Daily, Inpatient Multidisciplinary Rounds, 9 AM-11 AM
Daily inpatient attending walk rounds with the resident team include nursing input and discussion. A portion of the rounds is devoted to case management rounds with discussion and planning of patient care transitions, psychosocial barriers, pharmacy cost, medication reconciliation, compliance and risk/benefits. The addition of case managers, social work and pharmacists to inpatient resident teaching rounds provides an interprofessional work and teaching milieu.

Biweekly, Inpatient Medicine Morning Report, 9:30-10:15 AM
Morning Report is a case-based conference that allows residents and faculty to discuss patient care in an organized and efficient manner on the inpatient setting. The goals of Morning Report include development of effective communication skills, critical thinking skills and recognize areas of knowledge deficits to formulate and follow up on appropriate clinical questions. The PGY-1 resident presents a case of a newly hospitalized patient to faculty and members of the inpatient care team in attendance. Either a faculty member or chief resident serves as the facilitator. The senior resident meets with the attending or chief resident facilitator prior to the start of inpatient rounds to decide on the case presented. The facilitator uses the information in the resident’s presentation as a springboard for discussion, analysis and demonstration of the critical thinking skills required and the formulation of questions needing follow up.

Biweekly, Continuity Clinic Case-Based Teaching Sessions, 7:30-8 AM

The Continuity Clinical Case-Based Teaching Sessions facilitated by continuity clinic faculty. The curriculum is case-based with related questions that emphasize practical aspects of diagnosis or management of commonly seen outpatient acute complaints, management of chronic co-morbid conditions, health care disparities issues, population health and preventative care strategies.  These exercises prompt information recall, introduce new information and enhance problem-solving skills. Topics range from general internal medicine outpatient management of chronic co-morbidities including diabetes, hypertension, COPD, osteoarthritis to less commonly seen subspecialty areas in orthopedics, rheumatology, and dermatology. The Yale Office-Based Curriculum is available for additional case-based materials for both faculty teacher and resident learner. 

Residents’ complete assigned outpatient –based Hopkins outpatient medicine teaching modules over a wide variety of high yield outpatient adult medicine topics with self-assessment via pre & post-test for each module.

Daily, Continuity Clinic Conference, Multidisciplinary Huddles, 8 AM-8:15 AM (M-F—Continuity Clinic Week)
Expanding on the informational & inspirational Baptist Health “huddles,” the outpatient continuity team meets daily with the residents, teaching faculty, nurses and the other members of the multidisciplinary team to discuss each resident’s panel of patients for the day. Part of the daily review include, high-risk patient populations (e.g., poorly controlled co-morbid conditions, frequent hospitalizations or ED visits, behavioral health issues, social or economic struggles). Additionally, follow up labs, health prevention needs, and other specific exams e.g., diabetic foot exam and other patient quality-defining measures come under review with the resident and the team.

 

Residency Conference Schedule Noon-1 PM (M-F)  

Description of the curricular components:

18-month Recurring Clinical/Basic Science Lecture Series

Biweekly, Noon-1 PM

The topic subspecialty lectures have a case-based format & board review-style questions at the conclusion of each presentation.

 

Grand Rounds

Weekly, Noon– 1 PM

Grand Rounds conferences use a variety of formats for presenting material including topic review, clinical pathological conferences, often in a case-based format. Topics for Grand Round Conferences vary from week to week, but include patient cases, ethical topics, professionalism discussions, and additional competency-based topics presented by faculty specialists at UAMS. This conference broadcasts live at noon on Thursdays from the UAMS Medicine Grand Rounds lecture series to the BH –UAMS IM Residency program at our North Little Rock site. The recorded UAMS Grand Rounds are available for viewing through the UAMS IM faculty intranet webpage.

 

Morbidity & Mortality Conference

Monthly, Noon-1 PM

Morbidity and Mortality (M&M) conference occurs on a monthly basis and is a critical educational session that allows residents the opportunity to identify  issues with communication, professionalism, patient safety, medication errors and handoffs in a systems and practice –based learning & improvement competencies model. During the M&M conference, a resident presents a difficult case to peers and faculty audience. A faculty member facilitates a discussion regarding the plan of care, implementation, lapses in professionalism, communications, and medical or system errors. 

The goal of this conference is to allow residents to do a podium presentation with analysis of a tough case in a supportive, adult learning environment. Identifying system failures that may have caused a medical error with a facilitator-lead plan for improvement at the resident or hospital system level, models the thought processes and a methodology for future improvement in patient care to the resident class. Our M&M conference model expands the traditional M&M to frame the system-based issues, quality improvement practices, a risk/benefit analysis, and discuss professionalism, communication and cost. A portion of these monthly M&M conferences include interprofessional team members.

 

Journal Club

Monthly, Noon-1 PM

Journal Club occurs monthly as a noon conference. The materials covered will include instruction on how to construct the relevant clinical question, select the best resources, critically evaluate the resource and apply the evidence to clinical practice. Using lead journals, a resident presenter with both faculty facilitator instruction and oversight, reviews a paper recently published or a seminal paper that has influenced the practice of Internal Medicine. Appropriate statistical principles are reviewed and the articles relevance to current practice is discussed.

 

MKSAP18 Board Review

Biweekly, Noon-1 PM
This is a case-based Board Review-style interactive biweekly teaching session. Residents have individual paid subscription online access to the most updated MKSAP version. Board Review questions are also incorporated into the lectures in the rotating 18-Month Recurring Clinical/Basic Science Lecture Series.

 

QI & Patient Safety Curriculum

Fridays, Noon -1PM

All entering Interns complete the IHI (Institute for Healthcare Improvement) Open School Course Basic Certificate during the onboarding New Resident Orientation Process. 

Topics include:

IHI certificate units for the OPEN SCHOOL Basic Certificate in Quality & Safety. See the 13 units (with modules) listed below:

•   L 101: Introduction to Health Care Leadership
•   PFC 101: Introduction to Patient-Centered Care
•   PS 101: Introduction to Patient Safety
•   PS 102: From Error to Harm
•   PS 103: Human Factors and Safety
•   PS 104: Teamwork and Communication
•   PS 105: Responding to Adverse Events
•   QI 101: Introduction to Healthcare Improvement
•   QI 102: How to Improve with the Model for Improvement
•   QI 103: Testing and Measuring Changes with PDSA Cycles
•  QI 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools
•   QI 105: Leading Quality Improvement
•   TA 101: Introduction to the Triple Aim for Populations

QI project completion with Green Belt certification in Lean Six Sigma

Fridays, Noon-1PM

• Basic Improvement–Define ( 26 modules)
• Measure ( 12 modules)
• Analyze (20 modules) 
• Improve (12 modules)
• Control (7 modules)
• Exam ( Yellow Belt) 
• Team Project Completion Project Name/Description_____________________________

Resident Individual & quality updates:

Bi-Annual Updates, during monthly Resident-Faculty Meeting  

Residents receive biannual individual & outpatient team-based quality updates report card during conference sessions & individualized quality measure review during their semi-annual  performance reviews with the program director and their faculty advisor.

 

Communication Skills Training

Quarterly, Noon-1 PM

Incorporated into the IM Residency Noon Didactic Conference Schedule are the following but not limited to topic areas:

• Basic Communication Skills with the Patient
• Determining a Patient’s Decisional Capacity
• Breaking Bad News
• Communication with the Angry Patient & Family
• Interprofessional Team Communication & the Care Transition Hand-off

Most topics have a case-based or trigger-tape based interactive discussion section added to the didactic lecture.

 

Wellness Curriculum

Quarterly, Noon-1PM

Incorporated into the IM Residency Noon Didactic Conference Schedule are the following but not limited to topic areas:

• Recognizing & Addressing Fatigue & Burnout
• Wellness Programs at BH
• Stress & Depression
• Boundary Violations
• Physician Impairment
• Maintaining Life-Work Balance
• Sleep Deprivation: Understanding the Negative Impact on Your Life
• Thriving Through Residency: Resilience & Grit
• Protecting your Reputation: What Legal Advises

The AMA Core Competencies Curriculum is used as assigned modules & modules for group discussion & reflection.

Through the IM resident advisor program, resident wellness is individually surveyed during the faculty –resident quarterly meetings.

 

Residents as Teachers Curriculum

Semi-Annually, Noon-1PM

Incorporated into the IM Residency Noon Didactic Conference Schedule are the following but not limited to topic areas:

• Principles of Adult Learning & the Importance of Self-Directed Learning
• Giving & receiving feedback
• Teaching in the Presence of a Patient: Skills & Tools
• Didactic Teaching: Skills & Tools

 

Residents as Managers Curriculum

Semi-Annually, Noon-1 PM

Incorporated into the IM Residency Noon Didactic Conference Schedule or assigned AMA Resident Core Competency modules  are the following but not limited to topic areas:

• Managing Time
• Managing Stress
• Resolving Conflict
• Motivating others
• Developing a Career Plan

 

Prof/Humanism

Semi-Annually, Noon -1 PM

Incorporated into the IM Residency Noon Didactic Conference Schedule or assigned AMA resident Core competency Modules are the following but not limited to topic areas:

• Building the Patient-Physician Relationship
• Confidentiality
• Cultural competency
• Conflict of Interest
• Fraud & Abuse Regulatory Overview
• Humanism in Medicine
• Humanism in Literature & Application to the Practice of Medicine

  

Research Curriculum

Semi-Annually, Noon-1 PM

Incorporated into the IM Residency Noon Didactic Conference Schedule are the following but not limited to topic areas:

• IRB & Research approval Process
• Research Design, Refining the Question, Developing a Project
• Project Implementation & Analysis
• Human Factors & Safety
• Annual Resident Research/quality Day – slated for early spring, annually

 

Business of Medicine

Annually, Noon-1 PM

Incorporated into the IM Residency Noon Didactic Conference Schedule or as assigned modules in the AMA Residency Core Competency Curriculum are the following but not limited to topic areas:

• The US Health System: Medicare 101
• The US Health System: Medicaid 101
• Billing & Coding
• Physician Employment & Contracts: What to Know?

 

High Value Care Curriculum

Annually, Noon-1 PM

The program utilizes the ACP and AAIM High Value Curriculum. Residents are provided with interactive lectures that are focused on high-value, cost-conscious care.

Incorporated into the IM Residency Noon Didactic Conference Schedule are the following topic areas:

• Eliminating Healthcare Waste and Over-ordering of Tests
• Healthcare Costs and Payment Models
• High Value Diagnostic Testing and Cancer Screening
• High Value Hospitalization
• Overcoming Barriers to High Value Care
• High Value Quality Improvement

 

Additional Curricular Programs:

New Resident Orientation

Annually, last 2 weeks of June (M-F, 8 AM-4:30 PM)

The 10 day IM New Resident Orientation will include the following orientation, training skills and additional expectations.

• Welcome & Overview of the Program
• ACGME core competencies overview
• QI & Patient Safety—IHI modules completion
• the BH Patient Safety & QI—BH-NLR QACRS (Quality Assurance Communication Reporting System)
• BH patient error reporting system
• BH resident complaints–reporting strategies in the BH system and BH GME
• Review key residency/GME policies & procedures
• PGY-1 responsibilities
• PGY1 expectations
• Resident Evaluation System & the CCC
• Faculty Mentor Assignment
• Resident Performance Portfolio
• Resident Self-Reflection Exercise completion
• Fatigue mitigation instruction
• Impaired physician instruction
• Care Transitions/sign-out & I-PASS instruction
• Educational program and attendance expectations
• UAMS Library Orientations
• BEST BH-NLR orientation
• Scholarly requirements; QI project
• Resident on the PEC, resident-wide peer-selected council & QI/Patient Safety Hospital Committees
• EPIC training: expectations for chart completion, recommended note formats required chart information for documentation & billing
• New Innovations Training: completing evaluations, reviewing evaluations, completing procedure logs, logging duty hours
• Simulated history taking & exam experience at the UAMS SIMS Center
• Tour of BH-NLR campus
• Time for Q&A

 

Returning Resident Orientation

Annually, 4 Friday noon sessions in June.

The returning residents will have 4 sessions for orientation into the new PGY responsibilities.

• ACGME core competencies review & progress
• QI & Patient Safety— BH Patient Safety & QI—BH-NLR QACRS (Quality Assurance Communication Reporting System) updates
• BH resident complaints–reporting strategies in the BH system and BH GME
• Review key residency/GME policies & procedures
• Rising PGY-2/PGY-3 responsibilities/schedules
• Rising PGY2/PGY-3 expectations
• Updates Resident Evaluation System & the CCC
• Updates Faculty Mentor Assignment
• Resident Performance Portfolio
• Resident Self-Reflection Exercise completion
• Review Fatigue Mitigation
• Review Impaired Physician
• Review Care Transitions/sign-out & Hand-offs curriculum with workshop using IPASS
• Review Educational Program and attendance expectations
• Updates on Scholarly requirements; QI project timelines
• Updates on Resident on the PEC , resident-wide council & QI/Patient Safety hospital Committees
• EPIC training updates
• New Innovations Training updates
• Time for Q&A

 

ABIM In-Training Exam

Annually, end August, 8-5 PM

Resident medical knowledge and clinical reasoning is benchmarked annually using the ABIM In-Training Exam.  This exam serves as one important measure over the course of the 3 year IM residency curriculum of  resident medical knowledge, patient care, systems of care, quality improvement & patient safety issues. All residents complete the exam. Review of exam results with the program director occurs annually & helps to inform remediation in clinical training & further board prep.(e.g., reading material, board preparation course and electives) for the individual resident & the program.

 

 

Simulation Training

Bi-annually, scheduled for a day off campus at the UAMS SIMS center or during a noon didactic or during special half-day sessions. 

Residents have a simulation experience at the UAMS Simulation Center twice yearly in the PGY-1 year and additional SIMS are held on the BH-NLR campus at least twice yearly. Residents utilize the simulation center at UAMS in the PGY-1 academic year to assess their skills and gain skills in US guided procedure completion. The UAMS simulation center is home to a technologically advanced clinical simulation suite. The simulation center incorporates the use of both standardized patients and high-tech manikins. Code practice occurs in the BH-NLR hospital, ACLS SIMS also occur during Cardiology noon didactics. Bedside teaching and practice of Ultrasound- facilitated procedural skills occurs on the BH-NLR inpatient line team rotation, airway skills in the OR on the BH-NLR anesthesia rotation. Skills practice occurs with the Ultrasound machines in the MICU, facilitated by BH Pulmonary Critical Care faculty during the month-long MICU rotations in the PGY1-3 years of the program.

Resident simulation experiences includes:

• Basic instruction and patient interaction
• History taking and physical exam skills
• Diagnosis and documentation
• Ultrasound procedural skills training
• ACLS-style code situation simulations
• Emergency management
• High-risk/low-frequency scenarios

Specific training includes, code training, central (Femoral/IJ/Subclavian) lines, chest tubes, difficult air ways, additional procedures and ACLS scenarios. In addition to clinical procedures, residents also gain experience performing in simulated high-risk scenarios, gaining cultural awareness and addressing clinical ethics.

 

A variety of online curricula is used to supplement the didactic and bedside instruction you receive. 

These curricula include:

• American College of Physicians High Value Curriculum
  • https://www.acponline.org/clinical-information/high-value-care/medical-educators-resources/curriculum-for-educators-and-residents
• American College of Physicians MKSAP Board Review materials
  • https://www.acponline.org/featured-products/mksap-18
• American Medical Association GME Competency Education Program
  • https://www.ama-assn.org/life-career/ama-gme-competency-education-program
• IHI Open School: Patient Safety and Quality Improvement modules
  • http://www.ihi.org/education/IHIOpenSchool/Courses/Pages/default.aspx
• Johns Hopkins PEAC Internal Medicine Curriculum
  • https://www.peaconline.org/
• Six Sigma Green Belt training
  • https://asq.org/cert/six-sigma-green-belt
• Up-To-Date, an online point-of-care medical resource
  • https://www.uptodate.com/home
• Yale’s Office-Based Medicine Curriculum
  • https://medicine.yale.edu/intmed/obm/