physical abuse of patients, patients' family members, or fellow workers
- Reporting to work under the influence of intoxicants or drugs.
- Illegal possession or use of intoxicants or drugs
- Inefficient performance of duties or neglect of duty
- Falsification, misrepresentation, or omission of any information on employment or other official records
- Improper or unauthorized use of medical facilities or equipment.
- Failure to respect patient confidentiality or discussion of patient's condition with unauthorized personnel.
- Malicious gossip about an employee, patient, physician or departmental representative.
- Leaving assignment during working hours without prior knowledge or permission of trainer.
- Insubordination.
- Lack of cooperation in actual emergencies or in fire/disaster drills.
- Theft, regardless of value.
- Accepting monetary tips from patients or families.
- Intentional violation of other departmental policies.
RESIDENT HOURS
Each rotation will establish resident hours and on call schedules. They must comply with a schedule that allows time for educational conferences, study periods and meals.
All programs must comply with the New York State maximum residency workweek schedule.