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Don’t worry about how the text looks – just send it to me and I will make it look pretty.

The AME format will be much the same as we are doing now. The basic format will be:

ACGME Core Competencies

Learning Objectives

Introduction

Content

Cases and Questions

Answers

References

On the following pages you will find a detailed description of each of these categories.

Please try stick to this basic format.

ACGME Core Competencies:

List all of the ACGME core competencies that will be covered in your presentation. In case you forget what they are, here are the core competencies (in your AME you only need to list them):

Patient Care

The first ACGME core competency area, "Patient Care", states that residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. According to the ACGME, residents are expected to:

1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.

2. Gather essential and accurate information about their patients.

3. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

4. Counsel and educate patients and their families.

5. Use information technology to support patient care decisions and patient education.

6. Competently perform all medical and invasive procedures considered essential for the area of practice.

7. Provide health care services aimed at preventing health problems or maintaining health.

8. Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Medical Knowledge

The second ACGME core competency area, "Medical Knowledge", states that residents must demonstrate knowledge about established and evolving biomedical, clinical and cognate (epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. For this ACGME competency area, residents are expected to:

1. Demonstrate an investigatory and analytic thinking approach to clinical situations.

2. Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.

Practice-Based Learning and Improvement

For the third ACGME core competency area, "Practice-Based Learning and Improvement", residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. In this area, residents are expected to:

1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.

2. Locate, appraise and assimilate evidence from scientific studies related to their patient’s health problems.

3. Obtain and use information about their own population of patients and the larger population from which their patients are drawn.

4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

5. Use information technology to manage information, access online medical information; and support own education.

6. Facilitate the learning of students and other health care professionals.

Interpersonal and Communication Skills

In the fourth ACGME core competency area, "Interpersonal and Communication Skills", residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange, and teaming with patients, their families and professional associates. To demonstrate competency in this ACGME area, residents are expected to:

1. Create and sustain a therapeutic and ethically sound relationship with patients.

2. Use effective listening skills, and elicit and provide information using effective nonverbal, explanatory questioning and writing skills.

3. Work effectively with others as a member or leader of a health care team or other professional group.

Professionalism

For the fifth ACGME core competency area, "Professionalism", residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. The ACGME states that residents are expected to:

1. Demonstrate respect, compassion and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and ongoing professional development.

2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices.

3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities.

Systems-Based Practice

The sixth ACGME core competency area, "Systems-Based Practice", states that residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. To demonstrate competency in "Systems-Based Practice", the ACGME expects residents will be able to:

1. Understand how their patient care and other professional practices affect other health care professionals, the health care organization and the larger society, and how these elements of the system affect their own practice.

2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.

3. Practice cost-effective health care and resource allocation that does not compromise quality of care.

4. Advocate for quality patient care and assist patients in dealing with system complexities.

5. Know how to partner with health care managers and health care providers to assess, coordinate and improve health care, and know how these activities can affect system performance.

INTRODUCTION

This should be a brief statement of the importance of your topic, a ‘hook’ if you will, to get the reader interested. This may be a good place to ask a question that you know the residents don’t know the answer to.

LEARNING OBJECTIVES

A good learning objective is a brief, clear statement of what the student should be able to do as a result of training. It should look at how the learning relates to successful completion of the task or job. Good learning objectives:

1. Focus on student performance, not teacher performance.

2. Focus on product - not process.

3. Focus on terminal behavior - not subject matter.

4. Include only one general learning outcome in each objective.

Good learning objectives describe the behavior of the learner, and:

▪ are stated clearly

▪ define or describe an action

▪ are measurable, in terms of time, space, amount, and/or frequency.

Measurable Action Words (examples)

Recognize |Prioritize |Analyze |Create |Discuss | |Construct |Articulate |Describe |Apply |Assess | |Evaluate |Identify |Develop |Define |List | |

Words to avoid are to “To know” or “To Understand”. These are passive, can be answered with a yes or a no, and are difficult to measure: Do you know the causes of congestive heart failure?” asks the teacher. “Yes,” says the student. Better: “ Identify three causes of CHF,” says the teacher. In answering, the student demonstrates whether or not they really know something. Good learning objectives are short, contain only one thought per line, and are specific.

For example:

BAD: After this presentation the student should recognize the causes of renal failure.

BETTER: After this presentation the student should recognize five causes of renal failure.

The latter objective is objective is specific and measurable. The first one is not.

More good examples:

After this presentation the student should be able to:

1. List five indicators that link a healthy community to healthy economy

2. Demonstrate the proper technique in breaking bad news

3. Define the terms withdrawal, tolerance and addiction

4. Create a differential diagnosis for chest pain

5. Describe the first 3 steps in evaluating the chest pain patient

6. Properly dose 3 types of steroids in COPD

If you find it difficult to do this send me what you have and I will help you.

CONTENT

This is where you research a topic and present what you want the learner to learn. Here are some suggestions:

1. Keep it short – no more than 2 to 4 pages (12 font). If you can’t fit into 2 to 4 pages we’ll split it up into two or more weeks

2. Keep it relevant – topics should be things a primary care physician is likely to encounter during daily practice.

3. Keep it practical – make sure you have 3-5 take home points, and highlight what those points are.

4. Use a bottom line approach – provide a reference where the reader can go if he/she desires more information.

5. If you need tables or graphs let me know what they are I will get them for you.

CASES AND QUESTIONS

When we go web based I envision a set of cases and questions to begin each module with. The learner would have to answer the questions before getting to the module (if you want to see an example of what this looks like see: )

Preferred approach: write a realistic case or set of cases and ask several questions – some multiple choice, others for discussion (See example at end of this section)

What will make this project special is the quality of these cases.

An Example of a case followed by questions:

A 59-year-old man with no past medical history comes to your office because he was found to have high blood pressure on an insurance physical exam (he hands you the report -- BP right arm 170/100, left arm 168/100). He tells you an old doctor in the past said his blood pressure was a little high, but he didn’t prescribe anything. He feels well and has no complaints (other than the fact that his insurance rates are now much higher than before). He plays golf one time a week, using a cart most of the time. He does no other exercise. He has been trying to lose weight. He takes no prescribed drugs. He smokes four cigarettes a day (more on the weekends). He drinks a six-pack on Sundays. His brother had a heart attack at age 53.

BP right arm 180/104

BP left arm 176/102

Pulse 88

BMI 33

Normal Fundi

Neck: No bruits

Heart:II/VI SEM

Lungs: CTA

Abd: Obese, no bruit

Ext: no edema, 1+ pulses

1. The patient asks you if he has hypertension. Your best response:

A. Duh.

B. He has new classification stage 1 hypertension

C. He has new classification stage 2 hypertension

D. You don’t call it hypertension unless you’ve taken it yourself on two separate occasions

2. The patient tells you that he hates doctors because of an unfortunate incident involving an ear speculum when he was younger, and he gets nervous when he sees your white coat. He has a friend who wore a BP monitor at home and asks you if he could get one. You tell him:

A. Studies have shown there is no such thing as white coat hypertension

B. Studies have shown that white coat hypertension is a greater risk factor than levels measured by ambulatory blood pressure monitoring

C. Studies have shown that ambulatory blood pressure monitoring correlates better with office measurement for end organ damage

D. If blood pressure goes up when you sleep and you have a dream about it, you will die in your sleep

E. If blood pressure fails to decrease during sleep, there is an increase in cardiovascular events

3. What initial studies should you order for your patient?

A. EKG

B. UA

C. Blood glucose

D. Hematocrit

E. Potassium

F. Creatinine

G. Calcium

H. Lipid profile

4. Your patient has normal labs except for a fasting LDL cholesterol of 188, HDL of 33, and TG’s of 399, and glucose of 146. Given the entire scenario, how many major cardiac risk factors does he have?

A. 2

B. 4

C. 6

D. 8

E. 10

5. Should you prescribe medications for your patient at this visit?

6. If so, what drug (s) will you prescribe

7. If you are going to give you patient medications, how important is it for him to follow a diet?

ANSWERS

Provide answers to your questions, and the reasoning behind each answer.

Example of answers to above case:

Answers:

1. Answer C. Stage 2. The classification system has been simplified in JNC VII compared with JNC VI. D. is not correct because the patient has had at least two checks in the past.

2. Answer C and E : Ambulatory blood pressure monitoring (ABPM)17 provides information about BP during daily activities and sleep. ABPM is warranted for evaluation of “white-coat” hypertension in the absence of target organ injury. It is also helpful

to assess patients with apparent drug resistance, hypotensive symptoms with

antihypertensive medications, episodic hypertension, and autonomic dysfunction.

The ambulatory BP values are usually lower than clinic readings. Awake, individuals

with hypertension have an average BP of more than 135/85 mmHg and

during sleep, more than 120/75 mmHg. The level of BP measurement by using

ABPM correlates better than office measurements with target organ injury.18

ABPM also provides a measure of the percentage of BP readings that are elevated,

the overall BP load, and the extent of BP reduction during sleep. In most

individuals, BP decreases by 10 to 20 percent during the night; those in whom

such reductions are not present are at increased risk for cardiovascular events.

3. All correct: Routine laboratory tests recommended before initiating therapy include an

electrocardiogram; urinalysis; blood glucose and hematocrit; serum potassium,

creatinine (or the corresponding estimated glomerular filtration rate [GFR]),

and calcium;20 and a lipid profile, after 9- to 12-hour fast that includes high density

lipoprotein cholesterol and low-density lipoprotein cholesterol, and

triglycerides. Optional tests include measurement of urinary albumin excretion

or albumin/creatinine ratio. More extensive testing for identifiable causes

is not indicated generally unless BP control is not achieved.

4. Answer is D, eight (HTN, smoking, obesity, inactivity, dyslipidemia, diabetes, age, family history)

5. Yes

6. Best choices: ACE inhibitor, thiazide diuretic. Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers).

7. Very important: Adoption of healthy lifestyles by all persons is critical for the prevention of

high BP and is an indispensable part of the management of those with hypertension.

Major lifestyle modifications shown to lower BP include weight

reduction in those individuals who are overweight or obese,23,24 adoption of

the Dietary Approaches to Stop Hypertension (DASH) eating plan25, which is

rich in potassium and calcium,26 dietary sodium reduction,25–27 physical activity,

28,29 and moderation of alcohol consumption. (See table 5.)30 Lifestyle modifications

reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular

risk. For example, a 1,600 mg sodium DASH eating plan has effects

similar to single drug therapy.25 Combinations of two (or more) lifestyle modifications

can achieve even better results.

REFERENCES

Provide a list of references, and proved the link to any on-line resources that the learner can go to for more information.

Example:

-----------------------

AME FORMAT

Author: Eric Warm M.D.

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