Hospital Consults PGY-4

Hospital Consult Rotation Goals/Objectives PGY -4
Patient Care
Goal: To provide care for inpatients that is caring, sensitive, and effective in optimizing
diagnosis, management, patient education and outcomes.
Objectives:

1. Consistently identify information and subtle clinical patterns to diagnose complex disorders.
   PC1
2. Document a complete drug timeline in the chart for patients suspected of drug reaction and
   consistently identify the likely culprit medication. PC1
3. Teach junior learners to accurately interpret laboratory and imaging test results, including the
   selection of tests that are evidence-based and cost-effective. PC6
4. Articulate the limitations and challenges of dermatopathologic interpretation in the inpatient
   setting. PC4
5. Usually able to select alternative medications for patients with recalcitrant disease or
   significant side effects from therapy. PC8
6. Consistently make independent management decisions, including customizing care in the
   context of patient preferences, overall health, feasibility in the hospital setting, and ability to
   comply. PC8
7. Consistently give a targeted and precise presentation with pertinent negatives. PC1
8. Consistently develop a comprehensive and weighted differential diagnosis. PC7
9. Consistently seek appropriate specialist consultations. PC7
   Medical Knowledge
   Goal: To acquire knowledge in inpatient dermatology, demonstrate competence in knowledge
   of topics specified by the American Board of Dermatology and develop expertise in patient
   management.
   Objectives:
10. Consistently demonstrate comprehensive knowledge of the clinical and laboratory
    manifestations, expected course, and management options of common, uncommon, and complex
    inpatient dermatologic disorders. MK1
11. Identify and manage urgent dermatological conditions appropriately. MK1
12. Consistently recognize the value of preventive care and demonstrate sophisticated
    understanding of the socio-behavioral aspects of medical dermatologic disorders. MK1
13. Consistently demonstrate ability to organize, present, and apply relevant basic science
    knowledge to the care of dermatology patients in the inpatient setting. MK1
14. Identified variable presentations of uncommon and rare disease MK2
15. Identifies subtle morphologic variability MK2
    Practice-Based Learning and Improvement

Goal: Develop skills in acquiring, analyzing, applying and teaching medical knowledge.
Develop the ability to self-analyze.
Objectives:

1. Incorporate principles and basic practices of evidence-based practice and information mastery
   into clinical practice. PBLI1
2. Identify alternative resources to answer clinical questions (for example, microbiology lab
   director, E&M coding guidelines, Medicare policies, CDC reporting requirements). PBLI1
3. Perform mostly self- directed learning, integrating multiple feedback and assessment sources,
   with little external guidance. PBLI2
4. Demonstrate an effective method, system, or process for staying current with relevant
   changes in clinical dermatology and dermatology medical knowledge. PBLI1
5. Identify personal gaps in achieving necessary or desired aspects of residency education and
   communicate these with program director. PBLI2
6. Assume a significant role in clinically teaching learners. PBLI2
7. Maintain accurate and timely consultation logs. PBLI2
   Interpersonal Communication
   Goal: To communicate with patients, their families, and other health professionals in a clear.
   concise, caring, and respectful manner.
   Objectives:
8. Consistently communicate effectively and build rapport with patients and families in routine
   and stressful inpatient encounters. ICS1
9. Consistently recognize and effectively use non-verbal communication skills in relating to
   patients and families. ICS1
10. Consistently paces clinical interviews appropriately. ICS1
11. Customize communication of emotionally difficult information for patients and families.
    ICS1
12. Independently recognizes personal biases while attempting to proactively minimize
    communication barriers ICS1
13. Consistently communicate effectively with health care team members, including the nursing
    staff, in ways that demonstrate appreciation for their skills and contributions in routine and
    difficult or contentious situations. ICS2
14. Consistently obtain and provide consultation independently, and communicate effectively and
    efficiently with supervisors, consultants, and primary teams in routine and complex or nuanced
    patient care situations. ICS2
15. Promote care coordination and ongoing communication with other providers. ICS2
16. Provide some examples of the medicolegal repercussions of inappropriate medical record
    documentation. ICS3
17. Communicates clearly, concisely and in an organized written form, including anticipatory
    guidance ICS3
    Professionalism
    Goal: Develop a commitment to excellence, integrity, and sensitivity in the care for inpatients
    and in the interactions with other health professionals and staff.

Objectives:

1. Demonstrate ethical and professional behavior, and manage real and potential conflicts of
   interest in all professional activities, including patient care, research, publication, and
   relationships with industry. PROF1
2. Educate junior learners and ancillary staff members in, and model adherence to, institutional
   and departmental policies and procedures, proper use of social media (including appropriate
   transmission of patient photographs), equitable and empathic treatment of all patients, and
   maintaining patient confidentiality. PROF1
3. Achieve sufficient self - awareness and understanding to manage work-life balance, and to
   recognize signs of impairment, mental illness, substance abuse, or burnout in oneself or one’s
   colleagues to take appropriate action. PROF3
4. Assist junior residents in recognizing their own limitations. PROF3
5. Adjust priorities in response to changing demands. PROF2
6. Anticipate the needs of patients and primary teams, and work to meet those needs in daily
   practice. PROF2
7. Effectively advocate for individual patient needs. PROF2
8. Respect patient confidentiality, especially in hospital “common areas” (ie, elevators, waiting
   rooms, hallways, etc.). PROF1
   Systems Based Practice
   Goal: Competently navigate the health care system using the resources available to provide
   effective yet cost-conscious patient care.
   Objectives:
   Coordinate and organize hospital rounds with fellow residents.
9. Recognize the differences between a system change and a work-around (a bypass of a
   recognized system fault that attempts to improve efficiency). SBP1
10. Identify at least one work-around, explore opportunities for change, and when possible, take
    steps to improve the system fault that incited it. SBP1
11. Assess outcomes of quality improvement efforts, and apply these towards continuous quality
    improvement. SBP1
12. Demonstrate how to manage, utilize, and coordinate the inter- professional team. SBP2
13. Participate in an interdisciplinary team meeting for hospital or program improvement. SBP2
14. Consistently encourage open and safe discussion of error, and begin to identify and analyze
    error events. SBP1
15. Articulate an awareness of current debates/issues of health care financing and how it will
    affect patients, providers, third party payers, and other stakeholders. SBP3
16. Demonstrate the incorporation of cost-awareness principles into standard clinical judgments
    and decision-making. SBP3
17. Facilitate checklist- guided briefings (for example pre-procedure timeouts) in health care
    activities. SBP1
18. Consistently advocate for optimal patient care in the setting of interdisciplinary interactions.
    SBP2

10. Advocates for safe and effective transitions of care/hand-offs within and across health care
    delivery systems including outpatient settings SBP2