Internal Medicine
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Intent:
ACGME Internal Medicine Residency Requirements state that there must be institutional policies specifically pertaining to internal medicine training.
Policy Statement:
The Internal Medicine Residency Program will be in compliance with all requirements. The Graduate Medical Educational Committee will monitor these issues during the internal review process.
Description:
A sponsoring institution must not place excessive reliance on residents to meet the service needs of the participating training sites. To this end, the sponsoring and participating institutions must have institutional written policies or procedures that address the following:
- Residents must not routinely be required to provide intravenous, phlebotomy, or messenger/transport services.
- Residents' service responsibilities must be limited to patients for whom the training program bears major diagnostic and therapeutic responsibility.
- On inpatient rotations, residents should have continuing responsibility for most of the patients they admit.
- Supervision by faculty members must be provided for all patient care activities in which residents are engaged.
- Educational experiences must include interactions with attending physicians and other residents, as well as teaching rounds, conferences, evaluation, and formative feedback.
- For each rotation or major clinical assignment, the teaching ratio must not exceed a total of 8 residents or students to one teaching attending.
- Total required emergency medicine experience must not exceed 3 months in 3 years of training for a resident.
- Total required critical care experience must not exceed 6 months in 3 years of training for a resident. (Note: When elective experience is added in the critical care unit, it must not result in more than a total of 8 months in 3 years of training for any resident)
- When averaged over any 4-week rotation or assignment, residents must not spend more than 80 hours per week in patient care duties.
- Residents must not be assigned on-call in-house duty more often than every third night.
- When averaged over any 4-week rotation or assignment, residents must have at least 1 day out of 7 free of patient care duties.
- During emergency medicine assignments, continuous duty must not exceed 12 hours
- Emergency medicine or night float assignments must be separated by at least 10 hours of non-patient care duties.
- During ambulatory assignments, a first-year resident's patient load, on average, must not exceed two new patients or more than six return patients per ½ day session.
- On inpatient rotations or assignments:
- A first-year resident must not be assigned more than five new patients per admitting day; an additional 2 patients may be assigned if they are in-house transfers from the medical services.
- A first year resident must not be assigned more than eight new patients in a 48-hour period.
- A first-year resident must not be responsible for the ongoing care of more than 12 patients.
- The program must demonstrate a minimum of 210 admissions per year to the medical teaching services for each first-year resident.
- When supervising more than one first-year resident, the supervising resident must not be responsible for the supervision or admission of more than 10 new patients and 4 transfer patients per admitting day or more than 16 new patients in a 48-hour period.
- When supervising one first-year resident, the supervising resident must not be responsible for the ongoing care of more than 16 patients.
- When supervising more than one first-year resident, the supervising resident must not be responsible for the ongoing care of more than 24 patients.
- First-year residents should interact with second or third year internal medicine residents in the care of patients.
- Second or third year internal medicine residents or other appropriate supervisory physicians (e.g., subspecialty residents or attendings) with documented experience appropriate to the acuity, complexity, and severity of patient illness must be available at all times on-site to supervise first-year residents
- On inpatient rotations, residents should have continuing responsibility for most of the patients they admit.
- Residents from other specialties must not supervise internal medicine residents on any internal medicine inpatient rotation.
- Residents must write all orders for patients under their care, with appropriate supervision by the attending physician. In those unusual circumstances when an attending physician or subspecialty resident writes an order on a resident's patient, the attending or subspecialty resident must communicate his or her action to the resident in a timely manner.
- There must be a resident on-call schedule and detailed check-out and check-in procedures, so residents will learn to work in teams and effectively transmit necessary clinical information to ensure safe and proper care of patients.
- The on-call system must include a plan for backup to ensure that patient care is not jeopardized during or following assigned periods of duty.
- There must be a minimum of 6 months of inpatient internal medicine teaching service assignments in the first year.
- There must be a minimum of 6 months of inpatient internal medicine teaching service assignments over the second and third years of training combined.
- The required 12 months of inpatient internal medicine must include a minimum of 3 months of inpatient general internal medicine teaching service assignments over the 3 years of training.
- Geographic concentration of inpatients assigned to a given resident is desirable because such concentration promotes effective teaching and fosters interaction with other health care personnel.
(Note: These limits may be increased by 2 in special rotations where each admission does not require a full work-up, providing it is educationally justified).
Last Review: Institutional Committee for Graduate Medical Education June 12, 2003
