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Family and Community Medicine

Longitudinal Curriculum in Critical Thinking

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Critical Thinking Curriculum Journal Club
Chart Review Resident Project

The Longitudinal Curriculum in Critical Thinking is designed to assist residents obtain skills to evaluate and appropriately implement new information, develop methods of monitoring on-going care, and appreciate the need for lifelong learning in an increasingly complex and technological medical environment. The Family Practice residency program's longitudinal curriculum in critical thinking includes the following components:

Critical Thinking Curriculum

Year Training Activity Timing/Deadlines
Longitudinal Resident Conferences devoted to research design and methodology Throughout the year
Journal Club One per year/resident
Journal Club Schedule
PGY I Informatics training with a Medical Librarian Office rotation month
HIPAA Research Training New Resident orientation
PGY II Review of 10 charts using ABFP Reference Guides Office Rotation; written report due June 1
CITI training
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Independent study, complete by Dec. 1
iRIS training Resident Conference,Feb-March
Prepare Resident Project protocol: Objectives, methods, subjects, non-scientific summary, consent form (if applicable) Complete by May 1
Submit IRB application via iRIS Submit by June 1
Present Resident Project plan Resident Conference, June
PGY III Conduct Resident Project activities July-March
File applicable reports with IRB Throughout the year
Complete Progress Report form May 1
Present project report and findings Resident Conference, June
Prepare written report Due by June 30
Present at regional or national meeting or submit for publication, if appropriate
PGY II & III Research Elective: Conduct of a more in-depth and substantial research project under the direction of a faculty mentor Project completed by May 1

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Journal Club

  • Journal Club Rationale: The primary assumption on which the Journal Club is based is that while a consistent and close reading of the medical literature is essential to the practicing physician, time constraints prevent the busy clinician from reading every article that might be useful to his or her patients and practice setting. Thus, the Journal Club in the Family Practice Residency Program offers an on-going opportunity for resident physicians to share interesting, useful, and provocative articles among themselves. By giving Journal Club presentations, residents sharpen their presentation skills as well as their expertise in reading and analyzing medical literature. Those who attend add to their knowledge base and participate in lively discussions on pertinent topics.
  • Article Selection. Most often, articles selected for discussion during the Journal Club are clinical in nature, although they need not be. For example, articles on practice management or health care policy may yield fruitful discussion as well. Articles may come from any refereed journal in any health-care specialty.
  • Presentation Scheduling. Currently, Journal Club presentations are scheduled once or twice per month during Tuesday afternoon conferences. They are held in one-hour blocks that include two resident presentations and a summation by a faculty monitor. Ideally, a resident should have selected his or her article by the Tuesday preceding the presentation and should provide copies of the article to the other resident sharing the hour and to the faculty monitor.
  • Presentation Content. An available worksheet may be used as a guide for the content and/or organization of Journal Club presentations. Not all of the points included may be applicable to each article, and other information may be useful as well.
  • Presentation Techniques. Residents may wish to make copies of the article for others who attend the presentation, depending on the article's length and the presenter's assessment of its usefulness. Overhead transparencies depicting research results or summarizing the article's major points may be helpful as well. The blackboard may also be used to illustrate data, chronology, statistics, or other information.
  • Faculty Monitor's Participation. The faculty monitor, who will be appointed prior to the presentation, will attempt to help residents assess whether the articles discussed in the day's presentation are meaningful to the family physician. He or she will supplement the two presentations and may show relationships between presentations, demonstrate appropriate clinical situations, or provide another perspective on the resident's presentation and ensuing discussion.

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Chart Review

During the second year of residency training, each resident is required to perform an audit of at least 10 charts to investigate one of the specific issues addressed by the American Board of Family Practice Reference Guides. The aim of this component of the critical thinking curriculum is to gain experience in continuous quality assessment and improvement; it is exclusively educational and directed at quality improvement—not research.

During the Office Rotation month or another convenient time, residents will examine at least 10 of their own charts to determine appropriateness of treatment and chart management, based on practice guidelines published in the Reference Guides. PGYII residents will complete and submit a Chart Review Report Form by June 1.

Topics currently addressed in the Reference Guides include:

Acute Appendicitis Geriatric Patient
Alcoholism & Alcohol Abuse Hypertension
Carcinoma of the Breast Irritable Bowel Syndrome
Chronic Heart Failure Low Back Pain
Coronary Artery Disease Menstrual Disorders
Depressive Disorders Osteoarthritis
Diabetes Mellitus Urethral Discharge
Duodenal Ulcer Urinary Tract Infection
Normal Pregnancy Well Child Care
COPD (Chronic Obstructive Pulmonary Disease)

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Resident Project

The Resident Project, which spans the PGYII and PGYIII years,is designed to provide residents with training in research design and methodology that will help to improve their critical reading of the medical literature, foster lifelong learning, and provide hands-on experience with the systems, processes, and protocols for critical thinking and investigation. The aim of this component of the critical thinking curriculum is to allow residents protected time to satisfy their natural curiosities about issues of professional interest. Ideally, the study question will arise from the resident's patient care experience or future practice plans, but it may be a part of an on-going collaborative project involving other residents or faculty.

During the PGYII year, residents will receive training in the systems in place in an academic medical center to oversee research and provide protections for human subjects and medical information. They will plan their own project and submit all required applications with at least one faculty member serving as co-investigator. Residents will provide a brief report to their peers about their plans and progress at the end of the PGYII year.

During the PGYIII year, residents will undertake all project activities and provide a formal report to their peers at the end of that year. They will also produce a written report, which may take the form of a handout and other materials prepared for the formal report. Residents are encouraged to develop their projects as fully as they might wish, with opportunities for dissemination including poster sessions at regional and national meetings and articles submitted for publication.

Possible project methodologies could include:

  • Surveys
  • In-depth chart audits
  • Clinical research
  • Testing of clinic or practice management systems

Residents who wish to undertake a Research Elective will be expected follow the requirements for the regular Resident Project, but are expected to select a project with a larger scope or greater complexity under the direction of a faculty mentor.

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