Name of the Department: – Internal Medicine
Background of the department
Internal Medicine is a specialty program given to medical doctors for three years with the goal to produce the best possible physicians who practice safely and meet the health care needs of society. Medical educators, trainees, patients, and society recognize that being well trained in the scientific aspects of medicine is necessary but insufficient for effective medical practice; a good doctor must draw upon a wide array of knowledge and skills. The six core competencies included in Ethiopian Postgraduate Internal Medicine Training (EPGIMT), which is applied in postgraduate training programs in many countries, offers a model of physician competencies that emphasizes not only medical expertise, but also multiple additional nonmedical expert roles that aim to serve society’s needs competently.
An internist is a medical doctor who has passed through three years of internal medicine residency training program and proved qualified in all of the six EPGIMT core competencies or roles in internal medicine applying medical knowledge, clinical skills, and professional attitudes to the provision of patient-centered care.
Program Title: Internal Medicine specialty training program
Program Code: IMED
Objectives of the program
To produce internal medicine specialists who promote health and prevent disease for individuals, families, and communities at all levels of the health care system.
To produce internal medicine specialists who:
- are able to lead and manage internal medicine health services.
- ensure improvement of care that is appropriate, effective, compassionate, and safe in dealing with health problems and promotion of health, including a patient-centered and holistic approach.
- can effectively teach and facilitate learning in their field of expertise and act as a role model for learners.
- to become advocates for the promotion of health, prevention of disease, and prioritization of internal medicine care.
- are able to conduct clinical, epidemiological, and operational research to improve clinical service and health care system response.
- act according to ethical and legal principles.
- ensure that trainees have appropriate working conditions to maintain their own health.
- who are lifelong learners and are able to critically think and solve problems and develop innovative solutions for new problems.
The graduates of the program have to achieve the following competencies during their stay three-year course of study.
A graduate of this residency training program is expected to have the knowledge, skills, clinical judgment, attitudes, and values of professionalism that are essential to the practice of internal medicine. A graduate will be able to manage all aspects of infectious diseases, cardiac illnesses, hematologic diseases, pulmonary and critical illnesses, kidney diseases, neurologic diseases, gastrointestinal diseases, endocrine diseases, rheumatologic, and emergency diseases. A graduate will be able to manage common dermatologic, psychiatric, and oncologic diseases. The graduate is expected to work in inpatient and outpatient hospital settings, and critical care units.
The graduate will maintain his/her skills in general medicine and will have the required knowledge and skills to work with and support colleagues in many other specialties including obstetrics and gynecology, surgery, oncology, and emergency medicine, among others.
The graduate is expected to have the knowledge and skills to plan and implement health promotion and prevention programs for infectious and non-communicable diseases.
Additionally, teaching internal medicine to medical students and junior colleagues; planning and conducting clinical research in internal medicine are desirable attributes of graduates from the residency program.
A graduate of this residency training program is expected to have the following specific competencies:
Make a clinical assessment and provide management to patients presenting with but not limited to:
- Disturbed kidney functions and fluid and electrolytes balance, hypertension, acute, and chronic renal failure.
- Hematologic problems: management of anemia, bleeding disorders, chronic myelogenous and lymphocytic leukemia and lymphomas.
- Endocrine abnormalities: diabetes mellitus, thyroid diseases, adrenal abnormalities.
- Cardiac abnormalities: chronic rheumatic heart disease, ischemic heart disease, heart failure, cardiomyopathies.
- Infectious diseases including HIV/AIDS.
- Pulmonary and critical illnesses: pneumonia, tuberculosis, airway diseases, pulmonary embolism, sepsis, acute respiratory failure.
- Gastrointestinal abnormalities: peptic ulcer disease, liver diseases, pancreatic diseases, diarrhea, and malabsorption.
- Neurologic disorders: stroke, seizure disorders, movement disorders, peripheral neuropathies, spinal cord abnormalities.
- Rheumatologic diseases: Rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis.
- Dermatologic illness: allergic and infectious dermatitis.
- Oncologic diseases: Cancer of lung, GI.
- Psychiatric illnesses: depression, psychotic and anxiety disorders
- Design a research protocol to ascertain the burden of medical disease in a national or regional population.
- Implement a strategy for the prevention of medical disease in a defined patient population.
- Promote the support of programs for treating patients with medical disease by health programs and contribute to the cost-effective implementation of such programs.
- Participate in the management of health services so as to achieve optimal allocation of resources for the care of patients with medical disease.
- The contents for this training program are designed to meet the highest standards of training in internal medicine that will make it to be on a par with training programs provided by similar programs in the other parts of the world. At the same time the contents are tailored to meet the needs of internal medicine care in Ethiopia and will reflect the spectrum and burden of medical diseases in the country.
- Although the modules are sequenced in such a way that they could enable the residents to get clinical experiences from routine medical care to more complex exposure, a longitudinal and continuous experience of patient care is needed. To observe the evolution of diseases, follow treatment outcomes and complications, develop long-term relationship with patients, and understand the personal and social impact of diseases in patients, continuous involvement in the outpatient care of patients in a longitudinal fashion is needed. This is a distinctive feature of clinical training programs.
- Year one of the training program – Consists of eight modules which are conducted separately except for one module which is the Ethics module, which will be conducted for a few weeks in a longitudinal fashion. The total workload in the first year is 48 European Credit Transfer System (ECTS) credit equivalents which need to be completed in 11 months with one month of vacation.
- Although all modules are expected to be completed during the first year, one module is not considered a prerequisite to the other. Some residents are assigned to start one module along with supervising consultants, while other residents will start a different module with different consultants. At completion of the modules, residents will switch. Residents are expected to keep log books to document all the clinical activities they have experienced.
- All residents are expected to actively participate in the didactic lectures, seminars, journal clubs, and case discussions which will be conducted throughout the year.
- Promotion to the second year of the training requires completion of all ECTS credit equivalents and a cumulative score of 70% in the first year evaluation as stipulated in the assessment strategy part of the curriculum.
- Year two of the training program – The second year consists of 11 months of active learning activities and one month of vacation. There are seven modules in this year of study. Completing the internal medicine/ward module is a prerequisite to proceed to the specialty modules. The research module is allocated with a total of eight weeks. Residents will be allowed to choose the appropriate time for themselves to do the research work in consultation with their research mentor but they will have a common research methodology lecture. In order to not compromise the clinical work that residents are expected to deliver, the maximum time that they can take in blocks for research work is four weeks.
- Year three of the training program – The third year consists of 11 months of active learning activities and one month of vacation. There are seven modules in the third year. The residents can take a second four weeks’ research time in block during the third year. Completion of 48 ECTS credit equivalents, defending the research work, and completion of minimum exposures and procedures detailed in the assessment strategy will be required before taking the qualifying exam.
- Completion of a total of all credit equivalents, a pass in the research defense, and an overall score of 70% will be required for graduation.
Program duration: This Internal Medicine Residency Training Program will have a total duration of three years.
- Eligible candidates should have an M.D degree from a certified training program.
- The candidate should be in a good state of health, both mentally and physically, that enables him/her to practice internal medicine.
- The candidate should write a personal statement not more than one page (3,000 characters) showing interest and commitment.
- The candidate should include an application letter.
- The candidate should include two letters of reference from supervisors or professional colleagues.
- Candidates will sit for written exam and be interviewed before admission to the program through the FMOH Residency Matching Program.
- The candidate should include a sponsorship letter from sponsoring institution.
Resident should have a cumulative GPA of 3.00 or above.
- Residents should produce a dissertation paper and score > 70% (B) in the evaluation of the paper.
- The resident should not have serious medical misconduct.
- Residents must successfully perform the following procedural and diagnostic skills.
|PROCEDURAL AND DIAGNOSTIC SKILLS REQUIRMENTS IN THREE YEARS|
|Procedures to be done||Minimum numbers required|
|Insertion of central line||5|
|Thoracentesis Paracentesis||20 20|
|Ultrasound of chest/heart||20|
|Bone marrow aspiration||20|
|IV line insertion||20|
|Liver biopsy (observation)||4|
|Chest tube insertion||5|
|ECG performing and interpretation||20|
|Spirometry performing and interpretation||10|
|Peak Flow Meter measurement and interpretation||10|
Degree Nomenclature: At the successful completion of the training program, residents will be awarded a specialty certificate in internal medicine and entitled “internist”. In Amharic “የውስጥ ደዌ ህክምና ስፔሺያሊስት “
Evaluation Tools used to Assess Residents
Global Evaluation tool
A comprehensive evaluation tool will be completed by the attending faculty at the end of each rotation. After each rotation the faculty will fill a comprehensive evaluation form that encompasses the assessment of residents in all areas of competency divided in to knowledge, attitude, and practice.
Semi-annual residency program director evaluation
Each resident meets with the program director biannually to review their progress, assess any deficiencies, and create an individualized learning plan to enhance the resident’s education. The research advisor and resident also discuss research plans and future career goals.
During semi-annual program director meetings, residents will give verbal as well as written debriefing so that they will have a chance to reflect on their strengths and weaknesses.
Semi-annual mini-clinical evaluation exercises (360° evaluation tool)
The residents will be evaluated by all personnel involved in their training including attending faculty, interns, students, nurses, and patients.
Faculty formative evaluations
Faculty will be continually interacting with the residents and give feedback on the basis of their performance.
Residents will be evaluated by their peer trainees using the global evaluation tools.
Medical Chart Review (Part of the 360° evaluation tool)
This is part of the 360° evaluation of residents where the faculty will assess the medical recording ability and discipline of the resident.
Patient evaluations (Part of the 360° evaluation tool)
Patients are asked to evaluate the resident based on parameters including professionalism and patient satisfaction.
End of 1st Year Residency Examination
At the end of the first year, the internal medicine resident will sit for an exam that includes multiple-choice questions, spot slide, a clinical exam to examine skills in interpretation of internal medicine pathology, imaging findings, physical findings of (long case) and a short case physical examination skill.
End of 2nd Year Residency Examination
A written exam composed of multiple-choice and questions will be administered at the end of the second year of residency.
A final qualifying examination
A qualifying exam will be administered at the end of the three-year program after defense of the thesis. External examiners will conduct the practical examination along with staff faculty. The exam will have the following components:
- Written examination: Multiple-choice question examination.
- Interpretation of slides (Spot): Internal medicine histopathology, imaging and physical examination findings (pictures).
- Practical: Patient-based clinical examination and interviews (viva) by external/internal examiners.
Logbooks for diagnostic and therapeutic procedures
Residents will keep a logbook for recoding the procedures they have performed in each clinical rotation. The record should be signed by attending faculty during their rotations. The logbooks should be submitted two months before sitting for the qualifying examination. Residents will be able to sit for the qualifying examination when they fulfill the minimum requirements set for diagnostic and therapeutic procedures.
Evaluation of research project
The research projects will be evaluated by internal and/or external examiners and will be marked by a structured tool.
- Grading system:
|Raw mark interval||Corresponding fixed number grade||Corresponding letter grade||Status description|
Quality Assurance mechanism:
Indicators of quality and standards
The contents and the core competencies of the program are similar to the core curricula contents and competencies suggested by international societies in the field of internal medicine, namely the EPGIMT. The proposed curriculum will go through the approval/accreditation processes as recommended by the guidelines for program design, approval and review by the EPGIMT.
The program has set a maximum staff to resident ratio of 1:4. Resident number in the ratio indicates the total number of residents included both in the first, second, and third year of training. This standard is one of the indicators for the quality of the program.
Mechanisms to evaluate and improve quality and standards
Residents’ feedback: Residents will give feedback on the program at the end of the first year, second year, and third year of training.
External examiners/evaluators feedback: External examiners will be invited to examine the graduating residents for the first five consecutive groups. In addition to evaluating the residents, the external examiners will give feedback on the program contents, the hospital facility, the faculty, and the teaching-learning process. The feedback will be used for improvement in the conduct of the program, program amendment, or revision. After graduating the first five consecutive groups of residents, external evaluators will be invited at least every five years for the same purpose.
Stakeholder’s feedback: Universities, hospitals, and other consumers of the graduates will be requested to give feedback after a year of employment. The feedback will be used for amendment or review of the program.
Departmental program review: Departmental program review will be made every five years. Self-study and external review will be the essential parts of the review process. The process suggested by HERQA for program review will be used for this effect.