Mission-Driven MD Program Objectives

Program Objectives and Milestones (MD Program AY23/24 - )

Educational Program Objectives (EPOs)

Patient Care 1: Performs a history and physical

Patient Care 2: Demonstrates clinical reasoning and judgment

Patient Care 3: Incorporates health promotion and wellness

Medical Knowledge 1: Demonstrates knowledge of foundational sciences

Medical Knowledge 2: Explains the scientific and clinical rational for diagnostic testing

Medical Knowledge 3: Explains the scientific and clinical rational for therapeutic options

Medical Knowledge 4: Applies knowledge of ethics and humanities

Systems-based Practice 1: Demonstrates skill in team building and leadership

Systems-based Practice 2: Demonstrates skill in navigating the health System

Practice-based Learning and Improvement 1: Demonstrates reflective practice and a commitment to personal growth

Practice-based Learning and Improvement 2: Utilizes evidence based medicine, inquiry, analysis, evaluation and Information Resources

Professional Identity Formation 1: Values self-discovery and personal well-being

Professional Identity Formation 2: Demonstrates professional behavior and respect for all

Interpersonal and Communication Skills 1: Demonstrates effective communication with patient/family

Interpersonal and Communication Skills 2: Demonstrates effective communication with colleagues

Milestones*

Patient Care 1: Performs a history and physical

History	Lists the elements of a complete history and gathers information strictly following a template	Adapts template to filter and prioritize pertinent positives and negatives based on broad diagnostic categories or possible diagnoses	Filters, prioritizes, and synthesizes the history to develop a differential diagnosis in real-time for common patient presentations
Physical Exam	Performs fundamental rote physical examination using a strict head-to-toe approach	Performs complete physical examination attending to patient comfort and safety and identifies common abnormal findings	Performs a focused, hypothesis-driven physical examination for a common patient presentation and interprets common abnormal findings

Patient Care 2: Demonstrates clinical reasoning and judgment

Clinical Reasoning

Presents clinical information (e.g., history, exam, tests, consultations) in the order they were elicited

Synthesizes clinical information and moves towards a broad differential diagnosis

Organizes clinical information to compare and contrast diagnoses being considered, resulting in a prioritized differential diagnosis

Judgment

May be aware of limitations in knowledge and skill, but does not verbalize to supervisors; or overstates limitations and defers appropriate responsibility.

Acknowledges limitations and asks for assistance.

Assumes appropriate responsibility.

Strong sense of ownership and forthright acknowledgment of limitations that engenders trust.

Patient Care 3: I n corporates Health Promotion and Wellness

Health Promotion and Wellness

Identifies screening and prevention guidelines by
various organizations; Describes how biological, psychological/behavioral, and social/environmental factors impact patient health

Identifies opportunities to
maintain and promote
wellness in patients; Identifies biopsychosocial strategies to improve health

Apply prevention guidelines to individual patients and develop a health promotion plan with guidance

Medical Knowledge 1: Demonstrates knowledge of Foundational Sciences

Foundational Sciences

Explains the scientific knowledge (e.g. biological sciences, social sciences, behavior and development, mechanism of disease) for normal function and common medical conditions

Explains the scientific knowledge for normal function and common medical conditions, including major deviations from typical development/behavior, using language appropriate for the recipient

Explains the scientific knowledge for a subset of complex medical conditions, in addition to normal function and common medical conditions.

Medical Knowledge 2: Explains the scientific and clinical rational for diagnostic testing

Diagnostic Testing

Explains the scientific basis and clinical rationale for common diagnostic testing;
Interpret results of common diagnostic tests

Explains the scientific basis, clinical rationale, risks and benefits for common diagnostic testing;
Interpret results of common diagnostic tests

Explains the scientific basis, clinical rationale, risks and benefits for a subset of complex diagnostic testing;
Interpret results of a subset of diagnostic tests

Medical Knowledge 3: Explains the scientific and clinical rational for therapeutic options

Therapeutic options

Explains the scientific basis for common therapies

Explains the indications, contraindication, risks and benefits of common therapies

Explains the scientific basis, indications, contraindications, risks and benefits for a subset of new therapies

Medical Knowledge 4: Applies knowledge of ethics and humanities

Ethical principles	Demonstrates knowledge of ethical principles	Analyzes straightforward situations using ethical principles; identifies when to seek help	Addresses complex ethical situations with help, as needed
Humanities	Identifies historical, cultural, and social contexts for individual and systems-level understandings of health and healthcare.	Analyzes the origins and effects of healthcare practices, texts, and terms, considering historical, cultural, and social contexts.	Analyzes the origins and effects of healthcare practices, texts, and terms, considering historical, cultural, and social contexts and applies approaches and ideas from multiple disciplines in the everyday practice of medicine.

Systems-based Practice 1: Demonstrates skill in team Building and leadership

Initiative & Contribution

Actively engages in core individual and/or team activities with few if any reminders

Actively seeks opportunities to contribute. Reliably and thoroughly follows through on assigned tasks.

Spontaneously identifies needs of the patient/team and addresses these independently, as appropriate to optimize patient care or learning outcomes

Prioritization

Manages individual tasks well. Able to identify key issues when faced with multiple projects or patients, but requires supervision to determine priorities.

Able to prioritize among multiple projects or patient care activities. May be derailed by interruptions or distractions.

Able to maintain focus despite distractions and interruptions. Collaborates effectively with others to maintain team focus and address priorities.

Influence of group dynamics

Does not contribute to or reinforce unhealthy group norms; sometimes distracts group from tasks.

Promotes healthy group norms; consistently directs focus of the group on tasks. Participates in group improvement efforts.

Demonstrates positive group leadership and models healthy group norms.

Consistently directs focus of the group on tasks. Leads in group improvement efforts.

Systems-based Practice 2: Demonstrates skill in navigating the health System

Patient safety and Quality Improvement	Identify common patient safety events	Demonstrates knowledge of how to report patient safety events	Demonstrates knowledge of basic quality improvement methodologies and metrics for improving patient safety and outcomes
System Navigation/Patient-Centered Care	Acknowledges importance of care coordination	Identifies key elements for safe and effective transitions of care and hand-offs	Coordinates care of patients by effectively engaging interprofessional teams in routine clinical situations; Performs safe and effective transitions of care/hand-offs in routine clinical situations
Physician Role in Health Care System	Identifies key components of the health care system	Identifies key components of the health care system; Describes basic health payment systems	Describes how components of a complex health care system are interrelated, and how this impacts patient care
Population and Community Health	Acknowledges population and community health needs and disparities	Identifies specific population and community health needs and disparities; identifies local resources	Uses local resources effectively to meet the needs and reduce health disparities of a patient population and community
Advocacy	Acknowledges advocacy for patient populations as a professional responsibility	Identifies stakeholders/systems in patient advocacy	Describes how stakeholders influence and are affected by health policy at the local, state, and federal level

Practice-based Learning and Improvement 1: Demonstrates reflective practice and a commitment to personal growth

Reflective practice and commitment to personal growth

Accepts responsibility for personal and professional development by establishing goals; identifies the factors which contribute to gap(s) between one’s expected and actual performance with guidance; creates and implements a learning plan, with guidance

Demonstrates openness to feedback and performance data; Analyzes and reflects on the factors which contribute to gap(s) between one’s expected and actual performance; creates and implements a learning plan, with guidance

Seeks feedback and performance data episodically, with openness and humility; Analyzes, reflects on, and institutes behavioral change(s) to narrow the gap(s) between one’s expected and actual performance; creates and implements a learning plan, with guidance

Practice-based Learning and Improvement 2: Utilizes evidence based medicine, inquiry, analysis, evaluation and Information Resources

Evidence Based Medicine	Demonstrates how to access and summarize available evidence for routine conditions	Articulates focused clinical questions, accesses and synthesizes available evidence	Locates and applies the best available evidence to the individualized care of patients, applying a hierarchy of evidence
Inquiry	Has difficulty forming the relevant questions; spends time looking up irrelevant issues or does not pursue questions	Questions chosen to pursue are at times too simple or too complex for the time allowed, or are tangential to the group’s focus	Questions chosen to pursue are of appropriate scope and focus
Analysis	Sorts information to align with underlying principles; occasionally confuses association and cause.	Discriminates between competing hypotheses and understands how hypotheses might be strengthened or disproved.	Identifies and challenges one’s own assumptions; looks beyond basic information provided. Begins to challenge accepted hypotheses
Evaluation	Generally seems satisfied with a single explanation. States facts or opinions without citing supporting evidence. Does not analyze level of evidence.	Sometimes displays consideration of multiple possible explanations. Identifies relevant evidence to support explanations offered. Comments on level of evidence referenced (RCT, observational study, etc)	Identifies relevant evidence to support explanations offered and critiques this evidence. Comments on level of evidence referenced (RCT, observational study, etc)
Information resources	Analysis is based primarily on secondary information resources such as lectures, board prep materials, textbooks or aggregated resources such as “Up to Date.”	In addition to secondary resources, begins to cite literature, such as a single article or a review article.	Incorporates multiple primary sources, inclusive of differing findings or conclusions. Begins to critically appraise information sources, weighing the value of each for the topic at han

Professional Identity Formation 1: Values Self-Discovery and Personal Well-being

Self-discovery	Participates in developmental coaching, community gathering, self-reflection, and processing experiences during medical school	Utilizes self-reflection resources and coaches to explore and develop values, mission statement, and goals related to career exploration the specialty selection process	Exhibits reliance on a personal set of values, mission statement, and goals to derive meaning and purpose in future career as a physician. Able to balance external demands and expectations with internal capabilities.
Personal Well-being (to be used for coaching, not assessment)	Recognizes the importance of getting help when needed to address personal and professional well-being	Identifies and utilizes necessary resources to support personal and professional well-being; Recognizes that institutional factors affect well-being	With prompting, reflects on how personal and professional well-being may impact one’s clinical practice, relationships with colleagues, and the health system; Describes institutional factors that affect well-being Integrates well-being into one’s practice

Professional Identity Formation 2: Demonstrates professional behavior and respect for all

Professional Behavior	Describes professional behavior and potential triggers for personal lapses in professionalism; Takes responsibility for personal lapses in professionalism	Demonstrates professional behavior in routine situations; Describes when and how to report professionalism lapses in self and others	Demonstrates professional behavior in complex or stressful situations; Recognizes need to seek help from positive role models in managing and resolving complex professionalism lapses
Accountability/ Conscientiousness	Takes responsibility for failure to appropriately complete tasks and responsibilities, identifies potential contributing factors, and describes strategies for ensuring task completion in the future; Responds promptly to requests or reminders to complete tasks and responsibilities	Performs tasks and responsibilities in a timely manner with appropriate attention to detail in routine situations; Recognizes and anticipates situations that may impact own ability to complete tasks and responsibilities in a timely manner	Performs tasks and responsibilities in a timely manner with appropriate attention to detail in complex or stressful situations; Proactively implements strategies to ensure that the needs of patients, teams, and systems are met
Honesty/Integrity	General integrity regarding coursework and assignments. May attempt to circumvent rules for tasks perceived to be of minor importance.	Integrity regarding patient care duties and/or coursework, scholarly activity, research, and assignments (e.g., strict adherence to the honor code). Forthright if unable to complete assigned tasks. Behaviors inspire confidence among teammates and supervisors.	Fully transparent about conflicts of obligation and/or any “near-misses” or errors made. Acknowledges contributions of others. Actively contributes to group processes that encourage honesty and accountability among members; which may include appropriate reporting of lapses in others.
Demonstrate compassion and respect	Acknowledges that differences in values, beliefs, and experiences with fellow students, faculty and patients exist. Listens respectfully to personal views and opinions of classmates, faculty and/or patients with differing views; may not express willingness to consider altering one’s personal stance.	Empathetically listens in a non-judgmental manner. Acknowledges the perspectives of others; demonstrates willingness to critically analyze one’s personal views.	Models non-judgmental interactions across settings or situations. Actively encourages others to share opposing views. Strives to create a group or work environment that supports non- judgmental interactions among all members.

Interpersonal and Communication Skills 1: Demonstrates effective communication with patient/family

Patient and Family Centered Communication

Demonstrates respect and attempts to establish rapport; Attempts to adjust communication strategies based upon patient/family expectations and needs; Actively communicates own role within the health care system

Establishes a therapeutic relationship in straightforward encounters using active listening and clear language;
Identifies barriers to effective communication (e.g., language, health literacy, cultural, disability)

Establishes a therapeutic relationship
in challenging patient encounters; When prompted, reflects on personal biases while attempting to minimize communication barriers; Sensitively and compassionately delivers medical information, managing patient/family values, goals, preferences, uncertainty, and conflict

Interpersonal and Communication Skills 2: Demonstrates effective communication with colleagues

Interprofessional team communication	Uses language that values all members of the health care team; Recognizes the need for ongoing feedback with the health care team	Communicates information effectively with all health care team members; Solicits feedback on performance as a member of the health care team	Uses active listening to adapt communication style to fit team needs; Communicates concerns and provides feedback to peers
Content of presentations to colleagues	Presentations mostly accurate, but may omit basic information necessary for team to develop appropriate treatment (or learning or research) plan. May be overly inclusive of extraneous information.	Summary of findings is accurate and logical. More selective regarding pertinent information to report. May struggle to be appropriately succinct.	Presentation is systematic, appropriately concise yet thorough. Accurately reflects the encounter (or project or case content). Reports any uncertainties in data gathering.
Style of presentations to colleagues	Heavily reliant upon notes or other team members to articulate findings. Presentation disjointed; information presented in an irregular order.	Refers to notes only intermittently. Presentation cohesive. Focus is on delivery of information.	Minimal reference to notes. Fluid presentation of information. Confidence allows more focus on discussion of the case or project rather than the process of presentation. Able to integrate relevant data and respond to inquiries without disruption of thought process.
Communication within the healthcare system	Accurately documents information in the patient record; Communicates using formats specified by institutional policy to safeguard patient personal health information	Documents clinical encounter, including reasoning, through organized notes in the patient record; Selects direct (e.g., telephone, in-person) and indirect (e.g., progress notes, text messages) forms of communication based on context, with assistance	Documents clinical encounter through concise and thorough notes; Appropriately selects direct and indirect forms of communication based on context; Identifies the required components for a telehealth visit

*These milestones were adopted and adapted from various ACGME milestones, Vanderbilt University School of Medicine milestones, and from UCSF’s Inquiry Assessment Tool (DOI: 10.1097/ACM.0000000000002520)