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CARDIOLOGYCompetencies for Cardiovascular MedicineThe resident is expected to:1) Recognize the New York Heart Association’s classification of congestive heart failure.2) Understand the role of beta blockers in the treatment of CHF.3) Understand the difference between systolic and diastolic dysfunction.4) Recognize the treatment modalities for congestive heart failure secondary to diastolic and systolicdysfunction.5) Identify the major clinical and laboratory signs of endocarditis.6) Dispense antibiotic prophylaxis for endocarditis in patients undergoing dental procedures.7) Approach to the patient with newly diagnosed atrial fibrillation.8) Recognize the different anti-anginal mediation and their mechanisms of action (beta-blockers,nitrates, calcium channel blockers).9) Indications for coronary artery bypass graft.10) Recognize the different modalities to diagnose coronary artery disease.CHEST X-RAYCompetencies for Chest X-RayThe resident is expected to:1) Recognize the systematic approach to reading a Chest X-Ray.2) Differentiate a RML infiltrate from a RLL infiltrate.3) Understand the limitations of an Anterior/Posterior view of a Chest X-Ray.4) Determine if a pleural effusion layers.5) Recognize pulmonary vascular congestion, pulmonary edema, atelectasis, pleural effusion, cavitarylesions, and air bronchograms.6) Approximate the location of catheter tips.7) Identify the indications for a lateral view Chest X-Ray (LAC USC Medical Center only).DERMATOLOGYCompetencies for DermatologyThe resident is expected to:1) Recognize the major steroid responsive dermatoses seen in outpatient medicine. (allergic contact,atopic, insect bites, irritant, lichen simplex chronicus, nummular eczema, rhus dermatitis, seborrheic,stasis, dyshidrotic eczema, psoriasis.2) Ascertain the characterization of and treatment modalities for acne.3) Perform a punch biopsy, shave biopsy and excisional biopsy.4) Recognize the clinical features of melanoma, actinic keratosis, basal cell carcinoma, and squamouscell carcinoma.5) Diagnose and treat of seborrheic dermatitis.6) Perform a potassium hydroxide (KOH) prep of a skin scraping.7) Distinguish between eczematous and fungal dermatitis.9

DERMATOLOGYCompetencies for DermatologyThe resident is expected to:1) Recognize the characteristics of KS skin lesions.2) Identify the most common dermatoses affecting HIV/AIDS patients.3) Understand the difference between scabies and Norwegian scabies.4) Manage treatment modalities for condyloma acuminate/lata.5) Identify the chronic suppressive therapies for HSV.6) Recognize and manage the treatment for molluscum contagiosum.ENDOCRINOLOGYCompetencies for EndocrinologyThe resident is expected to:1) Recognize the different insulin analogs with respect to their peak onset of action, dosing schedules,compatibility with other agents.2) Identify the clinical presentations of pituitary tumors.3) Manage the treatment of prolactinomas.4) Perform a Cosyntropin stimulation test.5) Manage out-patient screening of adrenal insufficiency in patients who are on steroids.6) Ascertain the work-up for hirsutism.7) Diagnose and manage the treatment of polycystic ovarian syndrome.8) Identify the screening process for Cushing’s syndrome.9) Identify the screening process for pheochromocytoma.10) Effectively approach the patient with Galactorrhea.11) Learn how to examine the thyroid and obtain a history directed toward possible thyroid illness.12) Understand the use and interpretation of basic tests of thyroid function.13) Understand the therapeutic approach the hyper- and hypothyroidism.PRIMARY CARE/ GENERAL MEDICINECompetencies for General MedicineThe resident is expected to:1) Perform age appropriate cancer screening.2) Administer age appropriate immunizations.3) Diagnose obesity and the metabolic syndrome. Be able to calculate BMI. Identify treatmentstrategies including approaches to diet control and indications for bariatric surgery.4) Identify domestic violence screening/intervention.5) Perform alcohol/substance abuse screening.6) Identify JNC VII guidelines for diagnosis and treatment of hypertension.7) Identify NCEP guidelines for treating hyperlipidemia.8) Identify and administer vaccines for traveling outside the United States.10

HEMATOLOGYCompetencies for HematologyThe resident is expected to:1) Manage the evaluation of a patient with thrombocytopenia.2) Distinguish between normal and abnormal red blood cells on a peripheral smear.3) Diagnose and manage treatment of anti-phospholipid syndrome.4) Identify the major factor/co-factor deficiencies and their associated risks for bleeding and thrombusformation.5) Manage the treatment of a patient with a prolonged protime or prothrombin time.6) Diagnose and manage the treatment of pernicious anemia.7) Distinguish between primary and secondary polycythemia.8) Identify the diagnostic criteria for myelodysplastic syndrome and the subtypes of this condition.HEPATITISCompetencies for HepatitisThe resident is expected to:1) Manage the appropriate work-up for a patient who tests HCV antibody positive.2) Identify the risk factors for hepatitis B and C.3) Identify the major side effects of alfpha-interferon and ribavarin.4) Understand the factors that are taken into consideration before considering someone a candidate forinterferon based antiviral therapy.5) Administer appropriate lifestyle counseling for a patient who is newly diagnosed with chronic viralhepatitis.6) Identify the indicated immunization schedule for a patient who tests positive for hepatitis B and C.7) Interpret the different serologic tests for hepatitis B and C.LIVERCompetencies for Liver DiseasesThe resident is expected to:1) Identify the screening tests available to establish the diagnosis of hemochromotosis.2) Ascertain how to diagnose and treat non-alcoholic fatty liver disease.3) Distinguish the basic approach to a patient who is referred for evaluation of elevated liver enzymes.4) Identify the Child’s-Pugh classification of liver cirrhosis.5) Recognize the indications and for liver transplantation including fulminant hepatitis.6) Identify the risk factors and treatment of hepatic encephalopathy in a cirrhotic patient.7) Understand the significance of the serum-ascites albumin gradient (SAAG).8) Ascertain the major causes of high and low SAAG ascites.9) Identify how to diagnose and treat spontaneous bacterial peritonitis.10) Classify the indications for antibiotic prophylaxis in a patient with ascites.11) Classify the indications for TIPS procedure.11

NEUROLOGYCompetencies for Neurology:The resident is expected to:1) Diagnose and identify the treatment of Bell’s palsy.2) Perform a rapid, comprehensive neurologic exam and stroke risk assessment.3) Identify risks and benefits of different anti-platelet agents in primary and secondary stroke prevention.4) Diagnose and identify the treatment of carpal tunnel syndrome.5) Identify the presenting signs and symptoms of Multiple Sclerosis.6) Diagnose and identify the management of restless leg syndrome (periodic limb movement disorder).7) Recognize the presenting signs and symptoms of Parkinson’s disease.ONCOLOGYCompetencies for OncologyThe resident is expected to:1) Recognize the significance of the BRCA1 and BRCA2 gene mutations.2) Identify pain management in cancer patients.3) Assess performance status.4) Identify neutropenic precautions.5) Manage the treatment of anemia and leukopenia in patients undergoing chemotherapy.6) Identify treatment options for nausea in patients undergoing chemotherapy.7) Recognize and manage oncologic urgencies/emergencies including tumor lysis, hypercalcemia,neutropenic fever, cord compression, and brain metastases.OPHTHALMOLOGYCompetencies for OphthalmologyThe resident is expected to:1) Know which patients presenting with “red eyes” need emergency referrals.2) Recognize how to differentiate between bacterial, allergic and viral conjunctivitis and how to treat eachcondition.3) Diagnose and identify treatment of corneal abrasions (flourescein eye exam.)4) Identify and know how to treat chalazions.5) Recognize the signs and symptoms of acute narrow angle glaucoma.6) Perform the following procedures—fundoscopy, fluorescein eye exam, visual field testing, tonometry.7) Identify and manage the treatment of blepharitis.OTOLARYNGOLOGYCompetencies for Otolaryngology:The resident is expected to:1) Perform cerumen removal by curette extraction and water lavage.2) Identify and and differentiate anterior versus posterior epistaxis and manage anterior bleeds with use ofsuction, intra-mucosal anesthetics containing epinephrine, nasal tampons, anti-hypertensives, analgesicsand antibiotics.3) Evaluate and identify the management of a patient with chronic cough.4) Approach the patient with subjective hearing loss.5) Evaluate and manage the treatment of tinnitus.6) Recognize and identify the treatment of benign positional vertigo—Epley maneuver.12

7) Identify and manage treatment of nasal polyps.8) Approach the patient with rhinosinusitis.9) Diagnose and manage periorbital cellulitis.PULMONARYCompetencies for PulmonaryThe resident is expected to:1) Classify the work-up of a patient with newly diagnosed restrictive lung disease.2) Recognize the indications for inhaled steroids and beta agonists in patients with chronic obstructivepulmonary disease (COPD.)3) Identify the classifications of asthma and the appropriate treatment modalities.4) Recognize the signs, symptoms, and management of central/obstructive sleep apnea.5) Distinguish the indications for home oxygen.6) Identify the radiographic signs of interstitial lung disease and chronic obstructive pulmonary disease(COPD.)7) Diagnose and manage a patient with a solitary pulmonary nodule.RHEUMATOLOGYCompetencies for RheumatologyThe resident is expected to:1) Recognize the radiographic features of rheumatoid arthritis.2) Be familiar with the diagnostic criteria for systemic lupus erythematosus (SLE.)3) Diagnose and manage the treatment of Gout.4) Recognize the different disease modifying anti-inflammatory medications for treatment ofrheumatoid arthritis and their major side effects.5) Identify the characteristics of synovial fluid from degenerative, traumatic, inflammatory andinfectious joints.Understand the significance of various auto-antibodies in the ANA panel used in the diagnosis ofconnective tissue disseases13

LAC-USC AMBULATORY MILESTONES PER TRAINING YEARPGY 1 :Patient CareHistorical Data Gathering Consistently acquires accurate and relevant histories from patients Seeks and obtains data from secondary sources when neededPerforming a physical exam Consistently performs accurate and appropriately thorough physical exams. Identify pertinent abnormalitiesusing common maneuversClinical Reasoning Uses collective data from history, exam, laboratory and imaging studies to identify each patient’s central clinicalproblem Develops a valid differential diagnoses for the patient’s central clinical problem, using evidence based guidelines Makes proper real-time clinical decisions when informed by ancillary staff of findings such as vital sign changes,laboratory abnormalities, imaging findings, EKG results Makes proper real-time clinical decisions in response to consultant recommendationsPatient Management Recognize situations with a need for urgent or emergent medical care including life threatening conditions Seeks additional guidance and consultation from supervising residents and attendings when needed Provides appropriate patient counseling during hospitalization, and delivers patient education at time ofdischarge Carries out agreed upon care plan in a timely and efficient fashion, ensuring patient safety and quality care(including patients with multiple diagnoses) Work with medical student to provide patient care, but does not directly supervise When supervised, can demonstrate the appropriate technique for the following procedures: paracentesis,thoracentesis, lumbar puncture, arterial blood gas sampling Consistently obtains informed consent for the aforementioned proceduresMedical KnowledgeKnowledge of core content Understand the relevant pathophysiology for common inpatient medical conditions Demonstrate sufficient knowledge to diagnose common conditions that require hospitalization.Diagnostic tests Understand basic interpretation of common diagnostic testing, including laboratory abnormalities, imagingfindings, EKG results and other pertinent studies Can identify the indications, contraindications for each of the aforementioned procedures14

Systems Based PracticeWorks effectively within an interprofessional team Appreciate roles of a variety of health care providers, including, but not limited to, consultants, therapists,nurses, pharmacists, care coordinators and social workers Works closely with the assigned care coordinator for the inpatient team Work effectively as a member within the interprofessional team to ensure safe patient careWorks effectively within multiple health delivery systems Understand unique roles and services provided by local health care delivery systems Understands the services available to underserved patients within the communityRecognizes system error and advocates for system improvement Recognize health system forces that increase the risk for error including barriers to optimal patient care Identify, reflect upon, and learn from critical incidents such as near misses and preventable medical errors andnotify supervisor accordingly Open to feedback regarding specific decisions that could lead to error or harmIdentifies forces that impact the cost of health care and advocates for cost-effective care Open to feedback from EMR and care coordinator on documentation of intensity of service and clinical necessityDemonstrates awareness of common socio-economic barriers that impact patient careMinimize unnecessary care including tests, procedures, and therapies for hospitalized patientsTransitions patients effectively within and across health delivery systems Recognizes the importance of accurate, on-time and updated handovers during transitions of care Communicates to all accepting caregivers in a timely and pertinent fashion Works effectively with care coordinator to transfer patients with accurate and pertinent documentation in atimely mannerProblem Based Learning and ImprovementMonitors practice with a goal for improvement Understands the importance of self-reflection of one’s practice and performanceLearns and improves via performance audit Understands the importance of using information gathered from an audit to improve one’s practiceLearns and improves via feedback. Respond welcomingly and productively to feedback from all members of the health care team.Learns and improves at the point of care Aware of the strengths and weaknesses of specific sources of medical information Can use validated medical resources to form clinical questions With assistance, appraises clinical research reports, based on accepted criteria15

ProfessionalismHas professional and respectful interactions with patients, caregivers and members of the interprofessionalteam (e.g. peers, consultants, nursing, ancillary professionals and support personnel) Consistently respectful in interactions with patients, caregivers and members of the interprofessional team Seeks assistance in challenging interprofessional situations Is available and responsive to needs and concerns of patients, caregivers and members of the interprofessionalteam Emphasizes patient privacy, confidentiality and autonomy in all interactions Respond promptly and appropriately to clinical responsibilities including, but not limited to, calls and pagesAccepts responsibility and follows through on tasks Completes administrative and patient care tasks in a timely fashion, working effectively with care coordinatorsCompletes assigned professional responsibilities without the need for remindersCompletes all assigned rotation, attending and peer evaluations in a timely fashionDress and behave appropriatelyResponds to each patient’s unique characteristics and needs. Seeks to fully understand each patient’s unique characteristics and needs based upon culture, ethnicity, gender,religion, and personal preference and modifies care plan accordinglyUnderstanding the specific needs of the patient population specific to our safety net institutionExhibits integrity and ethical behavior in professional conduct. Document and report clinical information truthfullyAccept personal errors, demonstrates accountability and follows formal hospital policiesInterpersonal and Communication SkillsCommunicate effectively with patients and caregivers Engages patients in shared decision making while asking for assistance in facilitating discussions in complicatedsituations Is able to engage in communication with persons of different socioeconomic and cultural backgrounds Provides empathetic, timely and accurate communication to patients/advocates Consistently uses an interpreter to communicate with patients, caregivers and family in the clinical settingCommunicates effectively in interprofessional teams (e.g. peers, consultants, nursing, ancillary professionals andother support personnel). Engages in collaborative communication with appropriate members of the team by using verbal, non-verbal, andwritten methods that facilitate care Attempts to deliver appropriate, succinct relevant presentations Presentation skills improve with feedbackAppropriate utilization and completion of health records. Health records are organized and accurate with feedback from residents and attendings16

PGY 2/3/4:Patient CareHistorical Data Gathering Acquires accurate histories from patients in an efficient, prioritized, and hypothesis-driven fashion Uses elements of the history to formulate a prioritized differential diagnosis, assessment and plan Obtain collateral information when relevant to the casePerforming a physical exam Consistently performs accurate and appropriately thorough physical exams. Identify pertinent abnormalitiesusing common maneuvers Demonstrate and teach how to elicit important physical findings for junior members of the healthcare team Performs accurate physical exams that are targeted to the patient’s complaintsClinical Reasoning Uses collective data from history, exam, laboratory and imaging studies to generate a prioritized differentialdiagnosis and problem list Effectively uses history and physical examination skills to minimize the need for further diagnostic testing Guides junior trainees on real-time clinical decision-making Recognizes complex clinical presentations and effectively coordinates care Makes appropriate decisions regarding the need for consultative carePatient Management Appropriately modifies care plans based on patient’s clinical course, additional data, and patient preferences Independently manages inpatients who have multiple active disease processes. Appropriately weighs recommendations from consultants in order to effectively manage patient care Appropriately manages situations requiring urgent or emergent care Effectively supervises the management decisions of the team Possesses technical skill and can guide junior trainees through procedures required for certification Teaches the rationale, risks and benefits associated with common procedures and anticipates potentialcomplications when performing procedures patient counseling and patient education throughout hospitalizationand at the time of discharge Carries out agreed upon care plan in a timely and efficient fashion, ensuring patient safety and quality care(including patie

Report to first assigned clinic on amion promptly . Faculty in Charge of Rotation: Jennifer Marks, MD . 323-442-5100 . marksjr@med.usc.edu . Division of GHPGIM . Keck School of Medicine of USC . 2020 Zonal Avenue, IRD 306 . Los Angeles, CA 90033 . Phone: (323) 226-6571 . Fax: (323) 226-2718