General Objectives of the New York Medical College (Richmond) internal medicine curriculum for residents:
        
1. Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health in adults.

2. Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

3. Investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

4. Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patient families, and professional associates.

5. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

6. 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.

All internal medicine training is based on the six competencies - patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. These competencies are reflected in the goals and general objectives listed above.

In addition there has been a shift from process-based evaluation to outcomes- based evaluation. Accordingly the curriculum has changed formats to include goals, and objectives by competency and by PGY1 level. 
 
The current curriculum document reflects a high level of faculty and resident participation.
Residents and teaching faculty must review the curriculum for an upcoming rotation on a monthly basis. This review should clarify learning objectives and competency assessment methods. In accordance with RRC guidelines, faculty must also provide the resident evaluation feedback at the end of each rotation.


Principal teaching methods and settings
The principal teaching methods involve a combination of individual patient-based encounters and a series of didactic conferences.  In each individual patient encounter, there is a detailed discussion with an attending physician; the didactic conferences similarly integrate the basic sciences of pathophysiology with clinical presentations and an evidence-based approach to diagnosis and management.  Each month the lectures, Grand Rounds, CPC, and Radiology conferences are all geared to the particular area being discussed.   It is our strong belief that this approach, utilizing both individual and group teaching and didactic and patient-based approaches, maximizes our educational efficacy.

Patient  encounter
The settings include the General Medicine Clinic, subspecialty Medical Clinics, certain non-medical Ambulatory Care settings, community based office settings, the Medical Intensive Care Unit, the Coronary Care Unit, the Internal Medicine floors and consultation to patients on the non-medical floors.  On the Internal Medicine floors, the PGY-1 acts in the role of the primary physician under close supervision by senior residents and attending physicians.  He or she is expected to obtain his or her own medical history, perform a physical examination, interpret the available laboratory data, and develop an initial diagnostic/management plan on each patient.  The history, physical examination, and management plans are discussed in detail with both senior residents and attending physicians, facilitating immediate feedback and evaluation in all cases.  The PGY-2 is expected to oversee initial and daily patient management.  The PGY-3 is the "team leader".  In the other settings, the resident, depending on which level and/or which service, acts either as the primary care doctor or a consultant, supervised in both cases by the appropriate attending.

Teaching rounds
On the inpatient medicine service, teaching rounds are scheduled for 4 hours each week.  During teaching rounds, a limited number of patient issues are discussed by the team, with a focus on such points as pathophysiology, history taking, physical diagnosis skills taught at the bedside, differential diagnosis, interpretation of clinical data, appropriate use of technology, appropriate diagnostic strategies, and ethical issues in health care.  Similarly structured teaching rounds are also scheduled daily in the intensive care settings.  


Core curriculum
Attendance at conferences beginning at 11:30 a.m. is required for all residents Monday through Friday.  Only residents who are assigned to vacation, ED, or MICU are exempt from this requirement.  The core curriculum includes topics from all subspecialties in internal medicine, monthly journal clubs, several case presentations, monthly end of life conferences, radiology conferences, "residents as teachers," interviewing and physical diagnosis sessions, cultural competency, and research courses.  One conference during each subspecialty is dedicated to geriatric aspects of that subspecialty.  Principles of cost effectiveness and aspects of legal and government regulations are an integral component of the 11:30 a.m. conference presentations and also addressed during morning report on teaching and management rounds. 

Medical Grand Rounds
Medical Grand Rounds are held weekly by prominent guest speakers, covering a range of important topics in internal medicine and its subspecialties.  Once a month, a Clinicopathological Conference is presented, in conjunction with the pathology and radiology departments.  The third Tuesday of every month is a Quality Improvement Meeting of the Department of Medicine.  Attendance by the residents is mandatory.  

Morning Report
Morning Report is held daily from 7:30 am - 8:30 am.  Every Tuesday, morning report is devoted to Morbidity and Mortality Review with residents presenting cases, following an M & M format where they review what happened in a case where something went wrong, discuss the risk factors involved for problems, and devise lessons learned to improve care in the future.  Every Thursday, morning report is a "journal club" with an article selected by one of the attendings who leads morning report that day, or by a resident because of relevancy to a case.  The resident clinically appraises the evidence obtained, using the format of the Evidence-Based Medicine Group published as "Users' Guides" in JAMA.  Once a month, morning report is a "near miss" morning report where a case is presented that included a "near miss" and the housetaff and faculty present discuss the case in a "blame free" fashion, looking at how the medical system could be changed to avoid this type of "near miss" in the future.
Curriculum

Educational purpose
Internal Medicine Training in the New York Medical College (Richmond) program seeks to ensure that residents develop the skills, knowledge, and attitude necessary for a career in Internal Medicine.  On graduation, Internal Medicine residents trained in our program possess the breadth of training, the practice in evaluating complex medical problems, and the mastery in interpersonal skills that qualify them to pursue successful careers as general internists, as well as the detailed knowledge and practical skills to succeed in training in any of the subspecialties of internal medicine. 
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