VCU Internal Medicine Training Program
Promotion Milestones for Advancement

Each Internal Medicine resident will successfully complete 36 months of training in Internal Medicine rotations as specified by the ABIM certification requirements, the RRC-IM training program requirements and the VCU Internal Medicine Curriculum requirements. The resident will advance each year in training status according to the final yearly evaluation. Each resident’s yearly summative evaluation will be completed by the Program Director and will be approved by the Clinical Competency Committee in May/June of that year. The summative evaluation is based on a summary of rotation evaluations in the six core competencies (outlined below), program director observation, file documentation, achievement of the VCU Internal Medicine training objectives for that year of residency.

In addition, residents will complete the requirements outlined in the Training Requirements Policy.

The Six General Competencies

The ACGME and ABMS adopted six general competencies for resident training. The internal medicine community collaborated to define the competencies as they apply to our specialty. Representatives from several leading internal medicine organizations contributed to this effort. The resulting standards are described below.

1. Patient Care - This is defined as compassionate, appropriate, and effective care which encompasses the promotion of health, prevention of illness, treatment of disease, and end of life. At the cornerstone of competent patient care are the abilities to:

• gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, and diagnostic/therapeutic procedures;
• make informed recommendations about preventive, diagnostic, and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference;
• develop, negotiate, and implement effective patient management plans and integration of patient care; and
• competently perform the diagnostic and therapeutic procedures inherent to the practice of internal medicine.

2. Medical Knowledge - This is defined as demonstrating a command of established and evolving biomedical, clinical, and social sciences and the application of that knowledge to patient care and the education of others. Included in this context are:

• an open-minded and analytical approach to acquiring new knowledge;
• the ability to access and critically evaluate current medical information and scientific evidence;
• acquisition of applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine; and
• the application of this knowledge to clinical problem-solving, clinical decision-making and critical thinking.

3. Practice-Based Learning and Improvement - This is the ability to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. This effort encompasses the abilities to:

• identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes, values, and processes of care;
• analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient care;
• develop and maintain a willingness to learn from errors and use errors to improve the systems or processes of care; and
• use information technology and/or other avail­able methodologies to access and manage information, support patient care decisions, and enhance both patient and physician education.

4. Interpersonal and Communication Skills - These skills enable physicians to establish and maintain professional relationships with patients, families, and other members of health care teams. Included are the abilities to:

• provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues;
• use effective listening, nonverbal questioning, and narrative skills to communicate with patients and families;
• interact with consultants in a respectful, appropriate manner; and
• maintain comprehensive, timely, and legible medical records.

5. Professionalism - Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, and understanding and sensitivity to diversity, as well as a responsible attitude towards patients, the profession, and society. Included are the abilities to:

• demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues;
• demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors, and disabilities of patients and professional colleagues;
• adhere to principles of confidentiality, scientific/academic integrity, and informed consent; and
• recognize and identify deficiencies in peer performance.

6. Systems-Based Practice - This encompasses both an understanding of the contexts and systems in which health care is provided and the application of this knowledge to improve and optimize health care. Included are the abilities to:

• understand, access, and utilize the resources, providers, and systems necessary to provide optimal care;
• understand the limitations and opportunities inherent in various practice types and delivery systems and develop strategies to optimize care for the individual patient;
• apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management; and
• collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and improve systematic processes of care.