Educational Guidelines For Attending Physicians In Internal Medicine

A merit-based system has been used to put the attending schedule together.  Those of you on the schedule have been viewed by the housestaff as excellent attendings. Please take a moment to review the series of ACGME and Departmental expectations and responsibilities discussed below.

Educational Goals:

The primary educational goals of the attending physician on the inpatient service include:

Responsibilities for Teaching and Evaluating Students and Housestaff:

A.  General Teaching Responsibilities and Requirements

1. Orientation on Day 1 - The attending physician should review with the residents their responsibility for student teaching and determine if the responsibilities are being met.  If they are not, then attendings need to stress the importance of doing so.  The attending should stress to the housestaff the importance of timely completion of student evaluations for grading.

2. The attending physician will conduct teaching rounds with the housestaff for approximately one hour twice weekly and will conduct teaching rounds with the students for one hour three times weekly.  These sessions are to be reserved for teaching; they are not to be used to sign charts or conduct other ward business.  Such sessions are to be intensely patient-oriented.  Ideally, most would involve presentation and discussion of specific patients or common clinical problems.  There is an increased emphasis placed on performance based learning; bedside teaching sessions, in which physical findings and history-taking are demonstrated and observed, and particularly important.  Exercises that demonstrate how the attending physician approaches the evaluation and management of a specific patient are particularly valuable.  Clinical skills and knowledge, rather than personal research interests, should be stressed.  If the press of ward business intrudes on scheduled times, these sessions should be rescheduled.  

3. Attending physicians will conduct teaching rounds in their own styles.  All attendings should make sure that their students and residents can collect and present clinical information in an accurate, efficient, and logical manner.  The Department would like to emphasize physical diagnostic skill during teaching rounds with students. 

4. Four and a half hours of teaching are mandated by the ACGME.  A mutually convenient time should be established between you and the housestaff  to discuss literature involving patients on your service. Residents should be asked to bring in articles 1/week and students should be asked to give reviews on patient-related topics.  

5. Except under the most unusual circumstances, there are no restrictions on which patients can be used for teaching exercises. 

6. Student teaching sessions should be focused on clinical skills.  Activities should be focused on the students' patients and should include brief case presentations, bedside history and physical examination, case debriefings/discussion, radiological/test review, and review of student clinical notes (usually in the succeeding session after faculty review). The time allotted to each activity should be at the discretion of the faculty with the goal of repeatedly addressing all of these areas over the month. Time should also be budgeted in each subsequent session for a brief discussion of pertinent evidence-based case material which the student may be assigned to research independently between sessions.

The following represents the core curricular elements for inpatient student education:

a. Observed student history-taking

b. Observed and practiced physical examination, e.g.,
Head and neck examination
Pulmonary examination
Cardiovascular examination
Abdominal examination

c. Time-specified case presentations

d. Review and feedback of student notes
Initial Hx and PE
F/u chart notes

e. Selected test and image interpretation, e.g.,
Fluid/electrolytes
Acid-base
Organ-system chemistry
Arterial blood gas
Chest xray
Electrocardiogram

f. Observed patient communication and professionalism skills

7. Teaching Schedule - A typical schedule is outlined at the end of this document.

8. Conference Attendance:  One of the major weaknesses of our program as identified by the GMEC and the residents themselves is the poor participation of faculty at Departmental conferences. It is an ACGME and Departmental requirement that attendings participate in these conferences.  As of July 1, 2011, there will be a faculty sign-up sheet at the major conferences that require faculty attendance.  It is expected that you will be at two-thirds of these conferences. 
These conferences include:

a. Morning Report (8-9:00 Monday, Wednesday, Thursday, Friday in one of several rooms; you will be paged 30 minutes prior to the conference with the location) 
b. Morbidity and Mortality Conference (8-9am Tuesday, Jordan Hall Auditorium)
c. Grand Rounds (Wednesday 12-1 PM in Old Jordan Auditorium 1-5).

9. Rounding between 07:00 and 07:30 is important to aid in early discharges and should be the practice of all attendings. Discharge orders by 09:00 should occur in 60% of discharges. This will continue to be monitored.

B.  FACULTY DEVELOPMENT

1. It is an ACGME requirement that all faculty participate yearly in faculty development activities.  We will now need to document this participation.  Throughout the year, there are a variety of faculty development opportunities. We will notify all Departmental faculty as these opportunities occur. We will try to have at least one NetLearning program available per year.  By whatever means, all faculty in contact with housestaff will have to document this faculty improvement.

2. As noted under “Faculty Development”, NetLearning may be a means of documenting the ACGME mandated activities for faculty.  Presently, you are asked to become familiar with the Stress and Fatigue module in NetLearning.  The module will be updated as necessary. Again, yearly, this needs to be reviewed by all faculty.

C. EVALUATIONS - STUDENTS AND RESIDENTS

Students

1. The attending physician should meet briefly with each student individually to provide feedback at the midpoint of the rotation.  One should provide both positive and negative evaluations.  Even the superstars want advice about how they might improve.  Give feedback promptly.  The students need to know what you think early.  They should not be surprised when they review the evaluations with the clerkship director at the end of the rotation.  Provide a more formal feedback session at the end of the rotation.  You may want to use your last student teaching session for this purpose.  Students do not see individual attending evaluations.  

2. Fill out the students' evaluation forms carefully and promptly.  We will pursue you until you complete the forms in OASIS.  The grade for the inpatient service component of the Internal Medicine Clerkship is based 50% on attending, and 50% on housestaff, evaluations. Students are evaluated with regard to medical knowledge, clinical skills (including ability to perform a history and physical examination), and interpersonal skills as applied in the clinical setting. The Internal Medicine clerkship grade is calculated from grades on the inpatient service, AIM, and the Subject Examination in Internal Medicine of the USMLE, Step 2, each weighted at 33%.

3. Attending physicians may also utilize Praise and Early Concern Cards to provide feedback on students.  These forms are filed electronically and anonymously.  The website for accessing these cards is http://www.med-ed.virginia.edu/listen/facultycomment.cfm 

Housestaff

1. Provide feedback to the housestaff regularly.  Fill out housestaff evaluation forms promptly and carefully.  You will receive separate communication from the residency program regarding specifics on accessing evaluations.    

2. All written evaluations on the housestaff with whom you have worked have to be completed within two to three weeks.  Failure to complete evaluations in New Innovations within 2-3 weeks of completing a rotation may prevent you from attending again. 

3. At the end of each rotation, you have to evaluate each resident face-to-face giving objective and constructive critiques of their performance and receive a critique of yours. This is an ACGME requirement.

4. If you are doing a 4-week rotation, at the 2-week half-way mark, you need to meet with each houseofficer face-to-face to let them know how they are doing and where they have room to improve.  At the end of the rotation, you will be judging how well they have heeded your advice. This is a Departmental expectation.

FINAL NOTES

Questions can be addressed to Dr. Donowitz (4-1918) or Dr. Brian Wispelwey (via Karen Ward
3-9397).