Medical knowledge has been the typical emphasis of residency training programs. There are numerous subjective and objective, time-honored methods of examining trainee's knowledge.
1. American Board of Internal Medicine National In-Service - All residents and interns take the in-service every year. This test is used to define areas of strength and weakness for both trainees and the program. The results are reviewed in conference with each trainee and a plan is put in place to address weaknesses if necessary. This examination gives trainees the unique opportunity to gauge their knowledge (and test-taking skills) relative to the (national) peer group with whom they will be taking the examination.
2. Attending Rounds - Both Teaching and Work Attending Rounds provide a venue for teachers to gauge the knowledge of residents and interns and provide patient-based instruction. Both Teaching and Work Attendings provide monthly written evaluations.
3. Conferences (Morning Report) - Residents who are assigned to Ward services and those on sub-specialty hospital rotations attend Morning Reports. Cases are discussed in detail. Faculty members have the opportunity to hear trainees "think aloud" allowing the opportunity to provide substantive feed-back. It also allows an excellent opportunity for residents to teach each other.
4. Clinical Skills Examination - Once each year, all trainees perform a history and physical examination as they are observed by a faculty member. The trainee completes the exercise by presenting the case and his/her assessment and plan for diagnosis and treatment.
5. 6-Competency OSCE - Every other years trainees perform an objective clinical skills evaluation (OSCE) that includes one station devoted to medical knowledge about a "bread-and-butter" medical problem. A case presentation is followed by straight-forward questions that "every internist should know" the answers to.
6. Program Director's Rounds - Once a month a Teaching Attending Rounds is conducted by the Program Director with residents/interns assigned to Wards services. Roughly 1/3 of the session is spent assessing interns' 5-minute presentation skills (that includes demonstration of medical knowledge in outlining assessment/plans), 1/3 to medical reasoning skills and 1/3 in chart-stimulated recall exercises.
7. Rotation-Specific Portfolios - On several rotations (Hematology-Oncology, Infectious Disease, Geriatrics), residents keep a portfolio of their experience. In these rotations (Heme-Onc and Geriatrics are non-elective), residents must seek exposure to patients with a number of listed "core" diseases. They describe the patient in their portfolio then use the patient's case as an opportunity to read about the disease and record seminal facts about clinical facts, diagnosis, prognosis and therapies. This guided study "homework" maximizes the likelihood that they will learn about essential disease processes that are sub-specialty specific, chosen by Section Chiefs.
8. Board Review Course - Conducted by the Chief Resident with the aid of subspecialty Chiefs, this is a monthly after-hours conference in which one MKSAP subject area is reviewed through discussion of questions/answers from post-tests.
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A summary of all six ACGME competencies may be downloaded from the following link.
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