Georgetown University/Department of Medicine

Residents in the Department of Medicine are expected to have increasing levels of responsibility as they progress through residency. Advancement is predicated on progressing from competency to proficiency, and taking on progressive responsibility in all three of the following areas: patient management, teaching and scholarly activity.

The following outline describes minimum expectations for resident responsibility broken down by post-graduate year, and is applicable to every rotation throughout the residency. These are general guidelines, and do not include additional specialty-specific requirements which can be found in the online curriculum for each Departmental rotation.

Patient management / supervision

PGY-1
•   Interns are expected to be able to demonstrate competence in the six general competencies as listed in the GUH curriculum introduction and on the ACGME website.
•   Interns should be experts in collecting and reporting medical information, including but not limited to patient histories, physical examination, basic* laboratory testing, basic radiological imaging, consultant reports, and medical information from outside sources.
•   Interns should demonstrate competence in the interpretation of basic* medical testing, e.g., basic laboratory testing and basic radiological imaging.
•   Interns should demonstrate understanding of the initial management of common medical illnesses, by demonstrating the ability to verbally and in writing order initial diagnostic tests and initial treatment plans for these diseases.
•   Interns are expected to take primary responsibility for patient follow up, including collecting data, informing patients, explaining the results of the tests, and discussing basic management plans for patients under their care.
•   Interns should have basic understanding of invasive medical procedures and participate in these procedures under the supervision of a more senior resident, fellow or attending physician.

* "Basic" refers to common initial laboratory and radiologic testing for inpatients and outpatients. Examples include metabolic panels, complete blood counts, urinalyses, coagulation panels, cardiac chemistries, basic EKG interpretation, chest X-rays, microbiologic culture reports, etc.

PGY-2
•   Second year residents are expected to demonstrate not simply competence, but proficiency in all the responsibilities listed above for a PGY-1 resident.
•   Additionally, second year residents should be experts in the interpretation of basic* medical testing, e.g., basic laboratory testing and basic radiological imaging, and should have understanding of the interpretation of advanced** medical testing.
•   Second year residents should demonstrate understanding of both the initial and the ongoing management of common medical illnesses, and should have understanding of the initial management of rare and complex medical conditions.
•   Second year residents are expected to oversee and supervise interns and medical students, lead work and management rounds, and take primary responsibility for the overall supervision of patient management.
•   Second year residents should be competent in the performance of invasive medical procedures and independently perform these procedures under the supervision of a more senior resident, fellow or attending physician.
•   Although typically this responsibility will fall upon a third year resident, second year residents should be competent at acting as supervisor for a Code Blue ("code leader").

** "Advanced" refers to more specialized / uncommon laboratory and radiologic testing for inpatients and outpatients. Examples include autoimmune serologies, neuroendocrinological testing, pulmonary function testing, interpretation of nuclear cardiology imaging, etc.

PGY-3
•   Third year residents terns are expected to demonstrate proficiency in all the responsibilities listed above for a PGY-2 resident.
•   Additionally, third year residents should be proficient in the interpretation of advanced** medical testing and the initial and ongoing management of rare and complex medical conditions.
•   Third year residents should be proficient in the performance of invasive medical procedures and independently perform these procedures under the supervision of a fellow or attending physician.
•   Third year residents are expected to oversee and supervise interns and medical students, lead work and management rounds, and take primary responsibility for the overall supervision of patient management. Additionally, third year residents should be able to supervise and assist second year residents when needed. Examples include guidance with management of complicated medical disorders, supervision of more advanced invasive procedures, and acting as "code blue" leader.

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Scholarship / self-directed learning / teaching

PGY-1
•   In order to improve medical knowledge, interns should be prepared to read, review and understand general medical "textbook" material, and be prepared to review general medical literature as it relates to medical diagnosis and management, e.g., review articles.
•   Interns should take part in continuing self-directed learning with emphasis on understanding the pathophysiology, diagnosis and management of patients under their care.
•   Interns should be prepared to assist their resident in the education of medical students with a focus on practical management of patients under their care.
•   Interns should take part in scholarly work with a goal of writing up and defending a clinical vignette based upon a patient under their care (all residents are expected to complete at least one scholarly project by the completion of residency).

PGY-2
•   Second year residents should demonstrate proficiency in all the responsibilities listed above for a PGY-1 resident.
•   Second year residents should be able to review the medical literature and understand the practical application of this material.
•   Second year residents should take part in continuing self-directed learning with emphasis on understanding the diagnosis and management of patients under their care, and applying medical literature to their practice.
•   Second year residents should serve as the primary educator for students and interns during inpatient work and management rounds, and demonstrate the ability to disseminate clinical information to the team, based upon medical "textbook" material as well as general medical literature, e.g., review articles.
•   Second year residents should take part in scholarly work with a minimum goal of writing up and defending a clinical vignette based upon a patient under their care (all residents are expected to complete at least one scholarly project by the completion of residency). Second year residents interested in more advanced scholarly activity should prepare a research plan with their assigned mentor and the Associate Program Director for Research (Dr. Joseph Timpone). This plan may include designated time to design and prepare a research project, a dedicated month to perform at least the initial aspects of the research, and an expectation for the dissemination of the research outcomes both during and at the conclusion of the work (e.g., Research Noon Conference, poster presentations at the regional ACP meeting).

PGY-3
•   Third year residents should demonstrate proficiency in all the responsibilities listed above for a PGY-2 resident.
•   Second year residents should be able to review and critically appraise the medical literature and understand the practical application of this material.
•   Third year residents should take part in continuing self-directed learning as above, however should also begin to focus their self-education on their future career plans. This includes the selection of research and / or other electives with a greater emphasis on their field of choice, reviewing and critiquing medical literature in both general medicine and their field of choice, and taking part in selected specialty or subspecialty meetings.
•   Third year residents should serve as the primary educator for students and interns during inpatient work and management rounds, and will have the opportunity to take part in the Argy Teaching elective, during which the resident will prepare both didactic and case-based education for medical students under the supervision of the Clerkship Director (Dr. Sean Whelton) and the Program Directors.
•   Third year residents should take part in scholarly work as listed above, with the goal of completing research / scholarly projects begun in year two, submitting material to ACP and/or specialty meetings, and similar dissemination of scholarly work as outlined above.