**CENTRAL ALABAMA VETERANS**

**HEALTH CARE SYSTEM**

**MONTGOMERY / TUSKEGEE, ALABAMA**

![](media/image1.png){width="4.583333333333333in"
height="4.090277777777778in"}

**Podiatric Medicine & Surgery**

**24-Month Program**

**(PM&S-24)**

**Resident's Handbook**

**2008-2009 Training Year**

**Revision 6.08**

**[Introduction]{.underline}**

Welcome to CAVHCS. We are pleased that you have selected us for
completion of your formal podiatric medical education. In this manual
you will find the rules of conduct, expectations, rotation goals and
objectives, evaluation forms and logging requirements. If in doubt about
what to do or where to go, please ask. We are all here to guide you and
to maximize the educational experience you are about to embark on.

Please observe the following key rules and regulations:

1.  The podiatric resident will conduct himself or herself in a
    professional and courteous manner at all times during their stay at
    the medical center. Patients will be treated with compassion and
    confidentiality. Patient abuse will not be tolerated. Medical staff
    and other employees will be treated with respect. Any personal
    comments regarding patients or staff are to be made in PRIVATE and
    directed ONLY to podiatric teaching staff. Discussions regarding
    Podiatry attending staff are NOT to be held in front of or with
    patients or other staff members.

2.  All government telephones and computers are for official use only.
    No personal or business use other than official VA business use of
    the telephones, including the resident on-call cellular phone, for
    long distance calls, the computers or printers is permitted. Audits
    are conducted and personal use may result in suspension of computer
    and/or telephone privileges.

3.  You are required to keep a daily log of patient encounters in a
    format deemed acceptable by the Chief, Podiatry Service. Monthly log
    entries must occur within two weeks of the end of that month.

4.  You must adhere to a uniform dress code. Professional attire or
    surgical scrubs will be worn at all times while on duty at the
    medical center. You must wear your official VA photo identification
    badge at all times.

5.  You will be provided with a schedule of your required residency
    rotations. Your attendance is REQUIRED in order to complete these
    rotations. Only the Chief, Podiatry Service or the assigned Rotation
    Coordinator may excuse your absence. Except for sick leave and
    emergency leave, time off requests must be submitted 45 days in
    advance.

6.  You are not protected by the Federal Government in the event of
    malpractice, negligence or any other claim against you arising from
    the performance of duties not authorized by this facility.
    Moonlighting is NOT permitted unless approved by the Chief, Podiatry
    Service and, if authorized, must not interfere with the performance
    of your primary resident duties.

7.  Unless otherwise directed, discussions that are held between you and
    your attending(s) and/or supervisors are to be considered
    confidential and must not be repeated to other
    residents/attendings/staff without prior approval.

8.  Violation of any of these rules and regulations may result in your
    being placed on probation or dismissed from the program. Being
    placed on probation indicates that the resident's performance is not
    satisfactory and that that resident is in jeopardy of being
    dismissed from the program. A resident on probation must have all
    Doctor's Orders, prescriptions, consultation reports and progress
    notes countersigned by a member of the Medical Staff. Failure to be
    removed from probation status prior to the scheduled completion of
    the program will result in the resident not being issued a residency
    program certificate.

Best wishes for a successful training year.

Dan E. Robinson, DPM

Director Podiatric Medical Education

Central Alabama Veterans Health Care System

**HANDBOOK APPROVAL VERIFICATION**

The Central Alabama Veteran Health Care System (CAVHCS) Podiatric
Medical and Surgical Twenty-Four Month Residency Program (PM&S-24) has
been developed to comply with all criteria established by:

1.  The Council on Podiatric Medical Education of the American Podiatric
    Medical Association.

2.  VHA Central Office for Podiatry Services

3.  The Department of Veterans Affairs Medical Center, Central Alabama
    Veteran Health Care System, Montgomery/Tuskegee, Alabama.

4.  Joint Commission on Accreditation of Hospitals

APPROVED

Eddie B. Warren, M.D.

Acting Chief, Surgical Service

APPROVED

A.V. Pradhan, M.D.

Associate Chief of Staff for Acute Care and Specialties

APPROVED

Dan E. Robinson, DPM

Director Podiatric Medical Education

APPROVED

Cliff Robinson, M.D.

Chief of Staff

APPROVED

Shirley M. Bealer, MS, RN, CNAA, BC, CHPQ

Acting Director

**Resident Acknowledgement**

I acknowledge receipt of this Resident Handbook and, after reading it,
agree with the terms and conditions of my appointment as a podiatry
resident at the Central Alabama Veterans Health Care System.
Specifically, I have read and am aware of the policy regarding appeals
and due process to be afforded me in the event that I am subject to
disciplinary proceedings, remediation or supervisory disputes. I have
read the attached VHA 1400.1, [Resident Supervision
Handbook]{.underline}, and CAVHCS Memorandum 11-06-21, [Resident
Supervision Policy]{.underline}, and agree to abide fully with the rules
and regulations contained within those documents.

Resident Printed Name

Signature Date

RESIDENT AGREEMENT

This agreement is executed between the Department of Veterans Affairs
(DVA) at Central Alabama Health Care System (CAVHCS), hereafter called
the Health Care System, and
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, D.P.M.,
hereafter called the "Resident".

Witnesseth:

Whereas, the Health Care System is approved for the training of
Residents by the Council on Podiatric Medical Education (CPME) of the
American Podiatric Medical Association and has agreed to abide by the
residency standards, rules and regulations of said Association, and

Whereas, the Resident has made application to the Health Care System for
appointment as a podiatry resident in an approved podiatric residency
program, and said application has been approved by the Health Care
System, now and therefore, in consideration of the above and of their
mutual promises contained herein, the Health Care System and the
Resident agree as follows:

The Health Care Center agrees:

1.  To provide a Podiatric Medical & Surgical Residency Program
    (PM&S-24) for a twenty-four (24) month period commencing on July 1,
    2007 and ending June 30, 2009.

2.  To define the duties and privileges of the Resident within the
    Resident manual to include duty times. Non-O.R. duty time is 0730 --
    1600 hours and O.R. duty time is 0630 -- 1600 hours Monday through
    Friday with weekends and extended hours for the on-call and
    surgical-day residents. In no event shall any one resident work more
    than 80 hours in one week as averaged over a four-week period, as
    per ACGME published guidelines.

3.  To provide the Resident with a stipend of \$37,807 for the first
    year of training and \$40,057 for the second year of training paid
    biweekly, subject to payroll deductions.

4.  To provide 13 sick days per year and 13 days annual leave per year
    which may be taken subject to scheduling and program availability.

5.  To provide professional liability coverage through the "Federal Tort
    Claims Act", for approved activities, during the training program.

6.  To furnish clinical coats and surgical scrubs to the Resident for
    use during the training program.

7.  To furnish a written copy of a general schedule and curriculum at
    the beginning of the program as incorporated in the Resident manual.

8.  To present or cause to be presented to the Resident an appropriate
    certificate upon the satisfactory completion of the program.

The Resident agrees:

1.  To serve as a resident in the field of podiatry during the term of
    this agreement under appointment authority of 38 U.S.C. 7405.

2.  To perform to the best of his/her ability all duties assigned, to
    maintain standards of professional competence as determined by the
    Health Care System, and to maintain professional conduct at all
    times.

3.  To observe all the rules and regulations of the Health Care System
    as they pertain to Residents based on VHA Directive 1400.1 and
    CAVHCS Supervision of Resident Policy.

4.  To engage, during the entire period of this agreement, only in such
    activities of a professional and ethical nature as are appropriate
    and approved b the Health Care System.

5.  To refrain, during the entire period of this agreement, from
    engaging or participation in any professional or nonprofessional
    activities that would interfere with the effective performance of
    all duties and responsibilities of this agreement.

6.  To submit to a fitness for duty physical examination by the
    Occupational Health Service and to be interviewed by the Residency
    Review Committee when deemed necessary.

The parties further agree:

1.  That this agreement may be terminated at any time by mutual consent
    and with written release. In the event of termination of mutual
    consent the Health Care System shall determine credit to be given
    the Resident for part-time service.

2.  That if the Resident fails to perform satisfactorily any obligation
    under this agreement, the Health Care System may terminate the
    agreement, without certification.

3.  That if the Health Care System loses its approval, or resources for
    resident training, during the period of this agreement, on the
    effective date of loss, the Resident shall be released from this
    agreement and shall not be prohibited from immediately entering
    another approved residency program.

4.  That the Health Care System shall immediately notify the CPME of a
    termination of this agreement. In the event of a termination by
    mutual consent, the Health Care System will send a signed copy of
    this agreement with the written release by mutual consent proviso
    signed by the Health Care System and the Resident to the Council on
    Podiatric Medical Education of the American Podiatric Medical
    Association.

5.  That the "Requirements for Residency Training" of the Council on
    Podiatric Medical Education is hereby incorporated by reference in
    this agreement as part hereof to the same extent as if printed
    herein.

6.  That this agreement shall be effective on the date indicated below.

In witness whereof, the parties have executed this agreement on this
\_\_\_\_\_ day of \_\_\_\_\_\_\_\_\_,

2008\. Effective date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Resident

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Dan E. Robinson, DPM

Director Podiatric Medical Education

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Shirley Bealer, MS, RN, CNAA, BC, CHPQ

Acting Director CAVHCS

**INTRODUCTION**

The Department of Veterans Affairs at the Central Alabama Health Care
System has established a Podiatric Medical and Surgical Residency
Program. This twenty-four month program is designated to provide
training in all aspects of Podiatric Medicine and Surgery by utilizing
this health care system's resources. The training encompasses the
examination, diagnosis, treatment and prevention of primary and
secondary foot disorders and covers medical, surgical, diagnostic and
newly emerging technological treatment approaches.

The curriculum is designed not only to provide foot care, but also to
enhance the awareness of the correlation between foot problems and the
general health and well being of the total patient.

Two -- twenty-four month, medical center based, podiatric medical and
surgical residency positions will be available beginning in July of each
year. The resident will rotate through various services, achieving
competency within well-defined parameters specific to each area of
training.

The experiences include but are not limited to:

Podiatric Medicine -- Clinic Based, Podiatric Surgery, Internal Medical
/Geriatrics, General Surgery, Anesthesia, Orthopedic Surgery, Laboratory
Medicine, Diagnostic Imaging, Emergency Medicine, Pediatrics,
Cardiology, Wound Clinic and other assigned rotations or experiences.

General Program Goals

The Podiatric resident will:

1.  Develop and enhance his/his diagnostic and management skills with an
    emphasis on whole patient management.

2.  Gain basic podiatric medical and surgical skills in the management
    of foot and ankle conditions.

3.  Understand the various factors involved in the clinical practice
    management model.

4.  Understand the differences in the in-patient and out-patient medical
    models and methods for assuring quality of care and risk management
    in both settings

5.  Achieve competency in scholarly activities; specifically the use of
    Evidence Based Medicine as a foundation for selection of therapeutic
    modalities and peer lectures.

**Program Requirements**

1.  **[Lectures, Conferences, and Journal club]{.underline}**

***A detailed calendar of lectures, conferences and journal clubs will
be provided at the beginning of the training year.***

A. **Educational Meetings**

Educational meetings are designed to augment the clinical content of the
program with respect to the goals and objectives of the program. These
meetings will be held weekly on Friday afternoons. Attendance is
***mandatory.*** Attendance conflicts must be brought to the attention
of the Director. The PRESENT on-line program series is used to
supplement the lecture schedule. These presentations may be viewed at
the resident's leisure by logging into that website with their VA e-mail
address and supplied password.

B. **Conferences**

Conferences are scheduled as part of several rotations and your
participation is ***mandatory*** unless otherwise indicated. In
addition, all residents will attend programs and conferences as
designated by the Chief, Podiatry Service including the monthly Medical
Staff Meeting held on the 3^rd^ Friday of each month and the Morbidity
and Mortality (M&M) Conference scheduled on the 4^th^ Friday of every
month.

C. **Journal Club**

On the second Friday of each month, a Journal Club will be conducted.
Each resident will be responsible for reviewing one article (providing a
copy for each resident and faculty member in attendance and one
additional copy for the residency program file) and presenting it while
leading the follow-up discussion. Select a relevant article from a
recent **[PEER REVIEWED]{.underline}** publication. Your participation
in the Journal Club is ***mandatory***.

> **PM&S-24 RESIDENCY PROGRAM**
>
> **EVALUATION STRATEGY**
>
> **Rotation evaluations**
>
> Each rotation director based on the objectives established for each
> rotation will evaluate residents. These rotation evaluations will
> serve to evaluate the resident's knowledge and skills as well as their
> motivation and attitude. Unsatisfactory rotation evaluations will
> follow the remediation plan listed below.
>
> **Remediation Plan**
>
> Unsatisfactory Rotation Evaluation
>
> Directed remediation program development with rotation director
>
> Resident's self remediation
>
> Reassessment Successful Continue Program
>
> Unsuccessful
>
> Remediation program development with program and rotation directors
>
> Resident remediation Successful Continue Program
>
> Unsuccessful
>
> Recommend dismissal

**Program and faculty evaluation**

Program and faculty evaluations will involve the resident evaluation of
the program's administration, faculty and the educational component.
These forms will be completed at the end of each training year by all
residents. The completed forms will be evaluated by the Residency Review
Committee at their October meeting.

**Exit interviews**

In addition each resident will complete a final series of written
program and faculty evaluations and have an exit interview with the ACOS
for Education in June just prior to graduating from the program. This
interview will deal with the resident's overall evaluation of the
program, the programs administration and provide them an opportunity to
identify problem areas and suggest improvements.

**Residency Resource On-Line Log System**

CAVHCS participates in Residency Resource On-Line Case Log System (RR).
You will be instructed in its use and be assigned a log-in code. You are
required to complete one month's entries by the second week of the
following month. The only exception is that your last month of training
in each of the two-years MUST be completed by the last day of June in
order to be promoted/graduated on time. You can access case/procedure
log from any Internet-connected computer. All didactic and
lecture/workshop activities will documented in this system, as well. The
CPME reviewer assigned for CAVHCS will login from time to time to review
what you have entered. Therefore, timely, complete and accurate data
entries are important.

**PRESENT Courseware**

CAVHCS utilizes the PRESENT Courseware on-line lecture series. Residents
are assigned a log-in ID and password so that they can view lectures.
Quizzes are part of this teaching program and can be used as a
self-evaluation tool. The Director is able to view a report of resident
lecture viewings/completions to assure compliance with assignments. The
programs may be viewed at home or at CAVHCS by navigating your web
browser to:
[http://present.articulateglobal.com](http://present.articulateglobal.com/).

**ABPS In-Training Examination**

Each spring, the residents are required to take the computer-based
In-Training exam offered by the American Board of Podiatric Surgery.
This may involve travel to a city within a 2-hour drive of CAVHCS. When
this is necessary, a government car will be provided for your use as a
group. Friends and relatives are not permitted to travel with you when
using a government vehicle. The scores are sent to the resident and the
Program Director. The year-to-year difference in performance will be
used as an improvement measurement tool. The cost of the examination is
covered by CAVHCS. When the ABPOPPM In-Training examination becomes
available, this will become a mandatory in-training examination, as
well.

**Synquest Training**

CAVHCS has mandatory computer-based training for all employees,
including residents. You will be assigned course to view and tests to
take. A record will be kept of your progress. 40 hours of training are
required each year. Log into Synquest through the icon on your desktop
for access to your curriculum list. This is a MANDATORY activity.

**Podiatry Residency Program Orientation**

MANDATORY new resident/employee orientation will be conducted prior to
rotation commencement. As a CAVHCS employee, you are responsible for
understanding the bylaws and rules of the Medical Staff. These can be
located on the CAVHCS home web page on the intranet. Most official
communication will be conducted through Outlook Exchange e-mail. You are
responsible for checking your e-mail at least **[THREE
TIMES]{.underline}** per day including first thing in the morning,
during lunch break and before the end of the work day. If you maintain a
private e-mail address please provide the address to the Director of
Podiatric Medical Education. If you change addresses during the training
year, please inform the Director of Podiatric Medical Education.

You will be evaluated quarterly by your residency director. Many of the
items on the following checklist comprise the basis for your evaluation.
Time and attendance, adherence to the published schedule, CAVHCS
policies and procedures and, of course, patient care activities, are
some of the most important items to be aware of.

You will be issued a photo identification badge and a parking tag. You
must wear the I.D. tag above your waist so that it is always visible
**AT ALL TIMES WHEN ON CAMPUS** and your car must have the hanging tag
attached to the rear-view mirror at all times when parked on CAVHCS
property. You will be charged replacement costs if either is lost.
Please report any loss to the CAVHCS Police Department at either campus.
For access to the Maxwell Air Force Base Podiatry Clinic, you will need
a separate Department of Defense identification badge and parking
permit. To obtain these, you will need a copy of your vehicle
registration slip, a current driver's license and proof of insurance.
The in-processing at Maxwell will be arranged by the Program Director.

Sample orientation checklists and overviews are on the following two
pages. The orientation is a thorough process to ensure familiarity with
CAVHCS functions. If at any time you do not understand any duties,
responsibilities, rules or regulations -- please notify the Director of
Podiatric Medical Education or the orientation supervisor for the
service you are having difficulty with.

Computerized Patient Record System (CPRS) Orientation and Training

The VA system uses CPRS to record all patient interactions and all
diagnostic test results. The resident will enter progress notes (history
and physical admission notes, interdisciplinary treatment plans (IDT),
discharge instructions, tissue examination sheets, etc.), answer
consults, place orders for diagnostic tests (imaging, laboratory),
medications, prosthetic items, and reappointments as well as dictate
operative reports and discharge summaries. You will receive a basic
orientation to CPRS during a training class conducted by Clinical
Informatics. There is an overview of the functions within CPRS in the
Appendix section of this handbook. However, there are some important
things you need to know up front:

-   All progress notes are to entered in the SOAP format and are to
    contain all information pertinent to the care of the patient on that
    date

-   At no time are any portions of existing notes to be copied, cut
    and/or pasted into new notes

-   All outpatient visits will have an encounter created at the time the
    note is entered

-   The CAVHCS Approved Abbreviations and Symbols Policy 136-06-06 must
    be followed -- a copy of the policy is also in the Appendix section
    of this handbook

    -   You may view the policy while working in CPRS by clicking on the
        "Tools" menu at the top of the screen and clicking on the
        abbreviations link

-   All progress notes are to be entered into CPRS on the date the
    patient is seen

-   Al operative reports and discharge summaries are to be dictated on
    the day of the surgery of the discharge

-   All reports (operative, discharge summaries) are to edited on the
    day you receive the alert in CPRS and forwarded to the responsible
    staff attending

-   All orders for narcotic medications are to be discussed with your
    staff attending before entering as an order into CPRS

Pharmacy Issued VA Narcotic Prescription Pads

Pharmacy Service will issue you VA prescription pads for the purpose of
writing CII narcotic medication prescriptions for patients. These pads
are numbered and will each sheet used will be tracked back to the person
that pad was assigned to. It is vitally important that you keep these
pads under your control at all times. When not in use, if not on your
person, you MUST keep the pad under lock and key either in a secure desk
drawer or in your resident office. The prescription must contain the
patient's full name; full social security number and your VA issued
narcotic dispensing number which will be individually assigned to you.

If you lose a sheet or an entire pad AT ANY TIME, you MUST notify your
director, attending or the VA Police or Pharmacy Service. Failure to
follow these rules may result in dismissal from the program. This is a
very closely monitored area.

[Staff Orientation for Podiatry Residents - SAMPLE]{.underline}

ORIENTATION ACTIVITY/MEETING DATE TIME

IRM Computer Access/CPRS (x4920) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Room 4A-132) Ms. Cynthia Hopper

Pharmacy Service Manager -- Dr. Marilyn Wallace

(x4239) (Room GD102) TBD TBD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Pharmacy Procedures, Formulary, Adverse Drug Events

CPRS Training -- Claudia Garrison ext. 6261 pager 754

Room 4A-132 1B-120 TBD TBD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Pathology and Laboratory Medicine Service Manager -- Dr. Singh

(x4710) Ordering Lab procedures, etc. (Room 1C-103) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Imaging Service, Dr. S. Shroff, Service Manager TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Ordering imaging procedures, etc. (x4951) (Room GB101)

Human Resources Processing -- Ms. Cynthia Hopper (x4920) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Room 1A-122)

LSU/Staff -- Staff (x4361) (Room GC-110) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Corporate Compliance -- Vicki Huston (x4404 -- 1A-103) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CBI Policy & film. Sign Provider acknowledgment form.

Infection Control - Ms. Fitzgerald (x4302) (Room 1A-111) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(film in Human Resources)

Risk Management/ Gayle Warren (Rm 1A-132 ) TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Ext EC 4208, WC 4908 or Kena Cauthen (Rm 1A-114) Ext 4561

Employee Health-Mary Lovelady (GD 139) Ext. 4363 TBD TBD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Dictation Code & Procedure-Claudia DeVaughn (ec ext. 4045)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PODIATRY RESIDENCY ORIENTATION CHECKLIST - OVERVIEW

  ----------------- ----------------- ----------------- -----------------
  Activity /        Date of           Supervisor's      Employee's
  Function          Orientation       Initials          Initials

  Review                                                
  organization of                                       
  service, its                                          
  relationship                                          
  within health                                         
  care system.                                          

  Conduct tour of                                       
  office areas /                                        
  Introduce to                                          
  other staff.                                          

  Provide and                                           
  review schedule                                       
  of training                                           
  activities;                                           
  Review residency                                      
  training                                              
  requirements                                          
  overall and for                                       
  residency                                             
  training program.                                     

  Review job                                            
  description.                                          

  Review time and                                       
  leave                                                 
  expectations,                                         
  lunch periods.                                        

  Review requires                                       
  policies                                              
  including                                             
  applicable                                            
  services of                                           
  Medical Staff                                         
  Bylaws and Rules.                                     

  Indicate location                                     
  of fire alarms,                                       
  extinguishers /                                       
  Provide copy of                                       
  emergency phone                                       
  numbers, fire                                         
  alarm boxes, etc.                                     
  Review other                                          
  safety                                                
  procedures, etc.                                      

  Indicate where                                        
  can get access to                                     
  service specific                                      
  policies, health                                      
  care system                                           
  policies.                                             
  ----------------- ----------------- ----------------- -----------------

> **ROTATION COMPETENCIES**

# **PGY-1: First Year Experiences**

**[PODIATRIC MEDICINE]{.underline}**

This is an on-going rotation involving the outpatient podiatry clinics,
and inpatient clinical facilities at CAVHCS. You will be responsible for
the care of the patients assigned to you under the supervision of the
clinical faculty of the podiatry clinics. You will develop advanced
diagnostic and treatment skills in podiatric clinical care. The resident
will also become familiar with self-directed learning as a philosophy of
continuing medical education and learn to employ the principles of
evidence based medicine as a tool for selecting treatment regimes.

Also included in this rotation:

**[BIOMECHANICS]{.underline}**

Your objectives are to develop advanced diagnostic and treatment skills
in podiatric primary care as they relate to biomechanics and
orthopedics, specifically the identification of the patient's with
mechanical problems which would benefit from orthotic control, CAD/CAM
milling of orthotic devices on-site at Maxwell Air Force Base, on-site
construction of accommodative orthotic devices and adjustment of
biomechanical devices.

**[PODOGERIATRIC CARE]{.underline}**

Your objectives are to develop advanced clinical skills in caring for
the pedal conditions of the well elderly, and the compromised elderly
patient. The resident will participate in the planning and
implementation of a prevention program for the nursing home and other
in-patient populations. See the Medicine Service for specific
competencies.

**[PODOPEDIATRIC CARE]{.underline}**

You will be responsible for the diagnosis and management of pediatric
foot and ankle problems. This rotation will be conducted through the
CAVHCS podiatry clinics located at Maxwell Air Force Base in Montgomery.
See the Medicine Service for specific competencies.

**[CORE COMPETENCIES]{.underline}**

**Goal: Podiatric Medicine**

> The podiatric primary care resident should be able to synthesize
> patient data and develop differential medical hypothesis concerning
> patient's problems.

**Competencies: Podiatric Medicine**

1.0 Perform and interpret the findings of a thorough problem-focused
history and physical exam including

1.  problem focused history,

2.  neurologic examination

3.  vascular examination

4.  dermatologic examination

5.  musculoskeletal examination

    1.  Perform a complete biomechanical examination of the lower
        extremity and propose an appropriate treatment plan

    2.  Prescribe and modify functional biomechanical foot orthoses

    3.  Demonstrate a working knowledge of shoe construction and shoe
        therapy and be able to advise patients on the proper foot gear
        for particular foot structures and problems

    4.  Demonstrate the ability to prescribe, fabricate and adjust
        accommodative foot orthoses.

6.  Perform (and/or order) and interpret appropriate diagnostic studies,
    including

7.  Medical imaging,

    1.  including plain radiography

    2.  radiographic contrast studies

    3.  stress radiography

    4.  fluoroscopy

    5.  nuclear medicine imaging

    6.  MRI

    7.  CT

    8.  diagnostic ultrasound

    9.  vascular imaging.

8.  Laboratory tests in

    1.  Hematology

    2.  serology/immunology

    3.  toxicology

    4.  microbiology

    5.  blood chemistries

    6.  drug screens

    7.  coagulation studies

    8.  blood gases

    9.  synovial fluid analysis

    10. urinalysis

9.  Pathology, including

    1.  anatomic and cellular pathology

10. Other diagnostic studies including

    1.  electrodiagnostic studies

    2.  non-invasive vascular studies

    3.  bone mineral densitometry studies

    4.  compartment pressure studies

**Goal 2: Podiatric Medicine**

1.  The resident should be able to develop an accurate diagnosis and
    appropriate therapeutic plan.

**Competencies: Podiatric Medicine**

1.  Formulate an appropriate diagnosis and/or differential diagnosis

2.  Formulate and implement an appropriate plan of management, including

3.  Appropriate management when indicated, including

    1.  Palliation of keratotic lesions and toenails

    2.  Manipulation/mobilization of foot/ankle joint to increase range
        of motion/reduce associated pain and of congenital foot
        deformity.

    3.  Management of closed fractures and dislocations including pedal
        fractures and dislocations and ankle fracture/dislocation

        1.  Cast management.

        2.  Tape immobilization.

        3.  Orthotic, brace, prosthetic, and custom shoe management.

        4.  Footwear and padding.

        5.  Injections and aspirations.

        6.  Physical therapy.

4.  Pharmacologic management, including the use of

    1.  NSAIDs

    2.  Antibiotics

    3.  Antifungals

    4.  narcotic analgesics

    5.  muscle relaxants

    6.  medications for neuropathy

    7.  sedative/hypnotics

    8.  peripheral vascular agents

    9.  anticoagulants

    10. antihyperuricemic/uricosuric agents

    11. tetanus toxoid/immune globulin

    12. laxatives/cathartics

    13. fluid and electrolyte management

    14. corticosteroids

    15. anti-rheumatic medications.

5.  Appropriate consultation and/or referrals

6.  Appropriate lower extremity health promotion and education.

7.  Assess the treatment plan and revise it as necessary.

8.  Demonstrate an understanding of public health concepts, health
    promotion, and disease prevention

**Goal 3: Podiatric Medicine**

The podiatric primary care resident should develop advanced diagnostic
and treatment skills in podiatric primary care as it relates to all
patient populations.

**Competencies: Podiatric Medicine**

1.  Perform the following podiatric primary skills at an expert level

    1.  Nail debridement

    2.  Hyperkeratosis debridement

    3.  Ulcer debridement and care

    4.  Nail surgery and verrucae excision

    5.  Padding skills

    6.  Shoe modifications

    7.  Foot orthoses

    8.  Correction of digital deformities

2.  List and discuss the indications and contraindications for the
    various surgical procedures for common forefoot pathologies
    including

    1.  Hallux deformities

    2.  Neuromas

    3.  Miscellaneous bony deformities (digital, metatarsal, midfoot)

3.  Demonstrate the ability to manage patients suffering from vascular
    conditions of the lower extremities

4.  Discuss the role of the podiatrist in the management of diabetes

5.  Demonstrate the ability to manage patients with diabetes

6.  Discuss the role of the podiatrist in the care and management of the
    arthritic patient.

7.  Demonstrate the ability to manage the arthritic patient.

8.  Discuss the role of the podiatrist in the care and management of the
    neurological patient.

9.  Demonstrate the ability to manage the neurological patient with
    pedal problems.

**Community Podiatry**

# **PGY-1: First Year Experiences**

This rotation will expose the resident to those patients who are at a
financial, social or physical disadvantage. The experiences will be
accomplished with the VA system and at Maxwell AFB utilizing the East
Campus extended care and mental health inpatient facilities, VA
sponsored health fairs, VA Stand downs for homeless veterans and
detention facilities at the AFB.

Goal: Community Podiatry

1\. The podiatric primary care resident should develop advanced
diagnostic and treatment skills in podiatric primary care as it relates
to special patient populations.

Competencies: Community Podiatry

1.  Demonstrate an understanding of public health concepts, health
    promotion, and disease prevention

    1.  Discuss the role of the podiatrist in the care of the following
        patient populations;

    2.  extended care facility

    3.  patients with psychosocial disorders

    4.  homeless

    5.  under-served minorities

    6.  medically disenfranchised

2.  Provide care for patient's in the following patient populations:

    1.  extended care facility

    2.  patients with psychosocial disorders

    3.  homeless

    4.  under-served minorities

    5.  medically disenfranchised

**[PODIATRIC SURGERY PGY-I / PGY-II]{.underline}**

This is an on-going rotation involving the East and West Campus/Maxwell
clinics and the surgery suites located at the West Campus. The inpatient
clinical facilities at CAVHCS will be utilized as well. You will be
responsible for the care of the patients assigned to you under the
supervision of the clinical faculty of the podiatry surgery clinic. Your
objectives are to develop advanced diagnostic and treatment skills in
podiatric surgery. The resident should also become familiar with
self-directed learning as a philosophy of continuing medical education.

**[OBJECTIVES]{.underline}**

The Resident will be trained in techniques in forefoot, rearfoot, and
ankle surgery, pre-operative surgical work-up including assessment of
the indications for surgery, performance of surgery, and post-operative
care of the patient.

# **First Year Experiences: Podiatric Surgery** 

This experience will involve the pre-operative, peri-operative and
post-operative care of patients in the inpatient and outpatient
settings. There will be an interim evaluation between Podiatric Surgery
PGY-I and Podiatric Surgery PGY-II to ensure continued development,
growth and graduating levels of independence.

**Goal: PGY-I Podiatric Surgery**

The podiatric primary care resident should become proficient in the
evaluation of foot deformities including the indications and
contraindications for surgical intervention. The resident should be able
to articulate appropriate pre, peri and post-operative management plans
and develop skills in the performance of surgical procedures.

**Competencies: PGY-I Podiatric Surgery**

Upon the completion of this rotation, the resident will be able to do
the following.

1\. Perform a thorough history and physical examination of the foot and
ankle, evaluate the patient's problem and describe the deformities
accurately and in proper format.

2\. Determine if the patients' condition requires surgical intervention

3\. Describe the appropriate choice of procedure

Nail pathology

Skin lesions

Neuromas and heel pain

Digital deformities

Lesser metatarsal deformities

First ray pathology: Hallux Valgus, Hallux limitus, and Hallux rigidus
deformities.

Diabetic foot infections

Gangrene of one or more toes

Charcot foot deformity

Equinus

Tumors

Trauma

4\. Effectively communicate the advantages, disadvantages and risks
associated with the procedure(s)

A.  Diabetic foot infections with or without osteomyelitis

B.  Gangrene

C.  Charcot foot deformities

D.  Equinus

E.  Tumors

F.  Trauma, including sprains, tendon ruptures and fracture

5\. Write the appropriate preoperative orders and perioperative
management of:

A. The healthy patient

B. The diabetic patient

C. The occlusive arterial disease patient

D. The hypertensive patient

E. The cardiac patient

F. The immunocompromised patient

G. The arthritic patient

6\. Perform under direct supervision basic surgical skills

A.  Proper selection and performance of skin and deep tissue incisions.

B.  The use of manual and power surgical instrumentation.

C.  Disservice of tissue layers, osteotomy completion, and hardware
    implantation.

D.  Proper selection of suture materials and use in closure of various
    tissue layers.

E.  Application of post-operative dressings as appropriate for various
    procedures.

7\. Write post operative orders

8\. Perform post operative dressing changes

9\. Accurately evaluate the immediate post operative course including
early signs and symptoms of complications

A. The uneventful postoperative course

B. Post operative infection

C. Post operative swelling

D. Post operative pain

10.Provide home going instructions, prevention and patient education

# 

# 

# **Second Year Experiences: Podiatric Surgery**

**Rotation Description:**

This experience will involve the pre-operative, peri-operative and
post-operative care of patients in the inpatient and outpatient settings
under both direct supervision and under graduated resident
responsibility guidelines.

**Goal 1: Podiatric Surgery**

Upon completion of this experience the podiatric resident will be
expected to demonstrate the ability to independently evaluate and
diagnose patients, making appropriate recommendations for both surgical
and non-surgical treatments

**Competencies: Podiatric Surgery**

The resident will develop advanced clinical skills in the following
areas:

1.  Perform thorough history and physical examination

2.  Interpret all relevant clinical data

3.  Provide differential diagnosis

4.  Develop appropriate management plan of noted or anticipated medical,
    psychosocial and podiatric problems

5.  Present clinical findings and management plan to appropriate VA
    staff

**Goal 2: Podiatric Surgery**

Upon completion of this experience the podiatric resident will be
expected to demonstrate expertise in medical and surgical foot care in
various settings

**Competencies: Podiatric Surgery**

The surgical resident will develop advanced, independent clinical and
surgical skills, as well as, the ability to communicate effectively

1.  Develop and present an appropriate surgical management plan to
    include procedure selection, pre, peri and post op considerations
    including any medical/specialist consultation and psychosocial
    issues.

2.  Demonstrate proficiency in performing surgical skills during
    operative procedures including forefoot, midfoot and rearfoot
    procedures:

    1.  Sterile prep

    2.  Incisions

    3.  Disservice

    4.  Tissue handling -- soft tissue

    5.  Tissue handling - Bone

    6.  Suturing

    7.  Internal Fixation

3.  Appropriately manage foot and ankle conditions in the in-patient and
    out-patient settings

4.  Work effectively as a professional surgical team member.

5.  Demonstrate appropriate communication skills with patients, families
    and hospital staff members

6.  Perform specific procedures

    1.  Soft Tissue

        1.  Excise skin lesions

        2.  Excise soft tissue mass

    2.  Digital Surgery

        1.  Arthroplasty

        2.  Arthrodesis

        3.  Condylectomy

        4.  Exostectomy

        5.  Partial Amputation

        6.  Total amputation

    3.  Metatarsal Surgery

        1.  Distal metatphyseal osteotomy

        2.  Arthrodesis

    4.  First ray procedures

        1.  Keller Arthroplasty

        2.  Soft tissue bunion surgery

        3.  Distal metaphyseal osteotomy

        4.  Proximal osteotomy

        5.  Arthrodesis

    5.  Other arthrodesis

        1.  Met-cuneiform

    6.  Rear foot procedures

7.  Demonstrate various forms of fixation

8.  Trauma

    1.  Manage fractures

        1.  Digital

        2.  Metatarsal

        3.  Midfoot

        4.  Rearfoot

        5.  Ankle

9.  Ankle

    1.  Lateral ankle stabilization

    2.  Major tendon transfer

    3.  Tendo Achilles lengthening

10. Limb Salvage

    1.  Debride infected ulcers

    2.  Incision and drainage of abscess

    3.  Debride necrotic soft tissue and bone

    4.  Levels of amputation

        1.  Toes

        2.  Forefoot

        3.  Midfoot

        4.  Rearfoot Reconstruction

**[MEDICINE]{.underline}**

# **First Year Experiences: Pediatric/Geriatric Medicine Experience**

The medicine experience will be conducted in the Pediatric Clinic at
Maxwell AFB under direction of staff physicians at that facility and the
Geriatric (Long Term Care) clinics at CAVHCS. Included in this rotation
will be the opportunity to evaluate pediatric patients (at Maxwell AFB
clinics) for lower extremity pathology.

**Goal: Pediatric/Geriatric Medicine**

Upon completion of this experience the podiatric resident will be
expected to be able to perform a complete history and physical
examination on patients of all ages.

**Competencies: Pediatric/Geriatric Medicine**

1.1. Perform and interpret the findings of a thorough problem-focused
history and physical exam, including:

1.1.1. Problem focused history.

1.1.2.1.1. Understands the correct technique for performing the
following

components of a problem-focused neurologic examination:

> 1.1.2.1.1.3. Specific muscle testing.
>
> 1.1.2.1.1.4. Evaluation of coordination (stance and gait), including
> tests of
>
> cerebellar function (see also service 1.1.5.1.1.4)
>
> 1.1.2.1.1.5.1. Nerve palpation and percussion (Tinel's, Valleix's)

1.1.2.1.2. Understands the normal and abnormal findings for each of the

exam components listed in service 1.1.2.1.1

1.1.2.1.3. Understands the rationale for performing each of the exam

components listed in service 1.1.2.1.1

1.1.2.3.1. Utilizes the correct technique for performing each of the

components of a problem-focused neurologic examination listed in

service 1.1.2.1.1

1.1.2.3.2. Recognizes (correctly interprets) the normal or abnormal
findings

of each of the exam components in service 1.1.2.1.1 when performed

upon a patient.

1.1.2.3.3. Utilizes appropriate neurologic exam components indicated by

patient's chief complaint.

**1.1.3. vascular examination.**

1.1.3.1.1. Understands the correct technique for performing the
following

components of a problem-focused vascular examination:

> 1.1.3.1.1.1. Palpation of femoral, popliteal, and pedal (posterior
> tibial and
>
> dorsalis pedis) pulses.
>
> 1.1.3.1.1.2. Auscultation of the arterial tree from abdominal aorta to
>
> popliteal artery.
>
> 1.1.3.1.1.3. Observation of capillary (subpapillary venous plexus)
> filling
>
> time and venous filling time.
>
> 1.1.3.1.1.4. Observation for pallor on elevation / dependent rubor.
>
> 1.1.3.1.1.5. Observation for secondary skin changes of vascular
> disease,
>
> including temperature, turgor, color, hair distribution, texture, and
>
> the presence of ischemic, vasculitic, or varicose ulcers.
>
> 1.1.3.1.1.6. Observation for varicosities.
>
> 1.1.3.1.1.7. Examination for superficial and deep venous
> thrombophlebitis.
>
> 1.1.3.1.1.8. Palpation of inguinal and popliteal lymph nodes.
>
> 1.1.3.1.1.9. Observation of lymphangitis and cellulitis.
>
> 1.1.3.1.1.10. Observation of level/distributuion, severity, and
> density of
>
> peripheral edema.

1.1.3.1.2. Understands the normal and abnormal findings for each of the

exam components listed in service 1.1.3.1.1

1.1.3.1.3. Understands the rationale for performing each of the exam

components listed in service 1.1.3.1.1

1.1.3.3.1. Utilizes the correct technique for performing each of the

components of a problem-focused vascular examination listed in service

1.1.3.1.1

1.1.3.3.2. Recognizes (correctly interprets) the normal or abnormal
findings

of each of the exam components in service 1.1.3.1.1 when performed

upon a patient.

1.1.3.3.3. Utilizes appropriate vascular exam components indicated by

patient's chief complaint.

1.1.3.3.4. Performs the problem-focused vascular exam in an appropriate

period of time.

**1.1.4. dermatologic examination.**

1.1.4.1.1. Understands the correct technique for performing the
following

components of a problem-focused dermatologic examination:

> 1.1.4.1.1.1. Observation of skin tone, color, texture, moisture,
> temperature,
>
> turgor, and integrity.
>
> 1.1.4.1.1.2. Observation of hair distribution.
>
> 1.1.4.1.1.3. Observation of nail shape, color, thickness, orientation,
> and
>
> integrity.
>
> 1.1.4.1.1.4. Observation of characteristics (qualitative and
> quantitative) of
>
> potential neoplastic skin changes.
>
> 1.1.4.1.1.5. Observation of characteristics (qualitative and
> quantitative) of
>
> potential ulcerative skin changes.
>
> 1.1.4.1.1.6. Observation of qualities and characteristics of potential
>
> infectious (viral, bacterial, fungal) skin changes.
>
> 1.1.4.1.1.7. Observation of qualities and characteristics of skin
> changes
>
> associated with metabolic/systemic diseases.
>
> 1.1.4.1.1.8. Observation of qualities and characteristics of skin
> changes
>
> associated with trauma.
>
> 1.1.4.1.1.9. Observation of qualities and characteristics of primary
> skin
>
> disorders.

1.1.4.1.2. Understands the normal and abnormal findings for each of the

exam components listed in service 1.1.4.1.1

1.1.4.1.3. Understands the rationale for performing each of the exam

components listed in service 1.1.4.1.1

1.1.4.3.1. Utilizes the correct technique for performing each of the

components of a problem-focused dermatologic examination listed in

service 1.1.4.1.1

1.1.4.3.2. Recognizes (correctly interprets) the normal or abnormal
findings

of each of the exam components in service 1.1.4.1.1 when performed

upon a patient.

1.1.4.3.3. Utilizes appropriate dermatologic exam components indicated
by

patient's chief complaint.

1.1.4.3.4. Performs the problem-focused dermatologic exam in an

appropriate period of time.

**1.1.5. musculoskeletal examination.**

1.1.5.1.1. Understands the correct technique for performing the
following

components of a problem-focused musculoskeletal examination:

> 1.1.5.1.1.1. Qualitative and/or quantitative evaluation of
>
> positional/structural alignment.
>
> 1.1.5.1.1.2. Qualititative determination of range, axis, and quality
> of
>
> motion of the joints.

1.1.5.1.1.4. Understands characteristics of normal and abnormal gait,

including alignment, coordination, cadence, compensation, and

phasic muscle activity.

1.1.5.1.1.5. Understands characteristics of and differentiates abnormal
gait

patterns including, but not limited to:

> 1.1.5.1.1.5.1. Trendelenberg gait
>
> 1.1.5.1.1.5.2. Steppage gait / Dropfoot
>
> 1.1.5.1.1.5.3. Scissors gait (bilateral spastic paresis)
>
> 1.1.5.1.1.5.4. Spastic hemiparesis/Other spastic gait forms
>
> 1.1.5.1.1.5.5. Sensory Ataxia
>
> 1.1.5.1.1.5.6. Cerebellar Ataxia
>
> 1.1.5.1.1.5.7. Parkinsonism
>
> 1.1.5.1.1.5.8. Other gait forms

1.1.5.1.1.6. Palpation of musculoskeletal structures, including specific

bone, tendon, and joint landmarks.

1.1.5.3.1. Utilizes the correct technique for performing each of the

components of a problem-focused musculoskeletal examination listed in

service 1.1.5.1.1

1.1.5.3.2. Recognizes (correctly interprets) the normal or abnormal
findings

of each of the exam components in service 1.1.5.1.1 when performed

upon a patient.

1.1.5.3.3. Utilizes appropriate musculoskeletal exam components
indicated

by patient's chief complaint.

1.1.5.3.4. Performs the problem-focused musculoskeletal exam in an

appropriate period of time.

# **Second Year Experiences: Internal (Ward) Medicine** 

The podiatry resident will rotate through the Department of Medicine
within the Central Alabama Veterans Health Care System. During this
rotation the podiatry resident will attend rounds as well as attend
medical conferences held at the medical center. The resident will learn
how to medically manage the patients admitted to both the Medicine and
Surgical Services.

**Goal: Internal (Ward) Medicine**

Upon completion of this experience the podiatric resident will be
expected to be able to perform a complete history and physical
examination and articulate the role of the podiatrist in the complete
medical care of the patient.

**Competencies: Internal (Ward) Medicine**

1.  Perform and interpret the findings of a comprehensive medical
    history and physical examination (including pre-operative history
    and physical examination), including

    1.  Comprehensive medical history

    2.  Comprehensive physical examination

        1.  Vital signs

        2.  Physical examination including

            1.  head

            2.  eyes

            3.  ears

            4.  nose

            5.  throat

    3.  Neck

    4.  Chest/breast

    5.  Heart

    6.  Lungs

    7.  Abdomen

    8.  Genitourinary

    9.  Rectal

    10. Upper extremities

    11. Neurologic examination.

2.  Formulate an appropriate differential diagnosis of the patient's
    general medical problem(s)

3.  Recognize the need for (and/or order) additional diagnostic studies,
    when indicated, including:

    1.  EKG.

    2.  Medical imaging including

        1.  plain radiography

        2.  nuclear medicine imaging

        3.  MRI

        4.  CT

        5.  diagnostic ultrasound

    3.  Laboratory studies including

        1.  Hematology

        2.  Serology/immunology

        3.  Blood chemistries

        4.  Toxicology/drug screens

        5.  Coagulation studies

        6.  Blood gases

        7.  Microbiology

        8.  Synovial fluid analysis

        9.  Urinalysis

    4.  Other diagnostic studies

4.  Formulate and implement an appropriate plan of management, when
    indicated, including appropriate therapeutic intervention,
    appropriate consultations and/or referrals, and appropriate general
    medical health promotion and education for the following conditions

    1.  Diabetes mellitus

    2.  Hypertension

    3.  Coronary artery disease

    4.  Kidney disease

    5.  Liver disease

    6.  Common Gastrointestinal disorders

    7.  Common genitourinary disorders

    8.  Infectious disease processes

    9.  Common oncology disorders

##### 

##### 

##### 

#####  

##### CARDIOLOGY

# **PGY-2: Second Year Experiences**

# **Cardiology**

This is a rotation experience with the in-house cardiology staff in both
the outpatient clinics and in-patient wards.

**Goal: Cardiology**

This experience will combine participation in the LSU at CAVHCS. Upon
completion of this experience the podiatric resident will be able to
function in the care of the acute symptomatic patient.

**Competencies: Cardiology**

2.1.2.2.4. Heart

2.1.2.2.4.1. Performance Indicators -- Knowledge

> 2.1.2.2.4.1.1. Understands the correct technique for performing the
>
> following components of examination of the heart:
>
> 2.1.2.2.4.1.1.1. Inspection/Observation of:
>
> 2.1.2.2.4.1.1.1.1. Apical impulse
>
> 2.1.2.2.4.1.1.2. Palpation of:
>
> 2.1.2.2.4.1.1.2.1. PMI
>
> 2.1.2.2.4.1.1.3. Auscultation of:
>
> 2.1.2.2.4.1.1.3.1. Heart sounds -- normal and abnormal
>
> 2.1.2.2.4.1.1.3.2. Murmurs and gallops
>
> 2.1.2.2.4.1.1.3.3. Rubs

2.1.2.2.4.1.2. Understands the normal and abnormal findings for each of

the exam components listed in service 2.1.2.2.4.1.

2.1.2.2.4.1.3. Understands the correct method of grading heart murmurs

and the distinguishing features between benign and

pathologic murmurs

2.1.2.2.4.1.4. Correctly interprets the normal or abnormal findings of

each of the exam components in service 2.1.2.2.4.1.when

performed upon a patient

2.1.2.2.4.1.5. Understands the rationale for performing each of the exam

components listed in service 2.1.2.2.4.1.

**2.1.2.2.4.2. Performance indicators -- Attitudes**

> 2.1.2.2.4.2.1. Facilitates patient cooperation with the exam
>
> 2.1.2.2.4.2.2. Communicates effectively with the patient
>
> 2.1.2.2.4.2.3. Is attentive to the patient
>
> 2.1.2.2.4.2.4. Promotes a calm and reassuring atmosphere for the
>
> encounter
>
> 2.1.2.2.4.2.5. Is sensitive to the patient's discomfort during the
> exam

**2.1.2.2.4.3. Performance indicators -- Skills**

> 2.1.2.2.4.3.1. Utilizes the correct technique for performing each of
> the
>
> components of examination of the heart listed in service 2.1.2.2.4.1.
>
> 2.1.2.2.4.3.2. Recognizes the normal or abnormal findings of each of
> the
>
> exam components in service 2.1.2.2.4.1.when performed upon a patient
>
> 2.1.2.2.4.3.3. Utilizes appropriate heart exam components indicated by
>
> patient's chief complaint
>
> 2.1.2.2.4.3.4. Performs the heart exam in an appropriate period of
> time

##### ANESTHESIOLOGY

The podiatric primary care resident will rotate through CAVHCS
anesthesia department under the direction of Won Namkoong, MD. Resident
will participate in the preoperative evaluation of the surgical patient
about to undergo anesthesia, participate in the administration of the
various anesthetic modalities.

Please call Dr. W. Namkoong at extension 4828 one week prior to your
rotation to arrange your specific schedule.

# **PGY-1: First Year Experiences**

Anesthesiology

The PGY-1 resident will rotate through CAVHCS Anesthesiology Service and
will participate in the preoperative preparation for general anesthetic
procedures, participate in the administration of the various regional
anesthetic modalities and observe the various multidisciplinary pain
management modalities i.e. intubations, LMA, or Spinal Anesthesia.

**Goal: Anesthesiology**

Upon completion of this experience the podiatric resident will be
expected to have developed an understanding of how the various types of
anesthesia are used in the management of medical and surgical conditions
when indicated, including local and general, spinal, epidural, regional,
and conscious sedation anesthesia.

**Competencies: Anesthesiology**

1\) The resident should be able to appropriately evaluate the
pre-operative status of the surgical candidate with regard to general
anesthetic utilization.

2\) The resident should be able to articulate the indications and
contraindications for each of the following:

a\. General inhalation anesthesia.

b\. Spinal anesthesia/epidural.

c\. IV regional anesthesia.

d\. Specific regional anesthetic techniques.

e\. Conscious sedation

f\. Patient monitoring

3\) The resident should be able to describe how to start peripheral IV
line and airway management.

4\) The resident should be able to recognize malignant hyperthermia and
follow appropriate guidelines for its treatment.

##### RADIOLOGY

This rotation will be spent with the Department of Radiology at the
CAVHCS under the direction of Dr. Shroff, Chief, Imaging Service. During
this rotation the podiatric primary care resident will attend
conferences held within the department along with observing and
participating in the daily activities of the department. The resident
will become acquainted with the various radiographic and nuclear imaging
techniques utilized in the hospital setting.

**Please call Dr. Shroff at extension 4951 (west campus) one week prior
to your rotation to arrange your specific schedule. The rotation may
take place at both East and West campuses.**

# **PGY-1: First Year Experiences**

**Medical Imaging**

**Goal: Medical Imaging**

This is one-month rotation, which includes Medical Imaging, Infectious
Disease and Burn Unit

**Medical Imaging Experience**

This rotation will be spent with the Department of Radiology at CAVHCS
under the direction of an assigned radiologist. Upon completion of this
experience the podiatric resident will be expected to have developed an
understanding of how the various medical imaging modalities are used and
interpreted in the diagnosis and ongoing management of medical
conditions.

**Competencies: Medical Imaging**

1.  Perform (and/or order) and interpret appropriate diagnostic studies,
    including:

    1.  Medical imaging including

        1.  plain radiography

            1.  Evaluate a chest x-ray

        2.  radiographic contrast studies

        3.  stress radiography

        4.  fluoroscopy

        5.  nuclear medicine imaging

        6.  MRI

        7.  CT

        8.  diagnostic ultrasound

        9.  vascular imaging

            1.  Evaluate an arteriogram

#####  

##### CLINICAL LABORATORY / PATHOLOGY

This is a rotation at CAVHCS, under the direction of Dr. M. Singh,
Chief, Pathology and Laboratory Service

# **PGY-1: First Year Experiences**

## **Laboratory Medicine/Pathology**

##  

The pathology experience will involve observation and/or participation
in the activities of the department including but not limited to the
performance of microscopic analysis of pathological specimens,
bacteriological studies and clinical laboratory studies.

**Goal: Laboratory Medicine**

Upon completion of this experience the podiatric resident will be
expected to be able to describe, order and interpret the results of
diagnostic laboratory tests and examinations.

**Competencies: Laboratory Medicine**

**The resident will demonstrate the ability to:**

0.  Identify various osseous and soft tissue specimens both on gross
    examination and histological review, including anatomic and cellular
    pathology

1.  Perform bacteriological procedures such as gram stain, culture and
    sensitivity, etc.

2.  Identify abnormal laboratory studies and discuss their relevance to
    the patients overall health and their ability to undergo podiatric
    surgery safely including

    1.  Laboratory tests in

        1.  hematology,

        2.  serology/immunology,

        3.  toxicology,

        4.  microbiology,

    2.  blood chemistries,

    3.  drug screens,

    4.  coagulation studies,

    5.  blood gases,

    6.  synovial fluid analysis,

    7.  urinalysis.

##### URGENT CARE - LIFE SUPPORT UNIT EXPERIENCE

This is a rotation in the Life Support Unit (LSU) under the direction of
Dr. Alan Babb. The resident may be required to cover evening or night
rotations in the LSU (West campus only)

# **PGY-1: First Year Experiences**

## **Urgent Care**

This is a rotation experience involving the Life Support Unit.

**Goal: Emergency Medicine (LSU)**

Upon completion of this experience the podiatric resident will be able
to function in the care of the acute patient with lower extremity
pathology as well as urgent and emergent non-podiatric patients.

**Competencies Emergency Medicine**

**The resident will be able to;**

1.  List the signs and symptoms of common emergency conditions such as

    1.  Cardiopulmonary events

    2.  Cerebral Vascular events

    3.  Hypertensive events

    4.  Acute diabetic emergencies

    5.  Acute gastrointestinal events

    6.  Acute musculoskeletal events

    7.  Acute infectious events

    8.  Other acute conditions

2.  List the signs and symptoms of common lower extremity conditions
    such as

    1.  Fracture/dislocation

    2.  Infection/ulceration

    3.  Sprains/strains

    4.  Lacerations/penetrating wounds

    5.  Foreign body

## **1.3.6 Perform appropriate emergency care for lower extremity conditions**

# **PGY-2: Second Year Experiences**

## **Urgent Care**

This is a rotation experience involving the Life Support Unit.

**Goal: Emergency Medicine (LSU)**

This experience will combine participation in the LSU at CAVHCS. Upon
completion of this experience the podiatric resident will be able to
function in the care of the acute symptomatic patient.

**Competencies Emergency Medicine**

**2.4.1.1.1.2. Outpatient medical/**

**surgical management -- Acute and Subacute -- of patients with the**

**following:**

> 2.4.1.1.1.2.1. Infectious Disease
>
> 2.4.1.1.1.2.2. Neoplasms
>
> 2.4.1.1.1.2.3. Endocrine/Nutritional/
>
> Metabolic/Immune
>
> Disorders
>
> 2.4.1.1.1.2.4. Blood and Blood
>
> Forming Organ Disorders
>
> 2.4.1.1.1.2.5. Mental Disorders
>
> 2.4.1.1.1.2.6. Nervous System/Sense
>
> Organs Disorders
>
> 2.4.1.1.1.2.7. Cardiovascular Disease
>
> 2.4.1.1.1.2.8. Respiratory Disease
>
> 2.4.1.1.1.2.9. Digestive Disorders
>
> 2.4.1.1.1.2.10. Genitourinary Disorders
>
> 2.4.1.1.1.2.11. Pregnancy
>
> 2.4.1.1.1.2.12. Skin and subcutaneous
>
> tissue disorders
>
> 2.4.1.1.1.2.13. Concurrent
>
> musculoskeletal disorders
>
> 2.4.1.1.1.2.14. Polytrauma
>
> 2.4.1.1.1.3. Basic Life Support
>
> 2.4.1.1.1.4. Advanced Cardiac Life Support
>
> 2.4.1.1.1.5. Advanced Trauma Life Support
>
> 2.4.1.1.2. Understands the technical aspects of general
>
> therapeutic intervention for the entities listed in
>
> service 2.4.1.1.1.
>
> 2.4.1.1.3. Understands the instrument and material needs
>
> for the therapeutic intervention
>
> 2.4.1.1.4. Understands the normal and abnormal
>
> interactions between therapeutic modalities

**2.4.1.2. Performance indicators -- Attitudes**

> 2.4.1.2.1. Recognizes and addresses patient concerns
>
> regarding therapeutic intervention
>
> 2.4.1.2.2. Recognizes physical, psychological and social
>
> patient factors that may impact therapeutic
>
> management

**2.4.1.3. Performance indicators -- Skills**

> 2.4.1.3.1. BLS
>
> 2.4.1.3.2. ACLS
>
> 2.4.1.3.3. ATLS
>
> 2.4.1.3.4. Establishes IV access
>
> 2.4.1.3.5. Performs core surgical skills
>
> 2.4.1.3.6. Orders appropriate perioperative medical care
>
> 2.4.1.3.7. Orders appropriate inpatient medical care
>
> 2.4.1.3.8. Orders appropriate ancillary therapeutic services
>
> including but not limited to:
>
> 2.4.1.3.8.1. physical and occupational therapy
>
> 2.4.1.3.8.2. wound care
>
> 2.4.1.3.8.3. chronic pain management
>
> 2.4.1.3.8.4. psychosocial services
>
> 2.4.1.3.8.5. assistive devices
>
> 2.4.1.3.8.6. other

**2.4.2. Appropriate consultations and /or referrals**

> 2.4.2.1. Performance indicators -- Knowledge
>
> 2.4.2.1.1. Recognizes when consultation with another
>
> medical specialist is necessary for either
>
> diagnosis or management
>
> 2.4.2.1.2. Recognizes when referral to a medical specialist
>
> is necessary for either diagnosis or management
>
> 2.4.2.1.3. Understands appropriate written and verbal
>
> communication methods in obtaining
>
> consultation or referral
>
> 2.4.2.1.4. Interprets consultation report and/or
>
> recommendations appropriately
>
> 2.4.2.1.5. Selection of consultation and/or referral fits the
>
> overall management of the patient in terms of evaluation or management
> sequence, timeliness, and cost-effectiveness (see also service 3.4)
>
> 2.4.2.1.6. Recognizes when consultation results indicate further
> history, physical exam, diagnostic studies, therapeutic intervention
> or further consultation

**2.4.2.2. Performance indicators -- Attitudes**

> 2.4.2.2.1. Recognizes and addresses patient concerns
>
> regarding medical necessity of further
>
> consultation and/or referral

**2.4.2.3. Performance indicators -- Skills**

> 2.4.2.3.1. Utilizes effective written/oral communication
>
> skills when requesting consultation or referral

##### 

##### BEHAVIORAL MEDICINE

This is a rotation in the Mental Health Service under the direction of
Dr. Juan Carmona, Associate Chief of Staff, Mental Health and Behavioral
Medicine. The resident will be assigned to a staff
psychiatrist/psychologist. During the rotation the podiatric resident
will be able to understand the patient from a social/behavioral
perspective, and the effects of the behavioral aspects of disease on the
total health of the patient.

The resident will attend weekly team meetings and other conferences held
which will focus on the psychosocial aspect of the patient. Residents
will be expected to observe team consultants as time permits.

Please call Dr. Campbell at East Campus ext. 3506 one week prior to your
rotation to arrange your specific schedule.

# **PGY-1: First Year Experiences**

## **Behavioral Medicine**

This is a rotation involving the outpatient and inpatient facilities at
CAVHCS. Included in the inpatient facilities are the nursing home,
substance abuse rehabilitation ward and mental health ward.

**Goal: Behavioral Medicine**

Upon completion of this experience the podiatric resident will be able
to describe and discuss the psychological workup and indications for
psychological counseling.

**Competencies: Behavioral Medicine**

The psychology experience will involve participation in the
psychological workup and counseling sessions. The resident will spend
each Thursday for one-month observing and interacting in the counseling
process. Specifically, the exposure will give the resident experience in
management of patients in the obesity clinic, smoking cessation, and
other addictive behaviors.

1.  Demonstrate an understanding of the psychosocial and healthcare
    needs for patients in all life stages.

2.  Discuss and describe the psychological issues and treatment
    strategies related to the management of:

-   Obesity

-   Smoking cessation

-   Behavior modification

-   Dependency/addiction

3.  Given a real or simulated patient, be able to identify patients who
    require referral to Psychology Service

**[GENERAL / ORTHOPEDIC SURGERY]{.underline}**

This is a rotation with the Surgery department at CAVHCS, under the
direction of Dr. Eddie Warren. This rotation will consist of daily
rounds with the assigned surgeon, pre-operative, post-operative follow
up and participation in the surgical procedures performed. Surgical
conferences presented by the department will also be attended.

# **PGY-2: Second Year Experiences**

## **General Surgery/Orthopedic Surgery**

This rotation is designed to build on medical and surgical experiences
gained in the first year. VHA residency supervision policy provides for
graduating levels of responsibilities as the resident matriculates from
year to year.

**Goal 1: General Surgery**

Upon completion of this experience the podiatric resident will be
expected to be able to accurately work-up and diagnosis general surgical
disorders, develop an appropriate management plan and perform as
surgical assistant.

**Competencies: General Surgery**

The podiatric surgical resident should be able to

1.  Evaluate a patient suspected of having a general surgical problem
    and arrive at an appropriate diagnosis.

2.  Manage various medical and surgical conditions as part of the
    general surgical team.

3.  List the indications and contraindications for surgical intervention
    of a compromised patient.

4.  Manage the acute care needs of patients.

5.  Perform as assistant in the surgical management of patients
    undergoing general surgical procedures.

Identify patients who require referral to the general surgeon

## 

**Goal 2: Orthopedic Surgery**

Upon completion of this experience the podiatric resident will be
expected to be able to accurately work-up and diagnosis general
orthopedic (non-podiatric) surgical disorders, develop an appropriate
management plan and perform as surgical assistant.

**Competencies: Orthopedic Surgery**

The podiatric surgical resident should be able to

6.  Evaluate a patient suspected of having a general orthopedic surgical
    problem and arrive at an appropriate diagnosis.

7.  Manage various medical and orthopedic surgical conditions as part of
    the orthopedic surgical team.

8.  List the indications and contraindications for orthopedic surgical
    intervention of a compromised patient.

9.  Manage the acute care needs of orthopedic surgery patients.

10. Perform as a first assistant in the surgical management of patients
    undergoing orthopedic (non-podiatric) surgical procedures.

#####  

##### HIGH RISK FOOT CLINIC

##### 

# **PGY-1: First Year Experiences**

**Goals: High Risk Foot Clinic**

The High Risk Foot Clinic at CAVHCS is held twice weekly -- once at the
East Campus and once at Maxwell AFB campus. Following established PACT
guidelines and utilizing evidence-based medicine for selection of
advanced wound care techniques. The patients seen in these clinics are
at the highest risk for amputation or re-amputation. The PGY-I resident
will be responsible for evaluation, management and coordination of care
of patients in consultation with the PGY-II resident and clinic
attending. Procedures to be utilized in furtherance of this strategy
include debridement of skin and deep tissue structures, tissue biopsies
for pathology and quantitative wound cultures, application of
bioengineered tissue grafts and advanced technology devices such as the
V.A.C.^®^

**Competencies: High Risk Foot Clinic**

**1.4.2. Appropriate medical/surgical management when indicated,
including:**

**1.4.2.1. Debridement of superficial ulcer or wound.**

> **1.4.2.1.1. Performance Indicators-Knowledge**
>
> 1.4.2.1.1.1. Understands history and physical examination
> normals/abnormals
>
> that would indicate/contraindicate this procedure.
>
> 1.4.2.1.1.2. Understands imaging study normals/abnormals that would
>
> indicate/contraindicate this procedure.
>
> 1.4.2.1.1.3. Understands laboratory/other test normals/abnormals that
> would
>
> indicate/contraindicate this procedure.
>
> 1.4.2.1.1.4. Understands the etiologic characteristics
>
> (pathomechanics/pathophysiology/epidemiology/etc.) of the
>
> condition.
>
> 1.4.2.1.1.5. Understands the risks and benefits of performing the
> procedure.
>
> 1.4.2.1.1.6. Understands the risks and benefits of not performing the
>
> procedure.
>
> 1.4.2.1.1.7. Understands the advantages/disadvantages of the procedure
> versus
>
> other potentially applicable procedures.
>
> 1.4.2.1.1.8. Understands the instrument and material needs for
> performance of
>
> the procedure.
>
> 1.4.2.1.1.9. Understands the regional anatomy.
>
> 1.4.2.1.1.10. Understands peri-procedure and associated care
>
> requirements.
>
> **1.4.2.1.2. Performance Indicators-Attitudes**
>
> 1.4.2.1.2.1. Selection of this procedure is appropriate for the
> patient.
>
> 1.4.2.1.2.2. Can justify the procedure selection.
>
> 1.4.2.1.2.3. Can effectively present the procedure, alternatives,
> risks, and postprocedure
>
> care requirements to the patient.
>
> 1.4.2.1.2.4. Recognizes clinical variations and adapts accordingly.
>
> 1.4.2.1.2.5. Differentiates an infected ulcer or wound from one that
> is noninfected.
>
> 1.4.2.1.2.6. Demonstrates compassion and understanding for the needs
> of the
>
> patient.
>
> **1.4.2.1.3. Performance Indicators-Skills**
>
> 1.4.2.1.3.1. Selects appropriate instrument(s) (tissue nipper,
> scalpel, rongeur,
>
> currette).
>
> 1.4.2.1.3.2. Uses instrumentation appropriately.
>
> 1.4.2.1.3.3. Removes tissue appropriately, based on tissue type,
> quality, and
>
> depth.
>
> 1.4.2.1.3.4. Obtains microbiology and/or pathology specimens, as
> indicated.
>
> 1.4.2.1.3.5. Applies appropriate wound care agent.
>
> 1.4.2.1.3.5.1. Applies appropriate wound cover.
>
> **1.4.2.2. Excision or Destruction of skin lesion (including skin
> biopsies)**
>
> 1.4.2.2.1. Performance Indicators-Knowledge
>
> 1.4.2.2.1.1. Understands normal/abnormal dermatologic anatomy and
>
> histology.
>
> 1.4.2.2.1.2. Understands normal/abnormal clinical exam that would
>
> indicate/contraindicate appropriate procedure.
>
> 1.4.2.2.1.3. Understands etiology and pathology of lesion.
>
> 1.4.2.2.1.4. Understands surgical excision techniques including punch
> biopsy, incisional biopsy, excisional biopsy, and wide excision
>
> techniques.
>
> 1.4.2.2.1.6. Understands the risks, benefits, potential complications,
> and
>
> alternatives to procedure.
>
> 1.4.2.2.1.7. Understands postoperative care requirements.
>
> 1.4.2.2.1.8. Understands adjunctive medical therapies for care of
> malignant skin lesions.
>
> 1.4.2.2.1.9. Understands instrument and material needs for the
> procedure.
>
> **1.4.2.2.2. Performance Indicators-Attitudes**
>
> 1.4.2.2.2.1. Can describe procedure and present risks, benefits,
> potential
>
> complications and alternative to a patient in an effective manner.
>
> 1.4.2.2.2.2. Recognizes preoperative, intraoperative, and
> postoperative
>
> variations and adapts accordingly.
>
> 1.4.2.2.2.3. Selection of this procedure is appropriate to the
> patient.
>
> 1.4.2.2.2.4. Recognizes importance of proper follow-up evaluation of
>
> malignant skin lesions and initiates appropriate medical
>
> consultation.
>
> **1.4.2.2.3. Performance Indicators-Skills**
>
> 1.4.2.2.3.1. Can perform appropriate local anesthetic block.
>
> 1.4.2.2.3.2. Can perform appropriate skin incision as indicated (i.e.
> wide
>
> excision, punch biopsy, incisional and excisional biopsy
>
> techniques).
>
> 1.4.2.2.3.3. Can perform anatomic disservice appropriate to this
> anatomic
>
> area.
>
> 1.4.2.2.3.4. Can perform suture repair of deep tissue as indicated.
>
> 1.4.2.2.3.6. Can apply appropriate bandage.
>
> 1.4.2.2.3.7. Can initiate proper care for postoperative complications
>
> 1.4.2.2.3.8. Can interpret histologic/pathology report when indicated.

**1.2.2.7. Microbiology.**

**1.2.2.7.1. Performance indicators -- knowledge.**

> **1.2.2.7.1.1. Understands the technique for performing:**
>
> 1.2.2.7.1.1.1. Gram's stain
>
> 1.2.2.7.1.1.2. KOH prep
>
> 1.2.2.7.1.1.3. Aerobic cultures
>
> 1.2.2.7.1.1.4. Anaerobic cultures
>
> 1.2.2.7.1.1.5. Fungal cultures
>
> 1.2.2.7.1.1.6. Acid-fast (mycobacterial) cultures
>
> 1.2.2.7.1.1.7. GC cultures
>
> 1.2.2.7.1.1.8. Other
>
> 1.2.2.7.1.2. Can correctly interpret the results of the test listed in
> service 1.2.2.7.1.1.

**1.2.2.7.1.3. Understands the correct technique for obtaining specimens
and**

**specimen storage and processing, including:**

> 1.2.2.7.1.3.1. arthrocentesis.
>
> 1.2.2.7.1.3.2. tissue biopsy (nails, soft tissue, bone).
>
> 1.2.2.7.1.3.3. swabs or aspirants
>
> 1.2.2.7.1.3.4. blood cultures
>
> 1.2.2.7.1.3.5. stool cultures
>
> 1.2.2.7.1.3.6. CSF cultures
>
> 1.2.2.7.1.3.7. urine cultures
>
> 1.2.2.7.1.3.8. sputum cultures
>
> 1.2.2.7.1.4. Understands laboratory processing of the specimens,
> including:
>
> 1.2.2.7.1.4.1. the identification of organisms
>
> 1.2.2.7.1.4.2. the determination of organism sensitivities by Kirby-
>
> Bauer disc diffusion
>
> 1.2.2.7.1.4.3. the determination of organism sensitivities to
>
> antimicrobials by minimal inhibitory concentrations
>
> 1.2.2.7.1.4.4. the determination of organism sensitivities to
>
> antimicrobials by minimal bacteriocidal concentrations
>
> 1.2.2.7.1.4.5. serum bacteriocidal levels.

1.2.2.7.1.5. Differentiates normal flora from pathogenic microbes.

1.2.2.7.1.6. Understands the common pathogens associated with specific

infectious disease states (eg -- post-operative, diabetic fetid foot,

etc).

1.2.2.7.1.7. Identifies antimicrobial resistance, based upon sensitivity

results.

1.2.2.7.1.8. Understands the rationale for selecting specimen
procurement

methods listed in service 1.2.2.7.1.3.

1.2.2.7.1.9. Understands the rationale for ordering HIV screening.

**1.2.2.7.2. Performance indicators -- attitudes.**

> 1.2.2.7.2.1. Recognizes and addresses patient concerns with safety,
>
> comfort, and medical necessity.

**1.2.2.7.3. Performance indicators -- skills.**

> 1.2.2.7.3.1. Appropriately performs and reads a Gram's stain and a KOH
>
> prep.
>
> 1.2.2.7.3.2. Obtains specimens using appropriate techniques, as listed
> in
>
> service 1.2.2.7.1.3.
>
> 1.2.2.7.3.3. Choice of specimen collection method is appropriate for
> the
>
> patient's type and location of suspected infection.
>
> 1.2.2.7.3.4. Correctly interprets the results of cultures and
> sensitivities.
>
> 1.2.2.7.3.5. Selection of test(s) fits the overall management of the
> patient in
>
> terms of evaluation sequence, timeliness, and cost-effectiveness (see
>
> also service 3.4)
>
> 1.2.2.7.3.6. Recognizes when test values indicate further history,
> physical
>
> exam, diagnostic studies, consultation, or repeat/serial analysis.

##### 

##### 

# **PGY-2: Second Year Experiences**

**Goals: High Risk Foot Clinic**

The High Risk Foot Clinic at CAVHCS is held twice weekly -- once at the
East Campus and once at Maxwell AFB campus. Following established PACT
guidelines and utilizing evidence-based medicine for selection of
advanced wound care techniques. The patients seen in these clinics are
at the highest risk for amputation or re-amputation. The PGY-II resident
will be responsible for evaluation, management and coordination of care
of patients under graduated resident responsibilities as a resource to
the PGY-I resident and supervised by the clinic attending. Procedures to
be utilized in furtherance of this strategy include debridement of skin
and deep tissue structures, tissue biopsies for pathology and
quantitative wound cultures, application of bioengineered tissue grafts
and advanced technology devices such as the V.A.C.^®^ and ordering and
interpretation of both non-invasive vascular studies and advanced
imaging modalities (MRI, nuclear scans, etc.).

**Competencies: High Risk Foot Clinic**

**1.4.2. Appropriate medical/surgical management when indicated,
including:**

**1.4.2.1. Debridement of superficial ulcer or wound.**

> **1.4.2.1.1. Performance Indicators-Knowledge**
>
> 1.4.2.1.1.1. Understands history and physical examination
> normals/abnormals
>
> that would indicate/contraindicate this procedure.
>
> 1.4.2.1.1.2. Understands imaging study normals/abnormals that would
>
> indicate/contraindicate this procedure.
>
> 1.4.2.1.1.3. Understands laboratory/other test normals/abnormals that
> would
>
> indicate/contraindicate this procedure.
>
> 1.4.2.1.1.4. Understands the etiologic characteristics
>
> (pathomechanics/pathophysiology/epidemiology/etc.) of the
>
> condition.
>
> 1.4.2.1.1.5. Understands the risks and benefits of performing the
> procedure.
>
> 1.4.2.1.1.6. Understands the risks and benefits of not performing the
>
> procedure.
>
> 1.4.2.1.1.7. Understands the advantages/disadvantages of the procedure
> versus
>
> other potentially applicable procedures.
>
> 1.4.2.1.1.8. Understands the instrument and material needs for
> performance of
>
> the procedure.
>
> 1.4.2.1.1.9. Understands the regional anatomy.
>
> 1.4.2.1.1.10. Understands peri-procedure and associated care
>
> requirements.
>
> **1.4.2.1.2. Performance Indicators-Attitudes**
>
> 1.4.2.1.2.1. Selection of this procedure is appropriate for the
> patient.
>
> 1.4.2.1.2.2. Can justify the procedure selection.
>
> 1.4.2.1.2.3. Can effectively present the procedure, alternatives,
> risks, and postprocedure
>
> care requirements to the patient.
>
> 1.4.2.1.2.4. Recognizes clinical variations and adapts accordingly.
>
> 1.4.2.1.2.5. Differentiates an infected ulcer or wound from one that
> is noninfected.
>
> 1.4.2.1.2.6. Demonstrates compassion and understanding for the needs
> of the
>
> patient.
>
> **1.4.2.1.3. Performance Indicators-Skills**
>
> 1.4.2.1.3.1. Selects appropriate instrument(s) (tissue nipper,
> scalpel, rongeur,
>
> currette).
>
> 1.4.2.1.3.2. Uses instrumentation appropriately.
>
> 1.4.2.1.3.3. Removes tissue appropriately, based on tissue type,
> quality, and
>
> depth.
>
> 1.4.2.1.3.4. Obtains microbiology and/or pathology specimens, as
> indicated.
>
> 1.4.2.1.3.5. Applies appropriate wound care agent.
>
> 1.4.2.1.3.5.1. Applies appropriate wound cover.
>
> **1.4.2.2. Excision or Destruction of skin lesion (including skin
> biopsies)**
>
> 1.4.2.2.1. Performance Indicators-Knowledge
>
> 1.4.2.2.1.1. Understands normal/abnormal dermatologic anatomy and
>
> histology.
>
> 1.4.2.2.1.2. Understands normal/abnormal clinical exam that would
>
> indicate/contraindicate appropriate procedure.
>
> 1.4.2.2.1.3. Understands etiology and pathology of lesion.
>
> 1.4.2.2.1.4. Understands surgical excision techniques including punch
> biopsy, incisional biopsy, excisional biopsy, and wide excision
>
> techniques.
>
> 1.4.2.2.1.6. Understands the risks, benefits, potential complications,
> and
>
> alternatives to procedure.
>
> 1.4.2.2.1.7. Understands postoperative care requirements.
>
> 1.4.2.2.1.8. Understands adjunctive medical therapies for care of
> malignant skin lesions.
>
> 1.4.2.2.1.9. Understands instrument and material needs for the
> procedure.
>
> **1.4.2.2.2. Performance Indicators-Attitudes**
>
> 1.4.2.2.2.1. Can describe procedure and present risks, benefits,
> potential
>
> complications and alternative to a patient in an effective manner.
>
> 1.4.2.2.2.2. Recognizes preoperative, intraoperative, and
> postoperative
>
> variations and adapts accordingly.
>
> 1.4.2.2.2.3. Selection of this procedure is appropriate to the
> patient.
>
> 1.4.2.2.2.4. Recognizes importance of proper follow-up evaluation of
>
> malignant skin lesions and initiates appropriate medical
>
> consultation.
>
> **1.4.2.2.3. Performance Indicators-Skills**
>
> 1.4.2.2.3.1. Can perform appropriate local anesthetic block.
>
> 1.4.2.2.3.2. Can perform appropriate skin incision as indicated (i.e.
> wide
>
> excision, punch biopsy, incisional and excisional biopsy
>
> techniques).
>
> 1.4.2.2.3.3. Can perform anatomic disservice appropriate to this
> anatomic
>
> area.
>
> 1.4.2.2.3.4. Can perform suture repair of deep tissue as indicated.
>
> 1.4.2.2.3.6. Can apply appropriate bandage.
>
> 1.4.2.2.3.7. Can initiate proper care for postoperative complications
>
> 1.4.2.2.3.8. Can interpret histologic/pathology report when indicated.

**1.2.4.2. Non-invasive vascular studies.**

> **1.2.4.2.1. Performance indicators -- knowledge.**
>
> **1.2.4.2.1.1. Understands the general principles of noninvasive
> vascular testing including:**
>
> 1.2.4.2.1.1.1. Arterial doppler
>
> 1.2.4.2.1.1.1.1. Ankle Brachial Pressure Index
>
> 1.2.4.2.1.1.1.2. Modified Exercise test of Carter
>
> 1.2.4.2.1.1.5. Oscillometry
>
> 1.2.4.2.1.1.6. Digital Doppler
>
> 1.2.4.2.1.1.7. Elevation/Dependency testing
>
> 1.2.4.2.1.1.10. Palpation of normal and abnormal pulses
>
> 1.2.4.2.1.1.11. Venous Duplex study
>
> 1.2.4.2.1.1.12. Subpapillary venous plexus filling time (SPVPFT)
>
> 1.2.4.2.1.2. Understands the correct technique for performing
> noninvasive
>
> vascular tests listed in 1.2.4.2.1.1.
>
> 1.2.4.2.1.3. Understands normal and abnormal findings that may present
> on noninvasive vascular tests listed in 1.2.4.2.1.1.
>
> 1.2.4.2.1.4. Understands the rationale for ordering the noninvasive
> vascular tests listed in 1.2.4.2.1.1.
>
> **1.2.4.2.2. Performance indicators -- attitudes**
>
> 1.2.4.2.2.1. -- Recognizes and addresses patient concerns with safety,
> comfort,
>
> and medical necessity.
>
> 1.2.4.2.3. Performance indicators -- skills.
>
> 1.2.4.2.3.1. Recognizes (correctly interprets) the normal or abnormal
> findings on each test listed in service 1.2.4.2.2.1.
>
> 1.2.4.2.3.2. Selects appropriate noninvasive vascular test as
> indicated by
>
> patient's chief complaint and clinical findings.
>
> 1.2.4.2.3.3. Selection of noninvasive vascular test fits the overall
> management of the patient in terms of evaluation sequence, timeliness,
> and cost effectiveness
>
> 1.2.4.2.3.4. Recognizes when noninvasive vascular test results
> indicate further history, physical exam, diagnostic studies, or
> consultation

**1.2.1.5. Nuclear medicine imaging.**

> 1.2.1.5.1. Performance indicators -- knowledge.
>
> 1.2.1.5.1.1. Understands the general technical aspects of nuclear
> medicine
>
> imaging studies, including:
>
> 1.2.1.5.1.1.1. Technitium99 bone scan (three phase / four phase).
>
> 1.2.1.5.1.1.2. HMPAO scan (Ceretec).
>
> 1.2.1.5.1.1.3. Gallium scan.
>
> 1.2.1.5.1.1.4. Indium WBC scan.
>
> 1.2.1.5.1.2. Understands normal and abnormal findings that may present
> on
>
> the nuclear medicine imaging in service 1.2.1.5.1.1.
>
> 1.2.1.5.1.3. Understands the rationale for ordering the nuclear
> medicine
>
> imaging in service 1.2.1.5.1.1.
>
> 1.2.1.5.2. Performance indicators -- attitudes.
>
> 1.2.1.5.2.1. Recognizes and addresses patient concerns with safety,
>
> comfort, and medical necessity.
>
> 1.2.1.5.3. Performance indicators -- skills.
>
> 1.2.1.5.3.1. Reads nuclear medicine imaging listed in service
> 1.2.1.5.1.1. in
>
> a logical, orderly, and sequential method
>
> 1.2.1.5.3.2. Recognizes (correctly interprets) the normal or abnormal
>
> findings on the nuclear medicine imaging in service 1.2.1.5.1.1.
>
> 1.2.1.5.3.3. Selects appropriate nuclear medicine imaging as indicated
> by
>
> patient's chief complaint.
>
> 1.2.1.5.3.4. Selection of nuclear medicine imaging fits the overall
>
> management of the patient in terms of evaluation sequence,
>
> timeliness, and cost-effectiveness (see also service 3.4)
>
> 1.2.1.5.3.5. Recognizes when nuclear medicine imaging findings
> indicate
>
> further history, physical exam, diagnostic studies, or consultation.

**1.2.1.6. MRI.**

> 1.2.1.6.1. Performance indicators -- knowledge.
>
> 1.2.1.6.1.1. Understands the general technical aspects of MR imaging
>
> studies, including:
>
> 1.2.1.6.1.1.1. Pulse sequences and their effects on image.
>
> 1.2.1.6.1.1.2. Contrast techniques.
>
> 1.2.1.6.1.1.3. Slice thickness.
>
> 1.2.1.6.1.1.4. Contraindications.
>
> 1.2.1.6.1.1.5. Available vs. appropriate planes of imaging.
>
> 1.2.1.6.1.2. Understands normal and abnormal findings that may present
> on
>
> MR imaging, including normal serviceal anatomy.
>
> 1.2.1.6.1.3. Understands the rationale for ordering MR imaging.
>
> 1.2.1.6.2. Performance indicators -- attitudes.
>
> 1.2.1.6.2.1. Recognizes and addresses patient concerns with safety,
>
> comfort, and medical necessity.
>
> 1.2.1.6.3. Performance indicators -- skills
>
> 1.2.1.6.3.1. Reads MRI imaging studies in a logical, orderly, and
> sequential
>
> method
>
> 1.2.1.6.3.2. Recognizes (correctly interprets) the normal or abnormal
>
> findings on MR imaging.
>
> 1.2.1.6.3.3. Selection of MR imaging is indicated by patient's chief
>
> complaint.
>
> 1.2.1.6.3.4. Selection of MR imaging fits the overall management of
> the
>
> patient in terms of evaluation sequence, timeliness, and cost
> effectiveness
>
> 1.2.1.6.3.5. Recognizes when MR imaging findings indicate further
>
> history, physical exam, diagnostic studies, or consultation.

**1.2.1.8. Diagnostic ultrasound.**

> **1.2.1.8.1. Performance indicators -- knowledge.**
>
> 1.2.1.8.1.1. Understands the general technical aspects of diagnostic
>
> ultrasound studies, including:
>
> 1.2.1.8.1.1.1. Duplex ultrasound (DVT).
>
> 1.2.1.8.1.2. Understands normal and abnormal findings that may present
> on diagnostic ultrasound.
>
> 1.2.1.8.1.3. Understands the rationale for ordering diagnostic
> ultrasound.
>
> **1.2.1.8.2. Performance indicators -- attitudes.**
>
> 1.2.1.8.2.1. Recognizes and addresses patient concerns with safety,
>
> comfort, and medical necessity.
>
> **1.2.1.8.3. Performance indicators -- skills.**
>
> 1.2.1.8.3.1. Reads static and/or dynamic ultrasound study in a
> logical,
>
> orderly, and sequential method
>
> 1.2.1.8.3.2. Recognizes (correctly interprets) the normal or abnormal
>
> findings on diagnostic ultrasound.
>
> 1.2.1.8.3.3. Selection of diagnostic ultrasound is indicated by
> patient's
>
> chief complaint.
>
> 1.2.1.8.3.4. Selection of diagnostic ultrasound fits the overall
> management
>
> of the patient in terms of evaluation sequence, timeliness, and cost
> effectiveness
>
> 1.2.1.8.3.5. Recognizes when diagnostic ultrasound findings indicate
>
> further history, physical exam, diagnostic studies, or consultation.
>
> 1.2.1.9. vascular imaging
>
> **1.2.1.9.1. Performance indicators -- knowledge.**
>
> 1.2.1.9.1.1. Understands the pharmacology of various available
>
> radiographic contrast materials.
>
> 1.2.1.9.1.2. Understands the contraindications of and co-morbidity
> factors
>
> for various available radiographic contrast materials.
>
> 1.2.1.9.1.3. Understands the correct technique for vascular imaging
> studies, including:
>
> 1.2.1.9.1.3.1. Contrast arteriography.
>
> 1.2.1.9.1.3.2. Contrast venography.
>
> 1.2.1.9.1.3.3. MRI angiography.
>
> 1.2.1.9.1.3.4. digital subtraction angiography.
>
> 1.2.1.9.1.4. Understands normal and abnormal findings that may present
> on the vascular imaging studies in service 1.2.1.9.1.3.
>
> 1.2.1.9.1.5. Understands the rationale for ordering the vascular
> imaging
>
> studies in service 1.2.1.9.1.3.
>
> **1.2.1.9.2. Performance indicators -- attitudes.**
>
> 1.2.1.9.2.1. Recognizes and addresses patient concerns with safety,
>
> comfort, and medical necessity.
>
> **1.2.1.9.3. Performance indicators -- skills.**
>
> 1.2.1.9.3.1. Reads vascular imaging studies listed in service
> 1.2.1.9.1.3 in a
>
> logical, orderly, and sequential method
>
> 1.2.1.9.3.2. Recognizes (correctly interprets) the normal or abnormal
>
> findings on each study in service 1.2.1.9.1.3.
>
> 1.2.1.9.3.3. Selects appropriate vascular imaging study indicated by
>
> patient's chief complaint and clinical presentation.
>
> 1.2.1.9.3.4. Selection of vascular imaging study fits the overall
>
> management of the patient in terms of evaluation sequence,
>
> timeliness, and cost-effectiveness (see also service 3.4)
>
> 1.2.1.9.3.5. Recognizes when vascular imaging study findings indicate
>
> further history, physical exam, diagnostic studies, or consultation.

#  

# **Second Year Experience: Podiatric Trauma Clinic & Surgery**

**Rotation Description:**

This experience will involve the peri-operative care of patients with
foot and ankle trauma in the inpatient and outpatient settings under
direct supervision of provider staff at DVA Birmingham. This rotation
will consist of block assignments to the Orthopedic Service, Foot and
Ankle Section of the DVA Birmingham under the direction of Dr. James
Thomas.

**Goal 1: Podiatric Trauma Surgery**

Upon completion of this affiliated rotation experience the podiatric
resident will be expected to demonstrate the ability to competently
evaluate patients with lower extremity trauma then present appropriate
recommendations for both surgical and non-surgical treatments.

**Competencies: Podiatric Trauma Surgery**

**The resident will be able to:**

1.  List the signs and symptoms of common lower extremity conditions
    such as

    1.  Fracture/dislocation

    2.  Sprains/strains

    3.  Lacerations/penetrating wounds

    4.  Foreign body

    5.  Perform appropriate emergency care for lower extremity
        conditions

Trauma Intervention Management:

1.  Manage fractures

2.  Non-Surgical Treatment

3.  Cast/splints/immobilization devices

4.  Surgical Treatment

5.  Radiographic evaluation

6.  Advanced imaging necessity

7.  Patient positioning for surgery

8.  Anatomic Location Specific Knowledge

    1.  Digital

    2.  Metatarsal

    3.  Midfoot

    4.  Rearfoot

    5.  Ankle evaluation for derangement:

-   cotton test

-   squeeze test

-   talar tilt test

-   anterior drawer test

-   Silverskiold test

# **PGY-1/2: First and Second Year Experiences**

## **Attitudinal and Other Non Cognitive Competencies**

There are several competencies that by their very nature fit into the
overall practice of medicine and do not reside in any one rotation. The
content of this material is delivered and will be evaluated in the
following areas.

Practice with professionalism, compassion, and concern in a legal,
ethical, and moral fashion.

1\. Abide by state and federal laws, including the Health Insurance
Portability and Accountability Act (HIPAA), governing the practice of
podiatric medicine and surgery. (All rotations, logs and augment with
didactic lecture,)

2\. Practice and abide by the principles of informed consent. (Podiatric
medicine and surgery)

3\. Understand and respect the ethical boundaries of interactions with
patients, colleagues, and employees. (All rotations)

4\. Demonstrate professional humanistic qualities. (All rotations)

1.  Demonstrate ability to formulate a methodical and comprehensive
    treatment plan with appreciation of healthcare costs. (All
    rotations)

Communicate effectively and function in a multi-disciplinary setting.

1\. Communicate in oral and written form with patients, colleagues,
payors, and the public. (All rotations)

2\. Maintain appropriate medical records. (All rotations)

Manage individuals and populations in a variety of socioeconomic and
healthcare settings.

1\. Demonstrate an understanding of the psychosocial and healthcare
needs for patients in all life stages: pediatric through geriatric. (All
rotations)

2\. Demonstrate sensitivity and responsiveness to cultural values,
behaviors, and preferences of one's patients when providing care to
persons whose race, ethnicity, nation of origin, religion, gender,
and/or sexual orientation is/are different from one's own. (All
rotations)

3\. Demonstrate an understanding of public health concepts, health
promotion, and disease prevention. (All rotations)

Understand podiatric practice management in a multitude of healthcare
delivery settings.

1\. Demonstrate familiarity with utilization management and quality
improvement. (All rotations augment with didactic lecture)

2\. Understand healthcare reimbursement. (All rotations augment with
didactic lecture)

3\. Understand insurance issues including professional and general
liability, disability, and Workers' Compensation. (All rotations augment
with didactic lecture)

4\. Understand medical-legal considerations involving healthcare
delivery. (All rotations augment with didactic lecture)

5\. Demonstrate understanding of common business practices. (Didactic
lectures)

Be professionally inquisitive, life-long learners and teachers utilizing
research, scholarly activity, and information technologies to enhance
professional knowledge and clinical practice.

1\. Read, interpret, and critically examine and present medical and
scientific literature. (Journal Club/education program)

2\. Collect and interpret data and present the findings in a formal
study related to podiatric medicine and surgery. (Journal Club/education
program)

3\. Demonstrate information technology skills in learning, teaching, and
clinical practice. (Journal Club/education program)

4\. Participate in continuing education activities. (Journal
Club/education program)

##### GENERAL PROGRAM REQUIRMENTS AND DEFINITIONS

**DIRECTOR OF MEDICAL EDUCATION**

The Director of Medical Education (DME) serves as the administrator of
all graduate medical education at CAVHCS. The Director will be
responsible for assisting the Chief of Staff in assessing the quality of
residency training programs and ensuring that VHA, VA Southeast Network
and CAVHCS requirements of resident supervision are appropriately
followed. He will also be responsible for ensuring the establishment of
graduated levels of responsibility for each specialty and/or
subspecialty, monitoring and reporting requirements regarding training
issues and resident supervision, and the establishment of a procedure
for monitoring resident supervision that results in identification of
areas for improvement.

**DIRECTOR OF PODIATRIC MEDICAL EDUCATION:**

The Director of Podiatric Medical Education (DPME) serves as the
administrator of the podiatric residency programs and shall possess the
clinical, administrative and teaching qualifications that will allow for
the implementation of the program's stated goals. The responsibilities
of the Director shall include:

1.  Administration of the residency program in such a manner so that the
    program shall meet the requirements of the Council on Podiatric
    Medical Education of the American Podiatric Medical Association.

2.  Overseeing and coordinating the activities of the residents while
    they are under the supervision of the attending in the various
    services and department of the institution.

3.  Instruction, supervision, and evaluation of the residents.

4.  Periodic review and revision of the program's curriculum content
    with reporting to the Director of Medical Education.

5.  Responsibility for arranging the rotations of the residents through
    the required Medical Center departments.

6.  Assigning responsibilities to the Associate Director(s) of Podiatric
    Medical Education.

**ASSOCIATE DIRECTOR(S) OF PODIATRIC MEDICAL EDUCATION:**

The Associate Director(s) of Podiatric Medical Education (ADPME)
assist(s) the DPME in administering the podiatric residency programs.
ADPME's may be given primary responsibility for coordinating the
curriculum(s) of each residency program and may act as the Director of
Extern Training. Each ADPME will report to the DPME and advise of any
program changes or resident issues that require action.

**ROTATION COORDINATORS:**

The intention of the program is to have the residents on rotation in
various services and rotations within the medical center therefore; it
is necessary to have a rotation coordinator for each rotation. The
rotation coordinators must possess appropriate credentials and
privileges. The responsibilities of the rotation coordinator shall
include:

1.  Liaison with the Director of Podiatric Medical Education.

2.  Instruction, supervision, and evaluation of the resident while on
    the respective service / rotation.

**PODIATRY RESIDENT:**

The Podiatry Resident shall be a graduate of a college of podiatric
medicine approved by the Council of Podiatric Medical Education of the
American Podiatric Medical Association.

The resident shall be worthy in character, manner, and ethical conduct,
and possess an aptitude and attitude that is conductive to learning and
functioning within the health care system setting. Any podiatric
resident accepted for training can be suspended or dismissed without
certification for infractions of the rules and regulations of the
program or of the affiliated institution at which he / she is training.
Any action that may jeopardize the safety of patients, personnel or the
physical facilities may also be grounds for dismissal.

##### 

##### RULES and REGULATIONS

Residents shall observe the proprieties of conduct and courtesies that
are consistent with, and in accordance with rules and regulations
governing the resident staff of the Medical Center.

A.  Relation of resident to health care system personnel.

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1.  Residents shall not criticize or reprimand any member of the nursing
    staff. Any such criticism must be discussed with the program
    coordinator, who will take the necessary action.

2.  In no instance will the resident change the treatment of a patient
    without the

knowledge and approval of the staff attending provider for that patient
encounter.

A.  Ethics

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1.  Residents shall not engage in the teaching or the practice of their
    profession outside of the program. Under no circumstances shall they
    receive fees, perquisites or other emoluments from patients or
    others during their term of service, nor shall they publish records
    of cases connected with the Program or the affiliated hospitals
    without permission and appropriate releases.

2.  Residents must not sign or witness legal documents except as
    instructed.

3.  Residents shall not print out progress or other notes/reports notes
    pertaining to the care given to patients. Inquiries of this nature
    are to be referred to the staff. Only Release of Information can
    give patients copies of their records.

4.  Residents are not to fill-out or sign insurance forms or handicap
    license plate/placard requests.

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B.  Duty

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a.  Hours and duty shall include those listed on the podiatric residency
    scheduled. Normal program days and hours are Monday through Friday
    from 0800 to 1630 hours. On- residents can expect longer hours and
    occasional weekend duty. In no event shall a resident work more than
    80 hours in one week as averaged over a four-week period. CAVHCS
    agrees to abide by the American Council on Graduate Medical
    Education resident work policies. Leave of absence at times other
    than that which is specified in the scheduled may be granted under
    reasonable circumstances by the Director of the Podiatric Medical
    Residency Program and must be in accordance with the contractual
    agreement. The request for leave must be made in writing.

b.  The resident shall always wear the prescribed attire and appear
    clean and neat while on duty. A Medical Center issued I.D. badge
    will be worn above the waist at all times while on duty.

c.  The resident must make arrangements to be available for "call" and
    be able to contact and return to the Medical Center in a reasonable
    length of time.

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C.  TARDINESS

> Tardiness is bad for physicians and their patients. **ALWAYS BE
> PUNCTUAL.** Check your schedule and **[be there.]{.underline}**
> Failure to report to duty on time will be recorded as annual leave
> (minimum one-hour for each portion of an hour that you are late
> reporting for duty) or AWOL. In the event that you may be late, you
> are ill, or you cannot report to duty on time, **CALL YOUR DIRECTOR or
> ASSOCIATE DIRECTOR.** Repeated tardiness may result in disciplinary
> action.
>
> You are expected to be at your duty station in the clinic BEFORE the
> start of clinic (0800 hours or 1300 hours) so that the patient can be
> seated at your work station and the encounter begun by these clinic
> start times.

D.  ATTIRE

> Policy regarding attire applies at all times residents are on duty.
> You are still responsible for maintaining a professional appearance on
> weekends and evenings when administering any patient care.

a.  Outside the operating room, residents are expected to wear business
    casual street clothes or clean scrubs and a white lab coat furnished
    by this medical center.

b.  Scrubs are to be worn when performing surgery and must be changed
    when going outside the main building and then returning to the
    Operating Room area. Scrubs must be covered with a cover-up or white
    lab coat when outside of the Operating Room area.

E. PATIENT CARE ACTIVITY and DIDACTIC ACTIVITY LOGS:

Each resident will be required to keep a log of patient care
interactions. The log will also include a record of any learning
experience such as seminars, conferences, journal club etc. These logs
will be maintained within Residency Resource. See the Residency Resource
Addendum for logging instructions.

  -------------------------------------------------------- --------------
  **Case Activities**                                      **PM&S 24**

  Inpatient cases (podiatric and non-podiatric)            50

  Podiatric clinic/office encounters                       750

  Podiatric surgical cases                                 150

  Trauma cases                                             25

  Podopediatric cases                                      25

  Biomechanical cases                                      150
  -------------------------------------------------------- --------------

F. SURGICAL LOGS:

In addition to the activity log, each resident will maintain a surgery
log. This will provide a record of all surgery that the resident
observed, assisted or performed and will be maintained within Residency
Resource. The Minimum activity volume for surgery is:

  --------------------------------------------------------- -------------
  Procedure Activities                                      **PM&S 24**

  Number of Cases                                           150

  Number of Procedures (B and C level)                      350

  **C Level Procedures**                                    

  Digital procedures                                        80

  First ray procedures                                      60

  Other soft tissue procedures                              45

  Other osseous foot surgery procedures                     40

  Reconstructive Rear foot/ankle procedures                 0

  Other procedures                                          0

  **TOTAL**                                                 **225**
  --------------------------------------------------------- -------------

G. EVALUATION:

The rotation coordinator shall evaluate the resident upon the completion
of each non-podiatric rotation. The evaluation document must be signed
by the coordinator and submitted to the Director, Podiatric Medical
Education either directly or via the resident. All of the evaluation
forms used in this program are attached as an addendum to this Handbook.

H. PROFESSIONAL LIABILITY COVERAGE:

All podiatric residents under the supervision of the professional
attending staff are covered for professional liability by the Veterans
Administration through the "Federal Tort Practices Act", ONLY when
rendering authorized treatment of patients during the course of training
program. Unauthorized consultations, treatment, treatment of non-veteran
patients (except for assigned Maxwell patients), unless specifically
authorized by the DPME, and other acts not consistent with the goals of
the program are not covered by the Tort Act.

G. ANNUAL LEAVE:

Each resident is entitled to thirteen days paid annual leave. All
requests for leave must be made to the Director, in writing, 45-days in
advance of the leave commencement date and is subject to scheduling and
program availability. All annual leave will be used prior to the
completion of the second year of the program. An annual leave request
will not be approved by the Chief, Podiatry Section unless the resident
has accrued the number of leave hours at least equal to the number of
leave hours requested in the VISTA system.

UNIFORMS:

White clinical coats and surgical scrubs will be provided to each
resident for use during the training program with appropriate
identification to indicate that they are part of CAVHCS.

> **DUTIES OF THE PODIATRIC RESIDENT**

A.  Treat inpatients and outpatients. Residents will provide supervised
    care in the podiatry clinic, various medical center clinics and
    nursing home, as scheduled during the 24-month program.

B.  Residents may rotate through various services and services at this
    medical center including but not limited to:

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1.  Podiatric Medicine

2.  Rehabilitative Medicine

3.  Medical Imaging

4.  Surgical Service Specialties

5.  Internal Medicine

6.  Lab and Pathology Service

7.  Anesthesiology

8.  Geriatrics

9.  Pediatrics

10. Community Services (health fairs, nursing home care, etc.)

    A.  Residents will be required to participate in activities
        including but not limited to:

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1.  Weekly Education Meetings

2.  Journal Club -- second Friday of each month

3.  Morbidity and Mortality Conference -- 4^th^ Friday of each month

4.  Medical Staff Meeting -- 3^rd^ Friday of each month

5.  Preparation of articles and abstract reviews suitable for
    publication as assigned

6.  Health Fairs / Patient Screenings

7.  Scientific meetings as assigned

    A.  Residents will be required to be "on call" at designated times
        according to the resident call schedule and will be available to
        patients and professional staff of the medical center as needed.
        You will assure that the appropriate wards, operators and staff
        are able to reach you. You will wear your pager at all times and
        carry the On-Call pager and On-Call cell phone when assigned to
        you. You will not, except in case of a bona fide emergency, use
        the cellular phone for any personal reason.

    B.  Residents are required to keep a resident activity and a
        surgical log. These statistics are vital in determining the
        level and type of participation of each resident in the training
        program. This information will be used by the residency program
        director to help equalize participation of the training
        opportunities provided to each podiatric medical resident. This
        information will be entered in the format as set by Residency
        Resource.

    C.  This program is in a Veteran's Affairs Medical Center, a branch
        of the Federal Government; the resident will observe the
        proprieties of conduct and courtesy consistent with this
        environment.

    D.  **HOSPITAL PROTOCOL**

> **[RESIDENT SUPERVISION]{.underline}** -- See the appendix of this
> Handbook for the documents titled **[VHA Resident Supervision Handbook
> 1400.1]{.underline}** and **[CAVHCS Supervision of Residents
> Policy]{.underline}**. At all times each resident will follow this
> Medical Center policy on resident supervision. If there are any
> questions regarding resident supervision, while on any rotation,
> **[CONTACT YOUR PROGRAM DIRECTOR]{.underline}.**
>
> Upon entering each training year, all Podiatric Residents are assigned
> an individual Resident Scope of Practice. Each resident is responsible
> for knowing what their individual Scope of Practice is and not going
> beyond what is authorized in that document. The Scope of Practice is
> attached as an addendum to this Handbook.

1.  Each podiatry resident will maintain a log of surgical procedures
    performed as well as the level of participation, either "B" for
    assisting in the case or 'C" for performing 50% or more of any
    procedure performed in that case.

2.  In no case will be resident initiate or change a patient treatment
    plan without the knowledge and approval of the attending physician.
    This type of communication will always be well documented in patient
    records by summarizing the discussion in the progress note,
    consultations, or orders. Each resident will be responsible for
    documentation of this supervision for each patient treated at the
    medical center. **NO PATIENT SHOULD EVER BE TREATED WITHOUT
    SUPERVISON OF SOME TYPE. IF YOU SHOULD EVER HAVE ANY QUESTIONS ABOUT
    THIS MATTER CONTACT YOUR PROGRAM DIRECTOR IMMEDATELY.**

    1.  Residents will accompany members of the staff when they make
        rounds on the wards.

    2.  Residents will make careful notes of the directions given by the
        staff at all times.

    3.  The resident shall not criticize nor reprimand any member of the
        medical, nursing, or clerical staff. Any such criticism will be
        discussed with the Program Director who will act appropriately
        on the resident's behalf to resolve the issue.

A. **PODIATRIC ETHICS**

1.  Residents will not engage in outside teaching or practice of
    podiatry or any other business that might interfere with the
    performance of responsibilities at this residency program.

2.  Under no circumstances will the resident receive fees, gifts, or any
    other forms of payment from patients or patients' relatives.

3.  Residents will not publish any papers concerning CAVHCS without
    first familiarizing themselves with and following pertinent VA
    regulations and Medical Center policy.

4.  Residents will not sign or act as witness to any patient's signature
    on operation consent forms, insurance forms, or any legal documents.

5.  Residents will not distribute any medical documents or information
    to any patient, family member or outside party. Rather such requests
    will be discussed with your attending and referred to the Medical
    Information Service. Residents must maintain patient confidentiality
    and will not divulge any information regarding patient care or a
    patient's condition to anyone unless so directed by a staff member.
    HIPAA Rules and Regulations are in effect at CAVHCS.

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```
A.  **BENEFITS**

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1.  Stipend -- PGY-I is \$37,807 per annum; PGY-II is \$40,057 per annum
    exclusive of benefits.

2.  Meals -- Meals may be purchased on station at the rate provided by
    the Veterans Canteen Service.

3.  Housing -- Not available on station.

4.  Uniforms -- White coats and surgical scrubs are provided by the
    health care system. The coats and scrubs will be laundered at no
    charge.

5.  Leave- There are generally three types of leave:

    -   Annual Leave -- accumulated at the rate of four (4) hours per
        pay period or 13 days per year.

    -   Sick Leave -- accumulated at the same rate.

    -   Authorized Absence -- requested for attendance at required
        meetings or examinations.

6.  Insurance -- medical and life insurance benefits are provided on a
    contributory basis by the medical center. Please consult with Human
    Resources if you have any questions regarding these benefits.

7.  Professional Liability Coverage -- Through the "Tort Practices Act"
    federal employees performing activities approved by and conducted
    within CAVHCS are provided with this type of coverage.

8.  Professional Membership Fees / Dues -- These fees are not provided
    through the CAVHCS and are the residents responsibility. Through the
    Resident-in-Training service of the APMA, membership may be obtained
    at a very reasonable cost. The American College of Foot and Ankle
    Surgeons maintains a similar resident-in-training service with low
    membership fees.

.

A. Administration of the residency program is the responsibility of the
Program Director. The program is designed to meet the needs of the
resident and medical center. Selection of residents, schedules and
operation of the program is approved by the Director of Podiatric
Medical Education who reports to the Residency Review Committee of the
Health Care System and the Director of Medical Education.

### 

### RESIDENT GRIEVANCES

A.  All questions / problems regarding the program should first be
    directed to the Director of Podiatric Medical Education or his/her
    designated Associate Director. If the Director is unable to resolve
    an issue, the resident may contact the Manager, Surgical Service. If
    the Manager, Surgical Service is unable to resolve the issue, the
    Associate Chief of Staff for Acute Care and Specialties, the
    Director of Medical Education and the Chief of Staff will be
    consulted by the Program Director, the Chief, Surgical Service and
    the resident. The Director of Medical Education and the Chief of
    Staff will assure due process for both the resident and the Health
    Care System for all matters and may refer the matter to the
    Residency Review Committee for further consideration. The provisions
    of the resident's appointment under 38 U.S.C. 7405 (refer to Service
    C below) will govern the actions and remedies available to both the
    resident, the Residency Review Committee and the Health Care
    Facility.

B. REMEDIATION

Residents are responsible for patient care and presentations throughout
the training program. When areas of weakness in patient care delivery
are identified in order to assist the resident in improving in these
area, the following methods of remediation will be utilized as
appropriate:

> Library research
>
> Additional reading assignments
>
> Modification of rotation schedule
>
> Change in clinical supervision

C. INVOLUNTARY SEPARATION OF PODIATRY RESIDENTS APPOINTED UNDER 38 USC
7405(a)(1)(A)

> In the event that a resident violates the terms of the employment
> agreement entered into at the commencement of their training program,
> CAVHCS shall have as a remedy involuntary separation of the resident
> under the authority cited below. This decision is final and cannot be
> appealed.
>
> a\. In effecting involuntary separations of employees serving under 38
> U.S.C. 7405(a)(1)(A), the procedural requirements prescribed for
> separations, such as reviews by Professional Standards Boards or
> Disciplinary Boards, do **[not]{.underline}** apply.
>
> b\. Although not required, employees should, where feasible, be given
> such advance notice of separation as determined appropriate by the
> approving official.
>
> c\. The employee will not be entitled to a review of the involuntary
> separation.
>
> **Authority: 38 U.S.C. 7304, 7405 and 7421**

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Podiatric Medicine

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

1.  Demonstrates the ability to elicit a proper podiatric history and
    physical examination, and arrive at a podiatric diagnosis,
    prognosis, and treatment plan.

2.  Demonstrates the ability to determine when consultative services are
    necessary to confirm a diagnosis and / or assist in the management
    of the patient.

3.  Demonstrates an ability to manage wounds and ulcerations which fall
    to heal normally due to infection or other complications.

4.  Demonstrates the ability to manage medical, traumatic, structural
    functional foot disorders.

5.  Demonstrates competency in biomechanical evaluation and control of
    mechanical disorders of the foot.

6.  Demonstrates the ability to recognize pedal manifestations of
    systemic disease.

7.  Demonstrates sound surgical judgment and a level of proficiency in
    surgical procedures including tissue disservice, retraction,
    manipulation and wound closure

##### Comments: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

#####  CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation: Podiatric Surgery

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator
Name/Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates the ability to elicit a proper podiatric history and
    physical examination,

> and arrive at a diagnosis, prognosis, and surgical treatment plan.

-   Demonstrates the ability to determine when consultative services are
    necessary to confirm a diagnosis and / or assist in the management
    of the patient.

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-   Demonstrates the ability to manage medical, traumatic, structural
    functional foot disorders.

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```
-   Demonstrates sound surgical judgment and a level of proficiency in
    soft tissue, digital metatarsal, tarsal and rear-foot surgery.

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```
-   Demonstrates proficiency in post-operative management of podiatric
    surgical patients including post-operative complications

##### 

##### 

##### 

##### COMMENTS

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#####  

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

##### 

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation General Surgery

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates knowledge in pre-operative evaluation of a surgical
    patient and the indications for proceeding with or
    canceling/postponing a planned surgery.

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-   Demonstrates the proper techniques for tissue handling and
    instrumentation.

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```
-   Demonstrates knowledge of surgical gross anatomy, incision
    placement, concepts of adequate surgical exposure, hemostasis,
    surgical disservice and closure, and dressing management.

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```
-   Demonstrates an understanding of post-operative management of the
    surgical patient.

Comments:

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

##### 

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Anesthesiology

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates an understanding of intravenous fluid therapy including
    electrolyte balance and replacement i.e., transfusions.

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-   Demonstrates a familiarity with the various types of general
    anesthetic agents, including inhalation and I.V.

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```
-   Demonstrates a familiarity with the techniques of spinal and caudal
    anesthesia and has a comprehensive knowledge of various local
    anesthetic agents and blocks.

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```
-   Has the ability to perform a pre-anesthetic consultation and
    determine the anesthetic risk to the patient.

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```
-   Demonstrates a familiarity with pre-operative medications,
    post-anesthetic and recovery problems.

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```
-   Has satisfactorily assisted in the placement of I.V. lines and
    endotracheal intubation

Comments:

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Pathology / Laboratory Medicine

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates an understanding of the purpose, methodology and
    interpretation of various laboratory tests in hematology, blood
    chemistry and urinalysis.

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```
-   Demonstrates the ability to interpret sensitivity tests and identify
    culture growths for various common organisms in microbiology.

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```
-   Demonstrates an ability to identify normal and pathological tissue
    macroscopically and microscopically.

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```
-   Demonstrates the knowledge and ability to request the proper
    laboratory tests appropriate for various pathologic conditions.

```{=html}
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```
-   Demonstrates an understanding of tissue and specimen collection and
    the methods used for staining, slide mounting, and frozen service
    preparation.

> Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### 

##### 

##### 

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Podiatric Medicine

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Is familiar with the evaluation of the physical and mental status of
    the geriatric patient attained by the history and physical
    examination.

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```
-   Demonstrates the ability to assess the nutritional status of a
    pediatric or geriatric patient through clinical and laboratory data.

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```
-   Demonstrates knowledge in the recognition and evaluation of common
    disorders of the lower extremity, including the integument, of the
    pediatric or geriatric patient.

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```
-   Has an understanding of the need and the methods to adjust the
    medication dosages with regard to age, organ dysfunction, and
    concomitant medication.

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```
-   Demonstrates an ability to evaluate the gait cycle of a pediatric
    (up to age 14) patient with an emphasis on developing a conservative
    plan of care for any pathology identified.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Community Podiatry

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Is familiar with the social / behavioral / economic aspects of
    disease and their consequence in patient management.

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-   Demonstrates the ability to include, within the history and physical
    examination, pertinent social, behavioral and psychological
    information.

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```
-   Is familiar with and can describe the influence of social and
    economic factors in patient management.

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```
-   Has an understanding of emotional, social and / or behavioral
    manifestations in the elderly patient, the AIDS afflicted, or the
    drug dependant and its implication for that patient.

> Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### 

##### 

##### 

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Internal Medicine/ Ward Medicine

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates an understanding of hospital protocol and the use of
    consultative services.

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```
-   Demonstrates knowledge and ability in the performance of a medical
    history and physical examination (physical diagnosis).

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```
-   Demonstrates a familiarity with the various laboratory procedures
    and x-ray evaluations utilized in general medicine.

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```
-   Demonstrates knowledge in the diagnosis and treatment of diabetes
    mellitus and its complications.

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```
-   Demonstrates an understanding in the diagnosis and treatment of
    hypertension and its complications.

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```
-   Demonstrates and understanding of the pharmacology of diabetes and
    hypertension treatment regimes.

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```
-   Demonstrates an acute awareness of possible systemic disease by the
    assessment of a patient's podiatric complaints.

> Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Diagnostic Imaging

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates the appropriate interpretive skills in radiology,
    including specialized procedures i.e., CT, tomography, MRI, MRA and
    various soft tissue techniques.

```{=html}
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```
-   Demonstrates the ability to interpret chest films.

```{=html}
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```
-   Demonstrates an ability to identify radiographically various types
    of pathology in the forefoot and rearfoot including tumors,
    fractures, infections, ossification abnormalities.

```{=html}
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```
-   Demonstrates an understanding of the use of the radio-opaque dyes.

```{=html}
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```
-   Demonstrates positioning and can describe the uses for various views
    of the foot and ankle, and their use in diagnostic radiology.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### 

##### 

##### 

##### 

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Life Support Unit

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates an understanding of "triage protocol" and the use of
    consultative services.

```{=html}
<!-- -->
```
-   Demonstrates knowledge and ability in the performance of a medical
    history and physical examination (physical diagnosis).

```{=html}
<!-- -->
```
-   Demonstrates a familiarity with the various laboratory procedures
    and x-ray evaluations utilized in urgent care medicine.

```{=html}
<!-- -->
```
-   Demonstrates knowledge in the diagnosis and treatment of diabetic
    and hypertensive emergencies

```{=html}
<!-- -->
```
-   Demonstrates an understanding of other common medical emergencies
    and stabilization / treatment methods.

```{=html}
<!-- -->
```
-   Understands the factors that dictate hospital admission.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Behavioral Medicine

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Is familiar with the social and behavioral aspects of disease and
    their consequences in patient management.

```{=html}
<!-- -->
```
-   Demonstrates the ability to include, within the history and physical
    examination, pertinent social, behavioral and psychological
    information.

```{=html}
<!-- -->
```
-   Is familiar with and can describe the influence of social and
    economic factors in patient management.

```{=html}
<!-- -->
```
-   Has an understanding of emotional, social and / or behavioral
    manifestations in the elderly patient, the AIDS afflicted, or the
    drug dependant and its implication for that patient.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Orthopedic Surgery

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates knowledge in pre-operative evaluation of an orthopedic
    surgical patient.

```{=html}
<!-- -->
```
-   Demonstrates the proper techniques for tissue handling and
    instrumentation.

```{=html}
<!-- -->
```
-   Demonstrates knowledge of surgical gross anatomy, incision
    placement, concepts of adequate surgical exposure, hemostasis,
    surgical disservice, fracture fixation, closure and dressing
    management.

```{=html}
<!-- -->
```
-   Demonstrates an understanding of post-operative management of the
    orthopedic surgical patient.

Comments:

##### 

##### 

##### 

#####  

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

##### 

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation Cardiology

Dates of Service\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

1.  Is familiar with the evaluation of cardiac disease via auscultation.

2.  Demonstrates the ability to evaluate EKG's for major pathologic
    conditions .

3.  Is familiar with and can describe the social and economic factors in
    patients with advanced cardiac disease.

4.  Has an understanding of the diagnostic testing performed to
    determine levels of cardiac function and can describe at least two
    non-invasive tests in detail.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

##### 

Resident: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation: **High Risk Foot Clinic**

Dates of Service: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date of
Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature:
­­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

-   Demonstrates knowledge of wound evaluation and common wound
    classification protocols.

```{=html}
<!-- -->
```
-   Demonstrates knowledge of risk factors that lead to lower extremity
    ulcers

```{=html}
<!-- -->
```
-   Demonstrates knowledge of and proficiency in wound debridement,

> application of advanced wound dressings and tissue grafts in clinic
> and use
>
> of off-weightbearing devices

-   Demonstrates ability to properly prescribe antibiotic therapy

```{=html}
<!-- -->
```
-   Demonstrates ability to make appropriate referrals for specialty
    evaluations.

Comments:

##### CAVHCS Podiatric Resident PM&S-24 Rotation Evaluation Form

Resident\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rotation: **Pediatrics (Maxwell AFB)**

Dates of Service: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date of
Evaluation \_\_\_\_\_\_\_\_\_\_\_

Evaluator Name/Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1 -- 2     | 3 -- 4     | 5 -- 6          | 7 -- 8     | 9 -- 10    |
|            |            |                 |            |            |
| Poor       | Fair       | Good            | Very Good  | Excellent  |
+------------+------------+-----------------+------------+------------+

5.  Demonstrates the ability to evaluate pediatric and adolescent lower
    extremities including a gait analysis when indicated.

6.  Demonstrates the ability to evaluate a pediatric/adolescent history
    for diagnostic purposes.

7.  Demonstrates the ability to converse with pediatric patients in an
    age appropriate manner.

8.  Has an understanding of the common childhood diseases and their
    clinical presentation.

Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PODIATRIC MEDICAL AND SURGICAL 24 MONTH PROGRAM**

**PROGRAM DIRECTOR'S QUARTERLY RESIDENT EVALUATION**

Please complete the following evaluation as thoroughly as possible. If
any answers are in the "Poor" category, please explain in the comment
section located on the reverse side of this form.

RESIDENT NAME: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_­­­\_\_ Date
of Evaluation: \_\_\_\_\_\_\_\_\_\_\_\_\_

**Review Quarter**: \_\_\_\_1st \_\_\_\_ 2nd \_\_\_\_3rd \_\_\_\_4th
\_\_\_\_5th \_\_\_\_6^th^ \_\_\_\_7^th^ \_\_\_8th

  --------------------------------------------------------------------------------------------------
  **Review Area**                  Outstanding   High           Satisfactory   Low            Poor
                                                 Satisfactory                  Satisfactory   
  -------------------------------- ------------- -------------- -------------- -------------- ------
  Performance of resident duties -                                                            
  overall                                                                                     

  Resident-patient interactions                                                               

  Resident-hospital staff                                                                     
  interactions                                                                                

  Resident-resident staff                                                                     
  interactions                                                                                

  Resident-student interactions                                                               

  General attitude toward                                                                     
  residency and responsibilities                                                              
  as resident                                                                                 

  Response to constructive                                                                    
  criticism                                                                                   

  Emotional maturity, stability &                                                             
  dependability                                                                               

  Education Program                                                                           
  attendance/completion                                                                       

  Compliance with VHA                                                                         
  directives/policies                                                                         

  Personal appearance                                                                         

  Demonstration of initiative                                                                 
  and/or leadership                                                                           

  Flexibility and adaptability                                                                
  (policy changes, etc.)                                                                      

  Pre-Procedure patient                                                                       
  evaluations                                                                                 

  Appropriate & consistent                                                                    
  surgical case preparation                                                                   

  Podiatric medical/surgical                                                                  
  judgment                                                                                    

  Podiatric medical/surgical                                                                  
  technique                                                                                   

  General quality of work                                                                     
  presented                                                                                   
  --------------------------------------------------------------------------------------------------

  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  COMMENTS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

+-----------------------------------------------------------------------+
| If report is for final quarter of residency, complete the following:  |
|                                                                       |
| \_\_\_\_\_ Will receive certificate of completion of residency        |
| training                                                              |
|                                                                       |
| \_\_\_\_\_ Will not receive certificate of completion of residency -- |
| see comments below                                                    |
|                                                                       |
| \_\_\_\_\_ Other action recommended -- see comments below             |
|                                                                       |
| Brief comment as to recommendation of action:                         |
|                                                                       |
| \_\_\_\                                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Director, Podiatric Medical Education Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Resident Date

##### CAVHCS Podiatric Resident Faculty Evaluation Form

Program Dates: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Program: PM&S-24

Faculty Member:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Rotation:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Rotation Month :
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1          | 2          | 3               | 4          | 5          |
|            |            |                 |            |            |
| Excellent  | Good       | Adequate        | Fair       | Poor       |
+------------+------------+-----------------+------------+------------+

-   Teaching ability:

```{=html}
<!-- -->
```
-   Rapport with patients:

-   Rapport with residents:

-   Availability to residents:

-   Amount of discussion, constructive criticism and feedback:

```{=html}
<!-- -->
```
-   Qualification as positive role model:

**[Circle as many of the following descriptors to define your
relationship with this faculty member:]{.underline}**

Helpful Confrontational Professional Enjoyable

Respectful Challenging Valuable Educational

Unhelpful Waste of time Personable Exceptional

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### CAVHCS Podiatric Resident End-of-Rotation Evaluation Form

Program Dates: Program: PM&S-24

Rotation: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Month: \_\_\_\_\_\_\_\_\_\_\_\_\_\_

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+------------+------------+-----------------+------------+------------+
| 1          | 2          | 3               | 4          | 5          |
|            |            |                 |            |            |
| Excellent  | Good       | Adequate        | Fair       | Poor       |
+------------+------------+-----------------+------------+------------+

-   The goals and objectives for each rotation in relation to the
    practice of Podiatric Medicine/Surgery were:

```{=html}
<!-- -->
```
-   The extent to which the content stated in the goals and objectives
    was covered by all teaching methods including direct patient contact
    was:

```{=html}
<!-- -->
```
-   The supervision by rotation coordinator/faculty was:

```{=html}
<!-- -->
```
-   The patient exposures in regard to accomplishing rotation objectives
    were:

**[The overall strengths of the rotation are: (circle all that
apply)]{.underline}**

Diversity of workload Hands-on experience Facilities

Volume of patients Faculty Structure

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[The overall weaknesses of the rotation are: (circle all that
apply)]{.underline}**

Diversity of workload Hands-on experience Facilities

Volume of patients Faculty Structure

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### 

##### 

##### CAVHCS Podiatric Resident End-of-Year Program Evaluation Form

Program Dates: Program: PM&S-24

  -----------------------------------------------------------------------
  Evaluation Scale

  -----------------------------------------------------------------------

+-----------+-----------+-----------------+------------+------------+
| 1         | 2         | 3               | 4          | 5          |
|           |           |                 |            |            |
| Excellent | Good      | Acceptable      | Poor       | Un         |
|           |           |                 |            | acceptable |
+-----------+-----------+-----------------+------------+------------+

-   The planning and organization of the program is appropriate for the
    goals and objectives:

```{=html}
<!-- -->
```
-   The resources of the program are adequate to accomplish the program
    goals and objectives:

```{=html}
<!-- -->
```
-   The program is having a positive effect on students and residents:

```{=html}
<!-- -->
```
-   The program is having a positive affect in the care of patients:

-   The program director's administration was:

**[What are the strengths of the program? (circle all that
apply)]{.underline}**

Diversity of workload Journal Clubs Friday Lectures

Program rotations Faculty Outpatient clinics

Inpatient service O.R. Cases High Risk Clinic

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[What are the weaknesses of the program? (circle all that
apply)]{.underline}**

Diversity of workload Journal Clubs Friday Lectures

Program rotations Faculty Outpatient clinics

Inpatient service O.R. Cases High Risk Clinic

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PODIATRY RESIDENT ON-CALL SCHEDULE**

# **JULY 1, 2008 - JUNE 30, 2009**

# **PAGER: (334) 724-1464 CELL: (334) 318-7891**

  --------------- ------------------- ----------------- -----------------
  **6/27 -- 7/03  **Kelley**          **12/25 -- 12/30  **Griffin \*H**
  2008**                              2009**            

  **7/4 -- 7/10** **Davis/Swain \*H** **12/31 -- 1/08** **Davis \*H**

  **7/11-- 7/17** **Griffin/ Kelley** **1/09 -- 1/15**  **Griffin**

  **7/18 --       **Davis/Swain**     **1/16 -- 1/22**  **Kelley \*H**
  7/24**                                                

  **7/25 --       **Griffin/ Kelley** **1/23 -- 1/29**  **Swain**
  7/31**                                                

  **8/01-- 8/07** **Davis/Swain**     **1/30 -- 2/05**  **Davis**

  **8/08-- 8/14** **Griffin/ Kelley** **2/06 -- 2/12**  **Swain**

  **8/15-- 8/21** **Davis**           **2/13 -- 2/19**  **Griffin \*H**

  **8/22-- 8/28** **Swain**           **2/20 -- 2/26**  **Kelley**

  **8/29 --       **Griffin \*H**     **2/27 -- 3/05**  **Davis**
  9/04**                                                

  **9/05 --       **Kelley**          **3/06 -- 3/12**  **Swain**
  9/11**                                                

  **9/12 --       **Davis**           **3/13 -- 3/19**  **Griffin**
  9/18**                                                

  **9/19 --       **Swain**           **3/20 -- 3/26**  **Kelley**
  9/25**                                                

  **9/26 --       **Griffin**         **3/27 -- 4/02**  **Davis**
  10/02**                                               

  **10/03 --      **Kelley**          **4/03 -- 4/09**  **Swain**
  10/09**                                               

  **10/10 --      **Davis \*H**       **4/10 -- 4/16**  **Griffin**
  10/16**                                               

  **10/17 --      **Swain**           **4/18 -- 4/24**  **Kelley**
  10/23**                                               

  **10/24--       **Griffin**         **4/25 -- 5/01**  **Davis**
  11/01**                                               

  **11/02 --      **Kelley**          **5/02 -- 5/08**  **Swain**
  11/06**                                               

  **11/7 --       **Davis \*H**       **5/09 -- 5/15**  **Griffin**
  11/13**                                               

  **11/14 --      **Swain**           **5/16-- 5/22**   **Kelley**
  11/20**                                               

  **11/21 --      **Griffin**         **5/23 -- 5/29**  **Davis \*H**
  11/26**                                               

  **11/27--       **Swain \*H**       **5/30 -- 6/05**  **Swain**
  12/04**                                               

  **12/05 --      **Davis**           **6/06 -- 6/12**  **Griffin**
  12/11**                                               

  **12/12 --      **Swain**           **6/13 -- 6/19**  **Kelley**
  12/18**                                               

  **12/19 --      **Kelley**          **6/20 -- 6/26**  **Davis**
  12/24**                                               
  --------------- ------------------- ----------------- -----------------

**[On-Call Rules:]{.underline}**

-   Call duties will shared by all residents as scheduled. The Chief,
    Podiatry Section, must approve any changes.

-   The On-Call resident will activate and carry the on-call pager and
    cell phone at all times.

-   Call rotation will occur during the Friday education meeting --
    Grand Rounds will be conducted in the Conference room and continued
    on the floor if necessary. On-Call is a 24/7 responsibility.

-   All other residents will have their pagers on at ALL TIMES and will
    make arrangements to contact and/or return to CAVHCS in a reasonable
    length of time if requested as stated in the resident's handbook
    unless on approved annual leave, authorized absence or qualified
    sick leave.

-   Emergency admissions and surgery decision-making will require
    notification of the on-call attending.

-   The attending podiatrist MUST be notified of all admissions since
    they must personally evaluate them within 24 hours of admission.

-   On-Call attendings do NOT need to be present for routine dressing
    changes/wound care/low complexity decision making but may be
    consulted by pager alert at the discretion of the on-call resident

-   Resident notes generated over the weekend must be co-signed by the
    attending by COB next administrative workday except for Admissions
    which MUST be evaluated and co-signed by the attending within 24
    hours of the admission.

######## 

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######## 

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######## 

######## PRESENT COURSEWARE 2008-2009 LECTURE SCHEDULE 

\* Lecture schedule subject to revision. You are individually
responsible for viewing to completion each assigned lecture. You can
access PRESENT lectures from any PC by pointing your browser to:
[http://present.articulateglobal.com](http://present.articulateglobal.com/).

**[2008-2009 Podiatric Residency Programs Journal Club
Schedule]{.underline}**

**[Meets the Second Friday of Each Month]{.underline}**

**[Journal Club Ground Rules:]{.underline}**

1.  Each Journal Club participant (Residents and Students) selects one
    article for presentation.

2.  Must be from a **[peer-reviewed]{.underline}** journal such as
    Diabetes Care, Wounds, JACFAS, JBJS, etc.

3.  Should be less than 24 months old.

4.  Must be relevant to the practice of podiatric medicine and surgery.

5.  Please make enough copies for all in attendance. Please clip or
    staple as appropriate.

6.  If in doubt about an article's suitability for Journal Club, please
    ask!!!

7.  Be prepared to discuss the article in depth and answer questions
    relative to the concepts presented.

APPENDICIES

1.  **VHA 1400.1 Resident Supervision Handbook (revised 7/05) and CAVHCS
    Resident Supervision Policy (revised 4/06)**

2.  **CAVHCS Appt of VA Paid Residents**

3.  **VHA Resident Billing Guidelines**

4.  **VA Internet Log Protocols**

5.  **Residency Resource Resident User Guide**

6.  **Resident Scope of Practice**

7.  **Resident Rotation Schedule (PGY-I & PGY-II)**

8.  **Overview of CPRS**

9.  **CAVHCS Policy 136-06-06 on the use of Approved Abbreviations and
    Symbols**

### **APPENDIX 9**

### 

### Computerized Patient Record System (CPRS)

 

> **Overview**           
>
>  

CPRS enables clinicians to enter, review, and continuously update all
order-related information connected with any patient. With CPRS, staff
can order lab tests, medications, diets, radiology tests and procedures,
record a patient's allergies or adverse reactions to medications,
request and track consults, enter progress notes, diagnoses, and
treatments for each encounter, and enter discharge summaries. Close
integration with the Clinical Reminders and Text Integration packages
allows better record keeping and compliance with Clinical Guidelines and
medical record requirements.

 

CPRS not only allows hospital personnel to keep comprehensive patient
records, it also enables clinicians, managers, and QA staff to review
and analyze the data gathered on any patient in a way that directly
supports clinical decision-making.

 

**Features**            

 

CPRS improves the efficiency of entering orders, progress notes,
encounter data, and other clinical information in the patient chart,
through features such as:

 

         Order checking for:

>          Out-of-range values
>
>          Duplicates

         Maximum order frequency

>          Allergies
>
>          Potential drug-drug, drug-dosage, drug-overlap, drug-lab, and
> drug-allergy interactions, with appropriate warnings issued

         Orders integrated with progress notes, results, procedures,
diagnosis, and problems

         Templating utilities for speedy point-and-click composition of
notes

         Interdisciplinary notes that allow several users to enter
portions of a single note

         Tools to create Reminder dialogs for point-and-click resolution
of clinical reminders to meet Clinical Guidelines

         Quick orders

         Order sets

         Time-delay orders (for pre-admission or discharge orders)

>  

CPRS also improves the accessibility of online clinical information and
results via integration with:

 

         Clinical Reminders

         Adverse Reactions

         Discharge Summary

         Progress Notes

         Inpatient and Outpatient Pharmacy

         Dietetics

         Radiology

         Laboratory

         Notifications

         Health Summary

         Problem List

         Consult/Request Tracking

>  

**CPRS -- continued**

 

The application provides access to clinical information from other VAMC
sites through Remote Data Views.

 

         Displays other VAMCs where the patient has been seen

 

         From the listed sites, provides the capability to view
nationally released Health Summary components and results for many lab
tests

>  

A Graphical User Interface (GUI) provides a consistent, event-driven,
windows-style clinical user interface.

 

         Follows the **V***IST***A** GUI Guidelines, as well as the
common standard for Windows

 

         List Manager Interface allows Windows-like actions for
terminal-based users:

         Provides parameters and defaults that allow VAMC administrators
and CPRS users to fine-tune the functionality and processes specific to
their needs.

 

         Provides communication among **V***IST***A** packages
participating in CPRS through event-driven HL7 messaging.

 

 

 

 

######### CPRS Cover Sheet Example

![](media/image2.png){width="6.0in" height="3.917361111111111in"}

>  

### CPRS: Adverse Reaction Tracking

 

**Overview           **

 

The Adverse Reaction Tracking (ART) program provides a common and
consistent data structure for adverse reaction data. This module has
options for data entry and validation, supported references for use by
external software modules, and the ability to report adverse drug
reaction data to the Food and Drug Administration (FDA).

 

**Features**

                             

         Documents patient allergy and adverse drug reaction data.

 

         Provides the functionality for other **V***IST***A** modules to
extract and add patient reaction data.

 

         Provides a reporting mechanism that supports VHA Directive
10-92-070 which specifies reporting of adverse drug reactions to the
FDA.

 

         Includes ART event points in an Application Programmers
Interface (API) allowing other **V***IST***A** packages to know when
specific ART events take place so package tasks can be performed.

 

         Alerts the Pharmacy and Therapeutics Committee each time the
signs/symptoms are modified for a patient reaction.

 

         Generates progress notes. Displays all information at the time
of an ART event on the Progress Notes API and allows editing of the note
prior to sign off.

 

         Allows the site to track whether the patient has been asked if
he/she has allergies.

 

         Tracks when the patient chart and ID bands have been marked
indicating a particular reaction.

 

         Differentiates between historical and observed reactions.

 

         Tracks the particular signs/symptoms for a reaction.

 

         Allows for configuration of allergy files.

 

         Allows for editing and verification of reaction data.

 

         Allows for the addition of comments for each reaction to ensure
completeness in reporting.

 

         Contains extensive reporting capabilities.

 

         Contains an online reference guide.

 

### CPRS: Authorization/Subscription Utility (ASU)

 

Overview

 

The Authorization/Subscription Utility (ASU) provides a method for
identifying who is authorized to perform various actions on clinical
documents. These actions include signing, co-signing, and amending. ASU
originated in response to Text Integration Utilities\' document
definition needs. Current security key capabilities were unable to
efficiently manage the needs of clinical documentation (Discharge
Summaries, Progress Notes, etc.).

 

Features      

** **

         Defines, populates, and retrieves information about user
classes. User classes can be defined hospital-wide or more narrowly for
a specific service and can be used across **V***IST***A** to replace
and/or complement keys.

 

         Links user classes with Text Integrated Utilities (TIU)
document definitions and document events.

 

         Allows sites to maintain membership of users in User Classes
and to distribute such maintenance tasks.

 

         Lists class members as active or inactive.

 

         Allows infinite hierarchies of subclasses.

 

         Defines business rules to further manage document activities.

 

** **

** **

** **

** **

### CPRS: Clinical Reminders

 

**Overview**

           

The Clinical Reminders package is a valuable aid in patient treatment. 
Reminders assist clinical decision-making and educate providers about
appropriate care.  Electronic clinical reminders also improve
documentation and follow-up, by allowing providers to easily view when
certain tests or evaluations were performed and to track and document
when care has been delivered. They can direct providers to perform
certain tests or other evaluations that will enhance the quality of care
for specific conditions.

 

Clinical Reminders may be used for both clinical and administrative
purposes. However, the primary goal is to provide relevant information
to providers at the point of care, for improving care for veterans. The
package benefits clinicians by providing pertinent data for clinical
decision-making, reducing duplicate documenting activities, assisting in
targeting patients with particular diagnoses and procedures or
site-defined criteria, and assisting in compliance with VHA performance
measures and with Health Promotion and Disease Prevention guidelines.

 

The Quality Enhancement Research Initiative (QUERI), an HSR&D program,
and the National Clinical Practice Guidelines Committee have joined with
the Office of Information, System Design & Development office (SD&D) in
designing national reminders and dialogs that will help promote informed
decision-making and consistency of health care practices. Ischemic Heart
Disease (IHD) and Major Mood Disorder (MDD) reminders are two of the
first cooperatively developed reminders.

 

>  
>
>  

#### Features

 

         Allows results that are unique for each patient, by basing
reminder evaluation on the patient\'s clinical data.

         Allows facilities to copy, create, and customize their own
reminder definitions, based on local needs.

         Provides components that can be displayed on Health Summaries.

         Provides reminders reports for summary or detailed level
information about patients\' reminders that are due. Reports allow
providers to verify diagnoses, verify that appropriate treatment was
given, identify patients requiring intervention, and validate
effectiveness of care. Combined reports for multiple facilities or
multiple locations can now be generated.

         Provides an enhanced Exchange Utility that allows exchange of
reminder definitions and dialogs among sites and Veterans Integrated
Service Networks (VISNs).

         Provides clinicians with a simplified method of resolving
reminders within the CPRS GUI. Using point-and-click techniques, a
clinician can generate text for progress notes, update current and
historical encounter data in Patient Care Encounter (PCE), update vital
signs, update mental health test results/scores, and place orders.

#####   

##### CPRS: Clinical Reminders -- continued

#####  

#####  

##### Clinical Reminders Example: Reminders Resolution Dialog

 

![](media/image3.jpeg){width="5.936805555555556in"
height="5.144444444444445in"}

 

>  
>
>  
>
>  
>
>  
>
>  
>
>  
>
>  
>
>  
>
>  
>
>  

### CPRS: Consult/Request Tracking

 

**Overview**

                

The Consult/Request Tracking package provides an efficient way for
clinicians to order consultations and procedures from other providers or
services within the hospital system, at their own facility or another
facility. It also provides a framework for tracking consults and
reporting the results. It uses a patient\'s computerized patient record
to store information about consult requests.

 

**Features                **

 

         Allows direct access to Consults functions through menu options
in CPRS.

 

         Uses Consults\' own menu options for managing the system,
generating reports, tracking consults, or entering results for an
existing consult request.

 

         Allows staff to set up consults as CPRS Quick Orders,
streamlining the ordering process.

 

         Integrates with Prosthetics to track Home Oxygen, Eyeglasses,
Contact Lenses, and other Prosthetics services.

 

         Produces a permanent record of the request and resolution for
the patient\'s medical record.

 

         Allows all relevant parties to see the consult report in the
context of the patient\'s record.

 

         Allows use of TIU templates and boilerplate to report findings.

 

         Allows display of Consult reports through TIU and CPRS.

 

         Enables clinicians to order a consult at another facility,
using HL7 Messaging and the VA Intranet. 

 

** **

** **

 

 

 

 

 

 

 

** **

**CPRS: Consult/Request Tracking -- continued**

** **

** **

**Consults Example**

 

![](media/image4.jpeg){width="6.0in" height="4.5in"}

 

 

 

### CPRS: Health Summary

 

Overview     

 

A Health Summary is a clinically oriented, structured report that
extracts many kinds of data from **V***IST***A** and displays it in a
standard format. Health summaries can be printed or displayed for
individual patients or for groups of patients. The data displayed covers
a wide range of health-related information such as demographic data,
allergies, current active medical problems, and laboratory results.

 

Features      

 

         Integrates data from the following packages:

** **

> Adverse Reaction Tracking                                  Nursing
> (Vital Signs)
>
> Automated Medical Information                           Outpatient
> Pharmacy
>
>   Exchange (AMIE)                                             Patient
> Care Encounter (PCE)
>
> Clinical Reminders                                             Problem
> List
>
> Computerized Patient Record                              Progress
> Notes
>
>   System (CPRS)                                              
> Radiology
>
> Consults/Request Tracking                                 Registration
>
> Dietetics                                                          
> Scheduling          
>
> Discharge Summary                                           Social
> Work                       
>
> Inpatient Medications                                         Spinal
> Cord Dysfunction      
>
> Laboratory System                                            
> Surgery               
>
> Medicine                                                          
> **V***IST***A** Imaging     
>
> Mental Health                                                   

                                                                          

         Health Summary users can print an Outpatient Pharmacy Action
Profile with bar codes in tandem with a health summary.

>  

         Health Summary now exports components that allow staff to view
remote patient data through CPRS.  Currently, remote data views are
limited to predefined, nationally exported Health Summary Types. Remote
clinical data can be viewed using any Health Summary Type that has an
identically named Health Summary Type installed at both the local and
remote sites. 

 

         Clinical Reminders work with Health Summary to furnish
providers with timely information about their patients\' health
maintenance schedules. Providers can work with local coordinators to set
up customized schedules based on local and national guidelines for
patient education, immunizations, and other procedures.

 

         Health Summary components \'Progress Notes\' and  \'Selected
Progress Notes\' can display the new interdisciplinary progress notes
and all of the entries associated with the interdisciplinary note.

 

** **

>  

** **

**CPRS: Health Summary -- continued**

** **

  -- ---------------------------------------------------------------------
     

     ![](media/image5.jpeg){width="5.990972222222222in"
     height="4.34375in"}
  -- ---------------------------------------------------------------------

**Health Summary Example**

 

 

### CPRS: Problem List

 

Overview     

 

Problem List is used to document and track a patient's problems. It
provides the clinician with a current and historical view of the
patient's health care problems across clinical specialties and allows
each identified problem to be traceable through the **V***IST***A**
system in terms of treatment, test results, and outcome.

 

This application supports primary care givers, such as physicians,
nurses, social workers, and others, in inpatient and outpatient
settings. It is also designed to be used by medical and coding clerks. A
variety of different data entry methods are possible with this
application.

 

Use of Problem List varies from site to site, depending on the data
entry method a facility has chosen. Many sites use Encounter Forms, with
clerks entering most of the data in the encounter forms. Encounter forms
are generated from patient data in the system and added to or modified
by clinicians.

 

**Features            **

         Allows a clinician to view an individual problem list for any
given patient.

         Supports a variety of specialized views of a patient's problem
list.

         Uses the Lexicon utility that permits the use of "natural"
terminology when selecting a problem. Each term is well defined and
understandable. A user, site, or application may substitute a preferred
synonym.

         Can be linked to other sections of the medical record, such as
Health Summary, Progress Notes, Order Entry/Results Reporting, Consults,
test results, care plans for Nursing and Mental Health, Discharge
Summaries, and Billing/Encounter Forms.

         Supports import of problem information from other clinical
settings outside the immediate medical facility.

         Allows reformulation of a problem.

         Supports multiple forms of data capture: direct clinician
entries, clerk entry, encounter forms, foreign problem lists, scanned
encounter forms, hand-held devices, etc.

         Requires minimal data entry.

# ![](media/image6.png){width="6.4944444444444445in" height="0.8520833333333333in"} **APPENDIX 10** **Memorandum No. 136-06-06**

### ***March 22, 2006***

###### [APPROVED ABBREVIATIONS AND SYMBOLS LIST]{.underline}

***1.** [PURPOSE]{.underline}: **To state policy, assign responsibility,
and provide procedures for maintaining the list of approved
abbreviations and symbols to be used in the medical records at Central
Alabama Veterans Health Care System (CAVHCS) and maintain the Prohibited
Abbreviation List.***

***2.** [POLICY]{.underline}: **It is the policy of this health care
system that only approved abbreviations and symbols listed in this
policy are used in the medical records (includes hard copy and
electronic medical records, handwritten and typed).***

***3.** [RESPONSIBILITIES]{.underline}:*

***a. The Health Care System Director has the ultimate responsibility
for ensuring that health care providers utilize these abbreviations and
symbols in the medical records.***

***b. All Health Care Practitioners, who make entries in the medical
records, will use only those approved abbreviations and symbols listed
in this policy.***

***c. The Medical Records Committee will monitor medical record entries,
to ensure adherence to this policy through routine medical record
reviews.***

d\. The Medical Records Committee makes recommendations to the
Information Management Council for corrective action(s) and revisions.

***4.** [PROCEDURES]{.underline}:*

***a. Requests for additions and deletions to the Abbreviations and
Symbols List (Attachment A) or to the Prohibited Abbreviation List
(Attachment B) will be submitted in writing from service line managers
to the Medical Records Committee.***

b\. Final diagnoses listed on the discharge summary will be recorded in
full without the use of abbreviations or symbols.

c\. Staff may also access the approved abbreviations and symbols list on
the V-Drive under Business Office (BO-136) policies. The list will be
linked to CPRS to provide efficient provider access.

***5.** [REFERENCES]{.underline}: **VHA Handbook 1907.1; JCAHO
Accreditation Manual for Hospitals; JCAHO List of Unapproved
Abbreviations.***

***6.** [RESCISSIONS]{.underline}: **CAVHCS Memorandum No. 136-03-06,
dated December 23, 2003. ***

***7.** [RECERTIFICATION DATE:]{.underline} **This document is scheduled
for recertification on/before the last working day of March 2009.***

***8.** [FOLLOW-UP RESPONSIBILITY:]{.underline} **136***

##### Kathryn Maginnis

##### Interim Director, Central Alabama Veterans Health Care System 

##### Attachment: A: Approved Abbreviations List

***Attachment B: Prohibited Abbreviations List***

##### 

##### 

##### Distribution: C & F

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### 

##### Attachment A

##### APPROVED ABBREVIATIONS LIST

+-------------+--------------------------------------------------------+
| ***ABBR     | ***STANDS FOR***                                       |
| EVIATION*** |                                                        |
+-------------+--------------------------------------------------------+
| ### *A1*    | *first aortic sound*                                   |
+-------------+--------------------------------------------------------+
| *A2*        | *second aortic sound*                                  |
+-------------+--------------------------------------------------------+
| *A&A*       | *Aid and Attendance*                                   |
+-------------+--------------------------------------------------------+
| *AA*        | *authorized absence*                                   |
+-------------+--------------------------------------------------------+
| *AAA*       | *abdominal aortic aneurysm*                            |
+-------------+--------------------------------------------------------+
| *A-ADD*     | *Adult Attention Deficit Disorder*                     |
+-------------+--------------------------------------------------------+
| *aaf*       | *African American female*                              |
+-------------+--------------------------------------------------------+
| *AAL*       | *anterior axillary line*                               |
+-------------+--------------------------------------------------------+
| *aam*       | *African American male*                                |
+-------------+--------------------------------------------------------+
| *AB*        | *Abortion*                                             |
+-------------+--------------------------------------------------------+
| *Abd*       | *Abdomen*                                              |
+-------------+--------------------------------------------------------+
| *ABD*       | *Abductor*                                             |
+-------------+--------------------------------------------------------+
| *ABG*       | *arterial blood gases*                                 |
+-------------+--------------------------------------------------------+
| *ABLB*      | *alternate binaural loudness balance*                  |
+-------------+--------------------------------------------------------+
| *ACB*       | *before breakfast*                                     |
+-------------+--------------------------------------------------------+
| *Acid       | *acid phosphate*                                       |
| phos.*      |                                                        |
+-------------+--------------------------------------------------------+
| *ACL*       | *anterior cruciate ligament*                           |
+-------------+--------------------------------------------------------+
| *ACLS*      | *Advanced Cardiac Life Support*                        |
+-------------+--------------------------------------------------------+
| *ACS*       | *before supper*                                        |
+-------------+--------------------------------------------------------+
| *ACTH*      | *Adrenocorticotropic hormone*                          |
+-------------+--------------------------------------------------------+
| *A. D.*     | *right ear*                                            |
+-------------+--------------------------------------------------------+
| *Ad lib*    | *as much as desired*                                   |
+-------------+--------------------------------------------------------+
| *ADA*       | *American Diabetic Association*                        |
+-------------+--------------------------------------------------------+
| *ADD*       | *Adductor*                                             |
+-------------+--------------------------------------------------------+
| *ADE*       | *Adverse drug event*                                   |
+-------------+--------------------------------------------------------+
| *ADH*       | *Antidiuretic hormone*                                 |
+-------------+--------------------------------------------------------+
| *ADL*       | *Activities of daily living*                           |
+-------------+--------------------------------------------------------+
| *Aeb*       | *As evidence by*                                       |
+-------------+--------------------------------------------------------+
| *AFB*       | *Acid-fast bacillus (TB)*                              |
+-------------+--------------------------------------------------------+
| *AFIP*      | *Armed Forces Institute of Pathology*                  |
+-------------+--------------------------------------------------------+
| *AFib*      | *Atrial fibrillation*                                  |
+-------------+--------------------------------------------------------+
| *AFL*       | *Atrial flutter*                                       |
+-------------+--------------------------------------------------------+
| *AFO*       | *Ankle foot orthosis*                                  |
+-------------+--------------------------------------------------------+
| *AG*        | *Albumin-globulin ratio*                               |
+-------------+--------------------------------------------------------+
| *AHA*       | *American Heart Association*                           |
+-------------+--------------------------------------------------------+
| *AHHD*      | *Arteriosclerotic hypertensive heart disease*          |
+-------------+--------------------------------------------------------+
| *AI*        | *Aortic insufficiency*                                 |
+-------------+--------------------------------------------------------+
| *AIDS*      | *Acquired immunodeficiency syndrome*                   |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *AJ*           *Ankle jerk*

  *AKA*          *Above knee amputation*

  *ALA*          *Delta aminolevulinic acid*

  *Alb.*         *Albumin*

  *Alk. phos.*   *alkaline phosphatase*

  *alk.p'tase*   *alkaline phosphatase*

  *AlPS*         *aphasia Language Performance Scales*

  *ALS*          *Amyotrphic Lateral Sclerosis*

  *Alveo*        *alveolectomy*

  *ALT*          *alanine aminotransferase*

  *AM*           *Morning*

  *AMA*          *Against medical advise*

  *AMI*          *anterior myocardial infarction*

  *amp*          *ampule*

  *amt*          *amount*

  *ante*         *before*

  *ANA*          *antinuclear antibody*

  *ANF*          *antinuclear factor*

  *ant*          *Anterior*

  *MAOD*         *Medical Admitting Officer of the Day*

  *A & P*        *auscultation and percussion*

  *A-P*          *anterior-posterior*

  *AP*           *abdominoperineal*

  *AP & Lat*     *anteroposterior and lateral*

  *APC*          *atrial premature contraction*

  *appt*         *appointment*

  *as tol*       *as tolerated*

  *APVD*         *Arteriosclerotic peripheral vascular disease*

  *ARDS*         *adult respiratory distress syndrome*

  *ARF*          *acute renal failure*

  *ARI*          *acute renal insufficiency*

  *AS*           *aortic stenosis*

  *A.S.*         *left ear*

  *ASA*          *Acetylsalicylic acid*

  *ASAP*         *as soon as possible*

  *ASCUS*        *Atypical squamous cells of undetermined significance*

  *ASD*          *atrial septal defect*

  *ASHD*         *Arteriosclerotic heart disease*

  *ASO*          *Antistreptolysin O*

  *AST*          *Aspartate aminotransferase*

  *ASTRA-7*      *chemistry 7*

  *AT*           *atraumatic*
  -------------- --------------------------------------------------------

*Attachment A (cont'd)*

+-------------+--------------------------------------------------------+
| *ATN*       | *acute tubular necrosis*                               |
+-------------+--------------------------------------------------------+
| *AV*        | *Arteriovenous; atrioventricular*                      |
+-------------+--------------------------------------------------------+
| *AVL*       | *atrioventricular lead*                                |
+-------------+--------------------------------------------------------+
| *AVM*       | *arteriovenous malformation*                           |
+-------------+--------------------------------------------------------+
| *AWOL*      | *absent without leave*                                 |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *B*         | *black*                                                |
+-------------+--------------------------------------------------------+
| *baso*      | *basophil*                                             |
+-------------+--------------------------------------------------------+
| *BBB*       | *bundle branch block*                                  |
+-------------+--------------------------------------------------------+
| *BC*        | *bone conduction*                                      |
+-------------+--------------------------------------------------------+
| *BCM*       | *below costal margin*                                  |
|             |                                                        |
|             | *\]*                                                   |
+-------------+--------------------------------------------------------+
| *BCR        | *breakpoint cluster region (bloodwork)*                |
| Studies*    |                                                        |
+-------------+--------------------------------------------------------+
| *BE*        | *barium enema*                                         |
+-------------+--------------------------------------------------------+
| *BF*        | *black female*                                         |
+-------------+--------------------------------------------------------+
| *bf*        | *biofeedback*                                          |
+-------------+--------------------------------------------------------+
| *b.i.d.*    | *twice a day*                                          |
+-------------+--------------------------------------------------------+
| *biPAP*     | *non-invasive pressure support ventilator*             |
+-------------+--------------------------------------------------------+
| *BKA*       | *below knee amputation*                                |
+-------------+--------------------------------------------------------+
| *BM*        | *black male*                                           |
+-------------+--------------------------------------------------------+
| *bm*        | *bowel movement*                                       |
+-------------+--------------------------------------------------------+
| *BMI*       | *body mass index*                                      |
+-------------+--------------------------------------------------------+
| *BMJ*       | *bulbomembranous junction*                             |
+-------------+--------------------------------------------------------+
| *BMR*       | *basal metabolic rate*                                 |
+-------------+--------------------------------------------------------+
| *BP*        | *blood pressure*                                       |
+-------------+--------------------------------------------------------+
| *BPH*       | *benign prostatic hypertrophy*                         |
+-------------+--------------------------------------------------------+
| *BR*        | *bed rest*                                             |
+-------------+--------------------------------------------------------+
| *BRP*       | *bathroom privileges*                                  |
+-------------+--------------------------------------------------------+
| *BS*        | *bowel sounds*                                         |
+-------------+--------------------------------------------------------+
| *BSS*       | *Balanced Salt Solution*                               |
+-------------+--------------------------------------------------------+
| *BT*        | *blind rehabilitation therapy*                         |
+-------------+--------------------------------------------------------+
| *bs*        | *breath sounds*                                        |
+-------------+--------------------------------------------------------+
| *BSR*       | *bed side rails*                                       |
+-------------+--------------------------------------------------------+
| *BUN*       | *blood urea nitrogen*                                  |
+-------------+--------------------------------------------------------+
| *BV*        | *bacterial vaginosis*                                  |
+-------------+--------------------------------------------------------+
| *BW*        | *body weight*                                          |
+-------------+--------------------------------------------------------+
| *BX*        | *biopsy*                                               |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *^0^C*      | *centigrade*                                           |
+-------------+--------------------------------------------------------+
| *C*         | *cornea*                                               |
+-------------+--------------------------------------------------------+
| *C-1, C-2,  | *Cervical vertebrae 1-7*                               |
| etc.*       |                                                        |
+-------------+--------------------------------------------------------+
| *c*         | *with*                                                 |
+-------------+--------------------------------------------------------+
| *CA*        | *carcinoma*                                            |
+-------------+--------------------------------------------------------+
| *CAB*       | *coronary artery bypass*                               |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *CABG*         *coronary artery bypass graft*

  *CAD*          *coronary artery disease*

  *Cal, Kal*     *Calorie/Kilocarie*

  *CAPD*         *chronic ambulatory peritoneal dialysis*

  *caps*         *capsule*

  *CAST Study*   *cardia arrhythmic suppression*

  *cath.*        *catheter*

  *CBC*          *complete blood count*

  */C*           *mandibular complete denture*

  *C/*           *maxillary complete denture*

  *C/C*          *maxillary & mandibular complete dentures*

  *CBD*          *common bile duct*

  *CBP*          *chronic back pain*

  *CBS*          *chronic brain syndrome*

  *C.C.*         *chief complaint*

  *CCT*          *certified corrective therapist*

  *CCU*          *coronary care unit*

  *CD*           *cup disc ratio*

  *ceph.floc*    *cephalin flocculation test*

  *CF 3'*        *count finger vision at 3 feet*

  *CHEM 7*       *glucose, BUN, creatine, potassium, sodium, chloride,
                 CO2*

  *CHF*          *Congestive heart failure*

  *CHO*          *carbohydrate*

  *CHOL*         *cholesterol*

  *C1*           *chloride (T)*

  *cldy*         *cloudy (T)*

  *CMAP*         *compound muscle action potential (T)*

  *CRC*          *Community Residential Care (T)*

  *CLBP*         *chronic lower back pain*

  *cm*           *centimeter*

  *CMV*          *cytomegalic virus*

  *CNH*          *Community Nursing Home*

  *CNS*          *central nervous system*

  *CO*           *carbon monoxide*

  *c/o*          *complaints of*

  *CO2*          *carbon dioxide*

  *COAG*         *chronic open angle glaucoma (T)*

  *COLD*         *chronic obstructive lung disease*
  -------------- --------------------------------------------------------

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *COPD*         *chronic obstructive pulmonary disease*

  *C&P*          *compensation and pension examination*

  *CPC*          *clinicopathological conference*

  *CPAP*         *continuous position airway pressure*

  *CPK*          *creatine phosphokinase*

  *CPK-BB*       *creatine phosphokinase isoenzyme, brain*

  *CPK-MB*       *creatine phosphokinase isoenzyme, cardiac muscle
                 fraction*

  *CPK-MM*       *creatine phosphokinase isoenzyme, skeletal muscle
                 fraction*

  *CPR*          *cardiopulmonary resuscitation*

  *CRCS*         *colorectal cancer screening*

  *CRF*          *chronic renal failure*

  *CRI*          *chronic renal insufficiency*

  *CRRC*         *Coronary Risk Reduction Clinic*

  *C&S*          *culture and sensitivity*

  *CSF*          *cerebrospinal fluid*

  *CSP*          *Community Service Program*

  *C-Spine*      *cervical spine*

  *CT*           *Corrective Therapy*

  *CAT scan*     *computerized axial tomography*

  *CTS*          *carpal tunnel syndrome*

  *CTA*          *clear to auscultation*

  *CTPN*         *central total parenteral nutrition*

  *cv*           *costovertebral angle*

  *CVN*          *central venous nutrition*

  *CV*           *cardiovascular*

  *CVA*          *cerebrovascular accident*

  *CVP*          *central venous pressure*

  *CVS*          *cardiovascular system*

  *CW*           *chest wall*

  *CXR*          *chest x-ray*

                 

  *D's + V's*    *ductions + versions*

  *D-1,D-2,      *dorsal vertebrae 1-12*
  etc.*          

  *D5W, D10W,    *dextrose 5% water, dextrose 10% water, etc.*
  etc.*          

  *D&C*          *dilatation and curettage*

  *db*           *decibel*

  *Dent*         *dental*

  *Diab*         *diabetic*
  -------------- --------------------------------------------------------

*Attachment A (cont'd)*

+-------------+--------------------------------------------------------+
| *Derm*      | *dermatology*                                          |
+-------------+--------------------------------------------------------+
| #### DES    | *diethylstilbestrol*                                   |
+-------------+--------------------------------------------------------+
| *DIC*       | *disseminated intravascular coagulation*               |
+-------------+--------------------------------------------------------+
| *DIFF*      | *differential blood count*                             |
+-------------+--------------------------------------------------------+
| *dil.*      | *dilute*                                               |
+-------------+--------------------------------------------------------+
| *DIP*       | *distal interphalangeal*                               |
+-------------+--------------------------------------------------------+
| *DISCH*     | *discharge*                                            |
+-------------+--------------------------------------------------------+
| *DJD*       | *degenerative joint disease*                           |
+-------------+--------------------------------------------------------+
| *DKA*       | *diabetic ketoacidosis*                                |
+-------------+--------------------------------------------------------+
| *DM*        | *diabetes mellitus*                                    |
+-------------+--------------------------------------------------------+
| *DNR*       | *do not resuscitate*                                   |
+-------------+--------------------------------------------------------+
| *DO*        | *distral occlusal surface of tooth*                    |
+-------------+--------------------------------------------------------+
| *DOA*       | *dead on arrival*                                      |
+-------------+--------------------------------------------------------+
| *DOB*       | *date of birth*                                        |
+-------------+--------------------------------------------------------+
| *DOD*       | *mesial occlusal distal surface of tooth*              |
+-------------+--------------------------------------------------------+
| *DOE*       | *dyspnea on exertion*                                  |
+-------------+--------------------------------------------------------+
| *DP*        | *dorsalis pedis*                                       |
+-------------+--------------------------------------------------------+
| *DPT*       | *Diptheria & tetanus toxoids with pertussis*           |
+-------------+--------------------------------------------------------+
| *dr*        | *dram*                                                 |
+-------------+--------------------------------------------------------+
| *D-Spine*   | *dorsal spine*                                         |
+-------------+--------------------------------------------------------+
| *DSA*       | *digital subtraction angiogram*                        |
+-------------+--------------------------------------------------------+
| *DT's*      | *delirium tremens*                                     |
+-------------+--------------------------------------------------------+
| *DTR*       | *deep tendon reflexes*                                 |
+-------------+--------------------------------------------------------+
| *DUB*       | *dysfunctional uterine bleeding*                       |
+-------------+--------------------------------------------------------+
| *DVT*       | *deep vein thrombosis*                                 |
+-------------+--------------------------------------------------------+
| *DWI*       | *driving while intoxicated*                            |
+-------------+--------------------------------------------------------+
| *Dx*        | *diagnosis*                                            |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *ECG*       | *Electrocardiogram*                                    |
+-------------+--------------------------------------------------------+
| *ECT*       | *Electrocenvulvise therapy*                            |
+-------------+--------------------------------------------------------+
| *EECE-IOL*  | *Extracapsular cataract extraction-intraocular lens*   |
+-------------+--------------------------------------------------------+
| *EEG*       | *Electroencephalogram*                                 |
+-------------+--------------------------------------------------------+
| *EENT*      | *eyes, ears, nose and throat*                          |
+-------------+--------------------------------------------------------+
| *EFF*       | *Effective*                                            |
+-------------+--------------------------------------------------------+
| *e.g.*      | *for example*                                          |
+-------------+--------------------------------------------------------+
| *EGD*       | *Esophagogastroduodenoscopy*                           |
+-------------+--------------------------------------------------------+
| *EKG*       | *Electrocardiogram*                                    |
+-------------+--------------------------------------------------------+
| *EMD*       | *Electromechanical dissociation (asystole)*            |
+-------------+--------------------------------------------------------+
| *EMG*       | *Elentrolyogram*                                       |
+-------------+--------------------------------------------------------+
| *Endo*      | *Endodontia*                                           |
+-------------+--------------------------------------------------------+
| *ENG*       | *Electronystagmography*                                |
+-------------+--------------------------------------------------------+
| *ENT*       | *ears, nose and throat*                                |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *ent.*         *External Nutritional Therapy*

  *EOM*          *extra ocular movements*

  *EOM*          *Extraocular muscle*

  *EOMI*         *Extraoccular movements intact*

  *EPS*          *Extrapyramidal symptoms*

  *E-PAP*        *Expiratory positive airway pressure*

  *ER*           *Emergency room*

  *ERCP*         *Endoscopic retrograde cholangiopancreatography*

  *ERT*          *Estrogen replacement therapy*

  *ESR*          *Erythrocyte sedimentation rate*

  *ESRD*         *end stage renal disease*

  *etio.*        *Etiology*

  *ET*           *Educational therapy*

  *ETOH*         *ethyl alcohol*

  *ETT*          *Endotrachial tube*

  *ext.*         *Extremity*

  *Ext*          *Extraction*

  *EXU*          *Excretory urogram with post-voiding film*

                 

  *F*            *Female*

  *^0^F*         *Fahrenheit*

  *F.B.*         *Foreign body*

  *FBS*          *Fasting blood sugar*

  *Fdg*          *Feeding*

  *Fe*           *iron*

  *FeS04*        *Ferrous sulfate*

  *FEV*          *forced expiratory volume*

  *FH*           *family history*

  *Fib*          *Fibrillation*

  *FIO*          *forced inspiratory 02*

  *FRC*          *Functional residual capacity*

  *fl.dr.*       *fluid dram*

  *fl.oz.*       *fluid ounce*

  *FSH*          *Follicle stimulating hormone*

  *ft*           *feet/foot*

  *FTA*          *Fluorescent treponemal antibody*

  *FTA-ABS*      *Fluorescent treponemal antibody absorption test*

  *FTI*          *free thyroxin index*

  *FTR*          *failed to report*

  *FTSG*         *full thickness skin graft*

  *F/U*          *follow-up*

  *FUO*          *fever of undetermined origin*

  *FVC*          *forced vital capacity*

  *FWB*          *full weight bearing*
  -------------- --------------------------------------------------------

*Attachment A (cont'd)*

+-------------+--------------------------------------------------------+
| *Fx*        | #### Fracture                                          |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *G6PD*      | *glucose-6-phosphate dehydrogenase*                    |
+-------------+--------------------------------------------------------+
| *g*         | *gram*                                                 |
+-------------+--------------------------------------------------------+
| *G*         | *Gravida*                                              |
+-------------+--------------------------------------------------------+
| *GAF*       | *Global Assessment of Functioning*                     |
+-------------+--------------------------------------------------------+
| *GATB*      | *General Aptitude Test Battery*                        |
+-------------+--------------------------------------------------------+
| *GB*        | *gallbladder*                                          |
+-------------+--------------------------------------------------------+
| *GBS*       | *gallbladder series*                                   |
+-------------+--------------------------------------------------------+
| *GC*        | *gonorrhea*                                            |
+-------------+--------------------------------------------------------+
| *GCE*       | *general conditioning exercises*                       |
+-------------+--------------------------------------------------------+
| *GE*        | *gastroesophagel*                                      |
+-------------+--------------------------------------------------------+
| *GED*       | *general education development*                        |
+-------------+--------------------------------------------------------+
| *GE         | *gastroesophageal junction*                            |
| junction*   |                                                        |
+-------------+--------------------------------------------------------+
| *GGTP*      | *gamma-glutamyl transferase*                           |
+-------------+--------------------------------------------------------+
| *GI*        | *gastrointestinal*                                     |
+-------------+--------------------------------------------------------+
| *glob.*     | *globulin*                                             |
+-------------+--------------------------------------------------------+
| *gm*        | *gram*                                                 |
+-------------+--------------------------------------------------------+
| *Gm/dl*     | *grams per deciliter*                                  |
+-------------+--------------------------------------------------------+
| *GMC*       | *General Medicine Clinic*                              |
+-------------+--------------------------------------------------------+
| *gr.*       | *grain*                                                |
+-------------+--------------------------------------------------------+
| *GSW*       | *gunshot wound*                                        |
+-------------+--------------------------------------------------------+
| *gtt*       | *drop*                                                 |
+-------------+--------------------------------------------------------+
| *gtts*      | *drops*                                                |
+-------------+--------------------------------------------------------+
| *GTT*       | *glucose tolerance test*                               |
+-------------+--------------------------------------------------------+
| *G-tube*    | *gastrostomy tube*                                     |
+-------------+--------------------------------------------------------+
| *GU*        | *genitourinary*                                        |
+-------------+--------------------------------------------------------+
| *GXT*       | *graded exercise test*                                 |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *H2O*       | *water*                                                |
+-------------+--------------------------------------------------------+
| *H202*      | *hydrogen peroxide*                                    |
+-------------+--------------------------------------------------------+
| *hr*        | *hour*                                                 |
+-------------+--------------------------------------------------------+
| *HA*        | *headache*                                             |
+-------------+--------------------------------------------------------+
| *HAV*       | *Hallux Adductus Valgus*                               |
+-------------+--------------------------------------------------------+
| *HB*        | *housebound*                                           |
+-------------+--------------------------------------------------------+
| *HBP*       | *high blood pressure*                                  |
+-------------+--------------------------------------------------------+
| *H.C.*      | *Huntington's Chorea*                                  |
+-------------+--------------------------------------------------------+
| *HCMI*      | *Homeless Chronically Mentally Ill*                    |
+-------------+--------------------------------------------------------+
| *HCO3*      | *bicarbonate*                                          |
+-------------+--------------------------------------------------------+
| *Hct*       | *hematocrit*                                           |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *HDL*          *high density lipoprotein*

  *HEENT*        *head, eyes, ears, nose throat*

  *Hgb*          *hemoglobin*

  *HgbA1c*       *Hemoglobin A1c*

  *HGSL*         *Hygrade Squamous Epithelial Lesion*

  *H&H*          *hemoglobin and hematocrit*

  *HIDA (scan)*  *hepatobiliary iminodiacetic acid*

  *HIV*          *human immune deficiency virus*

  *HL*           *hearing level*

  *HLA B-27*     *tissue typing for human leukocyte antigen*

  *HM*           *hand motion vision*

  *HNI*          *hospitalization not indicated*

  *HNP*          *herniated nucleus pulposus*

  *H/O*          *history of*

  *HOB*          *head of bed*

  *H&P*          *history and physical*

  *HPF*          *high powered field*

  *HPI*          *history of present illness*

  *hr(s)*        *hour(s)*

  *HRT*          *Hormone replacement therapy*

  *h.s.*         *at bedtime*

  *ht.*          *height*

  *HTLV-III*     *human T-cell leukemia virus*

  *HTN*          *hypertension*

  *HVD*          *hypertensive cardivascular disease*

  *HCVD*         *hypertensive cardiovascular disease*

  *HTL*          *hearing threshold level*

  *Hyst*         *hysterectomy*

  *Hx*           *history*

  *Hz*           *Hertz, Frequency or cycles per second*

                 

  *I*            *iris*

  *IBC*          *iron binding capacity*

  *IBW*          *ideal body weight*

  *ICA*          *internal carotid artery*

  *ICU*          *Intensive Care Unit*

  *I&D*          *incision and drainage*

  *IDDM*         *insulin dependent diabetes mellitus*

  *i.e.*         *that is*

  *IGT*          *impaired glucose tolerance*

  *IHD*          *ischemic heart disease*

  *IHSS*         *idiopathic hypertrophic subaortic stenosis*

  *IM*           *intramuscular*

  *Imp*          *impression*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *IMP*       | *impaction (tooth)*                                    |
+-------------+--------------------------------------------------------+
| *IMU*       | *Intermediate Medicine Unit*                           |
+-------------+--------------------------------------------------------+
| *IMV*       | *intermittent (mechanical) mandatory ventilation*      |
+-------------+--------------------------------------------------------+
| *I&D*       | *incision & drainage*                                  |
+-------------+--------------------------------------------------------+
| *I&O*       | *intake and output*                                    |
+-------------+--------------------------------------------------------+
| *IO*        | *inferior oblique*                                     |
+-------------+--------------------------------------------------------+
| *IOP*       | *intraocular pressure*                                 |
+-------------+--------------------------------------------------------+
| *I-PAP*     | *inspiratory positive airway pressure*                 |
+-------------+--------------------------------------------------------+
| *IPPB*      | *intermittent positive pressure breathing*             |
+-------------+--------------------------------------------------------+
| *IQ*        | *intelligence quotient*                                |
+-------------+--------------------------------------------------------+
| *IR*        | *internal rotation*                                    |
+-------------+--------------------------------------------------------+
| *IT*        | *Incentive Therapy*                                    |
+-------------+--------------------------------------------------------+
| *IV*        | *intravenous*                                          |
|             |                                                        |
|             | *IVC*                                                  |
+-------------+--------------------------------------------------------+
| *IVC*       | *intravenous cholangiogram*                            |
+-------------+--------------------------------------------------------+
| *IVP*       | *intravenous pyelogram*                                |
+-------------+--------------------------------------------------------+
| *IVPB*      | *intravenous piggy-back*                               |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *JVD*       | *jugular venous distention*                            |
+-------------+--------------------------------------------------------+
| *JVP*       | *jugular venous pressure*                              |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *K*         | *kilo e.g., 64k, RAM*                                  |
+-------------+--------------------------------------------------------+
| *KCl*       | *potassium chloride*                                   |
+-------------+--------------------------------------------------------+
| *kg*        | *kilogram*                                             |
+-------------+--------------------------------------------------------+
| *KJ*        | *knee jerk*                                            |
+-------------+--------------------------------------------------------+
| *KT*        | *kinesiotherapy*                                       |
+-------------+--------------------------------------------------------+
| *Kt*        | *potassium*                                            |
+-------------+--------------------------------------------------------+
| *KUB*       | *kidneys, ureters and bladder*                         |
+-------------+--------------------------------------------------------+
| *KVO*       | *keep vein open*                                       |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *L-1, L-2,  | *lumbar vertebrae, 1, 2, 3, etc. through 5*            |
| etc.*       |                                                        |
+-------------+--------------------------------------------------------+
| *l*         | *liter*                                                |
+-------------+--------------------------------------------------------+
| *L*         | *left*                                                 |
+-------------+--------------------------------------------------------+
| *La*        | *left atrial*                                          |
+-------------+--------------------------------------------------------+
| *Lap*       | *laparotomy*                                           |
+-------------+--------------------------------------------------------+
| *LAD*       | *left axis deviation*                                  |
+-------------+--------------------------------------------------------+
| *LAFB*      | *left anterior fascicular block*                       |
+-------------+--------------------------------------------------------+
| *LAH*       | *left anterior hemiblock*                              |
+-------------+--------------------------------------------------------+
| *lab*       | *Laboratory*                                           |
+-------------+--------------------------------------------------------+
| *lat*       | *lateral*                                              |
+-------------+--------------------------------------------------------+
| *lb*        | *pound*                                                |
+-------------+--------------------------------------------------------+
| *LBBB*      | *left bundle branch block*                             |
+-------------+--------------------------------------------------------+

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *LBP*       | *lower back pain*                                      |
+-------------+--------------------------------------------------------+
| *LCM*       | *left costal margin*                                   |
+-------------+--------------------------------------------------------+
| *LDH*       | *lactic dehydrogenase*                                 |
+-------------+--------------------------------------------------------+
| *LDL*       | *low density lipoprotein*                              |
+-------------+--------------------------------------------------------+
| *L-DOPA*    | *levadopamine*                                         |
+-------------+--------------------------------------------------------+
| *LE*        | *lower extremity*                                      |
+-------------+--------------------------------------------------------+
| *LES*       | *lower esophageal sphincter*                           |
+-------------+--------------------------------------------------------+
| *LFT*       | *liver function test*                                  |
+-------------+--------------------------------------------------------+
| *lg*        | *large*                                                |
+-------------+--------------------------------------------------------+
| *LGI*       | *lower gastrointestinal*                               |
+-------------+--------------------------------------------------------+
| *LGL*       | *Lown-Ganong-Levin Syndrome*                           |
+-------------+--------------------------------------------------------+
| *LGSIL*     | *Low grade squamous epithelial lesion*                 |
+-------------+--------------------------------------------------------+
| *Ling*      | *Lingual surface of tooth*                             |
+-------------+--------------------------------------------------------+
| *LLE*       | *Left lower extremity*                                 |
+-------------+--------------------------------------------------------+
| *LLL*       | *Left lower lobe (lung)*                               |
+-------------+--------------------------------------------------------+
| *LLQ*       | *Left lower quadrant (abdomen)*                        |
+-------------+--------------------------------------------------------+
| *LMD*       | *Local medical doctor*                                 |
+-------------+--------------------------------------------------------+
| *LMP*       | *Last menstrual period*                                |
+-------------+--------------------------------------------------------+
| *LMMP*      | *Last normal menstrual period*                         |
+-------------+--------------------------------------------------------+
| *LOA*       | *Leave of absence*                                     |
+-------------+--------------------------------------------------------+
| *LOC*       | *Loss of consciousness*                                |
|             |                                                        |
|             | *ouousness*                                            |
+-------------+--------------------------------------------------------+
| *LOS*       | *Length of stay*                                       |
+-------------+--------------------------------------------------------+
| *LP*        | *Lumbar puncture*                                      |
+-------------+--------------------------------------------------------+
| *LPF*       | *Low power field*                                      |
+-------------+--------------------------------------------------------+
| *LPFB*      | *Left posterior fascicular block*                      |
+-------------+--------------------------------------------------------+
| *LPH*       | *Left posterior hemiblock*                             |
+-------------+--------------------------------------------------------+
| *LPHB*      | *Left posterior hernia block*                          |
+-------------+--------------------------------------------------------+
| *LS*        | *Lumbosacral*                                          |
+-------------+--------------------------------------------------------+
| *LSB*       | *Left sternal border*                                  |
+-------------+--------------------------------------------------------+
| *L-Spine*   | *Lumbar spine*                                         |
+-------------+--------------------------------------------------------+
| *LS Spine*  | *Lumbosacral spine*                                    |
+-------------+--------------------------------------------------------+
| *LTC*       | *Long term care*                                       |
+-------------+--------------------------------------------------------+
| *LTG*       | *Long term goal*                                       |
+-------------+--------------------------------------------------------+
| *LUE*       | *Left upper extremity*                                 |
+-------------+--------------------------------------------------------+
| *LUL*       | *Left upper lobe (lung)*                               |
+-------------+--------------------------------------------------------+
| *LUQ*       | *Left upper quadrant*                                  |
+-------------+--------------------------------------------------------+
| *LVCD*      | *Left ventricular conduction defect*                   |
+-------------+--------------------------------------------------------+
| *LVCD + MI* | *Left ventricular conduction c infarct*                |
+-------------+--------------------------------------------------------+

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *LVH*       | *Left ventricular hypertrophy*                         |
+-------------+--------------------------------------------------------+
| *Lymph*     | *Lymphocyte*                                           |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *M*         | *Male*                                                 |
+-------------+--------------------------------------------------------+
| *Mes*       | *Mesial surface of tooth*                              |
+-------------+--------------------------------------------------------+
| *m*         | *Meter*                                                |
+-------------+--------------------------------------------------------+
| *M          | *Murmur*                                               |
| (           |                                                        |
| encircled)* |                                                        |
+-------------+--------------------------------------------------------+
| *M/M*       | *Maxillary & mandibular*                               |
+-------------+--------------------------------------------------------+
| *MAL*       | *Midaxillary line*                                     |
+-------------+--------------------------------------------------------+
| *Malig*     | *Malignant*                                            |
+-------------+--------------------------------------------------------+
| *Mammo*     | *Mammogram*                                            |
+-------------+--------------------------------------------------------+
| *Mand*      | *Mandibular*                                           |
+-------------+--------------------------------------------------------+
| *Max*       | *Maxillary*                                            |
+-------------+--------------------------------------------------------+
| *Mcg*       | *Microgram*                                            |
+-------------+--------------------------------------------------------+
| *MCH*       | *Mean corpuscular hemoglobin*                          |
+-------------+--------------------------------------------------------+
| *MCHC*      | *Mean corpuscular hemoglobin concentration*            |
+-------------+--------------------------------------------------------+
| *MCL*       | *Midclavicular line*                                   |
+-------------+--------------------------------------------------------+
| *MCP*       | *Metacarpophalangeal*                                  |
+-------------+--------------------------------------------------------+
| *MCV*       | *Mean corpuscular volume*                              |
+-------------+--------------------------------------------------------+
| *MD*        | *Muscular dystrophy*                                   |
+-------------+--------------------------------------------------------+
| *MED*       | *Minimal brain dysfunction*                            |
|             |                                                        |
| *Ed*        |                                                        |
+-------------+--------------------------------------------------------+
| *Med*       | *Medial*                                               |
+-------------+--------------------------------------------------------+
| *MEN        | *Multiple endocrine neoplasia syndromes (Wermer,       |
| (I,II,III)* | Sipple's,etc)*                                         |
+-------------+--------------------------------------------------------+
| *Meq*       | *Milliequivalent*                                      |
+-------------+--------------------------------------------------------+
| *Mets*      | *Metastasis*                                           |
+-------------+--------------------------------------------------------+
| *MET*       | *Metatarsal (specify area)*                            |
+-------------+--------------------------------------------------------+
| *MHC*       | *Mental Hygiene Clinic*                                |
+-------------+--------------------------------------------------------+
| *Mhz*       | *Megahertz*                                            |
+-------------+--------------------------------------------------------+
| *MLB*       | *Monaural loudness balance*                            |
+-------------+--------------------------------------------------------+
| *Ml*        | *Milliliter*                                           |
+-------------+--------------------------------------------------------+
| *MMPI*      | *Minnesota Multiphasic Personality Inventory*          |
+-------------+--------------------------------------------------------+
| *MMT*       | *Manual muscle testing*                                |
+-------------+--------------------------------------------------------+
| *Mm*        | *Millimeter*                                           |
+-------------+--------------------------------------------------------+
| *MI*        | *Myocardial infarction*                                |
+-------------+--------------------------------------------------------+
| *mo(s)*     | *Months*                                               |
+-------------+--------------------------------------------------------+
| *MO*        | *Mesial-occlusal-distal surface of tooth*              |
+-------------+--------------------------------------------------------+
| *MOD*       | *Mesial-occlusal-surface of tooth*                     |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *MOM*          *Milk of Magnesia*

  *MP*           *Metacarpophalangeal*

  *MPJ*          *Metatarsal phalangeal joint*

  *MR*           *Mitral regurgitation*

  *MRI*          *Magnetic resonance imaging*

  *MRSA*         *Methicillin Resistant Staphylococcus Aureus*

  *MS*           *Multiple sclerosis*

  *MSL*          *Midsternal line*

  *Ms*           *Morphine sulfate*

  *MUGA (scan)*  *Multigated acquisition scan*

  *MV*           *Millovolt*

  *MVA*          *Motor vehicle accident*

  *MVC*          *Maximum vital capacity*

  *MVI*          *Multivitamins*

  *MVV*          *Maximum ventilatory volume*

                 

  *N*            *Nausea*

  *NA*           *Nasal antral*

  *Na+*          *Sodium*

  *n/a*          *Not applicable*

  *NAP*          *Nerve action potential*

  *NAPA*         *N-acetylprocaindmide*

  *NaCl*         *Sodium chloride*

  *NAD*          *No appreciable disease*

  *NBC*          *Nonbed care*

  *NC*           *Normocephalic*

  *NCV*          *Nerve conduction velocity*

  *Ng*           *Nanogram*

  *Neg*          *Negative*

  *NG*           *Nasogastric*

  *NGU*          *Nongonorrheal urethritis*

  *NH*           *Nursing home*

  *NHCU*         *Nursing home care unit*

  *NID*          *Not in distress*

  *NIDDM*        *Noninsulin dependent diabetes mellitus*

  *NIVLS*        *Noninvasive vascular lab studies*

  *Njcc*         *Near vision using Jaegger Chart with correction*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

  -------------- --------------------------------------------------------
  *NKA*          *No known allergies*

  *NKFA*         *No known food allergies*

  *nl.*          *Normal limits*

  *NLP*          *No light perception*

  *NMI*          *No middle initial*

  *NOK*          *Next of kin*

  *NP*           *Neuropsychiatric*

  *NPH           *Neutral Protamine Hagedorm (insulin)*
  (insulin)*     

  *NPN*          *Nonprotein nitrogen*

  *NPO*          *Nothing by mouth*

  *ns*           *Normal saline*

  *NS*           *Nuclear sclerosis (of lens)*

  *NSS*          *Normal saline solution*

  *NSAID*        *Non-steroidal anti-inflammatory drugs*

  *NSC*          *Non-service connected*

  *NSR*          *Normal sinus rhythm*

  *NST*          *Nutritional support team*

  *NTG*          *Nitroglycerin*

  *N&V*          *Nausea and vomiting*

                 

  *O2*           *Oxygen*

  *O*            *Objective*

  *OA*           *Osteoarthritis*

  *OBS*          *Organic brain syndrome*

  *Occ*          *Occlusal surface of tooth*

  *OCG*          *Oral cholecystogram*

  *O&E*          *Observation and evaluation*

  *OH*           *Oral hygiene*

  *OL*           *Occlusive lingual surface of tooth*

  *OMOL*         *Objective Measurement of Observed Language*

  *Oob*          *Out of bed*

  *OPT*          *Outpatient treatment*

  *OR*           *Operating room*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *ORIF*      | *Open reduction and internal fixation*                 |
+-------------+--------------------------------------------------------+
| *Ortho*     | *Orthopedic*                                           |
+-------------+--------------------------------------------------------+
| *OS*        | *Left eye*                                             |
+-------------+--------------------------------------------------------+
| *OU*        | *Both eyes*                                            |
+-------------+--------------------------------------------------------+
| *Oz*        | *Ounce*                                                |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *P*         | *Para*                                                 |
+-------------+--------------------------------------------------------+
| */P*        | *Mandibular partial denture*                           |
+-------------+--------------------------------------------------------+
| *P/*        | *Maxillary partial denture*                            |
+-------------+--------------------------------------------------------+
| *P/P*       | *Maxillary & mandibular partial dentures*              |
+-------------+--------------------------------------------------------+
| *P1*        | *First pulmonic sound*                                 |
|             |                                                        |
|             | *P*                                                    |
+-------------+--------------------------------------------------------+
| *P2*        | *Second pulmonic sound*                                |
+-------------+--------------------------------------------------------+
| *P&A*       | *Phenol and alcohol procedure*                         |
+-------------+--------------------------------------------------------+
| *PA*        | *Posterior anterior*                                   |
+-------------+--------------------------------------------------------+
| *PAC*       | *Premature atrial contractions*                        |
+-------------+--------------------------------------------------------+
| *PAL*       | *Posterioraxillary line*                               |
+-------------+--------------------------------------------------------+
| *PAO2*      | *Partial pressure of oxygen in the alveoli*            |
+-------------+--------------------------------------------------------+
| *PaO2*      | *Partial pressure of oxygen in arterial blood*         |
+-------------+--------------------------------------------------------+
| *Pap*       | *Papanicolaou test*                                    |
+-------------+--------------------------------------------------------+
| *PAP*       | *Positive airway pressure*                             |
+-------------+--------------------------------------------------------+
| *PAR*       | *Post Anesthesia Recovery*                             |
+-------------+--------------------------------------------------------+
| *PARR*      | *Post Anesthesia Recovery Room*                        |
+-------------+--------------------------------------------------------+
| *PAS*       | *Progressive activity schedule*                        |
+-------------+--------------------------------------------------------+
| *PAT*       | *Paroxysmal atrial tachycardia*                        |
+-------------+--------------------------------------------------------+
| *Path*      | *Pathology*                                            |
+-------------+--------------------------------------------------------+
| *PBC*       | *Prebed care*                                          |
+-------------+--------------------------------------------------------+
| *PBI*       | *Protein bound iodine*                                 |
+-------------+--------------------------------------------------------+
| *PB/Max*    | *Phonetically balanced/maximum*                        |
+-------------+--------------------------------------------------------+
| *p.c.*      | *After meals*                                          |
+-------------+--------------------------------------------------------+
| *PCA pump*  | *Patient controlled analgesic pump*                    |
+-------------+--------------------------------------------------------+
| *PCN*       | *Penicillin*                                           |
+-------------+--------------------------------------------------------+
| *PCO2*      | *Carbon dioxide pressure*                              |
+-------------+--------------------------------------------------------+
| *PCV*       | *Packed cell volume*                                   |
+-------------+--------------------------------------------------------+
| *PCWP*      | *Pulmonary capillary wedge pressure*                   |
+-------------+--------------------------------------------------------+
| *PE*        | *Physical examination*                                 |
+-------------+--------------------------------------------------------+
| *PEEP*      | *Positive end expiratory pressure*                     |
+-------------+--------------------------------------------------------+
| *PEG*       | *Percutaneous endoscopic gastrostomy*                  |
+-------------+--------------------------------------------------------+
| *PERLA*     | *Pupils equal, reactive to light and accommodation*    |
+-------------+--------------------------------------------------------+
| *PERRA*     | *Pupils round, reactive to light*                      |
+-------------+--------------------------------------------------------+

Attachment A (cont'd)

  -------------- --------------------------------------------------------
  *PET*          *Position emission tomography (scan)*

  *PFT*          *Pulmonary function test*

  *Pg*           *Picogram*

  *PH*           *Past history*

  *PHD*          *Public Health Department*

  *PI*           *Present illness*

  *PICA*         *Porch Index of Communicative Abilities*

  *PID*          *Pelvic inflammatory disease*

  *PIP*          *Proximal interphalangeal*

  *PM*           *Evening*

  *PMD*          *Primary myocardial disease*

  *PMI*          *Point of maximal impulse*

  *PND*          *Paroxysmal nocturnal dyspnea*

  *POMR*         *Problem Oriented Medical Record*

  *Pod*          *Podiatry*

  *p.o.*         *Per Oral*

  *PO2*          *Oxygen pressure*

  *Post*         *Posterior*

  *post-op*      *Postoperative*

  *POW*          *Prisoner-of-war*

  *PPBS*         *Postprandial blood sugar*

  *ppd*          *Pack(s) per day*

  *PPD*          *Purified protein derivative (test for TB)*

  *PPVT*         *Peabody Picture Vocabulary Test*

  *PRE-OP*       *Preoperative*

  *PRN*          *As needed*

  *Pro*          *Protein*

  *Prost*        *Prosthodontia*

  *Prophy*       *Praphylaxis (oral)*

  *PSA*          *Prostatic specific antigen*

  *PSP*          *Phenolsulfonphthalein*

  *PSYCH*        *Psychiatry*

  *pt.*          *Patient*

  *PT*           *Prothrombin time*

  *PTA*          *Prior to admission*

  *PTCA*         *Percutaneous transluminal coronary angioplasty*

  *PTE*          *Pulmonary thromboembolism*

  *PTPN*         *Peripheral total parenteral nutrition*

  *PTSD*         *Post-traumatic stress disorder*

  *PTT*          *Partial thrombplastin time*

  *PUD*          *Peptic ulcer disease*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

  -------------- --------------------------------------------------------
  *PVC*          *Premature ventricular contraction*

  *PVD*          *Peripheral vascular disease*

  *PVR*          *Post-voiding residual*

  *PWB*          *Partial weight bearing*

  *Px*           *Prognosis*

                 

  *Q*            *Every*

  *Quad*         *Quadriceps*

  *Quant*        *Quantity*

  *q.a.c.*       *Before every meal*

  *q.h.*         *Every [\_\_\_\_]{.underline} hours (blank represents
                 no. of hrs)*

  *q.i.d.*       *Four times daily*

  *q.ns*         *Quantity not sufficient*

  *q.s.*         *Quantity sufficient*

                 

  *R*            *Right*

  *RA*           *Rheumatoid arthritis*

  *RAD*          *Right axis deviation*

  *RAE*          *Right atrial enlargement*

  *RAI*          *Radioactive iodine*

  *RAO*          *Right atrial overload*

  *Red*          *Reduction*

  *RBBB*         *Right bundle branch block*

  *RBC*          *Red blood cell count*

  *RBT*          *Rational Behavior Therapy*

  *RCM*          *Right costal margin*

  *RDA*          *Recommended daily dietary allowances*

  *Rec.*         *Recommendations*

  *Resp*         *Respiration*

  *RDW*          *Red cell distribution width*

  *REST*         *Restorative (operative dentistry)*

  *RF*           *Rheumatoid factor*

  *RHD*          *Rheumatic heart disease*

  *RIA*          *Radioimmunoassay*

  *RLE*          *Right lower extremity*

  *RLL*          *Right lower lobe (lung)*

  *RLQ*          *Right lower quadrant (abdomen)*

  *RML*          *Right middle lobe (lung)*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

  -------------- --------------------------------------------------------
  *RMS*          *Rehabilitation Medicine Service*

  *ROM*          *Range of motion*

  *R/O*          *Rule out*

  *RPR*          *Rapid plasma reagent*

  *RR*           *Recovery room*

  *Ret. Root*    *Retained (dental) root*

  *RRR*          *Regular rate rhythm*

  *RS*           *Respiratory System*

  *RSR*          *Regular sinus rhythm*

  *RTC*          *Return to clinic*

  *RTW*          *Return to work*

  *RU*           *Resin uptake*

  *RUE*          *Right upper extremity*

  *RUL*          *Right upper lobe (lung)*

  *RUQ*          *Right upper quadrant (abdomen)*

  *RV*           *Residual volume*

  *RVCD+MI*      *Right ventricular conduction defect with infarct*

  *RVH*          *Right ventricular hypertrophy*

  *Rx*           *Prescription*

                 

  *S-1, etc.*    *Sacral vertebrae 1-5*

  *S1*           *First heart sound*

  *S2*           *Second heart sound*

  *S3*           *Third heart sound*

  *S4*           *Fourth heart sound*

  *SA*           *Sinoatrial*

  *SAO2*         *Saturated arterial oxygen*

  *S&A*          *Sugar and acetone*

  *sat.*         *Saturated*

  *SATP*         *Substance Abuse Treatment Program*

  *SBE*          *Subacute bacterial endocarditis*

  *SBO*          *Small bowel obstruction*

  *SC*           *Service-connected*

  *SCD*          *Sequential compression device*
  -------------- --------------------------------------------------------

*Attachment A (cont'd)*

+-------------+--------------------------------------------------------+
| *Subq*      | *Subcutaneous*                                         |
+-------------+--------------------------------------------------------+
| # SDS       | *Same day surgery*                                     |
+-------------+--------------------------------------------------------+
| *SD(s)*     | *Speech discrimination (Score)*                        |
+-------------+--------------------------------------------------------+
| *SDT*       | *Speech detection threshold*                           |
+-------------+--------------------------------------------------------+
| *SG*        | *Swan-ganz*                                            |
+-------------+--------------------------------------------------------+
| *SGOT*      | *Serum glutamic oxaloacetic transaminase*              |
+-------------+--------------------------------------------------------+
| *SGPT*      | *Serum glutamic pyruvic transaminase*                  |
+-------------+--------------------------------------------------------+
| *SI*        | *Seriously ill*                                        |
+-------------+--------------------------------------------------------+
| *SIADH*     | *Syndrome of inappropriate antidiuretic hormone*       |
+-------------+--------------------------------------------------------+
| *SICU*      | *Surgical intensive care unit*                         |
+-------------+--------------------------------------------------------+
| *SI joint*  | *Sacroiliac joint*                                     |
+-------------+--------------------------------------------------------+
| *SIMV*      | *Synchronized intermittent mandatory ventilation*      |
+-------------+--------------------------------------------------------+
| *Sibs*      | *Sibling*                                              |
+-------------+--------------------------------------------------------+
| *SISI*      | *Short Increment sensitivity index*                    |
+-------------+--------------------------------------------------------+
| *sl.*       | *Sublingual*                                           |
+-------------+--------------------------------------------------------+
| *SL*        | *Sensation level*                                      |
+-------------+--------------------------------------------------------+
| *SLE*       | *Systemic lupus erythematosus*                         |
+-------------+--------------------------------------------------------+
| *SLR*       | *Straight leg raising*                                 |
+-------------+--------------------------------------------------------+
| *Sm*        | *Small*                                                |
+-------------+--------------------------------------------------------+
| *SMA*       | *Sequential multichannel analysis*                     |
+-------------+--------------------------------------------------------+
| *SNS*       | *Specialized nutritional support*                      |
+-------------+--------------------------------------------------------+
| *SOAP*      | *Subjective, Objective, Assessment, Plan*              |
+-------------+--------------------------------------------------------+
| *SOAPIE*    | *SOAP plus intervention and evaluation*                |
+-------------+--------------------------------------------------------+
| *SOB*       | *Shortness of breath*                                  |
+-------------+--------------------------------------------------------+
| *SOFAS*     | *Social and Occupational Functioning Assessment Scale* |
+-------------+--------------------------------------------------------+
| *SOG*       | *Special observation group*                            |
+-------------+--------------------------------------------------------+
| *sol.*      | *Solution*                                             |
+-------------+--------------------------------------------------------+
| *SPL*       | *Sound pressure level*                                 |
+-------------+--------------------------------------------------------+
| *SP*        | *Status Post*                                          |
+-------------+--------------------------------------------------------+
| *sp. gr.*   | *Specific gravity*                                     |
+-------------+--------------------------------------------------------+
| *Ss*        | *One half*                                             |
+-------------+--------------------------------------------------------+
| *SR*        | *Standard release*                                     |
+-------------+--------------------------------------------------------+
| *SRT*       | *Speech reception threshold*                           |
+-------------+--------------------------------------------------------+
| *SR*        | *Suture removal*                                       |
+-------------+--------------------------------------------------------+
| *s&s*       | *Sign/symptoms*                                        |
+-------------+--------------------------------------------------------+
| *SS enema*  | *Soapsuds enema*                                       |
+-------------+--------------------------------------------------------+
| *st*        | *Soft tissue*                                          |
+-------------+--------------------------------------------------------+
| *Staph.*    | *Staphylococcus*                                       |
+-------------+--------------------------------------------------------+
| *Stat*      | *Immediately*                                          |
+-------------+--------------------------------------------------------+
| *STD*       | *Sexually transmitted disease*                         |
+-------------+--------------------------------------------------------+
| *STG*       | *Short term goal*                                      |
+-------------+--------------------------------------------------------+

Attachment A (cont'd)

  -------------- --------------------------------------------------------
  *STS*          *Serologic test for syphilis*

  *STSG*         *Split thickness skin graft*

  *Strep*        *Streptococcus*

  *SUI*          *Stress urinary incontinence*

  *Surg*         *Surgery*

  *SVC*          *Superior vena cava*

  *SVT*          *Supraventricular tachycardia*

  *Sx*           *Symptom*

                 

  *T*            *Temperature*

  *T-1, etc.*    *Thoracic vertebrae 1-12*

  *T-3*          *Triiodothyronine*

  *T4*           *Thyroxine (thyroid test)*

  *T&A*          *Tonsillectomy & Adenoidectomy*

  *TACHY*        *Tachycardia*

  *TAH*          *Total abdominal hysterectomy*

  *Tab*          *Tablet*

  *TB*           *Tuberculosis*

  *TBG*          *Thyroid binding globulin*

  *TBP*          *Thyroxine binding protein*

  *Tbsp*         *Tablespoon*

  *TED(s)*       *Thromboembolic deterrent - stocking (s)*

  *TEE*          *Transesophageal echocardiogram*

  *Temp*         *Temperature*

  *TENS*         *Transcutaneous electrical nerve stimulation*

  *THA*          *Total hip arthroplasty*

  *TI*           *Tricuspid insufficiency*

  *TIA*          *Transient ischemic attack*

  *TIBC*         *Total iron binding capacity*

  *t.i.d.*       *Three times daily*

  *TKA*          *Total knee arthroplasty*

  *TLC*          *Total lung capacity*

  *TM*           *Tympanic membrane*

  *TMJ*          *Temporal mandibular joint*

  *TNTC*         *Too numerous to count*

  *TNOMO*        *Used for staging cancer*

  *T*            *Tumor*

  *N*            *Nodes*

  *O*            *No node metastasis*

  *M*            *Distant metastasis*

  *O*            *Negative*
  -------------- --------------------------------------------------------

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *TO*        | *Telephone order*                                      |
+-------------+--------------------------------------------------------+
| *TP*        | *Total protein*                                        |
+-------------+--------------------------------------------------------+
| *TPA*       | *Tissue plasminogan activator*                         |
+-------------+--------------------------------------------------------+
| ##### TPN   | *Total parental nutrition*                             |
+-------------+--------------------------------------------------------+
| *TPR*       | *Temperature, pulse, respiration*                      |
+-------------+--------------------------------------------------------+
| *Trf*       | *Transfer*                                             |
+-------------+--------------------------------------------------------+
| *Trich*     | *Trichomonas*                                          |
+-------------+--------------------------------------------------------+
| *Trig.*     | *Triglycerides*                                        |
+-------------+--------------------------------------------------------+
| *T-Spine*   | *Thoracic spine*                                       |
+-------------+--------------------------------------------------------+
| *T-Surg*    | *Thoracic surgery*                                     |
+-------------+--------------------------------------------------------+
| *TS*        | *Tricuspid stenosis*                                   |
+-------------+--------------------------------------------------------+
| *TSH*       | *Thyroid stimulating hormone*                          |
+-------------+--------------------------------------------------------+
| *tsp*       | *Teaspoon*                                             |
+-------------+--------------------------------------------------------+
| *TU*        | *Transurethral*                                        |
+-------------+--------------------------------------------------------+
| *TUR*       | *Transurethral resection*                              |
+-------------+--------------------------------------------------------+
| *TURBT*     | *Transurethral resection of bladder tumor*             |
+-------------+--------------------------------------------------------+
| *TURP*      | *Transurethral resection of prostate*                  |
+-------------+--------------------------------------------------------+
| *TV*        | *Tidal volume*                                         |
+-------------+--------------------------------------------------------+
| *TWE*       | *Tap water enema*                                      |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *UA*        | *Urinalysis*                                           |
+-------------+--------------------------------------------------------+
| *UCL*       | *Uncomfortable loudness level*                         |
+-------------+--------------------------------------------------------+
| *UE*        | *Upper extremity*                                      |
+-------------+--------------------------------------------------------+
| *UGI*       | *Upper gastrointestinal*                               |
+-------------+--------------------------------------------------------+
| *UL*        | *Upper lid*                                            |
+-------------+--------------------------------------------------------+
| *Unk*       | *Unknown*                                              |
+-------------+--------------------------------------------------------+
| *UPJ*       | *Ureteropelvic junction*                               |
+-------------+--------------------------------------------------------+
| *URI*       | *Upper respiratory infection*                          |
+-------------+--------------------------------------------------------+
| *URTI*      | *Upper respiratory tract infection*                    |
+-------------+--------------------------------------------------------+
| *US*        | *Ultrasound*                                           |
+-------------+--------------------------------------------------------+
| *UTI*       | *Urinary tract infection*                              |
+-------------+--------------------------------------------------------+
| *UV*        | *Microvolt*                                            |
+-------------+--------------------------------------------------------+
| *UVJ*       | *Ureterovestical junction*                             |
+-------------+--------------------------------------------------------+
| *UVL*       | *Ultraviolet light*                                    |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *V*         | *Vomiting*                                             |
+-------------+--------------------------------------------------------+
| *VA*        | *Veterans Affairs*                                     |
+-------------+--------------------------------------------------------+
| *VC*        | *Vital capacity*                                       |
+-------------+--------------------------------------------------------+
| *Vcc*       | *Visual acuity with correction*                        |
+-------------+--------------------------------------------------------+
| *VD*        | *Venereal disease*                                     |
+-------------+--------------------------------------------------------+

Attachment A (cont'd)

+-------------+--------------------------------------------------------+
| *VDRL*      | *Venereal disease research laboratory test*            |
+-------------+--------------------------------------------------------+
| *VF*        | *Visual fields*                                        |
+-------------+--------------------------------------------------------+
| *VFC*       | *Ventricular fibrillary contractions*                  |
+-------------+--------------------------------------------------------+
| *V Fib*     | *Ventricular Fibrillation*                             |
+-------------+--------------------------------------------------------+
| *VH*        | *Vaginal hysterectomy*                                 |
+-------------+--------------------------------------------------------+
| *VI*        | *Veterans Industries*                                  |
+-------------+--------------------------------------------------------+
| *VIS*       | *Visual Impairment Services*                           |
+-------------+--------------------------------------------------------+
| *Vit*       | *Vitamin*                                              |
+-------------+--------------------------------------------------------+
| *VMA*       | *Vanillymandelic acid*                                 |
+-------------+--------------------------------------------------------+
| *VO*        | *Verbal order*                                         |
+-------------+--------------------------------------------------------+
| *Vol*       | *Volume*                                               |
+-------------+--------------------------------------------------------+
| *VP*        | *Venous pressure*                                      |
+-------------+--------------------------------------------------------+
| *VPC*       | *Ventricular premature contraction*                    |
+-------------+--------------------------------------------------------+
| *VPD*       | *Ventricular premature depolarization*                 |
+-------------+--------------------------------------------------------+
| *Vph*       | *Vision with pinhole*                                  |
+-------------+--------------------------------------------------------+
| *VQ*        | *Ventilation perfusion*                                |
+-------------+--------------------------------------------------------+
| *VS*        | *Vital signs*                                          |
+-------------+--------------------------------------------------------+
| *VSC*       | *Ventricular septal defect*                            |
+-------------+--------------------------------------------------------+
| *Vsc*       | *Visual acuity without correction*                     |
+-------------+--------------------------------------------------------+
| *V-Surg*    | *Vascular surgery*                                     |
+-------------+--------------------------------------------------------+
| *VT*        | *Ventricular tachycardia*                              |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *W*         | *White*                                                |
+-------------+--------------------------------------------------------+
| *WAIS*      | *Weschler Adult Intelligence*                          |
+-------------+--------------------------------------------------------+
| *WBC*       | *White blood cell*                                     |
+-------------+--------------------------------------------------------+
| *WC*        | *Wheelchair*                                           |
+-------------+--------------------------------------------------------+
| *WDWN*      | *Well developed, well nourished*                       |
+-------------+--------------------------------------------------------+
| *WD*        | *Well developed*                                       |
+-------------+--------------------------------------------------------+
| *WN*        | *Well nourished*                                       |
+-------------+--------------------------------------------------------+
| *WF*        | *White female*                                         |
+-------------+--------------------------------------------------------+
| *WM*        | *White male*                                           |
+-------------+--------------------------------------------------------+
| *wk(s)*     | *Week(s)*                                              |
+-------------+--------------------------------------------------------+
| *WNL*       | *Within normal limits*                                 |
+-------------+--------------------------------------------------------+
| *WPW*       | *Wolf Parkinson White Syndrome*                        |
+-------------+--------------------------------------------------------+
| *WSK*       | *Work sample kit*                                      |
+-------------+--------------------------------------------------------+
| *wt.*       | *Weight*                                               |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *X-ray*     | *Roentgen ray*                                         |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| *YO*        | *Year old*                                             |
+-------------+--------------------------------------------------------+
| *Yr*        | #### Year                                              |
+-------------+--------------------------------------------------------+
|             | ####                                                   |
+-------------+--------------------------------------------------------+
| *ZOE*       | #### Zinc oxide eugenol                                |
+-------------+--------------------------------------------------------+

*Attachment A (cont'd)*

  -------------- --------------------------------------------------------
  *Symbols*      

                 

  *&*            *And*

  *@*            *At*

  *=*            *Equal*

  *'*            *Foot*

  *"*            *Inch*

  *+*            *Positive*

  *\#*           *Pound*

  *?*            *Questionable*

  *2x*           *Twice*

                 *Percent*

  *^+/-^*        *Plus/minus*
  -------------- --------------------------------------------------------

  -------------------- ------------------------ -------------------- ------------------------
  *[Chemical           *[Symbol]{.underline}*   *[Chemical           *[Symbol]{.underline}*
  Name]{.underline}*                            Name]{.underline}*   

  *Actinium*           *AC*                     *Francium*           *Fr*

  *Aluminum*           *AL*                     *Gadolinium*         *Gd*

  *Americium*          *Am*                     *Gallium*            *Ga*

  *Antimony*           *Sb*                     *Germanium*          *Ge*

  *Argon*              *Ar*                     *Gold*               *Au*

  *Arsenic*            *As*                     *Hafnium*            *Hf*

  *Astatine*           *At*                     *Hafnium*            *Ha*
  -------------------- ------------------------ -------------------- ------------------------

*Attachment A (cont'd)*

  ----------------- ----------------- ----------------- -----------------
  *Barium*          *Ba*              *Helium*          *He*

  *Berkelium*       *Bk*              *Holmium*         *Ho*

  *Beryllium*       *Be*              *Hydrogen*        *H*

  *Bismuth*         *Bi*              *Iridium*         *Ir*

  *Boron*           *B*               *Iodine*          *I*

  *Bromine*         *Br*              *Iron*            *Fe*

  *Cadmium*         *Cd*              *Krypton*         *Kr*

  *Calcium*         *Ca+*             *Lanthanum*       *La*

  *Californium*     *Cf*              *Lawrencium*      *Lw*

  *Carbon*          *C*               *Lead*            *Pb*

  *Cerium*          *Ce*              *Lithium*         *Li*

  *Chlorine*        *Cl*              *Lutetium*        *lU*

  *Chromium*        *Cr*              *Magnesium*       *Mn*

  *Cobalt*          *Co*              *Mendelevium*     *Md*

                                      *Potassium*       *K+*

  *Cooper*          *Cu*              *Rhenium*         *Re*

  *Curium*          *Cm*              *Rhodium*         *Rh*

  *Dysprosium*      *Dy*              *Rubidium*        *Rb*

  *Einsteinium*     *Es*              *Ruthenium*       *Ru*

  *Erbium*          *Er*              *Rutherfordium*   *Rf*

  *Europium*        *Eu*              *Samarium*        *Sm*

  *Fermium*         *Fm*              *Scandium*        *Sc*

  *Fluorine*        *F*               *Selenium*        *Se*

                                                        

                                                        

  *Chemical Name*   *Symbol*                            

  *Silicon*         *Si*                                

  *Silver*          *Ag*              *Zinc*            *Zn*

  *Sodium*          *Na*              *Zirconium*       *Zr*

  *Strontium*       *Sr*                                

  *Sulfur*          *S*                                 

  *Tantalum*        *Ta*                                

  *Technetium*      *Tc*                                

  *Tellurium*       *Te*                                

  *Terbium*         *Tb*                                

  *Thallium*        *Tl*                                

  *Thulium*         *Tm*                                

  *Tin*             *Sn*                                

  *Titanium*        *TI*                                

  *Tungsten*        *W*                                 

  *Uranium*         *U*                                 

  *Vanadium*        *V*                                 

  *Xenon*           *Xe*                                
  ----------------- ----------------- ----------------- -----------------

### 

*Attachment B*

*PROHIBITED ABBREVIATIONS LIST*

*The Joint Commission has posted on its website -- under FAQ for 2004
National Patient Safety Goals, the approved list of 9 dangerous
abbreviations, acronyms and symbols that must be included on each
accredited organization\'s \"Do not use\" list: starting January 1,
2004. They are:*

*A \"minimum list\" of dangerous abbreviations, acronyms, and symbols
has been approved by JCAHO.*

+---+-------------------+-------------------------+--------------------+
| * | *Abbreviation*    | *Potential Problem*     | *Preferred Term*   |
|   |                   |                         |                    |
| * |                   |                         |                    |
+---+-------------------+-------------------------+--------------------+
| * | *U (for unit)*    | *Mistaken as zero, four | *Write "unit"*     |
| 1 |                   | or cc*                  |                    |
| . | * *               |                         |                    |
| * |                   |                         |                    |
+---+-------------------+-------------------------+--------------------+
| * | *IU (for          | *Mistaken as IV         | *Write             |
| 2 | International     | (intravenous) or 10     | "International     |
| . | unit)*            | (ten)*                  | unit"*             |
| * |                   |                         |                    |
|   | * *               |                         |                    |
+---+-------------------+-------------------------+--------------------+
| * | *Q.D., Q.O.D.*    | *Mistaken for each      | *Write "daily" and |
| 3 |                   | other. The period after | "every other day"* |
| . | *(Latin           | the Q can be mistaken   |                    |
| * | abbreviation for  | for an "I" and the "O"  |                    |
|   | once daily and    | can be mistaken for an  |                    |
| * | every other day)* | "I"*                    |                    |
| 4 |                   |                         |                    |
| . | * *               |                         |                    |
| * |                   |                         |                    |
+---+-------------------+-------------------------+--------------------+
| * | *Trailing Zero    | *Decimal point is       | *Never write a     |
| 5 | (X.0 mg),*        | missed*                 | zero by itself     |
| . |                   |                         | after a decimal    |
| * | *Lack of Leading  |                         | point (X mg), and  |
|   | Zero (.X mg)*     |                         | always use a zero  |
| * |                   |                         | before a decimal   |
| 6 |                   |                         | point (0.X mg)*    |
| . |                   |                         |                    |
| * |                   |                         | * *                |
+---+-------------------+-------------------------+--------------------+
| * | *MS, MSO~4,~ or   | *Confused for one       | *Write "morphine   |
| 7 | MgSO~4~*          | another.*               | sulfate" or        |
| . |                   |                         | "magnesium         |
| * |                   | *Can mean morphine      | sulfate"*          |
|   |                   | sulfate or magnesium    |                    |
| * |                   | sulfate*                | * *                |
| 8 |                   |                         |                    |
| . |                   |                         |                    |
| * |                   |                         |                    |
|   |                   |                         |                    |
| * |                   |                         |                    |
| 9 |                   |                         |                    |
| . |                   |                         |                    |
| * |                   |                         |                    |
+---+-------------------+-------------------------+--------------------+
|   |                   |                         |                    |
+---+-------------------+-------------------------+--------------------+

*#1-9 are mandated by JCAHO: These abbreviations are applicable whether
there are "periods" between the letters or not. For example, "I.U."
cannot be an acceptable replacement for "IU".*