General Medicine

Goals and Objectives

Medical Expert

  • Become more familiar with the clinical manifestations, investigations, and treatment of patients with common medical diseases. Gain experience dealing with patients in ambulatory care, emergency care, and in-hospital settings.
  • Perform a complete and appropriate assessment in the discipline.
  • Effectively identify and explore issues to be addressed in a patient encounter, including the patient’s context and preferences.
  • Elicit a history that is relevant, concise, and accurate.
  • Perform a focused physical examination that is relevant and accurate.
  • Select medically appropriate investigations in a resource effective and ethical manner.
  • Use appropriate and timely preventive and therapeutic interventions.
  • Implement an appropriate management plan in collaboration with a patient and their family.
  • Ensure appropriate consent is used for therapies.
  • Ensure patients receive appropriate end-of-life care.
  • As determined by the rotation supervisor(s), demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic, in particular those which result in material being sent for laboratory tests.
  • Become familiar with the means by which specimens are collected and transported to the laboratory, including the necessary paperwork that must be completed.
  • Ensure appropriate consent is obtained for these procedures.
  • Become familiar with the appropriate use of the autopsy as an end-of-life diagnostic tool, including:
  • Knowledge of provincial legislation pertaining to autopsy consent.
  • Knowledge of the chain of consent for autopsy and how consent should be obtained.
  • Knowledge of which deaths should be reported to the Coroner’s Office.

Specific Goals

  • To provide trainees with sufficient knowledge and skills to be confident in the detection and management, at a primary care level, of the most frequent forms of illness encountered in internal medicine.
  • To have knowledge of the common symptom complexes, acute illnesses and medical emergencies presented in an ambulatory care setting, as well as in the hospital, including the ability to diagnose and manage many of the following illnesses:
    • Myocardial infarction
    • Angina
    • Congestive heart failure
    • Bronchial asthma, exacerbation of chronic obstructive lung disease
    • Cardiac arrhythmias and cardiac arrest
    • Cerebrovascular accident
    • Drug overdose and poisoning
    • DVT/pulmonary embolism
    • Gastro-intestinal bleeding/peptic ulcer disease
    • Diabetes/hypoglycemia
    • Hypertension
    • Common infections such as pneumonia, cystitis and pyelonephritis
    • Altered level of consciousnessAcid base, fluid and electrolyte balance
    • Acid base, fluid and electrolyte balance
    • Anemias
    • Jaundice
    • Obesity
    • Seizure disorders
    • Degenerative and rheumatoid arthritis
    • Parkinson’s disease
    • Tuberculosis
    • Bleeding disorders
    • Sexually transmitted diseases
    • Myxedema and thyrotoxicosis
    • Peripheral vascular disease
    • Gout
    • Dementia
    • Acute and chronic renal failure
    • Aging and its influence on presentation, diagnosis and management
    • Headache
    • Common peripheral nerve disorders
    • Leukemias, lymphoma, multiple myeloma
    • HIV/AIDS
    • Neoplastic diseases
    • Knowledge of the side effects of treatment including drug toxicities.
    • Knowledge of the resuscitation and management of the critically ill- patient.
    • Learn to perform the following procedures:
    • insertion and management of intravenous lines
    • obtain an arterial blood gas
    • an electrocardiogram
    • bladder catheterization

Communicator

PGY1 residents should begin developing their role as communicators, encompassing all the competencies specified in the Royal College Objectives of Training in the Laboratory Medicine Programs. Specific objectives for pathology residents in their PGY1 year are:

  • Observe the means by which a pathologist communicates with their clinical colleagues (e.g. via written reports and at interdisciplinary rounds, informally) Reinforce with their clinical colleagues the need to provide appropriate clinical information when providing material for laboratory testing.
  • Read pathology and other lab reports on their own patients, and critically evaluate the effectiveness and relevance of the information provided for the management of those patients.
  • Appreciate the impact of acute or chronic illness on a child and his/her family and provide empathetically the appropriate information and support. Similarly, appreciate the impact of critical illness on a critically ill patient and his/her family.

Collaborator

  • Participate effectively and appropriately in a health care team.
  • Develop knowledge of the roles and responsibilities of a Pathologist in the team.
  • Develop knowledge of, and respect for, the roles and responsibilities of other professionals in the team.
  • Work with others to assess, plan, provide and integrate care for patients.
  • Attend and participate in interprofessional team meetings, including cancer teams.
  • Gain insight into means by which pathologists can provide direction in a health care team.
  • When possible, visit the pathology laboratory to review specimens from patients under your care, and report back the findings to clinicians.

Manager

  • Gain knowledge of the indications for, and effects of, admitting a patient to hospital.
  • Gain knowledge of the judicious use of available resources, particularly with respect to diagnostic and therapeutic procedures that directly or indirectly effect the laboratory (e.g. use of ordering of laboratory tests).
  • Observe ways in which pathologists contribute to the effectiveness of health care organizations and systems.
  • Learn to manage one’s practice and career effectively, with respect to:
    • setting priorities/effect time management
    • balancing one’s work and home life
    • employing appropriate use of information

Health Care Advocate

  • Respond to individual patient health care needs and issues as part of patient care. This includes learning to identify what these needs are, and identifying opportunities for advocacy, health promotion, and disease prevention among one’s patients.
  • Begin to identify the health needs of the community served by different clinical disciplines, including:
    • opportunities for advocacy, health promotion, and disease prevention among these communities
    • vulnerable or marginalized populations within those served
    • barriers to access to care and resources
  • When possible, attend autopsies of persons under one’s clinical care.
  • Gain knowledge of home and community services for the chronically ill.
  • Attend PGY1 Infection Control and Patient Safety Workshops.

Scholar

  • Maintain and enhance professional activities through ongoing learning, including: attendance at rounds as determined by the rotation, attendance at AP/GP academic full- day, individual study, etc.
  • Learn to critically evaluate medical information at its sources and apply this appropriately to practice decisions.
  • Attend Journal Clubs and Grand Rounds where medical literature is evaluated.
  • Facilitate the learning of others, which as a PGY1 could include: explaining medical conditions and procedures to patients and their families, medical students, residents.
  • Contribute to the development and dissemination of new knowledge and practices.
  • Observe ways in which staff and other colleagues practice evidence-based medicine.
  • Use one’s own clinical cases to propose scholarly questions and conduct a systemic search for evidence relating to pathogenesis, management, etc. for the illnesses/situations encountered. Disseminate one’s findings to colleagues.

Professional

  • Demonstrate commitment to patients, the profession, and society through ethical practice, including:
  • Schedule or report absences from work as required by the rotation, with respect for the needs of the service and one’s colleagues.
  • Attend learning activities as required, including workshops, orientations, and academic full-days.
  • Explore the professional bodies of which pathologists are typically members (e.g. Canadian Association of Pathologists, USCAP, etc).
  • Demonstrate a commitment to physician health and sustainable practice.
  • Observe how staff physicians and other colleagues strive to balance personal and professional priorities.
  • Learn to balance one’s own personal and professional.

 

Updated April, 2020

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