Interactive Report

Core competencies

 

Patient Care

“Demonstrate the ability to be able to provide care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health”

Residents will assemble and interpret essential and accurate information relevant to the health and function of people with ID/DD.

  1. Assemble information from multiple sources including the patient, caretakers, residential occupational and educational sources.
  2. Establish an etiologic diagnosis, referencing relevant information and resources.
  3. Perform annual health and function assessments, including oral health assessment, screening for specific high-risk conditions and co-morbidities.
  4. Appropriately evaluate changes in behavior and adaptive function.
  5. Conduct appropriate testing in order to identify common secondary health conditions.
  6. Recognize atypical presentations of common diseases.
  7. Recognize common psychiatric conditions and provide appropriate treatment and referrals.

Residents will provide and coordinate healthcare services and information aimed at optimizing wellbeing and function of persons with ID/DD.

  1. Employ appropriate and individualized health and oral health screening and prevention.
  2. Provide health supports to patients across a variety of residential settings.
  3. Identify opportunities for functional improvement through appropriate interventions, including assistive technology.
  4. Proactively evaluate and address the common unmet healthcare needs of patients with ID/DD in an interdisciplinary manner.
  5. Assess the impact of cognitive or physical decline on a patient’s independence and circle of support.

Residents will balance the risk and benefits of pharmacotherapy in patients with ID/DD.

  1. Recall common adverse effects, including oral health effects of medication classes often prescribed to this population.
  2. Provide education, referrals and medication management for behavior changes.
  3. Anticipate and treat polydrug interactions.
  4. Evaluate and reduce polypharmacy, when appropriate, in patients with complex medication regimens.
  5. Critically evaluate psychoactive medication use.

Residents will counsel patients and their support persons in the diagnosis and management of their health conditions.

  1. Discuss with patients the etiology and progression of disease.
  2. Communicate a simple care plan to patients across the spectrum of cognitive abilities.
  3. Appropriately raise and respond to issues concerning sexual and reproductive health.
  4. Encourage participation in health promotion activities.
  5. Maximize the health communication skills of patients in order to facilitate symptom self-report to other health team members and support personnel.
  6. Support condition self-management across the spectrum of cognitive abilities.
  7. Acknowledge barriers to medical care and community participation and brainstorm solutions to those barriers.
  8. Tailor health promotion and disease prevention education to individual needs of the patient.

Residents will collaborate within formal and informal support systems, to provide person-centered care in the context of a medical home.

  1. Formulate health plans, utilizing information from multiple sources including the patient, caretakers, and group home records.
  2. Utilize a team-based, interdisciplinary approach to ensure efficient, high-quality care.
  3. Provide proactive care to families based on an understanding of the family life cycle and changing individual and family needs.
  4. Identify appropriate local resources to support the caregiver’s physical and mental health.

Residents will assist in the healthcare transitions in patients with ID/DD throughout the lifespan.

  1. Assess the impact of cognitive and emotional development on a patient’s ability to be independent in managing their own health and healthcare.
  2. Facilitate referrals to educational, vocational and habilitative services.
  3. Provide anticipatory guidance regarding changes in health insurance during the transition period.
  4. Address the health system barriers that may impede a patient’s ability to be independent in managing their own health and healthcare.

Medical Knowledge

“Demonstrate knowledge of established and evolving biomedical, clinical, epidemiologic, and social-behavioral sciences, as well as the application of this knowledge to patient care”

Residents will demonstrate a broad knowledge of neurodevelopmental disorders

  1. Describe the general etiologic basis of neurodevelopmental disorders.
  2. Identify common co-morbidities and functional impairments associated with neurodevelopmental disorders.
  3. Describe examples of syndrome specific conditions associated with neurodevelopmental disorders.
  4. Explain common secondary health and oral health consequences that may arise in persons with neurodevelopmental disorders.
  5. Demonstrate a systematic approach to establishing a neurodevelopemental diagnosis.

Residents will familiarize themselves with the medical and behavioral features of more common neurodevelopmental disorders.

  1. Describe the physical and behavioral phenotypes and syndrome-specific healthcare needs of adults with Down syndrome, Fetal Alcohol Spectrum Disorder and Fragile X syndrome.
  2. Identify the common features and medical and behavioral health needs of adults with cerebral palsy.
  3. Explain the common features, associated syndromes and medical and behavioral health needs of adults with Autism.
  4. Outline an approach to preventive healthcare in adults with intellectual disability of unknown origin.

Residents will be familiar with key historical, support and service issues and terminology relevant to the field of developmental medicine.

  1. Describe the various residential settings in which people with ID/DD live.
  2. Identify the various employment settings and employment assistance available to persons with ID/DD.
  3. Describe the self-determination movement.
  4. Describe the concepts of the individualized health plan and the individualized support plan.
  5. Appreciate the historical context of the terms “medical model”, “social model” and “educational model” as they relate to deinstitutionalization and community integration.
  6. Explain the differences between aversive therapy and positive behavioral supports.
  7. Acknowledge alternative points of view in ethically charged situations.
  8. Describe commonly held attitudes toward sex and disability and the impact they may have on a patient’s quality of life.
  9. Differentiate between the concepts of impairment, disability, and handicap.
  10. Describe how the chronic care model can be applied to persons with ID/DD.

Residents will assimilate information from multiple disciplines and ancillary informants in order to enhance medical diagnosis and treatment.

  1. Identify the common health disparities experienced by people with ID/DD.
  2. Explain the medical and disease prevention implications of common dental findings.
  3. Become familiar with common terms and concepts utilized in psychological evaluations and behavior plans.
  4. Describe commonly employed assistive technologies and the process by which to procure them.

Interpersonal and Communication Skills

“Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.”

Residents will use effective strategies to optimize their communication with patients who require communication support.

  1. Modify one’s communication approach and utilize alternative modalities, as appropriate.
  2. Communicate directly with patients in a respectful and supportive manner.
  3. Check with the patient throughout the encounter to ensure that the patient understands questions, is comfortable and understands all aspects of the encounter.
  4. Ascertain the most effective communication method, utilizing assistive technologies, as appropriate, with both patients and ancillary informants.
  5. Continually assess the developmental level and functional health literacy of the patient throughout the patient encounter.

Residents will collaborate effectively with the patient’s family members and support network.

  1. Determine the patient’s family, social, formal and informal support network accurately.
  2. If family members or others are present, determine their level of familiarity with and responsibility for the patient, in order to collaborate with them for the patient’s care.
  3. Address critical issues that cannot be solved easily by convening a meeting with multiple support network members.

Residents will communicate effectively with health and non-health professionals and agencies across disciplines.

  1. Collaborate as a member or leader of a health care or interdisciplinary team in the comprehensive care of patients.
  2. Proactively share patient information with health and non-healthcare professionals involved in providing care or supports, while maintaining adherence to HIPAA compliance.
  3. Share knowledge of ID/DD issues with physicians and health professionals that do not have the same knowledge base.

Professionalism

“Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.”

Residents will demonstrate sensitivity and responsiveness to the individual needs of patients with ID/DD.

  1. Acknowledge the individual’s abilities, while recognizing and respecting the specific needs related to their disability.
  2. Adapt the physical environment and clinical interaction to optimize patient comfort.
  3. Demonstrate sensitivity and respect for culturally-based beliefs.
  4. Recognize the additive impact of cultural and linguistic considerations on health disparities.
  5. Clarify the patient’s personal meaning about their own disability and their health and life goals.

Residents will demonstrate empathy and respect in their behaviors with patients with ID/DD, families, support persons, and other ancillary informants.

  1. Develop an increased level of comfort working with patients and care teams during clinical encounters.
  2. Acknowledge the value of obtaining collateral information and demonstrate respect for team members from other disciplines.
  3. Explore the dehumanizing aspects of calling people by their disability, condition or organ first.
  4. Use, and encourage others to use, person-first language and proper disability etiquette.
  5. Demonstrate empathy for patients.
  6. Demonstrate empathy for patient’s families.

Residents will facilitate discussions regarding decision-making and consent, with respect to patient autonomy, self-determination, competency and legality

  1. Endeavor to conduct medical interviews and discussions with the patient directly.
  2. Ask about and demonstrate respect for patient values and preferences.
  3. Ensure that the guardian is informed and is making timely decisions.
  4. Assess patient’s decision-making competency.
  5. Investigate and apply state laws relating to informed consent.
  6. Assemble the legal supports necessary to obtain informed consent.
  7. Illustrate ways in which the human and civil rights of people with ID/DD may be compromised and describe ways in which health care providers can advocate to safeguard individual rights.
  8. Demonstrate competency in discussing end-of-life care plan with patients with ID/DD.
  9. Describe common medicolegal challenges.

Practice Based Learning

“Demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self evaluation and lifelong learning.”

Residents will systematically analyze the health care of persons with ID/DD in their residency practice settings and identify sustainable measures to improve that care.

  1. Appreciate the complexity of systematically identifying persons with ID/DD in the practice setting.
  2. Build and maintain a practice registry of persons with ID/DD.
  3. Design a Quality Improvement project based on process or outcome measures specific to individuals with ID/DD.
  4. Conduct a Quality Improvement project based on process or outcome measures specific to individuals with ID/DD.
  5. Design a multicycle quality improvement project based on process or outcome measures specific to individuals with ID/DD.

Residents will identify sources of information specific to the health care of persons with ID/DD and judge the scientific rigor of that information.

  1. Identify point-of-care resources for physicians that are founded upon evidence based literature and/or expert opinion.
  2. Identify resources for developmental disability-specific information and support that are readily available and accessible to the lay-person.
  3. Evaluate the clinical value of innovative or novel treatment and management strategies for which there is limited peer-reviewed scientific evidence.
  4. Critique a disability-specific website targeted to family members or other support persons.
  5. Apply a standard taxonomy for levels of evidence to a recommendation for healthcare of individuals with ID/DD obtained from the internet.

Residents will examine their practice culture as it relates to person-centered healthcare of individuals with ID/DD.

  1. From the patient’s point of view, describe the experience of an office visit.
  2. From the point of view of the family of an adult with ID/DD, describe the experience of an office visit.
  3. From the point of view of clinical and non-clinical office staff, describe the experience of providing service to a patient with ID/DD.
  4. Become familiar with the Americans with Disabilities Act (ADA) requirements for providing ambulatory medical care to persons with ID/DD.

Systems-Based Practice

“Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.”

Residents will work effectively within patient support systems.

  1. Describe the roles and responsibilities of individuals within a patient’s circle of support.
  2. Assess the impact that health and non-health professionals across disciplines have on that patient’s health and wellbeing.
  3. Illustrate ways that a physician influences patient health and wellbeing via the patient’s support system.

Residents will work effectively with medical and non-medical organizations that impact patient health and wellbeing.

  1. Identify and access local resources that impact the health, inclusion and independence of individuals with ID/DD.
  2. Outline ways that physicians can advocate for persons with ID/DD in, vocational, educational, legal and other non-medical domains.
  3. Describe how system level supports and services affect healthcare access, coordination, quality and safety.

Residents will identify practice management and healthcare financing considerations relative to patients with ID/DD.

  1. Distinguish the types of services and supports reimbursed by governmental and private health insurance payers.
  2. Describe payment mechanisms outside of traditional fee-for-service that support financially viable healthcare practice.
  3. Describe financial reimbursement mechanisms and resources for residential, health and other support services.
  4. Illustrate practice management strategies to optimize reimbursement for services delivered.

Residents will anticipate, recognize and reduce risk to patient safety within and outside of the healthcare system.

  1. Anticipate high-risk situations within the healthcare system when patient safety may be jeopardized.
  2. Assess patient vulnerability as it relates physical abuse, sexual abuse and financial exploitation.
  3. Design patient-specific recommendations to reduce the risk of physical injury.
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