HARBOR-UCLA MEDICAL CENTER

Transitional Year Program

OVERVIEW OF THE TY PROGRAM GOALS &

OBJECTIVES/GENERAL COMPETENCIES

The Transitional Year Residency Program at Harbor-UCLA Medical Center Hospital is an exceptional clinical training program and is sponsored by the Internal Medicine, Surgery, Pediatric and Emergency Medicine Departments at Harbor-UCLA Medical Center. This sponsorship provides the TY Resident with a foundation for the development of fundamental clinical skills necessary to become capable and compassionate physicians.

The goals of the Transitional Year Residency are that graduates will attain the professional, attitudinal, cognitive, and technical skills necessary to provide their patients with kind and compassionate care. Residents have many opportunities to learn and practice patient communications and shared decision making and to apply current evidence-based knowledge to achieve the best likelihood of the patient's desired outcome. Under the supervision of more senior residents and Attending Physicians, TY Residents are given guidance and advice to develop their careers, achieve scholarship, and complete the prerequisites needed for the next steps of their careers. Our house staff learn how to problem solve and begin the process of self-directed lifelong learning. Housestaff are taught to assess patient outcomes in order to improve future decision making and guide practice management. They acquire the ability to organize their workdays, as well as reflect upon and plan for professional-personal balance, stress reduction, and personal health.

The competencies listed below are achieved through a required set of rotations at Harbor-UCLA Medical Center, a didactic curriculum that combines both medical and surgical disciplines, and a self tailored set of electives. Our residents, faculty, and program are continuously evaluated to ensure success in achieving these competencies, goals and objectives.   The six ACGME competencies form the basis for our curriculum and include:  Medical Knowledge, Patient Care, Practice-based Learning and Improvement, Interpersonal Relations and Communication Skills with Patients, Professionalism, and System-Based Practice.  A confidential evaluation electronic web-based system, Verinform is used for both Faculty and Resident Evaluations.

Core Curriculum

Core Rotations for TY Residents to achieve the six competencies:

All rotations fulfilling the minimum 24 week requirement of fundamental clinical skill will occur at Harbor-UCLA Medical Center.

• Two months of Inpatient Medicine – one month of general medicine wards and one month of cardiac care unit.
• Two months of General Surgery – One month of Trauma Surgery and one month of general surgery
• One month of Emergency Medicine
• One month of Ambulatory Medicine to be scheduled at the choice of the trainee – Family Medicine, Internal Medicine or Pediatric Medicine.

*In addition to the 24 weeks of FCS scheduled above, six months of electives, including one month of research, if desired by the trainee, are scheduled for the each trainee to ensure that the TY Medicine experience meets the specific educational needs of the individual TY Resident.

Rotation Competency-based Goals & Objectives of all above required and elective rotations are available by clicking the following link Transitional Year Goals & Objectives.

The Competencies:

• Medical Knowledge. Every rotation during your TY Residency Training provides an opportunity to acquire medical knowledge needed to manage a wide range of problems encountered by the general practitioner.  It is important that both faculty and trainees commit themselves to seeing each patient encounter as a potential learning opportunity.  Specifically, while on each rotation TY Resident will:

• Demonstrate a sufficient level of understanding of the clinical, basic and social sciences that underlie the practice of medicine relevant to the evaluation and management common inpatient and outpatient problems in both medical and surgical specialties.

• Apply their knowledge to patient care, patient education, family education, and the education of other members of the health care team.

• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking.

• Use an open-minded, analytical approach to acquiring new knowledge. 

• Access and critically evaluate medical information and scientific evidence.

The core required clinical rotations (fundamental clinical skills, FCS) will the understanding of the pathogenesis, pathophysiology, epidemiology, historical issues, relevant physical findings, test utilization, means of confirming a diagnosis, treatment, monitoring and prevention of the most common inpatient and outpatient clinical disorders cared for by internists.

TY Residents will understand how various aspects of disease are affected by gender, age, ethnicity, culture and disability. In addition to understanding and being able to manage the common diseases in medical practices, residents will incorporate into their practice the following areas that cross all specialties: ethics, psychology, medical-legal issues, medical economics, managed care, public health, familial and societal violence, informatics, record keeping, quality assurance and risk management, and relevant areas of medical and surgical specialties (e.g. neurology, dermatology, ENT, ophthalmology, orthopedics and psychiatry, etc.).

Residents will need to demonstrate in areas for which they have limited prior experience the ability to recognize a problem, characterize it, formulate a question that needs to be answered in order to address the issue, identify sources of information, find and critically appraise relevant literature for accuracy and completeness and develop a plan of action in an effort to solve the problem. During each clinical rotation TY Residents will integrate and interpret factual information, extract knowledge that is relevant to their patient and apply it to their patient after recognizing factors that may influence the plan such as cost, opposition, alternate strategies and adverse effects. In addition, they will subsequently assess the results of their action. Residents will exhibit tolerance and consideration of opinions from others, understand the socioeconomic and cultural context of the problem, consider the problem as an opportunity for change and advancement of knowledge and seek help when the problem is outside the range of knowledge that they possess.

Ultimately, learning will require that the TY Resident be observant, empathetic, and a good listener, be able to recognize contradiction, discrepancy, and separate normal from abnormal findings, organize information, identify issues that have the greatest impact, and estimate the implications of the problem, its severity and extent. Affecting the plan is a key skill for the resident to demonstrate as well as assessing the outcome of their strategy.

• During each rotation, clinical teaching is reinforced by the weekly required Wednesday Core Primary Care Lecture Series.  The TY Resident is expected to attend this conference year round.  In addition, each rotation conducts its own set of didactic topic-based lecture series.  While on each clinical rotation, it is expected that the TY Resident will attend required didactics similar to that of other categorical trainees on that rotation.

• 2.  Patient Care. During every clinical rotation the focus will be on providing excellent patient care to our diverse patient population.  The Patient Care competency includes both “clinical” and management” skills.  TY Residents will:
• Participate in gathering accurate, essential information from all sources, including medical interviews, physical examination, medical records and diagnostic/therapeutic studies.
• Maintain appropriate, accurate, legible and timely medical records
• Participate in and deliver informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference.
• Attain skills in developing, negotiating and implementing effective patient management plans and integration of patient care.
• Participate in performing and interpreting competently diagnostic and therapeutic procedures considered essential to the practice of internal medicine. In addition, all TY Residents will be exposed to a variety of procedures including: performing, using appropriate indications, contraindications and informed consent and evaluating the results of the following procedures: nasogastric tube placement, foley catheterization, pelvic examination and pap smears, EKG interpretation, PFT interpretation, CXR interpretation, basic life and advanced life support, phlebotomy, arterial puncture, paracentesis, thoracentesis, arthrocentesis of the knee, central venous line placement and lumbar puncture.

Department Grand rounds and Morbidity and Mortality Conferences are conducted regularly during all clinical rotations and allow faculty and residents to join together to discuss patient care and management in a case-based format.

3. Practice Based Learning and Improvement. The TY Residency program emphasizes the importance of learning from your experiences.  Experiential learning may include formal written evaluations from supervising residents and Attending Physicians, or informal direct feedback during patient care activities.  All clinical rotations will provide TY Residents the opportunity to:

• Use information technology or other available methodologies effectively to access and manage information, support patient care decisions and enhance both patient and physician education.
• Engage in improvement activities based on an analysis of personal practice experiences and patient population data.
• Develop and maintain a willingness to learn from errors, seeking assistance when necessary.
• Learn to give and receive feedback effectively.
• Develop skills to design and implement strategies to improve the quality of patient care.

During the Institution’s Orientation you will receive instruction regarding the Institution’s Quality and Improvement Program.  The TY Residency Core curriculum also features formal didactics in the areas patient safety and risk management.  During clinical rotations TY Residents are expected to attend the respective Department’s Morbidity and Mortality Conference where an in depth case-based discussion provides the opportunity to learn directly from your clinical experiences.

Formal evaluations from both supervising residents and Attending physicians also provide an assessment of your growth and progress as a physician learner.  Above all however, it is vital that TY Residents understand the concept that the education of the heart and their personal growth is at least as important as the education of their mind and professional growth.

4. Inter Personal Communication Skills.  It is essential that TY Residents know how to alter their communication techniques to be more effective advocates and leaders. This will include the ability of a TY Residents to understand how others perceive them, to be able to modulate what they do so that others perceive them in a more positive environment with particular emphasis on instilling hope in their patients and their loved ones.  Each clinical rotation will afford the TY Resident the opportunity to:

• Display that they can create a therapeutic and ethically sound relationship with patients and their families by using effective communication skills, interpretable language, active and responsive listening, patient education and counseling and assisting other professionals to do the best job possible for patients of common concern.

• Communicates effectively and demonstrates caring, compassionate, and respectful behaviors.

• Demonstrate effective written, verbal and non-verbal communication when participating in patient care, consulting and collaborating with colleagues and coworkers, and teaching and presenting in the academic center, in the community and most importantly during information exchange and collaboration with patients and their loved ones.

• Demonstrate effective listening skills and be able to demonstrate to their patients that they understand their needs.

• Works effectively with other professional associates, including those from other disciplines, to provide patient-focused cares ass a member of a healthcare team.

Supervising residents and Attending Physicians form the basis of the feedback provided related to this competency and will give you both direct verbal and written feedback.  Verbal feedback will occur during all patient care activities.  In addition, written evaluations from supervisors will address this competency separately as it relates to both patients and colleagues.  Lastly,  interpersonal relations and communications skills are provided as a didactic during the required core lecture series on Wednesday afternoons.

5. Professionalism. The cornerstone of training requires physicians to practice with integrity, altruism, and compassion. Four cardinal relationships are fundamental to the understanding of professionalism: 1) your relationship to your self; 2) your relationship to patients and families; 3) your relationship to your colleagues and the profession of medicine; and 4) your relationship to the wider society. Throughout all aspects of training the TY Resident will:

• Practice effective self-care including attention to appropriate limitations in hours of work.
• Demonstrate respect, integrity, and altruism in interpersonal relationships.
• Demonstrate capacity for self reflection and commitment to self improvement in professional development.
• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues above any self interest.
• Identify ethical and legal dilemmas that arise in clinical practice and evaluate critical elements and core principles involved.
• Maintain obligations and due diligence related to matters such as follow-up in patient care, timeliness, accountability, attendance, and documentation.

Topics within the domain of professionalism are also formally addressed in the Institution’s patient safety curriculum, Departmental Grand Rounds, and as part of the Wednesday noon required core curriculum. In addition, it is expected that supervision residents and Attending Physicians will model professional behavior in all aspects of patient care and peer interactions.

One of the important dimensions of professionalism is your responsibility to attend to your evolving professional identity and nurture your developing career. As such, we consider relationships with advisors, mentors, and program directors fundamental. The Program Director for the TY program will serve as the Advisor and Mentor for all TY Residents.  The TY Program Director has an open door policy and strongly encourages residents to meet outside of the two formal meetings scheduled each year to review progress and plan the future, including optimal use of elective time.

6. System Based Practice.   It is important that TY Residents demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  As a TY Resident, your rotations will provide you with the opportunity to:

• Gather information about the community in which one works, including demographics, epidemiology of major health problems, socio-cultural history and values.
• Understands how the resident’s practices affect and are influenced by other healthcare professionals, healthcare, organizations and society.
• Understand, access, and utilize the resources, providers and systems necessary to provide optimal care in this health care system.
• Use fiscal and human resources efficiently and minimize redundant or unnecessary care.
• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.
• Understand and manage risk associated with transfers of care across venues and between providers.

TY Residents will engage in both formal and informal methods to gain competence in system-based practice.  A variety of didactic topics are included in the required weekly curriculum, as well as in departmental Morbidity and Mortality Conferences.  In addition, patient care rounds will focus specifically on the appropriate utilization of health care resources across the continuum of care.  Above all the TY Resident will gain experience in system based practice throughout his/her interactions with the healthcare system and the vast array of professionals and support systems for healthcare delivery.

TY Curriculum:  Competency Based Goals and Objectives

Transitional Year Medicine

Reviewed/revised:  6/01, 10/03, 7/05, 5/07, 6/08