DIAGNOSTIC RADIOLOGY
RESIDENT MANUAL
Revised August 5, 2020
SECTION 1 ______10
DEFINITION 11
GOALS 11
SPECIFIC OBJECTIVES 11 Medical expert/clinical decision-maker 11 Communicator 12 Collaborator 13 Manager 13 Health Advocate 14 Scholar 14 Professional 15
Training in Canada 16
Organizational Outline of the Program 16
Residency Training Committee 16
General Terms of Reference for Residency Training Committees 17
OVERVIEW OF ROUNDS AND TEACHING 20
Resident Responsibilities and Etiquette 21
JOURNAL CLUB (currently being discussed and revamped): 22
VISITING PROFESSOR PROGRAM: 22
ETHICS TRAINING: 22
COMMUNICATIONS TRAINING: 22
RESIDENT CALL DUTIES 22
ON CALL REPORTING POLICY 23
POST CALL POLICY 24 The Diagnostic Radiology Report 24 Written Communication 26 Direct Communication 26
SUPERVISION OF RESIDENTS 27
ATTENDING RADIOLOGIST RESPONSIBILITIES 27
RESIDENT RESPONSIBILITIES 28
Program Outline 29 By Number of Months Per Year 29 Program Outline By # Of Months Per Rotation 30 PGY1 ROTATIONS 31
RESIDENT EVALUATIONS: 32 Background: 32 Process of Evaluation: 32 What is WebEvaluation? 32 Core Benefits of WebEval 32 Benefits for Electronic Evaluation: 33 How does it work? 33
Guide To Resident Evaluation 34 EVALUATION TOOLS 34
Contingencies for Failure to Meet Defined Minimum Performance Standards 35
Evaluation Process 38
Conflict Resolution and Appeals 40
Appeal Procedure For An Unsatisfactory Evaluation 41 Pathway for Appeals 41
RESIDENT RESEARCH 42
DEPARTMENT OF DIAGNOSTIC IMAGING ______42
REQUIREMENTS AND RESOURCES ______42
(AUGUST 2016) ______42
REQUIREMENT BASED ON RCPSC LEARNING OBJECTIVES ______42
QUALIFYING PROJECT TYPES ______42
LESS DESIRABLE PROJECT TYPES ______42
DEFINITION OF COMPLETION ______42
AND EITHER OF THE TWO BELOW ______42
TIME ______43
ANY RESIDENT THAT COMPLETES THEIR RESEARCH PROJECT WITHIN THE EARLY YEARS OF RESIDENCY______43 RESIDENTS MAY ALSO APPLY TO DO RESEARCH ELECTIVES DURING THEIR PGY1 TRAINING ______43
EVALUATION ______43
RESEARCH MODULES ______43
MENTORS ______43
PROJECT APPROVAL, ETHICS AND FINANCIAL IMPACT STATEMENT ______44
KEY RESEARCH CONTACTS WITHIN DEPARTMENT OF MEDICAL IMAGING ______44
ROLE OF THE RESEARCH DIRECTOR ______44
ROLE OF THE DISCIPLINE RESEARCH ASSISTANT ______44
COMPOSITION OF THE DIRADS GROUP ______45
AT PRESENT, THE GROUP MEMBERS ARE ______45
DR. CONOR MAGUIRE, ASSOCIATE PROFESSOR, DISCIPLINE OF RADIOLOGY ([email protected]) ______45
MICHELLE SIMMS, DISCIPLINE RESEARCH ASSISTANT ([email protected]) ______45
ROLE OF THE DIRADS GROUP ______45
SERVICES PROVIDED TO RESIDENTS ______45
FINANCIAL SUPPORT FOR RADIOLOGY RESEARCH ______46
PRESENTATION ______47
EACH RESIDENT MUST PRESENT AT A CONFERENCE AT SOME POINT DURING THEIR RESIDENCY ______47
JOURNAL CLUB ______47
APPENDIX 1 ______48
PGY1 ______48 AT THE ONSET OF ANY RADIOLOGY RESEARCH PROJECT A SHORT DESCRIPTION OF THE PROJECT MUST BE ______48
PGY2 ______48
PGY3 ______49
PGY4 ______49
APPENDIX 2 ______49
MEDICAL EXPERT ______49
UNDERSTANDS TO ROLE OF RESEARCH IN MAINTAINING CLINICAL EXPERTISE ______49
COMMUNICATOR ______49
COLLABORATOR______49
MANAGER______50
INDEPENDENTLY IDENTIFY AN AREA OF RESEARCH INTEREST AND A RESEARCH MENTOR ______50
DEMONSTRATE EFFECTIVE TIME MANAGEMENT IN RESEARCH SETTING ______50
HEALTH ADVOCATE ______50
RECOGNIZE THE CONTRIBUTIONS OF SCIENTIFIC RESEARCH IN IMPROVING THE HEALTH OF PATIENTS AND COMMUNITIES ______50
SCHOLAR ______50
APPENDIX 3 ______51
A THREE-PHASE VENTURE ______51
2. STUDY ______51
3. PRESENTATION ______51 1) WHAT IS YOUR QUESTION? BE SPECIFIC. (THERE MAY BE MORE THAN ONE - BE VERY PRECISE IN DESCRIBING WHAT THEY ARE. THIS IS THE MOST IMPORTANT PART.) 52
2) WHAT DO YOU EXPECT TO FIND? WHAT OTHER POSSIBLE ANSWERS COULD THERE BE? ______52
A) WHY IS IT IMPORTANT TO ANSWER THIS QUESTION? WHAT EFFECT WILL YOUR ANSWER HAVE? ______52
B) HOW ARE YOU GOING TO ANSWER THIS QUESTION? ______52
C) WHAT STATISTICS WILL BE USED IN THE ANALYSIS OF THE DATA? ______52
PILOT STUDIES ______52
COMPLETION OF PROJECT ______54
GUIDELINES FOR MANUSCRIPT ______54
ABSTRACT: CLEARLY STATE THE PURPOSE OF STUDY AND WHY IT IS IMPORTANT. __ 54
APPENDIX 4 ______55
HEALTH RESEARCH ETHICS BOARD (HREB)______55
FINANCIAL IMPACT STATEMENT ______55
RESIDENT TRAVEL 56
OTHER RELEVANT DEPARTMENTAL POLICIES 58 CONFERENCE LEAVE 58 SICK LEAVE 58 VACATION TIME 58
Critical Incident and Stress Policy 59 PURPOSE 59 SCOPE 59 DEFINITIONS 59 POLICY AND PROCEDURES 60 Reporting a Critical Incident 60 Reporting a Significant Stressor 60 Referral and Meeting Guidelines 60
Harassment Policy 61
Memorial University Residency Program Safety Policy 61 Dress Code as per Memorial University Faculty of Medicine 62
PROGRAM TRANSFER POLICY 62
Eastern Health Policies 63
SECTION 2______65
INTRODUCTION 66
SECTION 3______67
PGY1 Radiology Ultrasound Rotation Objectives 68
PGY1 GI Radiology and Plain Film Rotation Objectives 70
PGY1 Radiology Anatomy and Research Rotation Objectives 72
PGY3 Angiography/Interventional Radiology 75
PGY2 Body CT GI/GU Imaging (HSC/SC) 79
PGY2 Body Imaging (HSC) 87
PGY3 Body Imaging (HSC) 91
PGY3 Body Imaging (SC) 95
PGY4 Body MR/CT/GI/GU Imaging (HSC) 99
PGY4 Body MR/CT/GI/GU Imaging (SCM) 104
PGY5 Body Imaging (HSC) 110
PGY5 Body Imaging (SC) 115
PGY2 Chest Cardio/Thoracic 121
PGY3 Chest Cardio/Thoracic (HSC/SC) 125
PGY4 Chest Cardio/Thoracic (HSC) 128
PGY5 Chest Cardio/Thoracic 133
PGY2 Emergency Radiology 140
PGY2 Gastrointestinal & Genitourinary (also PGY3, PGY4) 148
PGY2 Body CT GI/GU 149
PGY3 Body CT GI/GU (the rotation without MR) 149
PGY4 Body CT GI/GU (the rotation with last 2 weeks MR) 149 PGY3, PGY4 & PGY5 Mammography (SC) 154 PGY4 (two month rotation) 158 PGY5 (one month) 161
PGY3 & PGY5 MRI 164
PGY2 Musculoskeletal Radiology (HSC) 172
PGY3 Musculoskeletal Radiology (HSC) 176
PGY4 & PGY5 Musculoskeletal Radiology (HSC) 183
PGY2 Musculoskeletal Radiology (SC) 190
PGY3 Musculoskeletal Radiology (SC) 198
PGY4 & PGY5 Musculoskeletal Radiology (SC) 205
PGY2 Neuroradiology 213
PGY3 Neuroradiology 219
PGY4 & PGY5 Neuroradiology 224
PGY4 & PGY5 Obstetrical Ultrasound (OBS) 231
PGY2 Pediatrics: Introductory Month 237
PGY4 & PGY5 Pediatrics 242
PGY4 Rural Rotation 245
PGY2 Ultrasound Introductory Month (HSC) 248
PGY3 Ultrasound (HSC) 254
PGY4 & PGY5 Ultrasound (HSC) 261
PGY2 Ultrasound (SC) 267
PGY3 Ultrasound (SC) 272
PGY4 & PGY5 Ultrasound (SC) 278
Appendix One 285 Overview 285 HOW TO USE THIS MANUAL
This manual is divided into 3 sections for ease of reference:
SECTION 1 – Contains program information regarding Royal College training requirements, MUN Radiology General Program Goals and objectives, organization of the program, Terms of Reference of the Residency Training Committee, evaluations and appeals processes, research criteria, departmental and Eastern Health policies.
SECTION 2 - Contains goals and objectives for the PGY1 year of basic clinical training.
SECTION 3 - Contains rotation specific clinical radiology goals and objectives to be achieved during rotations at various levels of training. These objectives form the basis of rotation evaluations.
All residents should familiarize themselves with the contents of SECTION 1. First year residents should review Section 2. Residents should review appropriate parts in SECTION 3 before each radiology rotation and referred to throughout the rotation.
COPYRIGHT NOTICE
Copyright ©2017 Memorial University of Newfoundland
CANMeds competencies throughout this manual have been adapted with permission for our rotation objectives from the CANMeds Program of the Royal College of Physicians and Surgeons on Canada. “Copyright ©2015 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission”.
SECTION 1
Program Information
DEFINITION
Diagnostic Radiology is a branch of medical practice concerned with the use of imaging techniques in the study, diagnosis and treatment of disease.
GOALS
On completion of the educational program, the graduate physician will be competent to function as a consultant in Diagnostic Radiology. This requires the physician to have the ability to supervise, advise on and perform imaging procedures to such a level of competence, and across a broad range of medical practice, as to function as a consultant to referring family physicians and specialists.
Communication skills, knowledge, and technical skills are the three pillars on which a radiological career is built, and all are dependent on the acquisition of an attitude to the practice of medicine which recognizes both the need to establish a habit of continuous learning and a recognition of the importance of promoting a team approach to the provision of imaging services. Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Diagnostic Radiology. In addition, all residents must demonstrate an ability to incorporate gender, culture and ethnic perspectives in research methodology, data presentation and analysis.
SPECIFIC OBJECTIVES
At the completion of training, the resident will have acquired the following competencies and will function effectively as a:
Medical expert/clinical decision-maker
General Requirements: Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
Access and apply relevant information to clinical practice so as to have competence in clinical radiological skills.
Demonstrate effective consultation services with respect to patient care, education and legal opinions
Specific Requirements: Understand the nature of formation of all types of radiological images, including physical and technical aspects, patient positioning, contrast media. Knowledge of the theoretical, practical and legal aspects of radiation protection, including other imaging techniques and their possible harmful effects.
Knowledge of human anatomy at all ages, both conventional and multiplanar, with emphasis on radiological applications.
Knowledge of all aspects of clinical radiology, including understanding of disease, appropriate application of imaging to patients, importance of informed consent, complications such as contrast media reactions, and factors affecting interpretation and differential diagnosis.
Understand the fundamentals of quality assurance in radiology.
Understand the fundamentals of epidemiology, biostatistics and decision analysis.
Show competence in manual and procedural skills and in diagnostic and interpretive skills.
Demonstrate the ability to manage the patient independently during a procedure, in close association with a specialist or other physician who has referred the patient. The radiologist should know when the patients’ best interests are served by discontinuing a procedure, or referring the patient to another physician.
Understand the acceptable and expected results of investigations and/or interventional therapy as well as unacceptable and unexpected results. This must include knowledge of and ability to manage radiological complications effectively.
Understand the appropriate follow-up care of patients who have received investigations and/or interventional therapy.
Show understanding of a sound and systematic style of reporting.
Competence in effective consultation, conduct of clinico-radiological conferences, and the ability to present scholarly material and lead case discussions.
These objectives are achieved frequently over the 5 year training. Individual rotation objectives are listed in SECTION 3.
Communicator
General Requirements: Establish appropriate therapeutic relationships with patients/families.
Listen effectively.
Obtain the appropriate information during consultation with referring physicians in order to be able to make recommendations regarding the most appropriate testing and/or management of patients. Discuss appropriate information with patients/families and the health care team, and be able to obtain informed consent for tests and procedures when this is needed.
Specific Requirements: Have the ability to produce a radiologic report which will describe the imaging findings, most likely differential diagnoses, and, when indicated, recommend further testing and/or management.
Understand the importance of communication with referring physicians, including an understanding of when the results of an investigation or procedure should be urgently communicated.
Communicate effectively with patients and their families and have a compassionate interest in them.
Recognize the physical and psychological needs of the patient and their families undergoing radiological investigations and/or treatment, including the needs of culture, race and gender.
Collaborator
General Requirements: Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
Specific Requirements: Have the ability to function as a member of a multi-disciplinary health care team in the optimal practice of radiology.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds.
Manager
General Requirements: Utilize resources effectively to balance patient care, learning needs, and other activities.
Allocate finite health care resources wisely.
Work effectively and efficiently in a health care organization.
Utilize information technology to optimize patient care, life-long learning and other activities. Specific Requirements: Be competent in conducting or supervising quality assurance including an understanding of safety issues and economic considerations.
Be competent in computer science as it pertains to the practice of radiology.
These skills are learned on a day to day basis as well as through lectures. These lectures are given by the Department Manager and will teach residents how to run a department in terms of issues of equipment and staffing. In addition, residents will be exposed to situations when equipment is purchased for the department and through this will learn the basics of equipment purchase and tendering. The role of chief resident is another opportunity to develop managerial skills.
Health Advocate
General Requirements: Identify the important determinants of health affecting patients.
Contribute effectively to improve the health of patients and communities.
Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements: Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Recognize when radiological investigation or treatment would be detrimental to the health of a patient.
Educate and advise on the use and misuse of radiological imaging.
These skills are learned on a day to day basis and are incorporated as in the objectives of medical experts/decision maker. In addition, community involvement of residents will be encouraged including community education and charity projects.
Scholar
General Requirements: Develop, implement and monitor a personal continuing education strategy.
Critically appraise sources of medical information.
Facilitate learning of patients, house staff/students and other health professionals. Contribute to development of new knowledge.
Specific Requirements: Competence in evaluation of the medical literature.
The ability to be an effective teacher of radiology to medical students, residents, technologists and clinical colleagues.
The ability to conduct a radiology research project, which may include quality assurance.
Appreciation of the important role that basic and clinical research plays in the critical analysis of current scientific developments related to radiology.
The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long term plan. For a resident, this would include seeing as many cases as possible during the days with follow-up reading performed at night. It is recommended that a junior resident be reading at least two hours a night whereas a senior resident should be planning to read approximate four to six hours per night. It is very important not to fall behind and to understand the personal commitment to radiology and the personal responsibility. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this. Residents also participate in the TIPS workshop. Residents will be required to present and teach to other residents, medical students and house staff. In addition residents will be introduced to the MCOMP format through rounds which are accredited and therefore upon graduation will be able to maintain a recording of their scholarly activities using the MCOMP format (which is necessary for fellowship of the Royal College).
Professional
General Requirements: Deliver highest quality care with integrity, honesty and compassion.
Exhibit appropriate personal and interpersonal professional behaviours.
Practice medicine ethically consistent with the obligations of a physician respecting the needs of culture, race and gender.
Specific Requirements: Be able to accurately assess one’s own performance, strengths and weaknesses.
Understand the ethical and medical-legal requirements of radiologists.
The skills of being a medical professional were first introduced in medical school and are carried through the residency program and beyond. These qualities are developed through day to day activities on a continuing basis and hopefully enhanced through role models.
Please see below the Physician Charter.
Training in Canada
The foregoing represents the general and specific objectives that all candidates for the Royal College examinations in Diagnostic Radiology are expected to meet. For those training in Canadian programs, these objectives will be accomplished in a staged manner. Residents in Canadian programs may obtain the document describing this approach from their program directors.
Organizational Outline of the Program Interim Academic Chair Peter Collingwood, MD, FRCPC Program Director Angus Hartery, MD, FRCPC, ABR Research Director Jeff Flemming, MD, FRCPC
Residency Program Committee Chairperson Dr. Angus Hartery HSC Residency Coordinator Dr. Wes Chan Dr. Jenny Young Dr. Melissa Skanes St. Clare’s Residency Coordinators Dr. Connie Hapgood Dr. Lisa Smyth Janeway Residency Coordinator Dr. Nicole Hughes Research Director Dr. Jeff Flemming Nuclear Medicine Coordinator Dr. Jeff Flemming Professor and Interim Chair (Ex-officio) Dr. Peter Collingwood Administrative Resident Dr. Daniel Duggan Junior Resident Dr. Claire Woodworth Program Administrator Ms. Jennifer Collins Secretary Ms. Stephanie Herlidan Recording Secretary Ms. Jennifer Collins
The Diagnostic Radiology Residency Training Committee meets approximately every three months throughout the academic year. All major decisions, complaints, and concerns should be voiced and discussed at this meeting. The residents are strongly encouraged to present the residents’ concerns formally at this meeting. Individual residents should bring their concerns to the Administrative Resident and/or to other residents that may be on the Committee. As well, initial discussion should take place at each hospital site with the Residency Coordinator. The Program Director is always available as well.
General Terms of Reference for Residency Training Committees
Terms of Reference Radiology Residency Program Committee (RPC)
Meets approximately every three months throughout the academic year. All major decisions, complaints, and concerns are voiced and discussed. The resident representatives are strongly encouraged to present the residents’ concerns to the Program Director prior to the meeting and if not resolved, these concerns are discussed at the next scheduled RPC meeting. Individual residents are also strongly encouraged to present their concerns to the Administrative resident(s) and/or to other residents that may be on the Committee. Initial discussion should take place at each hospital site with the Residency Coordinator.
The Radiology Residency Program Committee (RPC) oversees all aspects of Radiology training. The specific roles and responsibilities of the RPC are as follows:
To develop a clear program plan, using CanMED objectives relating to knowledge, skills and attitudes and based upon the standard and specific objectives of training in the specialty training requirements of the Royal College of Physicians and Surgeons of Canada. This plan should also indicate the methods by which the objectives are to be achieved and the role played by each rotation and by each participating institution. Interview and select all new residents to the Radiology program in accordance with policies determined by the faculty postgraduate medical education committee. This occurs through the CaRMS selection subcommittee. To conduct the program, including the rotation of residents to ensure that each resident is advancing and gaining in experience and responsibility in accordance with the educational plan Ensure appropriate promotion of all residents throughout their residency. This occurs through the Promotions subcommittee. Ensure the highest degree of patient care and safety is delivered by radiology residents Administer and oversee oral examinations during the academic year Evaluate, formally and informally; the performance of all residents in the program through a well-organized program of in-training evaluation which will include the final evaluation at the end of the program as required by the College To maintain an appeal mechanism through which the residency program committee should receive and review appeals from residents and, where appropriate, refer the matter to the faculty Postgraduate Medical Studies Committee. Review the program on a regular basis to ensure excellence in radiology training Ensure the appropriate levels of supervision and responsibility are provided to radiology residents Address resident concerns in a timely and efficient manner Ensure the adequate resources are available to residents throughout their training Provide support, career planning, and counselling to all residents, but particularly those residents having difficulty within the program and experiencing psychological stress Provide, through various committees, the highest degree of academic training that can be provided. Foster life-long learning and research activities throughout all levels of training Confidentiality and professionally administer the program with respects to resident issues. Such other responsibilities which may be considered specific to the individual program
Composition of the Radiology RPC. Several of these positions maybe shared. Chair –Program Director Dr. Angus Hartery Site co-ordinators (approved by academic chair and program director). Voting members of the committee that bring representation and concerns from the major residency training sites. Dr. Connie Hapgood (St Clare Mercy Hospital co-supervisor) Dr. Lisa Smyth (St Clare Mercy Hospital co-supervisor) Dr. Wes Chan (Health Sciences Centre co-supervisor) Dr. Jenny Young (Health Sciences Centre co-supervisor) Dr. Melissa Skanes (Health Sciences Centre co-supervisor) Dr. Nicole Hughes (Janeway Childrens Hospital supervisor)
Research Director (approved by academic chair and program director). Provides guidance, coordinates and supports research with residents, medical students and staff. Also Chair of DIRAD group. Dr. Jeff Flemming Junior resident representative (elected by residents). Voting member of the committee that brings representation and concerns from residents. Dr. Claire Woodworth
Senior resident representative (selected by Program Director in consultation with RPC). Voting member of the committee that brings representation and concerns from residents. Dr. Daniel Duggan In addition, there is an ex-officio member. The Interim Academic Chair Dr. Peter Collingwood The work of the committee is supported by the academic program administrator, program executive assistant and secretary. Ms. Jennifer Collins Ms. Rhonda Marshall Ms. Stephanie Herlidan
OVERVIEW OF ROUNDS AND TEACHING
Rounds are held daily and offer residents an exposure to radiology and related teaching topics in didactic and case based format. Rounds are attended by staff radiologists and in most cases led by that person. There are opportunities for residents to develop teaching and presentation skills through “subspeciality” and “resident grand round” sessions. Residents are taught the essentials of radiology case discussion including the presentation of case material and the approach to evaluating this material. Cased based teaching offers residents an opportunity to develop consultative skills necessary to practice radiology and prepare for the Royal College examinations.
MONDAY Resident SubSpecialty Rounds - These rounds are organized by a staff member and a Resident. All residents are freed from clinical duties for this time slot. Monday from 4-5pm. Residents present cases in PowerPoint format around a topic selected by them and the participating staff radiologist. BlackBoard Collaborate is used to stream these rounds between the Health Science site to the teaching room at St. Clare's Mercy Hospital.
TUESDAY Interesting Case Rounds (ICR) - These rounds are held at both the Health Science site and St. Clare's Mercy Hospital site for staff and residents at each location. Tuesday from 12-1pm. Residents will attend these rounds and bring interesting cases in Power Point format with prepared discussion. Residents attend the rounds at the site that they are rotating through. Any resident at the Janeway site would attend the Health Science site rounds. Residents and/or staff radiologists will present cases to the residents in attendance. The resident presented with the case will offer a description of the images provided, provide a differential diagnosis and offer further management suggestions. Staff present for rounds will ensure this is done in a concise and efficient manner offering assistance and feedback as necessary to complete the case. It is the goal that each resident in attendance be shown a case.
WEDNESDAY - Academic Half Day Held every Wednesday.
12:30-1:15 each Wednesday – Physics Lecture prior to ½ day teaching 1:30 until 5pm with a short break at 3pm until 3:30pm, then resume from 3:30-5pm All residents are freed from clinical duties to attend. All residents go to the hospital where the Academic Half day is being taught that week. Residents are occasionally divided into junior and senior groups and each group is assigned a room and staff person. Teaching material is prepared and presented by staff radiologists. Subjects are selected to cover topics from the radiology curriculum. Usually takes the form of a didactic or case based lecture component. Cases presented by staff are routinely taken by individual residents in a format similar to the ICR rounds outlined above.
THURSDAY - Staff SubSpecialty Rounds Held every Thursday. 12 noon -1pm unless a staff member from the Janeway is teaching at which time they are held from 4-5pm. Topic based as are the Monday subspecialty rounds. (The difference is that all teaching material and cases are prepared and presented by a staff radiologist scheduled) These rounds will often reflect a topic in a core area of radiology. Also be an opportunity for residents to be exposed to subspecialty interests of the staff radiologist. All residents are freed from clinical duties to attend. BlackBoard Collaborate is used to stream these rounds between the Health Science site and the teaching room at St. Clare's Mercy Hospital.
FRIDAY - Fundamentals OR Grand Rounds -
Fundamentals of Radiology Held from 4-5pm and is a great Memorial Radiology tradition that focuses on basic fundamental topics at each session, loosely based on the core textbook for the program. This lecture series has become popular with residents of all levels of training. It is a lecture based series that began informally to assist new residents in development of an academic base for radiology training. It attempts to guide residents through the core chapters of a major radiology text, “Fundamentals of Diagnostic Radiology”, By Brandt and Helms. W
Resident Responsibilities and Etiquette *Attendance at rounds and lectures is mandatory for radiology residents to ensure maximal exposure to curriculum. Attendance records are kept. Speakers spend time preparing for lectures and rounds and will not be encouraged to improve their teaching material if attendance is low.
*Be punctual! Residents have priority to attend departmental rounds and teaching. It is the staff radiologist’s responsibility to cover radiology services during this period.
*Participate and be enthusiastic. Contribute to rounds! This will benefit fellow residents presented with the case and benefit your learning through case preparation.
*Collect cases during your rotation. Cases are to be prepared in Power Point format with a brief summary of findings and discussion of the main learning points.
Be responsible and switch time slots if you cannot present case/topic material on assigned time. Inform Margie so that an email can be sent to inform everyone of the change. Rounds must be discussed with assigned staff several days before rounds are presented. JOURNAL CLUB (currently being discussed and revamped):
Journal Club is an opportunity for residents to practice critical appraisal techniques as they pertain directly to radiology. Journal Club is held approximately three times per year and, generally, two papers are discussed during a session. Staff radiologists with specialty interest in the field covered by the paper are asked to attend sessions. Papers and topics are chosen by residents in consultation with a staff radiologist. These papers must offer some educational value to residents. The paper must be amenable to critical appraisal. Typically such papers tend to be found in scientific journals such as The American Journal of Radiology or Canadian Journal of Radiology for example. Articles of a review nature typically do not lend themselves to critical appraisal unless they consist of a meta-analysis in which case they may be more complex. While such review articles are of great interest in the practice of radiology they are better reserved for presentation in the context of other rounds/conferences.
VISITING PROFESSOR PROGRAM:
Each year, 2 – 3 visiting professors spend 2-3 days each with residents providing small group teaching sessions and mock oral examinations. Guest professors are invited to speak to staff in addition to holding teaching sessions with residents. This offers an invaluable opportunity for residents to learn a fresh perspective from a range of excellent radiologists practicing throughout North America.
ETHICS TRAINING: Ethics training is an important part of our radiology residency program. The ethics of patient care is an important of daily clinical practice and is discussed on a regular basis at the viewbox. It does also involve teaching, videotapes, care-based discussion, and review of journal articles. Dr. Christopher Kaposy, Memorial University Ethicists, are available to speak with residents and are involved in ongoing ethics teaching. There are approximately four sessions per year. Also, please refer to the Royal College Policy regarding “Physicians and Industry – Conflicts of Interest”. Ethics has an online course for HREA Health Research Ethics Authority in PGY1 year.
COMMUNICATIONS TRAINING: A didactic presentation of reporting will be made early each academic year. Reporting formats will be reviewed along with discussion of legal obligations. This will be in addition to day to day review of resident reports. Please see below guidelines. Further, residents receive ongoing training as they review cases with staff radiologists and dictate their findings. Staff radiologists review all resident reports and will offer feedback as necessary. Feedback early in training is strongly encouraged to help guide residents in proper reporting technique. RESIDENT CALL DUTIES
Radiology Residents at Memorial University share call duties with staff radiologists. There is a graded system of increasing responsibility on call. The frequency of call varies over the course of residency training. Call in our program is categorized as “home call” and not “in house”. The responsibility for creating the resident call schedule falls with the chief resident. This is a fair process and includes the input of all residents where possible. Junior residents entering the program at the PGY1 and PGY2 level initially have no independent call duties. PGY1 residents do approximately 6 shifts of shadow call while in PGY1. Junior residents then do 9 shifts of shadow call when they enter PGY2. After that, they start being on call with mandatory backup/double read with PGY5 residents. This is 9 call in total. After that, they have 6 more “optional backup” call where a senior is available to help if needed. After that time, they are on their own with staff. They are usually doing solo call with staff on their own by mid December. According to PGME, residents are post-call “relieved of duties/go home” at 10am. Exposure to call is structured to allow residents time to obtain the necessary radiology skills to function in a first call capacity. Every effort is made for all PGY2 residents to rotate through ultrasound, emergency, body CT, Neuro CT blocks before any first call duties are assigned. To offset the stress of scheduling PGY2 residents during these blocks, there is an online PGY1 ER course delivered the year previous. The process of learning/observing call gives residents the opportunity to watch and learn as senior residents field pages, consult with clinicians, communicate with radiology technologists, oversee imaging studies, review these studies and report to the ordering physician. This low stress experience is extremely valuable. Following a “shadow call “period the resident will begin a “buddy call” phase (4 months). For a period of 2 months the PGY2 resident will carry the on call pager and report directly to a senior resident who reviews all studies with the junior resident in hospital. During the next 2 months the junior has backup from the senior who will assist as needed. Junior residents are strongly encouraged to seek assistance if there are any concerns. During the initial months on service PGY2 residents attend lectures by staff on emergency-related topics. In the late fall the PGY2 resident will be evaluated with an emergency OSCE examination covering many areas within radiology. Upon successful completion of this exam (PASS mark 70%) and following successful completion of core radiology rotations the resident will be ready to begin first call duties with staff backup. While the resident begins first call duties there is staff assistance. Residents at all levels of training are encouraged to seek the assistance of staff when concerns or problems arise. Staff are very approachable and readily available on call! Staff radiologists are committed to a process of graded responsibility and to resident education 24 hours a day. Summary of graded call responsibilities: 3 months shadow call 2 months buddy (senior in house reviewing all studies with the junior resident) 2 months buddy (senior home call and reviews studies as needed) After this period the resident is on call with staff backup.
ON CALL REPORTING POLICY
Residents engaged in on-call duties are expected to review imaging studies in a timely fashion and to provide a report of the findings to the ordering physician. This report must be issued verbally to the ordering physician and/or physician responsible for care of the patient in question. A typed report of major findings must also be completed and accompany the imaging study on the PACs system for review by consultants involved in the case. Post call duties include review of cases done on call with the staff radiologist on call and the dictation of a completed radiology report using the Speech Q voice dictation system.
POST CALL POLICY
A resident shall be permitted to be relieved of his/her duties at 1200 hours of a regular work day which follows the in-hospital duty period after a handover of patient care responsibilities.
Residents are encouraged to participate in teaching post call when they have not been called into the hospital to evaluate a patient after midnight.
DIAGNOSTIC RADIOLOGY REPORTS– Prepare an Informative and concise report Communication is a critical component of the art and science of medicine and is especially important in Diagnostic Radiology. Diagnostic Radiology is one of the most important consultative services in medicine. This standard has been largely based on the ACR guidelines, which we acknowledge. The final product of any consultation is the submission of a report on the results of the consultation. In addition, the diagnostic radiologist and the referring physician have many opportunities to communicate directly with each other during the course of a patient’s case management. Such communication should be encouraged because it leads to more effective and appropriate utilization of Diagnostic Radiology in addressing clinical problems and focuses attention on such concerns as radiation exposure, appropriate imaging studies, clinical efficacy, and cost-effective examinations. In order to afford optimal care to the patient and enhance the cost effectiveness of each diagnostic examination, radiological consultations ought to be provided and radiographs interpreted within a known clinical setting. The CAR supports radiologists who insist on clinical data with each consultation request. This standard is based on the Communications Standard of the American College of Radiology.
The Diagnostic Radiology Report
An authenticated written interpretation should be performed on all radiographic (imaging) procedures. The report should include the following items: 1. Name of patient and another identifier, such as birth date, pertinent ID number, or hospital or office identification number.
2. Name of referring (attending) physician: (a) Name of most responsible physician (b) Names of other physician(s) Rationale: Quality control. 3. Name of type of examination. 4. Date of dictation: Rationale: Quality control. 5. Date of the examination and transcription: Rationale: To permit tracking of the report. 6. Time of the examination (for ICU / CCU patients): Rationale: To identify multiple examinations (e.g., chest) that may be performed on a single day. 7. Body of the report The effective transmission of radiographic information from the radiologist’s mind to the clinician constitutes the purpose of the report. The report should be clear and concise. Normal or unequivocally positive reports can be short and precise. Whenever indicated, the report should include: (a) Procedures and Manuals: Include in the report a description of the procedures performed and any contrast media (agent, concentration, volume, and reaction, if any), medications, catheters and devices, if not reported elsewhere. Rationale: To ensure accurate communication and be available for future reference. (b) Findings: Use precise anatomical and radiological terminology to describe the findings accurately. (c) Limitations: Where appropriate, identify factors that can limit the sensitivity and specificity of the examination. Comment: Such factors might include technical factors, patient anatomy (e.g., dense breast pattern), limitations of the technique (e.g., chest examination for pulmonary embolism), incomplete bowel preparation (e.g., barium enema for neoplasm), wrist examination for carpal scaphoid injury, or skeletal examination for detection of stress fracture. (d) Clinical Issues: The report should address or answer any pertinent clinical issues raised in the request for the imaging examination. Comment: For example, to rule out pneumothorax, state: “There is no evidence of pneumothorax”; or to rule out fracture, “There is no evidence of fracture”. It is not advisable to use such universal disclaimers as “the mammography examination does not exclude the possibility of cancer”. (e) Comparative Data: Comparisons with previous examinations and reports when possible are part of the radiologic consultation and report and, optionally, may be part of the “impression” section. 8. Conclusion of Diagnosis: (a) Each examination should contain a “conclusion” section unless the study is being compared with other recent studies, and no changes have occurred during the interval, or the body of the report is brief.
(b) Give a precise diagnosis whenever possible.
(c) Give a differential diagnosis when appropriate.
(d) Recommend, only when appropriate, follow-up and additional diagnostic radiologic studies to clarify or confirm the impression.
Written Communication
An authenticated written interpretation should be performed on all radiographic (imaging) procedures. The report should include the following items: 3. The timeliness of reporting any radiologic examination varies with the nature and urgency of the clinical problem. The written radiological report should be made available in a clinically appropriate, timely manner.
4. The final report should be proofread carefully to avoid typographical errors, deleted words, and confusing or conflicting statements, and signed (authenticated) by a radiologist, whenever possible. Comment: Electronic or rubber-stamp signature devices, instead of a written signature, are acceptable if access to them is secure. The signature of the radiologist who dictated the report should appear on the report. If this is not possible, the initials or name of the radiologist who dictated the report as well as the initials or name of the radiologist who signed it should appear on the report.
5. A copy of the final report should accompany the exchange of relevant radiographic examinations from one health professional to another health professional.
Direct Communication
An authenticated written interpretation should be performed on all radiographic (imaging) procedures. The report should include the following items: 6. Radiologists should attempt to coordinate their efforts with those of the referring physician in order to best serve the patient’s well-being. In some circumstances, such coordination may require direct communication of unusual, unexpected, or urgent findings to the referring physician in advance of the formal written report. Examples include:
(a) The probable detection of conditions carrying the risk of acute morbidity and/or mortality which may require immediate case management decisions. (b) The probable detection of disease with non-acute morbidity or mortality sufficiently serious that it may require prompt notification of the patient, clinical evaluation, or initiation of treatment. 7. In these circumstances, the radiologist – or his/her representative – should attempt to communicate directly (in person or by telephone) with the referring physician or his/her representative. The timeliness of direct communication should be based upon the immediacy of the clinical situation.
8. Documentation of actual or attempted direct communication is appropriate in accordance with department policy, legal advisability, understanding with the referring physician, and individual judgement.
9. Any discrepancy between an emergency or preliminary report and the final written report should be promptly reconciled by direct communication to the referring physician or his/her representative.
NOTE: This standard is structured with statements of principles followed by rationales or comments. Only the principles define the range of suggested practices. The rationales or comments serve only to clarify the principles
SUPERVISION OF RESIDENTS
The supervising radiologist has a dual professional responsibility to provide appropriate patient care and to provide education for trainees. There must be a careful assessment of the responsibility delegated to the trainee. The resident has a dual responsibility to ensure patients (and their families) for whom they are providing care know they are on a teaching unit and to keep attending and consulting physicians informed about their patients.
ATTENDING RADIOLOGIST RESPONSIBILITIES
It is the responsibility of the attending physician to:
1. Review the examinations and procedures with the resident in a timely manner. This includes:
A discussion of the findings and their significance to patient management. Involvement in major decisions relating to diagnosis and management. Involvement with the planning and performance of procedures including direct supervision when required by patient safety or requested by the trainee. Trainees should be assisted directly by staff commensurate with their level of training. Identification of the main teaching points of a case requiring educational emphasis.
2. Be accessible (ex. available by pager or phone at all times).
RESIDENT RESPONSIBILITIES
It is the responsibility of every resident to:
1. Identify oneself as a resident and inform patient (or family) that they are on a teaching unit and that patient care is a team approach under the supervision of the attending physician.
2. Notify the supervising radiologist, or consulting physician, as appropriate when: a patient’s condition is deteriorating, The diagnosis or management is in doubt, A procedure with possible serious morbidity is planned.
3. Notify the attending or consulting physician of any abnormal imaging results that may need urgent management or may significantly affect current patient management.
4. Record in writing on the patient’s report the notification of the attending or consulting physician. Program Outline By Number of Months Per Year (1 MONTH = 4 WEEKS)
FOLLOWING 2010 THE NEW ROYAL COLLEGE REQUIREMENTS WILL BE APPLIED.
1st YEAR:
1 month Gastrointestinal/Genitourinary Radiology 2 months Musculoskeletal Radiology 2 months Chest Radiology 2 months Ultrasound 2 months Neuroradiology 1 month Pediatrics 1 month Emergency 2 month 1 each of Body CT GI/GU and Body CT
13 months
2nd YEAR:
3 months Angiography and Interventional Radiology 2 months Nuclear Medicine 1 month Ultrasound 1 months Neuroradiology/ENT 1 month Body CT GI/GU Imaging 2 months Chest Radiology 1 month Mammography 1 month MRI 1 month Musculoskeletal 13 months
3rd YEAR:
1 month Chest/Cardio Thoracic Radiology 1 month Musculoskeletal 1 month Body CT GI/GU Imaging 2 months Mammography 2 months Pediatrics 1 month Ultrasound 1 month Neuroradiology 1 month Obstetrics 1 month Elective 1 month AIRP 1 month Rural – Corner Brook
13 months
4th YEAR:
1 month Ultrasound 1 month Body Imaging 2 months Neuroradiology 1 month MRI 1 month OBS 1 month Chest Radiology 1 month Musculoskeletal Radiology 1 month Elective (must be NUCS if writing ABE) 1 month Selective 1 month Mammography 1 month Pediatrics 1 month Nuclear Medicine
13 months
Program Outline by # of Months Per Rotation
1st Year 2nd Year 3rd Year 4th Year ROTATION TOTALS PGY 2 PGY 3 PGY 4 PGY 5 GI/GU 1 0 0 0 1
1 Chest / CardioThor 2 2 1 6 (Card/Thor)
Musculoskeletal* 2 1 1 1 5*
AIRP 0 0 1 0 1
Nuclear Medicine** 0 2 0 1 3
Angio / Interventional 0 3 0 0 3
1 ea. Elective / Selective 0 0 1(Elec) 3 E/S = 2
Neuroradiology/Neuro/ENT 2 1(Neuro/ENT) 1 2 **** 6
Body CT GI/GU Imaging 2 1 1 1 5
Ultrasound 2 1 1 1 5
Mammography*** 0 1 2 1 4
Pediatrics 1 0 2 1 4
MRI 0 1 0 1 2
Emergency 1 0 0 0 1
Obstetrics 0 0 1 1 2
Rural 0 0 1 0 1
* ER/NUCS/Rural/Peds/Body rotations includes some MSK **Residents wishing to write the American Board examinations must do additional elective time in Nuclear Medicine. ***Includes Breast Ultrasound & MR
PGY1 ROTATIONS DIAGNOSTIC IMAGING MEMORIAL UNIVERSITY OF NEWFOUNDLAND
Emergency ………………….. 4 weeks
General Medicine ...... 4 weeks CTU’s ...... 4 weeks
Rural Obstetrics...... 4 weeks Wards Pediatrics ...... 4 weeks OPD Pediatrics ...... 4 weeks General Surgery ...... 4 weeks Subspecialty Surgery...... 4 weeks Electives ...... 4 weeks*
Radiology…………………..….8 weeks Anatomy……………………….4 weeks
*Options include any of the following clinical rotations:
ICU (St. Clare’s/HSC) CTU4 (Health Sciences Centre) General Surgery OBS/GYNE US Radiation Oncology Radiology or research is not an option for electives Vacation = 4 weeks
PGY-1 house-staff are encouraged to attend rounds, including Journal Club, if attendance does not interfere with their clinical duties. Residents in PGY1 year have half day teaching on Fridays and are encouraged to attend any rounds held at that time in the radiology department. The Fundamentals of Radiology lecture series is a great introduction to residents entering the radiology program.
During PGY1, residents are informed of this site through the Postgraduate Office. This information is also on One45 and is linked to each of the individual rotations.
In addition, PGY1 Diagnostic Imaging residents are encouraged to attend rounds in Diagnostic Imaging especially Friday Rounds and all Physics teaching. PGY1 residents should complete the on line ethics course (www.pre.ethics.gc.ca/english/tutorial/) during this period.
RESIDENT EVALUATIONS: Background: Evaluation is an essential part of our Residency Program. It is meant to be a process of continuous communication. Evaluations from residents are an important reference for program improvement.
Process of Evaluation: 1. At the beginning of a rotation, you must discuss rotation objectives with your preceptor(s). 2. At the end of the rotation, a summative evaluation should be completed and discussed and the electronic form validated by you.
What is WebEvaluation?
WebEval is an online web evaluation system. It was created by One45 Software for both undergraduate and postgraduate university programs.
Core Benefits of WebEval:
Improve workflow efficiency Enhance communications across all levels Centralize student, resident and faculty information Identify trends for decision making Better service students, resident and staff
Benefits for Electronic Evaluation: Automate the sending, receiving, and collating of evaluations Evaluate rotations, courses, academic half-day, teaching rounds, residents, students, and faculty Establish low performance flags to identify those students and residents having problems Collect valuable research data with surveys Generate email reminders for overdue forms Display photos on the forms
How does it work? You will receive e-mail reminders with username and password information to complete evaluations online. Your login information is confidential. You will need to complete the faculty and rotation evaluation Once forms are completed and confirmed they will be stored in resident file.
If you notice any errors in your personal information or have any trouble accessing the site please contact the administrator at 777-2201. Examples of Resident E dossier Account: http://www.one45.com/help/postgradAdmin/eDossres.html
Guide To Resident Evaluation
DEPARTMENT OF DIAGNOSTIC IMAGING
The goal of our residency training program is to ensure that our residents receive the best possible training to master the knowledge, skills and attitudes required of our specialty. A number of evaluation tools will be used to provide feedback, and to judge and measure performance. Detailed and timely feedback allows a trainee’s program to be enhanced in any area of weakness. If problems occur, the resident can be informed early and can be provided with adequate opportunity for remedial assistance. This document identifies the evaluation system and guidelines for our Department. It was last reviewed by the RTC in June, 2010.
EVALUATION TOOLS
ITEM MINIMUM PERFORMANCE STANDARD
1. ITER (end of rotation) “at expected level”, overall and on PGY2, PGY3, PGY4, PGY5 each section of ITER
2. End of rotation Test PASS (usually 70% or above 30th percentile)
3. ACR Written Exam at least 20th percentile for level PGY2, PGY3, PGY4, PGY5
4. Bi-annual Oral Exam 70% overall – scored for each level, based on PGY2 (2nd half), PGY3, PGY4 Royal College guidelines -Pass PGY5 Fail - (borderline: 68-69; 67 – below)
5. Bi-annual OSCE Exam Overall Pass for level (70% or higher PGY5, 60% or higher PGY4, 50% or higher PGY3, 40% or higher PGY2).
6. Research Requirement Completed by end of PGY4 year
Contingencies for Failure to Meet Defined Minimum Performance Standards
Rarely do residents fall below the minimum performance standards of the Department, but if this should occur, the resident, the faculty and the Department members responsible for the training program need to understand the program which will be structured for the resident. In general, if a resident’s weakness is focused then the resident will be assigned extra assistance by the rotation supervisor. If there is a more general or significant problem documented, a more structured program of Departmental assistance will be assigned under the supervision of the Program Director. Continued difficulties which necessitate a change in the usual program of resident rotations will generally require a more formal program of remediation which will be structured and monitored under guidelines of the post graduate department of the Faculty of Medicine and residency training committee. This may lead to interruption in the normal promotion through residency.
1. ETHICS AND CONDUCT: A resident can be recommended for dismissal by the Program Director, subject to approval by the Resident Training Committee if he/she is found to have violated the University Codes of Ethical Behavior, the Code of Ethics of The College of Physicians and Surgeons of Newfoundland and Labrador, or the Code of Ethics of the Canadian Medical Association. A resident can be recommended by the Program Director for suspension for improper conduct, pending a hearing and formal review, if the conduct is such that the continued presence of the resident in the clinical setting would be potentially hazardous to persons or to the academic function of the training program. Faculty of Medicine guidelines will be followed in all such matters.
2. Research: Each resident will design, conduct and complete a research project or departmental audit supervised by a qualified individual, usually a staff radiologist, other staff physician or a basic scientist (Ph.D.) approved by the Residency Program Director. This project is to be presented at the NLAR (Newfoundland and Labrador Association of Radiologists conference) or a relevant conference approved by the Program Director.
Each resident will complete a second such project or get permission to expand on an existing project for the purposes of publication or presentation at a relevant meeting or conference. An acceptable alternative to completing a second project will be the completion of a presentation, consisting of a short review of a radiology topic, for the NLAR (Newfoundland and Labrador Association of Radiologists conference). If a resident fails to complete the Research requirements to the satisfaction of the Department and Research director by the end of PGY4, the resident will be allowed to advance to the PGY5 year on the condition that the Research requirement will be completed within four months. If the resident does not complete the research within this four month extension, this will be grounds for recommending notification to the Royal College that Department Training requirements have not been met and can be waived at the discretion of the Program Director.
3. Levels PGY2, PGY3, PGY4: A) If a resident is evaluated “below the expected level” on two ITER sections (Medical Expert, Scholar, Advocate, etc…) or end of rotation tests within the same year, the resident will be assigned remedial assistance (relevant to the section of weakness) by the Program Director in consultation with the Residency Training Committee and/or rotation supervisors.
B) If a resident, on any one of the following evaluation tools is evaluated
a) “below the expected level” or “unacceptable” on three sections of ITERs OR b) “borderline” or “fail” overall on any ITER OR c) receives a grade on the ACR below the minimum standard OR d) receives a grade on the Department Oral below the minimum standard OR e) receives a grade on the Department OSCE below the minimum standard
The resident will meet with the Program Director to discuss the problem(s). The resident may be assigned remedial work which could include any combination of assigned reading or academic review, work with an assigned mentor or repeat exams at the discretion of the Program Director. This remedial work could extend up to three months and will be evaluated under the direction of the Program Director.
If within one year of commencing this Departmental remedial work the resident receives a second evaluation below the minimum performance standard the resident may be recommended for a more intensive program of remedial assistance.
If within one year of commencing the Departmental remedial work the resident receives a third evaluation below the minimum performance standard, the resident may be recommended to a formal program of remediation, or remediation with probation, or probation by the Program Director with the guidance of the Residency Training Committee. This recommendation will be subject to review by the Post Graduate Department of Memorial University. The remediation program and evaluation guidelines will be indicated in writing prior to the start of the program. If this remediation program is successful, the resident may be recommended for continuation in the program at the appropriate level. If this program is not successful, the resident will be recommended for further remediation, remediation with probation or probation. Credit for remediation rotations may not be given if the goal(s) of the remediation is not attained. Remediation with probation or probation implies the possibility of refusal for promotion or of dismissal if the resident is unwilling or unable to meet the required standards of performance. This is to subject to review by the Post Graduate Department of Memorial University of Newfoundland.
If a resident successfully completes a program of remediation but within the next twelve months falls below the minimum performance standard on any evaluation, the resident will again be recommended for a further formal program of remediation, remediation with probation, probation or dismissal.
PGY5: Failure to meet the minimum performance standard on any ITER overall or other evaluation item will be grounds for an immediate review of training performance and recommendation for formal remediation. Failure to meet the minimum performance standard on two evaluations in the PGY5 year will be grounds for recommending notification to the Royal College that Department Training Standards were not met and for recommending the resident not proceed to the college exams. This will also be grounds for recommending the resident repeat the PGY5 year. This will be at the discretion of the residency program director and/or residency training committee.
If unusual or extenuating circumstances exist concerning a resident subject to any of the above items, the Program Director with the approval of the Residency Committee and/or post Graduate Department can alter the recommendations listed.
Any decision by the Program Director to recommend remediation for, probation for, or dismissal of a resident must be made in consultation with, and approval by, the Residency Training Committee of the Department of Diagnostic Imaging. Any decision by the Program Director to recommend remediation for, probation for, or dismissal of a resident must be made in consultation with, and approval by, the Residency Training Committee of the Department of Diagnostic Imaging. The Chair of the Department and Post Graduate Department shall be informed of all decisions.
Any decision to recommend remediation for, probation for, or dismissal of a resident must be reviewed and approved by the Postgraduate Education Evaluation Board of Memorial University. Any decision to dismiss must also be approved by the Chair of the Department and by the Associate Dean, as indicated in University Guidelines.
Any decision by the Board may be appealed by a resident according to the University’s Guidelines for appeals.
Evaluation Process DEPARTMENT OF DIAGNOSTIC IMAGING
1. All trainees should be provided with a copy of the Department Guidelines for Resident Evaluation at the beginning of their PGY2 Year and at any time these standards are changed.
2. All trainees should be provided with a copy of “Guidelines for Evaluation of Residents of the Faculty of Medicine of Memorial University”.
3. A resident should receive a copy of and/or provided with verbal details of all evaluation results or this should be provided on request to the trainee. All such results should as well be kept as part of the resident’s University file.
4. The Resident Evaluation form (ITER) should be designed and adopted by the Residency Training Committee. The form must be accompanied by guidelines to assist the supervisor(s) in marking individual items. Comments should be made on any specific areas of performance, which contribute significantly to the evaluation, especially in areas of weakness. For the purpose of completing the form, appropriate medical and non-medical personnel should be consulted about the resident’s performance. If a problem is identified at any point during a rotation, the supervisor must bring this to the attention of the resident promptly.
5. At the midpoint of any rotation which is 2 months or longer, the supervisor must provide the resident a mid-way evaluation.
6. At the end of every rotation, an evaluation (ITER) must be completed. The supervisor should discuss this evaluation with the resident preferably before the end of rotation or as soon thereafter as possible. Residents should approach rotation supervisors requesting this by the end of the rotation or shortly thereafter if they are not aware of arrangements to meet staff.
7. The resident will be given a reasonable time to consider and comment on the evaluation.
8. Completed evaluation forms are to be reviewed by the program coordinator within one month of the end of rotation. This will allow the program coordinator to be aware of and if appropriate, address problems in the rotation or relating to the residents’ performance in a timely fashion. Any supervisor providing a “borderline” or “failed” evaluation is required to speak directly to the program coordinator before the end of rotation. One45 evaluation systems alerts the program director to Low Performance grades.
9. Completed evaluation forms are to be sent to the administrative office within one month of the end of rotation. One45 evaluations are automatically forwarded to administration for review once completed.
10. All evaluations are reviewed by the Program Director.
11. Results of ACR Exams, Department Exams, the Physics Exam, and completion of the Research requirement will be sent to and reviewed by the Program Director. 12. A Resident Evaluation Committee, which will be a subcommittee of the Residency Training Committee, under the leadership of the Program Director, shall be responsible for all matters pertaining to the Standards, Process, Review and Promotions of the residents.
13. The Resident Evaluation Committee will be appointed annually by the Program Director with the approval of the Residency Training Committee. Members will include the Program Director, residency training committee members and one resident representative (preferably a senior resident).
14. The Resident Evaluation Committee or Residency Training Committee shall meet/communicate i) once a year to consider and approve all resident promotions for notification of the Post-Graduate Office. ii) at any time that the performance of a resident requires consideration of assistance, remediation or program modification. 15. When a resident’s performance falls below the minimum evaluation standards, the Program Director shall meet with the resident and review the performance issues. The Program Director may call a meeting of the Resident Evaluation Committee to discuss a program of remedial assistance which will be outlined to the resident. A report on this program shall be presented to the Residency Training Committee at the next regularly scheduled meeting and/or discussed with individual committee members when no meeting is pending.
16. Any recommendation for formal remediation under the University guidelines shall first be considered by the Resident Evaluation Committee, but shall then be presented to and approved by the Residency Training Committee. The Chair of the Department shall be informed of all decisions.
17. The notification, approval and process of Remediation shall follow the Guidelines outlined by the University. Conflict Resolution and Appeals
If a resident has a concern he/she should address it at earliest convenience according to the following process:
Staff member +/- chief resident support
Site Coordinator
Program Director Resident Representative/Chief Resident
Training Committee
Chair
Postgraduate Dean
Dean
University Senate
The Program Director can be approached directly as deemed appropriate by the resident.
Appeal Procedure For An Unsatisfactory Evaluation
In the training of Radiologists the Memorial University Radiology Residency Program aims to provide an educational program which will be adequate to meet the trainee’s educational and professional needs. We strive to evaluate the trainees to ensure that they have successfully acquired the required knowledge, skills, attitudes, behaviors and ethical standards to practice competently.
While regrettable, there may be the occasional trainee whose academic performance or professional behavior is unsatisfactory requiring that the resident’s program be extended or that the training be terminated. It is essential that the evaluation systems be valid and appeal mechanisms fair. Residents may appeal an evaluation through their Residency Training Committee. Residents should be aware that an appeal process may or may not support their case.
Pathway for Appeals
Where applicable, residents are urged to first discuss an evaluation or concern with the rotation supervisor.
The resident then may appeal first to the Program Director in order that the appeal can be reviewed by the Residency Training Committee. This can be done by the resident alone, the resident accompanied by the chief resident or staff radiologist of the resident’s choosing. The Residency Training Committee will convene in a reasonable time not to exceed 2 weeks.
If the resident is unsatisfied with the findings and decision of Residency Training Committee, an appeal can be made to the Associate Dean, Post Graduate Medical Education, for the appeal to be heard by the Post Graduate Medical Education Committee. The decision reached by the PGME Committee will be forwarded to the Program Director. After an appeal to the PGME Committee the trainee can appeal to the Student Appeal Committee of the Faculty of Medicine, Memorial University of Newfoundland.
There is a Post-graduate counsellor is Dr. Stephen Lee who can be reached at [email protected]
RESIDENT RESEARCH DEPARTMENT OF DIAGNOSTIC IMAGING Requirements and Resources (August 2016)
Requirement based on RCPSC learning objectives:
A. At least one completed research project during residency. B. Regular attendance and participation at journal club. D. Complete online research modules during research block in the PGY1 year.
Qualifying project types:
Prospective or retrospective study Audit of technique, examination, or procedure Meta-analysis
Less Desirable Project Types:
Case Reports Letters to Editors Case of the Month Review type exhibits
Definition of completion
Mandatory - all residents must submit a report describing the project idea, objective, methods, results and conclusions to the research director/discipline office at the completion of the research, or at the end of PGY4 if the research is not complete.
And either of the two below:
Presentation at national or international meeting and/or at the NLAR Research Day (held annually)
Formal written submission for publication to a Medical Journal (Follow guidelines for a uniform requirement for manuscripts submitted to Bio-Medical Journals -Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals. http://www.icmje.org/recommendations Time Over the first four years of residency (PGY 1-4) each resident will have an appropriate amount of time allocated for the completion of a research project. This includes the June, July, and August ½ day time period which are set aside to complete research projects, as no formal teaching schedule is in place at that time. Any additional time must be formally requested, by special application to the DIRADS group. The Group will make a decision based on the expectation of time to project completion.
Any resident that completes their research project within the early years of residency will be encouraged to do additional projects. Academic ½ days during the summer, i.e., June, July and August are to be used for such additional research or other academic endeavors.
Residents may also apply to do research electives during their PGY1 training.
Evaluation
The resident should make all reasonable attempts to meet the milestones described below during completion of their research project (Appendix 1). This is not always possible, and allowances can be made for extenuating circumstances. The evaluation of the progress of each resident will be a combined effort of the research director/DIRADS group and the residents research mentor. Every resident will meet with the research director at the end of the academic year, and report on their progress to ensure that the milestones are being met. The research director will report to the DIRADS group regarding the progress of each resident, and will fill out a research ITER (Appendix 2) after conferring with the residents mentor for inclusion in the residents’ yearly evaluation. At this time, decisions will also be made for requests for additional time from rotations to complete projects.
Research Modules 3 research learning modules have been developed and must be completed prior to beginning your research project. These were developed to ensure that each resident receives the same basic information, given the wide variety of research experience and formal training each resident received prior to residency. The modules cover 4 key topics, with each able to be completed in less than an hour. These are available on the D2L (desire to learn) website and should be completed by the end of your PGY1 anatomy-research block. Each module has a learning and an evaluation component, with the evaluation completed within a single session. This will be reviewed by the research director and program director.
These modules include; a. Introduction to research b. Development of a research question c. Searching the medical literature Mentors All research should be performed in conjunction with a staff mentor. That person can either be an active participant in the research project or may simply be available for guidance. Mentors/projects can be selected in a number of ways. Often residents study in an area of interest, and should feel free to approach staff with expertise in that area with a preformed idea, or to enquire about research opportunities. The members of the DIRADS group are staff radiologists/scientists who have a particular interest in research and have many active and potential projects. There are many other staff radiologists who are keenly interested in research as well, and will often contact members of the DIRADS group when looking for resident interest, so this is a great place to start. That staff person will be responsible for ensuring the quality and completion of the project and therefore must be identified when the research project is reported to the Discipline of Radiology office. Project Approval, Ethics and Financial Impact Statement Each research project will require approval from the Newfoundland and Labrador Health Research Ethics Authority (HREA). In order to apply, residents need to complete an on-line ethics course; Tri- Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2). This requires approximately 4 hours to complete. After completion, a copy of the TCPS2 certificate should be emailed to the programs’ Research Director. A financial impact statement will also need to be completed for all projects. Details regarding completing the TCPS2, ethics approval and financial impact statement are contained in Appendix 4. Key Research Contacts within Department of Medical Imaging -Research Director Role of the Research Director The radiology residency has faculty member who is designated as the Radiology Research Director. The role of the research director is to ensure that all residents receive the necessary assistance/guidance to fulfill the research requirements described above. Each resident will meet with the research director in their PGY1 year to discuss the requirements and expectations of the program, and so that he/she may answer any questions the resident may have. Upon choosing a project/mentor, the resident must inform the research director with a short written research proposal (see appendix 3). The research director will then meet with each resident at the end of the year, discuss progress, ensure that milestones are being met, and complete an ITER with the help of the research mentor and the DIRADS group for inclusion in the resident’s yearly evaluation. The research director is also available at any time for all residents and staff to assist with research questions, and to help assist in making use of available resources. He/she will do this with the assistance of the DIRADS group. The research director reports to the Residency Program Committee. At present the research director is Dr. Jeff Flemming, Assistant Professor in the Discipline of Radiology/Nuclear Medicine ([email protected]).
-Discipline Research Assistant Role of the Discipline Research Assistant The main function of the Discipline Research Assistant is to provide assistance with HREA applications and material arrangements. The Research Assistant will not be available to assist in data gathering or otherwise function in performing aspects of research. He/she can be reached through the DIRADS group. -DIRADS group Composition of the DIRADS group The DIRADS group is chaired by the Research Director and is otherwise composed of the Discipline Research Assistant, Program Director, Academic Head, the previous Research Director and Research Scientists in the department of Radiology. At present, the group members are
Dr. Angus Hartery, Residency Program Director ([email protected])
Dr. Peter Collingwood, Interim Academic Chair, Discipline of Radiology ([email protected])
Dr. Conor Maguire, Associate Professor, Discipline of Radiology ([email protected])
Dr. Edward Kendall, Professor of Radiology, Discipline of Radiology, Physicist ([email protected])
Dr. Jeff Flemming, Assistant Professor in the Discipline of Radiology/Nuclear Medicine ([email protected]), Resident Research Director
Dr. Ravi Gullipalli, Associate Professor in the Discipline of Radiology ([email protected]), Previous Resident Research Director
Michelle Simms, Discipline Research Assistant ([email protected])
Role of the DIRADS group The role of the DIRADS group is to assist the research director perform his/her duties, mainly with respect to resident evaluation and assisting residents and staff researchers to access available resources and in the successful completion of research projects. -All office administrative staff are available for material services related to research projects. Services provided to residents:
- Type/assist with completion of proposal/consent for Health Research Ethics Authority (http://www.hrea.ca/home.aspx) - Type/assist with completion of research grant applications, if any - Type/submit manuscripts and abstracts
-Library Support - Pam Morgan ([email protected]) is the librarian assigned to help Radiologist with library resources in HSC library. -Health Sciences Information and Media Services (http://www.med.mun.ca/HSIMS/Home.aspx)
Steve Pennell, Manager of Health Education and Media Services ([email protected]) is helpful with educational surveys. Graphic Design for illustrations (http://www.med.mun.ca/HSIMS/Multimedia-Services/Medical- Illustration.aspx) Medical Photography (http://www.med.mun.ca/HSIMS/Multimedia-Services/Medical- Photography.aspx)
Other support services in the University can be accessed through the DIRADS group. -NL SUPPORT
NL SUPPORT (http://www.nlsupport.ca/Home.aspx) is a support unit for patient oriented research. Patient centered research refers to research that is developed with research questions of interest to patients as the primary focus. They are able to help with funding applications, patient engagement, biostatistics, knowledge translation. The contacts are below.
SUPPORT Director: Catherine Street, ([email protected]) Biostats: as of September 1, 2016 – Dr. Hensley Mariathas ([email protected]) Knowledge Translation Coordinator: Amanda Hall ([email protected] ) Research Officer (SUPPORT) Dale Humphries, ([email protected]) Eva Vat – Training and Capacity Lead and Patient Engagement Lead ([email protected])
-Medical Education Scholarship Center (MESC) The Medical Education Scholarship Centre (MESC) is a support unit staffed with individuals who possess expertise in education scholarship. The purpose of the centre is to foster research and development in medical education. MESC supports faculty and students in developing expertise in medical education scholarship over the continuum of lifelong learning but with a focus on undergraduate, graduate and postgraduate education to complement activities of the Office of Professional Development and Conferencing Services (PDCS) of the Faculty of Medicine.
Contact: [email protected]
Financial Support for Radiology Research The University has limited funding for assisting residents to either publish or present their research at organized meetings, but will aim to cover resident travel expenses for presentation at an international, national or local meeting. Application must be made in advance of submission through the Discipline of Radiology office. Residents are required to submit the title of their presentation, along with the name and dates of meeting the resident will be attending at least two months prior to the meeting.
Some of the publication expenses can be covered through the Office of Research. (http://www.mun.ca/research/funding/opportunities/opportunity.php?id=77) The application form can be found at the bottom of the page.
The Discipline of Radiology office can enable coordination of any applications for research funding. Presentation
Each resident must present at a conference at some point during their residency.
All residents are encouraged present at the Newfoundland and Labrador Association of Radiologists (NLAR) Annual Scientific Meeting held at the end of February each year. All 2nd and 3rd year residents may give a 10 minute presentation outlining their project idea, methods and progress to date. 3rd and 4th year residents may give a 20 minute presentation of their completed project. For the 10 minute presentations abstracts should include a Background section including rationale for the project, objectives, statement about what you aim to discover and a methods section. For the 20 minute presentations, the abstract should include a Results and Conclusions section.
Residents will be funded for travel expenses to this meeting from either the Discipline of Radiology or the NLAR if they are presenting. Residents who do not present will be funded a maximum of $500 towards their travel costs.
Application is made yearly to have this meeting accredited by the Canadian Association of Radiologists (CAR). There is a deadline for this application to be made to the CAR. Therefore all presenters to this meeting are required to have the title and objectives of their presentation submitted to the meeting coordinators by November 1st each year. If this deadline is not met, funding for travel expenses will not be granted.
There is a mandatory requirement that all residents are expected to present at an annual research day, which will be held in the Medical School of the Health Science Centre. Invited judges and guests will also be in attendance and awards will be given. The research day will be open to medical students as well.
Journal Club Journal club is an integral part of the research curriculum. Journal club will occur 4 times each year. These 4 will have a strong critical appraisal component. Additional Journal Clubs can be held, if there are other interesting topics that are brought forward, using other approaches. The DIRADS group wishes to bring this topic forward to the Residency Program Committee for further discussion at this time. This is meant to be a resident led endeavor, and as such the junior chief resident will be tasked with organizing the journal club schedule. There will be 2 residents assigned to each journal club (1 during each quarter of the academic year) who have the responsibility of identifying a staff mentor, potentially in a specific area of interest. Together they will decide on journal articles to review with the emphasis on critical appraisal (a useful resource is the article in the AJR “Evidence-Based Radiology: A Primer in Reading Scientific Articles, July 2010, VOLUME 195 NUMBER 1”). Each journal club will be evaluated in the same way as other lectures. The journal clubs will continue to be held at 16:00 at the HSC, with every attempt made to keep them within one hour. The organizers should feel free to investigate other times and venues, as journal clubs are often meant to also serve as a social event. Appendix 1 Milestones for Completion of Research Project
PGY1 October Meet research director July Identify mentor Select Research Project Topic Complete 4 online modules during research rotation Complete TCPS 2 Ethics Certificate Complete short description of research project PGY2 December Complete literature review March Draft Research Protocol Submit Ethics Application Present Protocol at NLAR PGY3 July Complete data collection Analyze data PGY4 September Prepare research report Prepare results for publication/conference if merited March Present results at NLAR
PGY1 Meet with the research director (by the end of September) to discuss expectation/requirements of the research component of the program. Complete the online teaching modules during the PGY1 year anatomy-research block. These will be available on the “Desire to Learn” (D2L) system. Feel free to contact the research director with any questions about these modules.
Choose a mentor and project.
At the onset of any radiology research project a short description of the project must be submitted to the Resident Research Director giving details about the project and the staff member that has agreed to act as mentor for the project. All research even if not completed must be documented with the discipline office. Obtain TCPS certificate by the end of the PGY1 year. Details are available in Appendix 4. PGY2 Complete literature review. The librarian assigned to assist with radiology research is Pam Morgan ([email protected]) Draft research protocol (Appendix 3). Residents are encouraged to present this at the NLAR meeting. Complete HREB application and financial impact statement (Appendix 4). PGY3 Data acquisition and data analysis (Appendix 3). PGY4 Prepare research report. After the project is completed a one page abstract identifying the principal investigators, the design of the project and the conclusions, if any, must be submitted to the Discipline of Radiology Office and Resident Research Director. Documentation of all research projects must be provided. Residents are encouraged to present the completed research at the NLAR meeting. Presentation of results at conference or submission to peer reviewed journal if applicable.
Appendix 2 Research Goals and Objectives
Research
Role/Clinical Competencies
Medical Expert
Understands to role of research in maintaining clinical expertise
Clearly understands the topic of interest, and the specific aspects of that topic which are most relevant and important for clinical practice
Understands how to critically appraise the background literature and how it is applied to clinical practice
Communicator
Demonstrates the ability to convey scientific research through posters, abstracts, manuscripts, grant applications, or other scientific communications
Communicate effectively with research team members and study participants to conduct research
Collaborator
Identify, consult and collaborate with individuals (experts or other interested parties) to conduct the research Able to collaborate effectively with the research mentor, or other residents/students involved in the research
Manager
Independently identify an area of research interest and a research mentor
Independently identify a research question and develop an appropriate protocol
Independently utilize available resources and regularly meet with a research mentor
Demonstrate effective time management in research setting
Demonstrate leadership and administrative abilities, where appropriate, in leading a research team
Health Advocate
Recognize the contributions of scientific research in improving the health of patients and communities
Scholar
Pose a research question (clinical, basic or population health)
Develop a proposal to solve the research question:
conduct an appropriate literature search based on the question
propose a methodological approach to solve the question
Carry out the research outlined in the proposal
Demonstrate an understanding of the basic principles of research design, methodology, biostatistics, and clinical epidemiology
Critically analyze and disseminate the results of the research
Identify areas for further research
Professional
Maintain ethical and professional standards as laid out by the Health Research Ethics Board (HREB)
Demonstrate to ability to set and achieve reasonable research goals Publish accurate and reliable research results, with attention to appropriate authorship attribution criteria
Disclose potential financial conflicts of interest (including speaker fees, consultative relationships, investments, etc.) as appropriate when engaging in and disseminating research results
Appendix 3 Guidelines for Resident Research Projects (Revised: February 2016)
A Three-Phase Venture:
1. Proposal: before commencing any study proposal it must be reviewed by: - mentor of the research study (staff person) If funding is required for the study, application must be made to the appropriate agencies. Appropriate application must be made to HREA as well as the Organizational Review Board. A draft proposal must also be registered with the Discipline of Radiology office.
2. Study: The actual collection and analysis of data.
3. Presentation: A written paper or poster presentation for submission to a medical journal, international, national or local meeting. A page summary must be submitted to the Discipline of Radiology office. Projects will be funded if presented in North America or at an authorized international location. Please confirm with Rhonda BEFORE the submission of your abstract, that you will be seeking funding for travel expenses to present.
I. Proposal The research proposal is outlined. It is then to be reviewed by the appropriate staff person. This should achieve several objectives: a) learn the correct way to design a small project b) help the resident design an achievable goal c) documentation must be provided to the radiology office so that possible conflicts or repeating research projects can be avoided. d) after completing these steps the appropriate applications to the HREA as well as hospital review committees must be made. II. Study - Considerations for Designing a Research Project
1) What is your question? Be specific. (There may be more than one - be very precise in describing what they are. This is the most important part.) Do a literature search and read the papers. Has this been done by others? What can you learn from their work?
2) What do you expect to find? What other possible answers could there be? a) Why is it important to answer this question? What effect will your answer have? Does it have any clinical (practical) implication?
b) How are you going to answer this question? What type of study will this be?
c) What statistics will be used in the analysis of the data?
Descriptive: i.e. Find a number of cases of a disease and describe the findings on imaging modalities.
Pilot Studies - feasibility of new technique - acceptability of the method to patients and hospital staff - quality of images
Comparison of Technique - i.e. Two types of films, two filters, two methods of labeling, etc. (may not need gold standard)
Diagnostic Accuracy - assessing a test or tests against a “gold standard” and possibly comparing them. How will you define your gold standard. Very Important!!
Clinical Value - aim to evaluate the contribution of an imaging technique to the clinical management of a patient, both diagnostic and therapeutic.
Randomized Comparisons- outcome after randomization to one or other imaging techniques Before and After Studies - study of diagnostic practice before and after introduction of a major new technology such as CT/MR etc. c) I) How will you get your participants? How will you collect your data? How many participants/cases will you need?
II) What data will you collect? Name, DOB, MCP#, etc... - collect more rather than less information
- make sure you answer enough questions to decide if participants have met your “gold standard” criteria!
- make notes on why you made a particular decision! (You will forget).
- design a data chart and do a “pilot” to check you have enough information
- consider using a computer database and figure out how to code information
III) Decide on a time frame! Is this realistic? Who will need to help you get this done? Are they willing to help? Does this need money? IV) What problems and limitations do you anticipate? How can you get around this? III. Paper. Write up a proposal - ready for presentation. a) Summary. Brief summary. b) Background and rationale. Why this study needs to be done. Review of literature (brief) c) Aim of the study. ie. What is the question or questions? (also may be called objectives) d) Hypothesis. What do you expect to find? e) Design of the study. Materials (Participants) and Methods. f) Analysis. How do you expect to analyze your results? g) Anticipated problems and limitations
Completion of Project: Project considered completed when: - Presented at Annual Radiology Research Day and/or provincial, national or international meeting - Paper Submitted in written format to the Radiology office. The paper should be written up following guidelines for a uniform requirement for manuscripts submitted to Bio-Medical Journals -Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals. http://www.icmje.org/recommendations/. If the manuscript has been published, a copy of the published article may be submitted to the Research Committee.
Guidelines for Manuscript: Abstract: Clearly state the purpose of study and why it is important.
Method: Basically this is your proposal - written in past tense as opposed to future tense. For example: Who or what did you study? How did you do it and What did you do with the information when you got it?
Results: Present in clear fashion with appropriate use of tables, figures, point out important trends and findings.
Discussion: Point out any limitations of your study. What is the significance of your results? If they disagree with others - why? Sum things up in one paragraph at the end. Appendix 4 Guidelines for HREB application and Financial Impact Statement
Health Research Ethics Board (HREB)
HREA (http://www.hrea.ca/Home.aspx) has information about research ethics in Newfoundland. There are independent research boards in other provinces if research is done outside of Newfoundland.
If you need help deciding if ethics approval is needed there is help at: http://www.hrea.ca/Ethics- Review-Required.aspx Ethics applications are now paperless and are entered through the Memorial Researcher Portal. To access the portal, application is made through the following link: https://rpresources.mun.ca
1. Writing the proposal is the first step to getting the research organized. It will need to be submitted with the application as well. 2. Along with the application, the following documents will need to be submitted for first time applicants: a) TCPS Certificate: http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/Default/ b) Current Curriculum Vitae c) Oath of confidentiality, a proto type can be found at: http://www.hrea.ca/How-To-Apply- %281%29.aspx
3. On the portal, the type of research will need to be selected before the information can be entered. If you need help deciding which format to use there is help at: http://www.hrea.ca/Ethics-Review-Required.aspx
4. Information that needs to be attached to the application usually include: a. Supervisor Attestation Form.docx b. Oath of Confidentiality c. Spreadsheet with all the data elements that will be collected for the research protocol d. Any interview questions that are to be asked of participants e. If needed, a consent form f. Letter requesting the data if doing chart reviews or access to Meditech or PACS are needed
The Discipline of Radiology Research Assistant is willing to assist residents in this process if requested. Financial Impact Statement All research impacts the hosting institution. Therefore a mechanism has been developed to identify that impact. Once full approval has been granted by HREA, research proposals are then reviewed for Organizational Approval. Links to the Newfoundland Health Boards can be found at:
http://www.hrea.ca/Organizational-Approvals.aspx The primary mandate of this committee is to review resource utilization for any project to be conducted within the corporation and to protect privacy of the participant and personnel. Review by each organization requires submission of a short form, which provides a brief explanation of the project, associated costs and sources of funding. All projects are reviewed and approved by the Program Clinical Chair before receiving final full approval from the organization. - The committee meets monthly - It will be the responsibility of the investigator initiating the research project to ensure appropriate institutional and departmental approvals are in place prior to undertaking any research project.
RESIDENT TRAVEL FUNDING GUIDELINES:
Travel Policies\Resident Travel for Research and Scholarly Work Guidelines.docx
Travel Policies\RESIDENT TRAVEL GUIDELINES.docx
Travel Policies\Resident CPD Guidelines.docx
OTHER RELEVANT DEPARTMENTAL POLICIES CONFERENCE LEAVE
7 days/year per resident (this includes the day before and the day after).
SICK LEAVE Contract states 2 days/month – cumulative during each contract year. Forms must be completed and submitted to the academic office upon returning to work.
VACATION TIME 4 weeks/year.
Preferably taken in one-week blocks. No more than one week off per 4 week rotation.
At discretion of Administrative Resident, Hospital Chief, and Program Director.
If vacation has not been arranged for each year, it may be arbitrarily assigned.
Holiday and conference leave forms must be signed and returned to the Chairperson’s office at least two weeks prior to any leave; if not, we will not guarantee that payroll will continue the resident's salary during this time off.
The program strives to have at least 2 residents at each site at all times, with the exception of the Janeway site.
Please refer to Resident’s contract for further details.
Critical Incident and Stress Policy
DISCIPLINE OF RADIOLOGY
Adopted September, 2010
PURPOSE
To establish authority and process to be followed within the Discipline of Radiology in response to a Critical Incident or Significant Stressor ultimately assisting residents who are involved directly or indirectly in patient care situations that involve negative outcomes, either real or perceived or assisting residents confronted with other significant stressors.
SCOPE
This policy will apply to all residents in the Discipline of Radiology as well as any residents or medical students who are participating in a radiology elective at the time of a critical incident.
DEFINITIONS
Critical Incident (CI) - An occurrence in which the resident is exposed to a negative patient outcome over which he or she feels they had a direct or indirect influence. This could include a patient’s death that they personally witnessed or were involved with, regardless of whether they felt they acted appropriately or not.
Significant Stressor – Any significant stimulus contributing to a level of undue stress on a radiology resident that is identified by the resident, staff radiologist or other individual which requires attention to improve the quality of life, quality of work, academic progress, well-being of the resident and/or patient care.
Program Director – The faculty member responsible for the Radiology Residency Program Staff
Radiologist – Radiologist employed by Eastern Health and engaged in resident education. POLICY AND PROCEDURES Reporting a Critical Incident A critical incident occurs in which the resident or supervising staff radiologist feels the resident needs to have a debriefing regarding the event. Either the resident or supervising staff shall be responsible for identifying the incident to the program director. Examples of CI may include any adverse outcome during a patient encounter. This would be most relevant to residents on rotations with procedural components such as interventional radiology.
Reporting a Significant Stressor
A significant resident stressor may be identified by the resident him/herself, the program director or another individual(s).
Referral and Meeting Guidelines
* The staff person is responsible for referring the resident to the CI/stress process. Referral is made to the program director by the staff person or resident involved. The referral can also be made by another health care provider who has knowledge of the event.
* Where possible the referral for CI/stressor must be made within 3 days of the event. In situations where the effect of the CI/stressor is not immediately obvious, the referral must be made as soon as possible after the effect becomes obvious. The program director will arrange the meeting.
* The first meeting shall be attended by the program director and the involved resident +/- the attending staff. The resident may elect to have another staff radiologist or mentor present/involved if there is a preference. If the resident designates such a staff to assist in the process then the program director may be excused.
* Further referrals to other experts may be deemed appropriate; the Program Director or designated staff will be responsible for arranging such meetings with permission of the resident.
* The confidentiality of the meeting is paramount and discussions will not leave the room. The only documentation shall be that the meeting occurred, who was present, when the next meeting is scheduled and that all parties are in agreement with what was discussed. This meeting shall not become part of the resident’s permanent record.
* There must be a follow-up meeting between the program director/other designated staff radiologist and resident, within 2 weeks to ensure any outstanding issues are resolved and that the resident is coping with the event. The Program Director or designated staff will arrange this meeting.
Support Services for Residents Involved in a Critical Incident or facing significant stressors:
The Resident shall be offered or referred for further counselling to one or more of the following services; * Ms. Rosemary Lahey (Professionals’ Assistance Program 754-3007, 1-800-563-9133)
* Dr. Rick Singleton (Pastoral Care 777-6959)
* Eastern Health’s Employee and Family Assistance Program (EFAP, 777-7777)
* PAIRN, if appropriate
* CMPA, if appropriate
Harassment Policy A formal policy on Intimidation and Harassment is available through Postgraduate Medical Studies. This policy also briefly addresses ethics and guidelines of conduct. The web site is: http://www.med.mun.ca/getdoc/759aa8ce-9b52-4989-bb50-f55c9f4c8a7e/Policy-on-Intimidation- and-Harassment.aspx Support is offered by the office of Postgraduate Medical Studies through their Postgraduate Counsellor, Dr. Scott Moffatt. Dr. Moffatt is available directly or through the Postgraduate Office. This confidential service is separate in every way from the residents’ evaluations and the discipline’s assessments of the resident. Issues which arise among residents include the academic stress of residency, career choice issues, interpersonal conflict, financial stresses, and personal issues as a resident tries to find balance between their personal life and their life as a resident. The services are confidential and there is full backup support. In addition the Postgraduate Medical Studies office has had visiting speakers discussing stress management.
Memorial University Residency Program Safety Policy: The Radiology Residency Program is committed to ensuring residency safety. We accept and follow a safety policy drafted by the Post Graduate Medical Education office. Please refer to this appended safety policy. Herein the phrase, “the resident”, refers to any person currently enrolled in post graduate radiology residency training at Memorial University of Newfoundland or any person not enrolled that is authorized by educational authorities to rotate through the radiology services of Eastern Health. 1. Safety policies of the Memorial University Radiology program reflect the broader safety policies of the postgraduate office, Eastern Health and Memorial University of Newfoundland. Please refer to each authority for current policies. Policies of those authorities supersede points 2 through 5 below. 2. Assessment of safety threats in the day to day performance of tasks performed as a radiology resident is left to the discretion of the resident. 3. Any work place situation deemed a threat is to be avoided at the discretion of the resident until such a time that the resident has sufficient support from other staff and/or security to proceed. 4. Campus police and civil police are available at 7280 and 911 respectively and should be notified of significant security/safety risks at the discretion of the resident. 5. Resident travel encompasses a variety of transportation modes potentially used by the resident through the course of residency training. It is the responsibility of the resident to ensure that travel, in the context of the residency training requirements, is safe in all respects. All travel choices are at the discretion of the resident. Residents are encouraged to consult relevant agencies or authorities when traveling or planning to travel for necessary information to aid in the decision process.
Dress Code as per Memorial University Faculty of Medicine As physicians, along with other health professionals, your principal focus is the client – your patient. Patients come from a wide range of cultures, diverse economic and educational backgrounds, as well as extremes in age groups. In addition, they and their families come to us often under a great deal of stress and vulnerability. It behooves us all to present ourselves as professionals who are sensitive and responsive to our patient’s expectations regarding appropriate identification, apparel etcetera while on duty. In general clothing must be clean, proper fitting, comfortable and non restrictive. Beach style clothing, crop tops, halter tops and revealing clothing are not appropriate. Stiletto heels are also not appropriate.
PROGRAM TRANSFER POLICY The Postgraduate Medical Education Committee recognizes that postgraduate trainees may wish to change programs and has developed the following policy and procedure in an attempt to ensure a fair and equitable process which will work to the benefit of all stakeholders. Although all requests for transfers will be considered, there must be recognition that not all requests will be granted. This policy applies only to those who are in positions matched through CaRMS.
PRINCIPLES: 1. Postgraduate trainees should have options if they are enrolled in a program which they feel is inappropriate for their needs.
2. No program will be required to accept a postgraduate trainee who does not meet the programs' admission criteria or for whom adequate training resources are not available.
3. All transfer requests will go through the Postgraduate Medical Studies Office. The PGME Office will facilitate application while maintaining postgraduate trainee confidentiality.
4. The application and approval process will follow the “Procedures for Transfer”.
5. Potential recipient programs will have access to the trainee's original CaRMS application, in- training evaluations and academic record; with signed authorization of release by the applicant.
6. Approved transfers will occur: i. January – first changeover in January ii. . July – start date of academic year 7. In order for programs to have an opportunity to review all potential candidates, the deadline for completed application will be: i. October 30 - for January transfer ii. . April 30 - for July transfer
8. All trainees will be advised of this policy at orientation and a copy of the policy will be contained in the PGY I Handbook.
9. Recognizing the potential stresses related to decisions to transfer, all applicants are encouraged to seek counseling through EAP or the Postgraduate Counselor.
(Candidates may be required to seek this following that interview with the Postgraduate Dean).
10. Candidates with return-in-service agreements must clear potential transfers with their Sponsoring body.
11. Candidates who have received bursaries must clear potential transfers with the Department Of Health prior to application deadlines.
12. This transfer process is not intended to subvert the CaRMS match. 13. Candidates are not eligible for transfer prior to their PGY I year.
(July 21, 2000)
Eastern Health Policies
Policies can be accessed on the Eastern Health intranet at: http://intranet.easternhealth.ca/EH/policies.aspx
Samples include (but are not limited to): - Requests for Diagnostic Imaging Services - Distribution of Reports - Verbal Reports - Copying of Images - Professional Ethics - Emergency Department D.I. Reports - Significant Findings - Contrast Medium - Infection Control in D.I. - Imaging of Female Patients of Child Bearing Age - Radiation Equipment - Radiation Protection Patients-Public - Diagnostic Imaging Safety - Diagnostic Imaging Safety Orientation, Education and Training - CT Patient Shielding.pdf - Virtual Colonography Preparation Kits - Requests for Mammography - Breast Imaging Guidelines - Consent for Mammography Procedures - Galactogram - Imaging the Post Lactating Breast SECTION 2
Aims and Objectives: PGY I RCPSC Specialty Programs Aims & Objectives: PGY I RCPSC Specialty Programs
INTRODUCTION
A training program must have clear and measurable objectives. These objectives must include both cognitive and non-cognitive areas and appropriate evaluation is essential. In-training evaluation will be completed by the designated attending staff in each rotation. The trainee will be responsible for completing the trainee evaluation of the rotation. The in-training objectives and the trainees' attention to these objectives become very important as they attempt to achieve the goals we have set. These objectives are intended to serve as an outline of the essential elements of each rotation. Although not all named conditions may be seen by every trainee for every rotation, trainees should be familiar with them. In many cases, you may be able to achieve a much higher level of knowledge than outlined by these minimal objectives.
The up to date objectives for the PGY1 RCPSC Non Radiology Specialty Programs can be found at http://www.med.mun.ca/Radiology/Residents/Curriculum/PGY-1.aspx
Rotations include: Emergency Internal Medicine Obstetrics and Gynecology Pediatrics Surgery
SECTION 3
Specific Rotation Objectives This section is currently being reviewed and updated regularly. PGY1 Radiology Ultrasound Rotation Objectives
Daily Performance Cards are required for this rotation. SUPERVISOR: Dr. Eric Sala, Health Science Centre, Dr. Cheryl Jefford, St. Clare’s Hospital ASSESSMENT: ITER. Face to face feedback will be given and resident should pursue this with staff. There is an End of rotation exam that will test on the objectives, mainly the pathologies listed in medical expert. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date. There are practice questions to be attempted on D2L focused on basic ultrasound and physics. Overall Goal: To provide an introduction to ultrasound.
MEDICAL EXPERT: Focus on shadowing the ultrasound techs throughout the day. NOT dictate reports. All day shadowing occurs on Tuesday, Wednesday and Thursday. Monday and Friday will be research/study days.
Practice some hands on ultrasound scanning after formal patient exam is finished. This can occur for several minutes after formal exam is complete, so not to impede patient flow and technologist workflow significantly. Resident is expected to save an image on PACS with resident initials on image to show rotation supervisor by rotation end. Images to be saved: Sagittal Aorta Sagittal Gallbladder Sagittal CBD Sagittal Kidney Portal venous Doppler waveform
Recognize the ultrasound features and clinical presentations of: Acute appendicitis, cholelithiasis & cholecystitis, pancreatitis, abnormal bile duct dilatation, cholodocholithiasis Features of a simple cyst versus abscess Aortic Aneurysm
Complex adnexal cyst or mass Ectopic pregnancy
Complications of pregnancy: missed abortion, placenta previa, subchorionic hemorrhage Attempt the practice D2L MCQ exams, based on the readings below
MANAGER: Buddy call for total of 6 calls this month. 1 Saturday, 1 Sunday, 4 week days. Organize with chief resident. Shadow responsibility is watch and learn Shadow responsibility is up to 10PM, thus no post call
PROFESSIONAL: Resident will be punctual, organized and courteous to coworkers.
Required Reading:
Ultrasound Scanning - Betty B. Tempkin
Chapters Abdominal Aorta, Liver, Gallbladder and Biliary Tract, Renal, Female pelvis, Transvaginal, Abdominal Doppler and color flow http://guides.library.mun.ca/ultrasound
Ultrasound: The Requisites - Middleton, the specific sections as listed in Medical Expert http://guides.library.mun.ca/Radiology
Harris & Harris' the radiology of emergency medicine - Pope, Thomas Lee, Jr. Chapter 16 - Gynecologic, Obstetric, and Scrotal Emergencies SUBSECTION: OBSTETRIC EMERGENCIES http://guides.library.mun.ca/RAD-ER
http://www.susme.org/learning-modules/learning-modules/
Complete specific modules: Physics, Instrumentation, Abdomen, Pelvic, Neck PGY1 GI Radiology and Plain Film Rotation Objectives
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s Mercy Dr. Sarah Jenkins, Health Science Centre ASSESSMENT: ITER. Face to face feedback will be given and resident should pursue this with staff. The total number of plain films dictated and RF procedures over the rotation will recorded. There is an End of rotation exam that will test on the objectives. The test is mainly plain film, and flouro from required reading. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date. There are practice questions available for the topics covered. These will prepare you for the end of rotation exam. Overall Goal: To provide a strong foundation in performing fluoroscopic procedures and plain film reporting.
MEDICAL EXPERT: Describe how to perform a variety of general flouroscopic procedures including UGI, barium swallow, modified barium swallow, small bowel follow through, contrast enema.
Recognize a variety of pathology on plain films including wrist, elbow, hip, shoulder, abdomen and chest
Have an approach to plain films listed above
Recognize a variety of fluoroscopic procedures of the post-surgical condition, including but not limited to colostomy, ileostomy, J-pouch, Kocks pouch, colo-anal anastomosis
HEALTH ADVOCATE: Demonstrate how to minimize radiation exposure during fluoroscopy to the patient Demonstrate an understanding of radiation exposure and dose units COLLOBORATOR: Maintain effective relationships with technologists PROFESSIONAL: Act cordial with colleagues Be punctual
READINGS: GI FLOURO http://individual.utoronto.ca/ecolak/gi_techniques/techniques/index.htm Gastrointestinal Radiology - Ronald L. Eisenberg (available in library)
PLAIN FILM (available online on D2L) The Elbow: Radiographic Imaging Pearls and Pitfalls Conventional Radiography of the Shoulder
Radiography of the Hip Lines, Signs, and Patterns of Disease Approach to Abdominal XRay PDF file
Chest Radiology Sixth Edition Reed James C Abdominal Imaging Sahani, Dushyant V., Chapter 1 Plain Radiography of the Abdomen PGY1 Radiology Anatomy and Research Rotation Objectives
Overall Goal: To provide an introduction to anatomy, as it relates to diagnostic imaging, with supplementary introduction to ultrasound and CT anatomy. To use proper anatomical terminology for description. The PGY1 is read the objectives below, study the relevant anatomy, using the suggested readings, and apply their knowledge in completing the online D2L anatomy exams. Each exam is very comprehensive, and long. The PGY1 will get unlimited rewrites of each exam until they get 80%. SUPERVISOR: Dr. Angus Hartery, St. Clare’s Mercy ASSESSMENT: Weekly MCQ exams that will test on the objectives. Resident should coordinate with Program Administrator to write the weekly anatomy exams. Exam topics are listed under medical expert. Resident should rewrite exams (unlimited rewrites) until achieving 80% on all 4 exams BEFORE rotation end.
MEDICAL EXPERT: Week 1: Thoracic: Recognize mediastinal lines from border-forming structures on the CXR (such as anterior junctional line, azygoesophageal recess, etc); Recognize lung segments on CXR and CT. Recognize common anatomical lines, recesses and spaces on CXR and CT. Recognize normal cardiac valve and coronary artery CT anatomy. Recognize normal branches of aortic arch. Week 2: Abdomen & Pelvis: Recognize normal anatomy of abdominal vasculature on fluoroscopic images and CT including inferior vena cava, mesenteric arteries and veins, aorta and main branch arteries. Recognize and understand the intra and extra peritoneal spaces, retroperitoneal spaces and contents. Recognize liver segments on CT and ultrasound. Recognize solid and hollow organs on CT images.
Week 3: Neuro: Vascular territories, vascular anatomy on fluoroscopic images of the carotids, neck, face, circle of willis, dural sinus anatomy; anatomy of ventricular system; basal ganglia, brainstem, pons, cerebellum, vermis. Week 4: MSK: Carpal and tarsal bones on various projections, bony anatomy of foot, hand, wrist, shoulder, elbow and pelvis on x-ray, lines of the wrist (including greater and lesser arcs, arcs of Gilula) and bony pelvis, landmarks for muscle avulsion injury in the pelvis and knee, arterial vasculature of the lower extremity, x ray of the vertebrae - body, pedicles, lamina, transverse processes, spinous processes.
MANAGER: Throughout this year, shadow call must be performed for a total of 12 calls There can be a maximum of 6 calls this month. 1 Saturday, 1 Sunday, 4 week days. Shadow responsibility is watch and learn
Shadow responsibility is up to 10PM, thus no post call Please speak to your chief resident for more details.
Expected to prepare 1 ER case per call – see scholar below
SCHOLAR: It is suggested the resident use some time on this rotation to set up a research project, with milestones, objectives, and a research supervisor.
During PGY1 the resident will create a total of 12 powerpoint teaching files from call cases (1 per call). These will be collected on D2L. Please see Margie Chafe for sample powerpoint template. A reference article (not a website) is mandatory. This reference must be an actual journal article to demonstrate resident can perform reasonable literature evaluation and to encourage resident to read around topic. Any MCQ question that the resident feels is worth learning is acceptable. Case should be checked with staff of choice. Approved Case is saved on D2L as unknowns.
Required Reading: Weir J. Imaging Atlas of Human Anatomy http://guides.library.mun.ca/angio Atlas of CT Angiography http://guides.library.mun.ca/angio
Felson's Principles of Chest Roentgenology http://guides.library.mun.ca/chest
StatDX Anatomy Sections
Net anatomy link http://guides.library.mun.ca/Radiology
Suggested readings available on D2L: Anatomy of the Heart at Multidetector CT What the Radiologist Needs to Know Lines and Stripes Where Did They Go From Conventional Radiography to CT Normal and Variant Coronary Arterial and Venous Anatomy on High-Resolution CT Angiography pelvic xray_ OrthoIntern Peritoneal and Retroperitoneal Anatomy and Its Relevance for CrossSectional Imaging PGY3 Angiography/Interventional Radiology SUPERVISOR: Dr. Melissa Skanes, HSC
SUPERVISOR: Dr. Ravi Gullipalli, SCM The following is an outline of the goals and objectives of the Interventional Radiology rotation during PGY3, incorporated into CANMEDS format. The CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES • To understand the rationale for interventional procedures for each patient. • To have an expectation of expected positive outcomes and possible complications. • To fully understand the anatomy of the organ systems involved in each intervention. • To be able to obtain informed consent and discuss the case appropriately with the patient and family members if necessary. • To review requests for in-patient procedures and to make recommendations as to the appropriate investigation and intervention with the approval of the staff interventionalist. • To be exposed to a wide variety of angiographic and interventional procedures as possible during the rotation and participate in the procedures with the staff interventionalist. • To understand interventional techniques. • To report these examinations in a timely fashion under the supervision of the staff interventionalist. • To supervise the pre and post-procedure care of inpatients and outpatients in conjunction with the staff radiologist.
SUGGESTED READING LIST (Copies of the suggested reading can be obtained through either Dr. Heale or Dr. Collingwood)
Imaging Atlas of Human Anatomy – Weir & Abrahams Vascular & Interventional Radiology – Kaufman & Lee Introduction to Cerebral Angiography – Osborn SIR syllabi-
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Have thorough working knowledge of the anatomy of the vascular, biliary and urologic systems and other necessary anatomy. The vascular anatomy includes the aorta and its major branches as well as the vascular anatomy of the brain and neck. Understand the pathophysiology of atherosclerosis and be familiar with the techniques of vascular recanalization including angioplasty stenting and thrombolysis. Become competent in basic interventional techniques especially with respect to accessing the femoral artery and central and peripheral veins to gain some understanding of basic interventional devices. Gain an understanding of the IR role in hemodialysis patients, especially as it relates to access problems regarding, native fistulas, grafts, and central lines. Understand the various central venous access techniques and devices used in IR. Gain an understanding in urologic interventions, including percutaneous nephrostomy and antegrade stenting. This includes the indications for and the complications of the procedure. Gain an understanding in biliary interventions including percutaneous transhepatic cholangiography, percutaneous biliary drainage and stenting. This includes the indications for and the complications of the procedure. Understand the rationale for catheter neuroangiography and be able to identify the major vessels. Become familiar with conscious sedation and analgesia and be able to manage complications of intravenous sedation. Be familiar with contrast reactions and their treatment. Become familiar with contrast injection rates and volumes for angiographic procedures. Be able to independently perform an angiograph examination of the abdominal aorta and lower extremities. Gain knowledge of how to perform an angiographic procedure including contrast injection volume and rates and the indications for antibiotic prophylaxis. Be able to perform a cerebral angiogram (PGY4 & PGY5).
2. Communicator Communicate effectively with patients/families, referring physicians, and co-workers, including IR technologists and nurses. Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management. Establish effective relationships with patients and be able to obtain informed consent for interventional procedures. Establish good relationships with peers and other health professionals while effectively providing and receiving information. Handles conflict situations well. Produce succinct reports that describe findings, most likely diagnosis and interventions performed. Complete records and reports effectively, as well as oral presentations.
3. Collaborator Gain an understanding of the role of Interventional Radiology in patient care. Interact effectively with health professionals by recognizing their roles and expertise. Collaborate effectively and constructively with other members of the health care team. Contribute to interdiscipline activities and rounds. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition residents will be required to be active participants in inter and intra discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology. Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Make cost effective use of health care resources based on sound judgment. Set realistic priorities and use time effectively in order to optimize professional performance. Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate Recognize the benefits and risks of interventional investigations including the risks and benefits of interventional radiology procedures versus surgical options. Promote health of the population through the application of radiology. Recognize the Radiologist’s role to ensure appropriate radiological investigation and act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment including population screening. Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac calcification and total body). Recognize the burden of illness upon the patients served by Radiology.
6. Scholar Understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Have a personal commitment of continued education and demonstrate a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long term plan. For a resident, this would include seeing as many cases as possible during the days with follow-up reading performed at night.
7. Professional Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate reliability and conscientiousness. Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY2 Body CT GI/GU Imaging (HSC/SC)
Daily Performance Cards are required for this rotation.
**************** (The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
SUPERVISORS: Dr. Wesley Chan, Health Sciences Centre Dr. Angus Hartery, St. Clare’s
For this rotation, there ARE flouro responsibilities. These are discussed under the PGY2 GI/GU rotation objectives
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department. Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
Understand the basic physics of CT including pitch, slice thickness, mA and kV, scanner types.
Learn principles and effects of contrast enhancement, timing and its applications.
Learn to appropriately protocol and oversee studies.
Learn appropriate form of dictation.
Be able to recognize and effectively treat all forms of adverse contrast reactions.
Be able to interpret basic CT pathology.
Be studied in CT anatomy.
Understand the importance of radiation dose & when it is appropriate (or Not) to use CT as a diagnostic tool.
Be able to effectively carry out these goals while maintaining professionalism.
REQUIRED READING LIST:
PLEASE READ THE CORRESPONDING RSNA PHYSICS MODULE as outlined in the Physics curriculum http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott- Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven (Senior Residents)
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols. Silverman PM. Lippincott-Raven.
1. Medical Expert
Be able to identify the CT appearances of:
- Obstructive uropathy secondary to ureteric calculus - Renal cystic disease - Renal cell carcinoma - Adrenal masses and adenoma - Liver cirrhosis - Hepatic hemangioma - Liver cancer – primary and metastatic - Biliary obstruction, gallstones - Pancreatitis and complications - Pancreatic cancer - Bowel and gastric cancer - Bowel obstruction - Visceral Perforation – free air - Lymphoma - Ovarian cancer - Cervical, uterine cancer - Prostate cancer - Omental disease - Aortic aneurysm and dissection - Ascites - Trauma – liver, spleen, kidney, bowel, bladder, arterial injury - Appendicitis - Bladder carcinoma, TCC, CT urography - Inflammatory bowel disease and its complications - Pseudomembranous and other forms of colitis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Multi phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging - CT urogram - CT enterography and CT colonography - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess & interpret CT images of the intra-abdominal & pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors. Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers PGY2 Body Imaging (SC)
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Angus Hartery, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging.
Residents will review all CT requisitions with the responsible staff radiologist when able and record the examination plan on the requisition.
The resident will review each CT examination, present it to the staff radiologist for discussion, and dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1. Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Multi phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor) - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies (Senior residents as time permits).
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis and secondary complications - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes, ureteric and bladder mass (ureterolithiasis, TCC) - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Signs of ischemic bowel - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Be able to describe and identify couinaud segments of the liver. Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
2. Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
PGY2 Body Imaging (HSC)
Daily Performance Cards are required for this rotation.
For this rotation, there ARE flouro responsibilities. These are discussed under the PGY2 GI/GU rotation objectives (The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
SUPERVISOR: Dr. Wesley Chan, Health Sciences Centre The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management. DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
Understand the basic physics of CT including pitch, slice thickness, mA and kV, scanner types.
Learn principles and effects of contrast enhancement, timing and its applications.
Learn to appropriately protocol and oversee studies.
Learn appropriate form of dictation.
Be able to recognize and effectively treat all forms of adverse contrast reactions.
Be able to interpret basic CT pathology.
Be studied in CT anatomy.
Understand the importance of radiation dose & when it is appropriate (or Not) to use CT as a diagnostic tool.
Be able to effectively carry out these goals while maintaining professionalism.
REQUIRED READING LIST:
PLEASE READ THE CORRESPONDING RSNA PHYSICS MODULE as outlined in the Physicscurriculum http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005 Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott- Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols. Silverman PM. Lippincott-Raven.
1. Medical Expert
Be able to identify the CT appearances of: - Obstructive uropathy secondary to ureteric calculus - Renal cystic disease - Renal cell carcinoma - Adrenal masses and adenoma - Liver cirrhosis - Hepatic hemangioma - Liver cancer – primary and metastatic - Biliary obstruction, gallstones - Pancreatitis and complications - Pancreatic cancer - Bowel and gastric cancer - Bowel obstruction - Visceral Perforation – free air - Lymphoma - Ovarian cancer - Cervical, uterine cancer - Prostate cancer - Omental disease - Aortic aneurysm and dissection - Ascites - Trauma – liver, spleen, kidney, bowel, bladder, arterial injury - Appendicitis - Bladder carcinoma, TCC, CT urography - Inflammatory bowel disease and its complications - Pseudomembranous and other forms of colitis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor) - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty Infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages. Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers
PGY3 Body Imaging (HSC)
Daily Performance Cards are required for this rotation.
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
-Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from CT responsibilites
-One day a week (for a total of 4 days) of flouro on the day that has the most bookings
-If once flouro is taken care of, resident can attempt reading of CTC, CTE, MRE
-Resident should check in with MRI and CT techs to see when these exams are performed and then schedule readout time with staff.
SUPERVISOR: Dr. Wesley Chan, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
To expand on those listed as a PGY2.
Continue to build on interpretative skills.
Effectively identify life threatening findings and notify appropriate staff.
Be able to direct and protocol choice of test and change if necessary.
Be able to consent patients and participate in image guided procedures.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Please read the corresponding RSNA Physics module, as outlined in the Physics curriculumhttp://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott- Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
1. Medical Expert
Expand on those listed as a PGY2.
Be able to identify:
- Abscess – liver, pancreatic, renal, bowel - Carcinomatosis - Cholangiocarcinoma - Budd-Chiari Syndrome - Closed loop obstruction - FNH, HCC, adenoma of liver - Pancreatic Islet cell tumours - Cystic Pancreatic neoplasms - VHL and MEN syndromes - Pseudoanuerysms - Retroperitoneal fibrosis - Bowel ischemia and pneumatosis intestinalis - Carcinoid and carcinoid syndrome - Polysplenia syndromes and findings - Congenital anomalies - CT urography and enterography
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor ) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, anueyrsm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver. Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
PGY3 Body Imaging (SC)
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Angus Hartery, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the examination plan on the requisition.
The resident will review each CT/MRI examination, present it to the staff radiologist for discussion, and dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1. Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor ) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
2. Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator
Become an effective consultant of radiology. Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation. 6. Scholar
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
PGY4 Body MR/CT/GI/GU Imaging (HSC)
Daily Performance Cards are required for this rotation. (The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below) -Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from CT responsibilities -One day a week (for a total of 2 days) of flouro on the day that has the most booking - Traditionally Tuesdays at HSC, and Wednesdays at SC. -If once flouro is taken care of, resident can attempt reading of CTC, CTE, MRE -Resident should check in with MRI and CT techs to see when these exams are performed and then schedule readout time with staff.
SUPERVISOR: Dr. Wes Chan, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
THE RESIDENT IS REQUIRED TO GET 2 WEEKS OF DEDICATED BODY MRI READING IN THE LAST 2 WEEKS OF THE ROTATION.
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely. Participate in Image guided procedures.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 2 rotations.
Participate in CT guided procedures.
Effectively be able to use CT fluoroscopy.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott- Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
Please read the coresponding RSNA physics module, as outlined in the physics curriculumhttp://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert
Expand on those listed as a PGY3.
Identify the CT appearance of and interpret:
- CT angiography - CT Urography - CT Enterography - Endovascular stent placement and endoleak - Renal artery stenosis - Complicated Bowel obstruction - Pneumatosis intestinalis Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor ) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify cunard segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
PGY4 Body MR/CT/GI/GU Imaging (SCM)
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Angus Hartery, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES
THE RESIDENT IS REQUIRED TO GET 2 WEEKS OF DEDICATED BODY MRI READING IN THE LAST 2 WEEKS OF THE ROTATION.
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the examination plan on the requisition. The resident will review each CT/MRI examination, present it to the staff radiologist for discussion, and dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1. Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor ) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies. Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers. Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
2. Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management. Understand the fundamentals of quality assurance.
5. Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
PGY5 Body Imaging (HSC)
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Wes Chan, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner. Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 3 rotations.
Effectively perform CT guided procedures and manage complications.
Assist other residents in their interpretation, teaching and management of the daily CT worklist.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott- Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
Please read the corresponding RSNA physics module, as outlined in the physics curriculumhttp://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert
Be proficient in CT interpretation and the management of CT diagnosed pathology.
Be able to identify and give appropriate differential diagnosis for CT findings.
Continue to expand on knowledge from all previous Body rotations.
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes. Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor ) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
2. Communicator
Be an effective communicator with referring clinicians and house staff.
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team. Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
PGY5 Body Imaging (SC)
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Angus Hartery, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the examination plan on the requisition.
The resident will review each CT/MRI examination, present it to the staff radiologist for discussion, and dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1. Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys, - Gallbladder/biliary tree, and pancreatic imaging (for workup of cholangiocarcinoma or pancreatic tumor) - CT urogram - Adrenal washout study - CT aortic protocol (for assessment of dissection, aneurysm leak/rupture) Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree - Fatty infiltration of the liver - Biliary duct dilatation - Cirrhosis/Portal hypertension - Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC) - Ascites - Gallbladder wall thickening - Solitary and multiple splenic masses - Splenomegaly - Pancreatic mass - Pancreatitis - Adrenal mass, hypertrophy and hemorrhage - Renal mass including both benign and malignant causes - Masses of the renal collecting system and bladder - Hydronephrosis - Nephrolithiasis/Nephrocalcinosis - Omental caking/Peritoneal disease - Pseuodomyxoma peritoneum - Lymph node enlargement - Bowel wall thickening, including infectious and inflammatory causes such as IBD - Bowel obstruction, diagnosis and determination of etiology - Pneumoperitoneum - Mesenteric masses, including such tumors as Carcinoid - Aortic aneurysm/dissection - Pelvic mass (including uterine/adnexal masses) - Prostatic carcinoma and hypertrophy - Abscess
Be able to perform CT guided biopsies, aspirations and drainages. Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
2. Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
PGY2 Chest Cardio/Thoracic
Daily Performance Cards are required for this rotation.
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS: Dr. Rick Bhatia, Health Sciences Centre Dr. Scott Harris, Health Sciences Centre
SUPERVISOR: Dr. Lisa Smyth, St. Clare’s The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during PGY2, incorporated into CanMEDS format. Assessment: ITER. Face to Face feedback will be given and resident should pursue this with staff. There is an end of rotation exam that will test on the objectives. The inability to pass the exam could render the rotation incomplete, and the rotation may need to be completed at a later date.
Reading List ABR Study Guide “Diagnosis of Diseases of the Chest” by Fraser, pare and Genereaux (Reference Text) “The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read) “Chest Radiology” by Felson (Must Read) “Imaging Diseases of the Chest” by Armstrong (Must Read) “High Resolution CT Scanning” by Myller (Addiional Text) At the end of this rotation, the resident will be able to: 1. Medical Expert
Discuss the Medical Expert topics which are obtained from “Revised Curriculum on Cardiothoracic Radiology for Diagnostic Radiology Residency with Goals and Objectives Related to General Competnecies”. Published in Academic Radiology, Vol 12, No 2, February 2005. Topics are in Addendum (see end) and are broken down for each year. Please note that the topics listed are the minimum topics to be covered in each rotation. Residents are expected to read around cases and topics discussed during the rotation, even if they are outside of the medical expert topics provided for that specific rotation.
2. Communicator
Establish effective relationships with patients and obtain consent for thoracic interventional procedures.
Give a clear concise report and discuss possible management options with referring physicians with regards to cardiothoracic imaging.
Dictate accurate, error-free radiology reports in a timely manner.
3. Collaborator
Establish good relationships and work harmoniously with physicians, nursing staff and technologists.
Act as “first contact” for attending physicians, technologists, and nursing staff.
4. Leader
Take initiative to determine what thoracic procedures are occurring that day, managing time effectively.
5. Health Advocate
Be knowledgeable in radiation dose reduction strategies in the adult population in particular with low dose nodule surveillance, and HRCT.
Be knowledgeable in risk reduction strategies with respect to contrast induced nephropathy and Nephrogenic Systemic Fibrosis.
6. Scholar Present well-prepared thoracic case by presenting thoracic case at ICR. Present well-prepared thoracic case by giving Cardiothoracic radiology subspecialty rounds, when assigned for that academic rotation. 7. Professional
Demonstrate responsibility by organizing daily review sessions, and coordinating other resident responsibilities with supervising staff schedule
Demonstrate integrity, honesty, compassion and respect for diversity.
Demonstrate punctuality.
Demonstrate an awareness of personal limitations, by seeking advice when necessary.
Addendum for the Medical Expert. The Medical Expert topics are obtained from “Revised Curriculum on Cardiothoracic Radiology for Diagnostic Radiology Residency with Goals and Objectives Related to General Competencies”
Published in Academic Radiology, Vol 12, No 2, February 2005
Topics in Addendum are broken down by Year
PGY3 Chest Cardio/Thoracic (HSC/SC)
Daily Performance Cards are required for this rotation.
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS: Dr. Rick Bhatia, Health Sciences Centre Dr. Scott Harris, Health Sciences Centre
Supervisor: Dr. Lisa Smyth, St. Clare’s
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during PGY3, incorporated into CanMEDS format. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with particular attention to plain film studies. Interpret and report plain film examinations of the chest of both in-patients and outpatients including preoperative films and daily ICU/CCU/CVICU patients. In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac studies. To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty with resident on ultrasound duty). To attend Chest Oncology rounds. To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES Report - Chest CT’s - Pre-op chest radiographs Perform lung biopsies and chest drains (time permitting) Report at least 20 Chest plain films per day.
Report Cardiac CT and MRI’s on Tuesdays* * On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work. Please note there is a graded responsibility within Pulmonary Radiology implying residents will progress from having all their procedures closely supervised and all examination study reports checked, to being able to perform procedures with little or no supervision and to report independently.
REQUIRED READING LIST It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night. A binder of mandatory reading is provided to each resident, organized with weekly reading assignments. All needed texts and articles are provided and scaled to the resident’s level. Cardiac Imaging - the requisites
The Royal College also provides the following reading list: “Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text) “The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read) “Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read) “High Resolution CT Scanning” by Műller (Additional Text)
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Know the anatomy of the chest and the normal variations which can be seen on chest imaging. Know the anatomy of the heart and coronary arteries. Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image and clinical history. Become proficient in the interpretation of critical care chest imaging. Be able to perform a lung biopsy and pleural drainage and manage the potential complications. Understand the physics of how a chest image is created. Know the staging of lung cancer and the factors which determine the operability of a lesion. Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies. Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT. Recognize and give the differential diagnosis of at least the following: • Lobar collapse • Solitary pulmonary nodule • Multiple pulmonary nodules • Interstitial lung disease • Airspace disease • Mediastinal mass • Pleural fluid • Pleural mass • Chest wall mass • Pulmonary vascular disease • Cardiac disease: valvular, congenital, myocardial, pericardial • Anomalies/abnormalities of the aorta • Elevation of the diaphragm • Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of at least the following chest and cardiac conditions: • Pneumonia (including viral, bacterial, mycobacterial and fungal infections) • Lymphoma • Lung cancer • Metastatic disease to the chest including lymphagitic carcinomatosa • Carcinoid • Extrinsic allergic alveolitis • Occupational lung disease (including silicosis and asbestosis) • Idiopathic pulmonary fibrosis • Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus • Sarcoidosis • Alveolar proteinosis • Pulmonary hemorrhage syndromes • Wegener’s granulomatosis • Eosinophillic pneumonia • BOOP • Pulmonary edema • Pulmonary hypertension • Pulmonary embolism • Pneumothorax • Mitral stenosis/regurgitation • Aortic stenosis/regurgitation • Aortic aneurysm • Aortic dissection • Right-sided aortic arch • Congestive heart failure • Thymoma • Superior vena cava obstruction • Pulmonary hematoma • Pulmonary sequestration • Bronchogenic cyst • Pericardial effusion • Mesothelioma • Benign pleural fibroma • Anomalous coronary artery • Bicuspid aortic valve • Ascending thoracic aortic aneurysm • Myocarditis • Hypertrophic cardiomyopathy • ARVD • Partial Anomalous pulmonary venous return • Atrial septal defect • Myocardial Infarction
PGY4 Chest Cardio/Thoracic (HSC)
Daily Performance Cards are required for this rotation.
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS: Dr. Rick Bhatia, Health Sciences Centre Dr. Scott Harris, Health Sciences Centre
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during PGY4, incorporated into CanMEDS format. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with particular attention to plain film studies. Interpret and report plain film examinations of the chest of both in-patients and outpatients including preoperative films and daily ICU/CCU/CVICU patients. In conjunction with Body CT/MRI, resident reviews chest CT & MRI examinations including cardiac studies. To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty with resident on ultrasound duty). To attend Chest Oncology rounds. To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES Report - Chest CT’s - Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting). Report at least 20 Chest plain films per day. Report Cardiac CT and MRI’s on Tuesdays.* Report consults. * On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work. Please note there is a graded responsibility within Pulmonary Radiology implying residents will progress from having all their procedures closely supervised and all examination study reports checked, to being able to perform procedures with little or no supervision and to report independently.
REQUIRED READING LIST It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night. A binder of mandatory reading is provided to each resident, organized with weekly reading assignments. All needed texts and articles are provided and scaled to the resident’s level. Cardiac Imaging - the requisites The Royal College also provides the following reading list: “Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text) “The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read) “Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read) “High Resolution CT Scanning” by Műller (Additional Text) http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Know the anatomy of the chest and the normal variations which can be seen on chest imaging. Know the anatomy of the heart and coronary arteries. Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image and clinical history. Become proficient in the interpretation of critical care chest imaging. Be able to perform a lung biopsy and pleural drainage and manage the potential complications. Understand the physics of how a chest image is created. Know the staging of lung cancer and the factors which determine the operability of a lesion. Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies. Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT. Recognize and give the differential diagnosis of at least the following: • Lobar collapse • Solitary pulmonary nodule • Multiple pulmonary nodules • Interstitial lung disease • Airspace disease • Mediastinal mass • Pleural fluid • Pleural mass • Chest wall mass • Pulmonary vascular disease • Cardiac disease: valvular, congenital, myocardial, pericardial • Anomalies/abnormalities of the aorta • Elevation of the diaphragm • Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of at least the following chest and cardiac conditions: • Pneumonia (including viral, bacterial, mycobacterial and fungal infections) • Lymphoma • Lung cancer • Metastatic disease to the chest including lymphagitic carcinomatosa • Carcinoid • Extrinsic allergic alveolitis • Occupational lung disease (including silicosis and asbestosis) • Idiopathic pulmonary fibrosis • Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus • Sarcoidosis • Alveolar proteinosis • Pulmonary hemorrhage syndromes • Wegener’s granulomatosis • Eosinophillic pneumonia • BOOP • Pulmonary edema • Pulmonary hypertension • Pulmonary embolism • Pneumothorax • Mitral stenosis/regurgitation • Aortic stenosis/regurgitation • Aortic aneurysm • Aortic dissection • Right-sided aortic arch • Congestive heart failure • Thymoma • Superior vena cava obstruction • Pulmonary hematoma • Pulmonary sequestration • Bronchogenic cyst • Pericardial effusion • Mesothelioma • Benign pleural fibroma • Anomalous coronary artery • Bicuspid aortic valve • Ascending thoracic aortic aneurysm • Myocarditis • Hypertrophic cardiomyopathy • ARVD • Partial Anomalous pulmonary venous return • Atrial septal defect • Myocardial Infarction
PGY5 Chest Cardio/Thoracic
Daily Performance Cards are required for this rotation.
CO -SUPERVISORS: Dr. Rick Bhatia, Health Sciences Centre Dr. Scott Harris, Health Sciences Centre
SUPERVISOR: Dr. Lisa Smyth, St. Clare’s
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during PGY5, incorporated into CanMEDS format. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with particular attention to plain film studies. Interpret and report plain film examinations of the chest of both in-patients and outpatients including preoperative films and daily ICU/CCU/CVICU patients. In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac studies. To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty with resident on ultrasound duty). To attend Chest Oncology rounds. To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES Report - Chest CT’s - Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting). Report at least 20 Chest plain films per day. Report Cardiac CT and MRI’s on Tuesdays.* Report consults All duties listed above, with the caveat of self directed learning to focus on knowledge gaps and prepare for exams. Exact goals and duties will be discussed with the resident at the start of the rotation. * On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work. Please note there is a graded responsibility within Pulmonary Radiology implying residents will progress from having all their procedures closely supervised and all examination study reports checked, to being able to perform procedures with little or no supervision and to report independently.
REQUIRED READING LIST It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night. A binder of mandatory reading is provided to each resident, organized with weekly reading assignments. All needed texts and articles are provided and scaled to the resident’s level. Cardiac Imaging - the requisites
The Royal College also provides the following reading list: “Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text) “The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read) “Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read) “High Resolution CT Scanning” by Műller (Additional Text)
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Know the anatomy of the chest and the normal variations which can be seen on chest imaging. Know the anatomy of the heart and coronary arteries. Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image and clinical history. Become proficient in the interpretation of critical care chest imaging. Be able to perform a lung biopsy and pleural drainage and manage the potential complications. Understand the physics of how a chest image is created. Know the staging of lung cancer and the factors which determine the operability of a lesion. Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies. Know principles and indications for coronary CT angiography. Protocol and interpret pulmonary CT/MRI studies including high resolution CT. Recognize and give the differential diagnosis of at least the following: • Lobar collapse • Solitary pulmonary nodule • Multiple pulmonary nodules • Interstitial lung disease • Airspace disease • Mediastinal mass • Pleural fluid • Pleural mass • Chest wall mass • Pulmonary vascular disease • Cardiac disease: valvular, congenital, myocardial, pericardial • Anomalies/abnormalities of the aorta • Elevation of the diaphragm • Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of at least the following chest and cardiac conditions: • Pneumonia (including viral, bacterial, mycobacterial and fungal infections) • Lymphoma • Lung cancer • Metastatic disease to the chest including lymphagitic carcinomatosa • Carcinoid • Extrinsic allergic alveolitis • Occupational lung disease (including silicosis and asbestosis) • Idiopathic pulmonary fibrosis • Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus • Sarcoidosis • Alveolar proteinosis • Pulmonary hemorrhage syndromes • Wegener’s granulomatosis • Eosinophillic pneumonia • BOOP • Pulmonary edema • Pulmonary hypertension • Pulmonary embolism • Pneumothorax • Mitral stenosis/regurgitation • Aortic stenosis/regurgitation • Aortic aneurysm • Aortic dissection • Right-sided aortic arch • Congestive heart failure • Thymoma • Superior vena cava obstruction • Pulmonary hematoma • Pulmonary sequestration • Bronchogenic cyst • Pericardial effusion • Mesothelioma • Benign pleural fibroma • Anomalous coronary artery • Bicuspid aortic valve • Ascending thoracic aortic aneurysm • Myocarditis • Hypertrophic cardiomyopathy • ARVD • Partial Anomalous pulmonary venous return • Atrial septal defect • Myocardial Infarction
2. Communicator Communicate effectively with patients/families, referring physicians, and co-workers. Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management. Establish good relationships with peers and other health professionals while effectively providing and receiving information. Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator Become an effective consultant of radiology. Interact effectively with health professionals by recognizing their roles and expertise. Collaborate effectively and constructively with other members of the health care team. Interact with house staff and referring physicians as “first contact”. Be active participants in inter and intra discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology. Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Make cost effective use of health care resources based on sound judgment. Set realistic priorities and use time effectively in order to optimize professional performance. Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate Promote health of the population through the application of radiology. Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification). Recognize the burden of illness upon the patients served by Radiology.
6. Scholar Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this. Demonstrate an ability to be an effective teacher of radiology. See as many cases as possible during the days with follow-up reading performed at night. Residents are required to present and teach to other residents, medical students and house staff.
7. Professional Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
Addendum for the Medical Expert. The Medical Expert topics are obtained from “Revised Curriculum on Cardiothoracic Radiology for Diagnostic Radiology Residency with Goals and Objectives Related to General Competencies”
Published in Academic Radiology, Vol 12, No 2, February 2005
Topics in Addendum are broken down by year and should be built upon in each subsequent year.
PGY2 – First Rotation
Indication and Limitations of chest imaging Normal Anatomy
Lung lobes and segments Airways Mediastinum Heart and great vessels Pulmonary vasc. Chest wall Thoracic Trauma and Imaging Emergencies
Monitoring and support devise – tubes and line Infection and immunity Atelectasis
PGY2 – Second Rotation Physics and Safety (CT, X-Ray, MRI, Contrast, Radiation Dosing) Mediastinal Masses and Mediastinal/Hilar Lymph Node Enlargement Pulmonary Vascular Disease Benign and Malignant neoplasms of lung and esophagus
PGY3 Rotation Large and Small Airway Disease Interstitial and cystic disease
Solitary and Multiple Pulmonary Nodules Signs in Thoracic Radiology
Congenital Lung Disease Ischemic heart Disease Myocardial Disease Cardiac Valvular Disease Pericardial Disease Congenital Heart Disease in the Adult
PGY4 – Cardiothoracic Rotation Diseases of the pleura and pleural space Management of ground glass nodules
CT, US and Fluoroscopic guided procedures: *including indications, risks, and knowledge of how to perform the procedure Postoperative thorax
PGY5 Cumulative of Previous Years
PGY2 Emergency Radiology SUPERVISOR: Dr. Paul Jeon, Health Sciences Centre The following is an outline of the goals and objectives of the Emergency rotation during PGY2, incorporated into CanMEDS format. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES: At the beginning of the rotation, the ER resident will inform the ER department of his/her responsibility to help organize, coordinate, recommend and whenever possible report appropriate diagnostic imaging tests. It is the duty of the resident to function at all times in a professional, mature and responsible manner, whether dealing with patients, colleagues, or health care workers. The ER resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or ER physician) dictate the same. A verbal report must be provided to the responsible ER physician for major findings that are detected; the details of this communication must be then acknowledged subsequently at the end of the generated report (i.e. time and date of verbal report and the physician’s name receiving the verbal report). The ER resident will present cases to staff in a prepared, organized fashion. The ER resident will be responsible to prepare 2 ER cases, on Powerpoint (in an ICR format) from a provided list, to the ER supervisor by the end of the rotation. The resident is responsible to review and read vigorously from the suggested reading list. An end of rotation exam will be given during the last week of the rotation to assess knowledge and where applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
SPECIFIC DAILY DUTIES Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible. The ER Resident will review at least 20 ER PF day with the staff designated in the ER Plain Film category contained in the Work Rota. When there is no staff designated in this slot, then the review can occur with the staff designated in the standard Plain Film slot. The ER resident will review the ER renal colic CT exams ordered the evening before, but performed the morning after, with the designated CT body staff for that day. Whenever possible, the ER resident is responsible to report any cross sectional studies that have been performed on patients from the ER, with the designated staff for that day (i.e. ER renal US with the radiologist covering US that day).
REQUIRED READING LIST Please note: The books needed will be provided from Dr. Jeon at the beginning of the rotation and must be returned on the final day of the rotation. It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night. Emergency Radiology: Case Review Series -Stuart E. Mirvis MD FACR (Author), Kathirkamanathan Shanmuganathan MD (Author), Lisa A. Miller MD (Author), Clint W. Sliker MD (Author)
Emergency Radiology: The Requisites (Requisites in Radiology)-Jorge A Soto MD (Author), Brian Lucey MD (Author)
SUGGESTED READING LIST Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth Edition, 2000 . Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams and Wilkins, Baltimore, MD, Third Edition, 1995.
McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.
Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and Wilkins, Baltimore, MD, 1992.
Novelline RA. Advances in Emergency Radiology, Volumes I and II, Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.
Stern EJ. Trauma Radiology Companion. Lippincott-Raven, Philadelphia, PA 1997. West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology. American Roentgen Ray Society, 2000 http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert After completing this rotation, the resident should be able to: 1. Identify and describe the basic PF/CT/US anatomy (where applicable) of the CNS, Respiratory, Cardiovascular, Abdominal/Pelvic (including GI, GU and OB/Gyne), and MSK systems.
2. Discuss the ER radiology Curriculum after studying the accompanying ER Core Curriculum and content structure/suggested readings: A Central Nervous System - 3 B. Face and Neck -5 C. Spine: -7 D. Chest - 8 E. Cardiovascular -10 F. Abdomen -12 G. Gynecological and Obstetrical - 14 H. Male Genitourinary -16 I. Upper Extremity -17 J. Pelvis and Hip -19 K. Lower extremity -21
3. Develop and master a systematic approach to the interpretation of plain radiographs of the spine, chest and abdomen.
4. Discuss in detail the various CT/US imaging protocols used in the ER rotation.
5. Distinguish abnormal from normal findings on PF( where applicable)/ CT images of the brain, head/neck and spine regions and to recognize the major disease processes that occur in these areas particularly in the following areas : a. Extra-axial hemorrhage i. Subdural hematoma ii. Epidural hematoma b. Parenchymal Injuries i. Cortical Contusion/traumatic hemorrhage ii. Diffuse Axonal Injury iii. Brainstem Injury c. Non-traumatic Hemorrhage i. Subarachnoid Hemorrhage ii. Parenchymal Hemorrhage d. Herniation Syndromes e. Cerebral Infarction f. CNS Infections g. Spinal trauma h. Facial Fractures i. Acute Infections of the Sinuses and Neck
6. Distinguish abnormal from normal findings on PF/US/CT ( where applicable) images of the chest, and to recognize the major disease processes that occur in these areas particularly in the following areas :
a. Aorta i. Trauma ii. Dissection iii. Aneurysm b. Pulmonary Edema c. Thrombo-embolic Disease i. Pulmonary Embolism ii. Deep Vein Thrombosis d. Pericardial Effusion/Tamponade e. Pneumothorax/Pneumomediastinum
7. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the abdomen and pelvis and to recognize the major disease processes that occur in these areas particularly in the following areas: a. Abdominal Trauma:
i. Solid/Hollow Visceral Injuries ii. Hemoperitoneum/Intraperitoneal Fluid iii. Intraperitoneal /Retroperitoneal Hemorrhage iv. Gas Collections –intraluminal and extraluminal v. Bowel and Mesenteric Injuries vi. Abdominal Wall and Diaphragmatic Injuries
b. Non-Traumatic Abdominal Emergencies
i. The Peritoneal Cavity Ascites Abscess Peritonitis
ii. Liver and Biliary Tract Jaundice o Obstructive and Non-obstructive Cholecystitis
iii. Pancreatitis iv. GI Tract Bowel Obstruction Bowel Infarction Bowel Infection o Appendicitis o Diverticulitis o Infectious Enteritis/Colitis Inflammatory Bowel Disease o Crohn o Ulcerative Colitis Epiploic Appendagitis/Omental Infarction
v. GU Urinary Tract Calculi Infection o Renal Abscess o Pyelonephritis
8. Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the major disease processes that occur in these areas particularly in the following areas: a. Ovarian Torsion b. Ovarian Cystic Disease c. Pelvic Inflammatory Disease d. Endometritis e. Subchorionic Hemorrhage f. Spontaneous Abortion/Fetal Demise g. Ectopic Pregnancy
9. Distinguish abnormal from normal findings in imaging the male GU system and to recognize the male GU emergencies that occur in these areas particularly in the following areas:
a. Traumatic i. Urethral/Penile ii. Scrotal/Testicular b. Acute Non-traumatic Scrotal Conditions i. Testicular Torsion ii. Epidydimitis iii. Orchitis iv. Infarction v. Acute Scrotal Fluid Collections Hydrocele Pyocele Hematocele vi. Testicular Abscess vii. Fournier’s Gangrene 10. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the MSK system and to recognize the major disease processes that occur in these areas particularly in the following areas:
a. Upper Extremity i. Scapular/Clavicular fractures ii. Shoulder/Elbow Dislocations iii. Forearm fractures /dislocations iv. Metacarpal/Carpal fractures/dislocations b. Pelvis and Hip i. Pelvic Ring Fractures ii. Isolated Pelvic Fractures iii. Acetabular Fractures iv. Hip fractures/disloctions v. Femoral Fractures vi. Septic Arthritis vii. AVN c. Lower Extremity i. Tibial Fractures 1. Plateau 2. Plafond ii. Ankle Injuries iii. Patellar Injuries iv. Knee Dislocations v. Talar/Subtalar Fracture/Dislocation vi. Tarso-metatarsal dislocation ( Lis Franc) vii. Metatarsal Fracture/Dislocation viii. Septic Arthritis
11. Develop a systematic approach in the CT evaluation of a patient involved in multi trauma.
12. Gain knowledge of anatomy and pathology related to organ systems commonly involved in trauma including the brain, spine, chest, abdomen and pelvis, cardiovascular and musculoskeletal system. ( See objectives for specific topics)
13. Have film reading ability of plain film examinations from the Emergency Room as well as Ultrasound and CT examinations ordered through the Emergency Room.
14. Be able to recommend an appropriate imaging study in an emergency situation.
2. Communicator Communicate effectively with patients/families, referring physicians, and co-workers. Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management. Establish good relationships with peers and other health professionals while effectively providing and receiving information. Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator Become an effective consultant of radiology. Interact effectively with health professionals by recognizing their roles and expertise. Collaborate effectively and constructively with other members of the health care team. Interact with house staff and referring physicians as “first contact”. Be active participants in inter and intra discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology. Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Make cost effective use of health care resources based on sound judgment. Set realistic priorities and use time effectively in order to optimize professional performance. Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate Promote health of the population through the application of radiology. Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment including population screening. Understand the issues regarding screening (i.e. lung cancer and cardiac calcification). Recognize the burden of illness upon the patients served by Radiology.
6. Scholar Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this. Demonstrate an ability to be an effective teacher of radiology. See as many cases as possible during the days with follow-up reading performed at night. Residents are required to present and teach to other residents, medical students and house staff.
7. Professional Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously. PGY2 Gastrointestinal & Genitourinary (also PGY3, PGY4)
Daily Performance Cards are required for this rotation.
Supervisor: Dr. Jennifer Young (HSC) Supervisor: Dr. Cheryl Jefford (SC)
ASSESSMENT TOOLS: ITER. End of Rotation examination assessing knowledge obtained at each stage of training will be given during the last week. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date. Exposure to GI and GU fluoroscopic exams throughout residency is a MUST to maintain skills. Flouroscopic skills will be introduced and maintained in the follow rotations:
DUTIES AND RESPONSIBILITIES
Protocol for CT colonography review:
- Review Terarecon video instructions to ensure you know how to use the software - Independently review a CTC study and discuss results (colonic and extra colonic) with staff - Discrepancies in findings require further review (be sure to bookmark the images or record image numbers of polyps to be time efficient) - If no discrepancies, a report can be dictated and sent to staff
PGY2 GI/GU FLOURO ROTATION RESPONSIBILITES Resident rotates between sites to allow greater exposure to pathology and machinery at both sites
- Resident is assigned to the flouro days at both sites to allow for maximum exposure to flouro- - Busier flouro days at HSC: Tuesday, Thursday, Friday - Busier flouro days at SCH: Monday, Wednesday, Thursday, Friday
- This suggested schedule can be modified according to bookings with communication of rotation supervisors between sites. - Flouroscopic exams take precedence over all other radiologic studies. - If rarely, there are no flouro studies, inpatient film list is resident responsibility. - In the AM, contact the assigned staff and schedule read out times. - If once flouro and inpatient plain films are take care of, resident can attempt reading of CTC, CTE, MRE. - Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule read out time with staff.
http://www.terarecon.com/support/iNtuitionVideo/iNtuitionVideo.html online video tutorials CTC software can be found in session 8 and 9
PGY2 Body CT GI/GU
Daily Performance Cards are required for this rotation.
· Occurs at whatever site the resident is assigned to
· 1 day/week the resident is on flouro room and EXEMPT from CT responsibilities · This is the day with most flouro booked to ensure maximum exposure · Traditionally Tuesdays at HSC, and Wednesdays at SCH · If rarely, there are no flouro studies, inpatient film list is resident responsibility. · In the AM, contact the assigned staff and schedule read out times.
PGY3 Body CT GI/GU (the rotation without MR)
Daily Performance Cards are required for this rotation.
- Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from CT responsibilities - One day a week (for a total of 4 days) of flouro on the day that has the most bookings - If once flouro is take care of, resident can attempt reading of CTC, CTE, MRE - Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule read out time with staff.
PGY4 Body CT GI/GU (the rotation with last 2 weeks MR)
Daily Performance Cards are required for this rotation.
- Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from CT responsibilities - One day a week (for a total of 2 days) of flouro on the day that has the most booking. Traditionally Tuesdays at HSC, and Wednesdays at SCH - If once flouro is take care of, resident can attempt reading of CTC, CTE, MRE - Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule readout time with staff
Other Duties and Responsibilities The resident may be asked to perform other fluoroscopic studies when there is no other resident assigned to that specific procedure rotation. Required Reading List
Please read the corresponding RSNA physics module, as outlined in the Physics curriculumhttp://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
- Fundamentals of Diagnostic Radiology Text Readings, Chapter 26 - Pages 733- 755 The Perihepatic Space: Comprehensive Anatomy and CT Features of Pathologic Conditions RadioGraphics 2007; 27:129–143 Published online
- Anatomic CT Demonstration of the Peritoneal Spaces, Ligaments, and Mesenteries: Normal and Pathologic RadioGraphics 1995; 15:755-770
1. Medical Expert
Gain knowledge of the pharmacology as it relates to barium, gastrografin and glucagon.
Perform, interpret and report upper and lower GI studies including small bowel studies.
Become competent in the interpretation and technical aspects with a focus of attention on plain film examinations and contrast studies.
Know the indications, limitations and complications and be able to perform, interpret, and report the following studies:
• Double contrast upper gastrointestinal series including esophogram • Small bowel follow-through with screening of terminal ileum • Small bowel enema • Single contrast barium enema • Double contrast barium enema • Gastrograffin swallow / upper GI and enema • T-tube cholangiogram • Sialogram • Interpretation of ERCP
Know the indications and be able to interpret and report an abdominal series. Know the anatomy and function of the GI tract from the mouth to the anus.
Be able to recognize and give the differential diagnosis of at least the following:
• Pneumoperitoneum, pneumoretroperitoneum • Gas in the biliary tree, portal venous system and pneumotosis intestinalis • Ascites • Abdominal mass • Abdominal calcification • Esophageal, gastric, small and large bowel obstruction • Ileus • Mucosal thickening (i.e., “thumbprinting”) • Strictures • Fistulas and sinus tracts • Abnormalities as seen on contrast studies outlined in Objectives #1 and #2
Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of the following:
Benign masses/lesions of the GI tract including:
Inflammatory ulcers/lesions Infectious ulcers/lesions Spindle cell tumour Polyps Strictures Malignant masses/lesions of the GI tract including:
Aden carcinoma, squamous and sarcomas of the GI tract Carcinoid Metastatic disease to and from the GI tract Inflammatory bowel disease Ischemic bowel disease Motility disorders of the GI tract Congenital anomalies of the GI tract Diverticulae of the GI tract Know and recognize the surgical procedures commonly performed on the GI tract, for example: Bilroth I and II Roux-en –Y Whipple’s procedure Esophagectomy with gastric pull through Hemi and total colectomy, A-P resection
Outline and discuss the different imaging modalities available and their appropriate indications in the comprehensive evaluation of the abdomen. Identify, describe, and discuss the following:
1. Peritoneal fluid 2. Pneumoperitoneum 3. Abdominal calcifications
Acquire a sound knowledge base in and accurately recognize, describe, and discuss the following:
1. Acute Abdomen 2. Small Bowel Obstruction 3. Large Bowel Obstruction 4. Bowel Ischemia and Infarction Abdominal Trauma 5. Lymphadenopathy 6. Abdominopelvic Tumors and Masses 7. AIDS in the Abdomen
2. Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis and, where appropriate, recommend further investigation or management.
3. Collaborator
Interact with house staff and referring physicians as “first contact”.
4. Manager
Make cost effective use of health care resources based on sound judgment.
Understand the fundamentals of quality assurance.
5. Health Advocate
Promote the health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate Radiation dose and to act as an advocate for patients in terms of their diagnostic imaging needs.
6. Scholar
See as many cases as possible during the days with follow-up reading performed at night.
7. Professional
Be Punctual.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and applies these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
PGY3, PGY4 & PGY5 Mammography (SC)
SUPERVISOR: Dr. Connie Hapgood, St. Clare’s Overall educational goals for the program:
Residents will spend a total of 4 months working in breast imaging, and will be expected to develop general competency in all aspects of breast screening and diagnosis. General competency is defined as the ability to interpret screening and diagnostic mammography, breast ultrasound, and breast MRI; to guide clinical colleagues in the correct imaging evaluation of screening patients as well as diagnostic patients with various clinical breast problems; and to have a working knowledge of breast interventional procedures and breast pathologies. The goal of residency training in breast imaging is to be proficient at screening and diagnostic mammography, breast ultrasound, needle localization procedures, and core biopsy techniques. As well as to develop a working knowledge of breast MRI.
Residents rotate through breast imaging at St. Clare’s hospital. Duties will involve screening and diagnostic mammography/ultrasound, as well as breast MRI and interventional procedures. Trainees will function as a daily member of the breast imaging service while rotating through the various breast imaging duties that comprise the section’s work, including participating in weekly Radiology Pathology rounds. Currently, residents rotate through breast imaging in their third, fourth and fifth year of residency.
The following is an outline of the objectives of the breast imaging rotation during residency incorporated into the CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations.
The assessment tools utilized during each rotation include an end of rotation exam and ITER. For all breast imaging blocks, a score of 70% must be obtained on end of rotation exams. If not, the exam must be repeated until a score of 70% is achieved. There will be a mid rotation progress discussion to help guide the resident as needed.
Suggested reading list (PGY3, 4, 5);
ACR BI-RADS® Atlas Fifth Edition Quick Reference Guide. Available at: https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/BIRADS/Posters/BIRA DS-Reference-Card_web_F.pdf?la=en Fundamentals of Diagnostic Radiology by Brant and Helms (Breast chapter). Clinical breast imaging by Gilda Cardenosa Breast MRI Diagnosis and Intervention by Morris and Liberman Breast Imaging: The requisites. Breast Imaging: Case review series.
Goals and objectives for each trainee at each educational level:
PGY3 (1 month):
Medical Expert
Develop an organized approach to dictating a mammographic/breast ultrasound study.
Know the anatomy of the female breast including lymphatic drainage routes and physiologic changes that occur with age, pregnancy and HRT.
Know the anatomy of the male breast and how it differs from a female. Become familiar with the appearance of gynecomastia on breast imaging.
Understand the difference between and role of screening mammography and diagnostic mammography.
Recognize the commonly used mammographic projections and what constitutes proper positioning and technique. Observe one mammogram being performed by the technologists during the first week of the rotation.
Recognize common mammographic artifacts.
Be able to appraise breast density and describe the risks associated with dense breast tissue.
Be able to localize a lesion within the breast given standard (MLO, CC) and problem solving mammographic views (spot views, true lateral, exaggerated CC).
Identify and classify breast masses, calcifications, architectural distortions and other abnormalities on mammographic images using the Birads Lexicon.
Develop an understanding of Birads classification with regards to mammography. Distinguish benign features from malignant ones.
Understand the indications, correlation and complications of breast interventional procedures initially observing and then performing under supervision of a radiologist. Procedures such as: guidance.
ultrasound guidance
Be able to localize pathology in a breast lumpectomy specimen.
Develop an understanding of the indications for breast ultrasound.
Develop an understanding of what constitutes adequate sonographic technique with regards to breast imaging.
Be able to correlate mammography and breast ultrasound with regards to lesion localization.
Perform and interpret breast ultrasound examinations under the supervision of a radiologist.
Identify and classify breast masses and other abnormalities on ultrasound using Birads Lexicon.
Recognize common artifacts often encountered in the assessment of a lesion using ultrasound.
Develop an understanding of Birads classification with regards to breast ultrasound. Distinguish benign features from malignant ones.
Introduction to breast MRI imaging.
Introduction to the physics of breast imaging (dedicated teaching in Physics curriculum). a) Mechanism of obtaining and optimizing film-screen or digital mammograms i) Target/filter combinations ii) Use of a grid iii) Reduction of scatter iv) Radiation dose b) Adjustment of mammography techniques for special cases, including thin breasts c) Mechanism of obtaining and optimizing breast US images d) Mechanism of obtaining and optimizing breast MR images e) Recognizing, understanding, and correcting artifacts in breast imaging, including mammography, US, and MR imaging f) Workstation display of digital mammograms i) Required equipment parameters ii) ) Image processing
Computer-assisted display software for breast MRI, including the role of dynamic enhancement characteristics
Communicator:
Develop an organized approach to dictating a mammographic study and breast ultrasound.
Establish good relationships with other health professionals. Actively take part in discussions at weekly Radiology Pathology rounds, first week observing then responsible for dictating addendum to biopsy report and faxing the addendum to the referring physician. This ensures open communication so that the referring physician is aware of the result of the biopsy (benign or malignant) and the plan of action.
Establish good relationships with the patient and their families. Obtain informed consent for all interventional procedures. Address concerns of the patient and their family members when needed.
Collaborator:
Become an effective consultant of radiology.
Work effectively with other members of the health care team. Interact with house staff, nurses, technologists, booking staff, and other physicians as “first contact” to streamline requests. Staff radiologist always available for consult.
When needed, discuss with booking staff and referring physician the need for additional studies/biopsy and corresponding booking dates.
Effectively involve the patient in the decision making process of their follow up care whether it be additional radiographic studies, biopsy or consultation with other health professional i.e. surgery.
Leader:
Set realistic priorities and use time effectively to optimize professional performance.
Understand the principles of practice management and quality assurance.
Demonstrate effective use, allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competency in ensuring patient safety.
Health Advocate:
Understand the issues regarding screening mammography.
Recognize the radiologist’s role to ensure all patients receive the appropriate radiological investigation.
Understand and communicate the benefits and risks of radiological intervention and treatment, including screening.
Recognize the effect on over calling findings on the patient’s mental health.
Scholar: Demonstrate an understanding and a commitment to the need for continuous learning.
Be aware of up to date literature concerning the current staging and Birads classification of breast carcinoma.
Be up to date on current surgical and medical management techniques with regards to breast pathologies both benign and malignant.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to breast radiology.
Demonstrate an ability to be an effective teacher of breast radiology. Actively contribute to weekly Rad Path rounds.
Contribute one interesting case per rotation to the Radiology Breast Imaging teaching file. Review such case with one of the breast Radiologists and then present the case at weekly interesting case rounds.
Professional:
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of care and professionalism to all colleges and patients.
Demonstrate integrity, honesty, compassion and respect for diversity.
Demonstrate reliability and conscientiousness.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Be committed to the health and well being of all patients, however also understand the importance of one’s own health and well being.
Accept advice graciously.
Fulfill medical, legal and professional obligations of a diagnostic radiologist.
PGY4 (two month rotation)
Medical Expert:
Continue to expand and develop the skills and knowledge learned during the PGY3 rotation with regards to mammography and breast ultrasound. Understand Mammography Quality Assurance standards (MQSA). Know the requirements for the various components of an inspection. Have a working knowledge of use of Kuhls curves Know the indications for breast MRI Develop a working knowledge of breast MRI imaging protocols and techniques needed to produce high quality breast MRI images; review methods for optimizing MRI in keeping with current recommended standards Review the image patterns of normal fibroglandular tissue on breast MRI and the effect of hormonal influences. Characterize breast lesions, interpret and report on breast MRI examinations in accordance with the ACR BI-RADS lexicon Be able to assess and interpret the post surgical breast on MRI, including implant assessment. Use MRI guided breast biopsy tools effectively and safely, first observing then performing under the supervision of a radiologist. Develop an approach to the interpretation and follow up of the post surgical breast on mammography, ultrasound and MRI. This would include such entities as breast reduction, post lumpectomy and implant evaluation. Recognize radiation changes on mammography, ultrasound and MRI. Recognize commonly encountered artifacts on breast MRI.
Continue to build on knowledge of physics related to breast imaging.
Communicator:
Develop an organized approach to dictating a breast MRI.
Continue to effectively dictate mammography and breast ultrasound.
Establish good relationships with other health professionals.
Continue to actively take part in discussions at weekly Radiology Pathology rounds, dictating addendum to biopsy report and faxing the addendum to the referring physician. This ensures open communication so that the referring physician is aware of the result of the biopsy (benign or malignant) and the plan of action.
Establish good relationships with the patient and their families. Obtain informed consent for all interventional procedures. Address concerns of the patient and their family members when needed.
Collaborator: Be an effective consultant of radiology.
Work effectively with other members of the health care team. Interact with house staff, nurses, technologists, booking staff, and other physicians as “first contact” to streamline requests. Staff radiologist always available for consult.
When needed, discuss with booking staff and referring physician the need for additional studies/biopsy and corresponding booking dates.
Effectively involve the patient in the decision making process of their follow up care whether it be additional radiographic studies, biopsy or consultation with other health professional i.e. surgery.
Leader:
Set realistic priorities and use time effectively to optimize professional performance.
Understand the principles of practice management and quality assurance particularly in how it relates to breast imaging.
Demonstrate effective use, allocation and utilization of health care resources with specific attention to breast radiology.
Demonstrate competency in ensuring patient safety.
Health Advocate:
Understand the issues regarding screening mammography, screening breast MRI.
Recognize the radiologists role to ensure all patients receive the appropriate radiological investigation.
Understand and communicate the benefits and risks of radiological intervention and treatment, including screening.
Recognize the effect on over calling findings on the patient’s mental health.
Scholar:
Demonstrate an understanding and a commitment to the need for continuous learning.
Be aware of up to date literature concerning the current staging and Birads classification of breast carcinoma.
Be up to date on current surgical and medical management techniques with regards to breast pathologies both benign and malignant.
Develop and implement an ongoing and effective personal learning strategy. Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to breast radiology.
Demonstrate an ability to be an effective teacher of breast radiology. Actively contribute to weekly Rad Path rounds.
Contribute one interesting case per rotation to the Radiology Breast Imaging teaching file. Review such case with one of the breast Radiologists and then present the case at weekly interesting case rounds.
Professional:
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of care and professionalism to all colleges and patients.
Demonstrate integrity, honesty, compassion and respect for diversity.
Demonstrate reliability and conscientiousness.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Be committed to the health and well being of all patients, however also understand the importance of one’s own health and well being.
Accept advice graciously.
Fulfill medical, legal and professional obligations of a diagnostic radiologist.
PGY5 (one month)
Medical Expert:
Continue to expand and develop the skills and knowledge learned during the PGY3 and PGY4 rotation with regards to mammography, breast ultrasound and breast MRI. Recite the staging of breast carcinoma with ease. Function at a junior staff level in breast imaging. Have a good understanding on the physics of breast imaging, including mammography, ultrasound and MR imaging.
Communicator:
Have an organized approach to dictating a mammogram, breast ultrasound and breast MRI. Establish good relationships with other health professionals.
Continue to actively take part in discussions at weekly Radiology Pathology rounds, dictating addendum to biopsy report and faxing the addendum to the referring physician. This ensures open communication so that the referring physician is aware of the result of the biopsy (benign or malignant) and the plan of action.
Establish good relationships with the patient and their families. Obtain informed consent for all interventional procedures. Address concerns of the patient and their family members when needed.
Collaborator:
Be an effective consultant of radiology.
Work effectively with other members of the health care team. Interact with house staff, nurses, technologists, booking staff, and other physicians as “first contact” to streamline requests. Staff radiologist always available for consult. When needed, discuss with booking staff and referring physician the need for additional studies/biopsy and corresponding booking dates.
Effectively involve the patient in the decision-making process of their follow up care whether it be additional radiographic studies, biopsy or consultation with other health professional i.e. surgery.
Leader:
Set realistic priorities and use time effectively to optimize professional performance.
Understand the principles of practice management and quality assurance in breast imaging.
Demonstrate effective use, allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competency in ensuring patient safety.
Health Advocate:
Understand the issues regarding screening mammography, screening breast MRI.
Recognize the radiologists role to ensure all patients receive the appropriate radiological investigation.
Understand and communicate the benefits and risks of radiological intervention and treatment, including screening.
Recognize the effect on over calling findings on the patient’s mental health. Scholar:
Demonstrate an understanding and a commitment to the need for continuous learning.
Be aware of up to date literature concerning the current staging and Birads classification of breast carcinoma.
Be up to date on current surgical and medical management techniques with regards to breast pathologies both benign and malignant.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to breast radiology.
Demonstrate an ability to be an effective teacher of breast radiology. Actively contribute to weekly Rad Path rounds.
Contribute one interesting case per rotation to the Radiology Breast Imaging teaching file. Review such case with one of the breast Radiologists and then present the case at weekly interesting case rounds.
Professional:
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of care and professionalism to all colleges and patients.
Demonstrate integrity, honesty, compassion and respect for diversity.
Demonstrate reliability and conscientiousness.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Be committed to the health and well being of all patients, however also understand the importance of one’s own health and well being.
Accept advice graciously.
Fulfill medical, legal and professional obligations of a diagnostic radiologist.
PGY3 & PGY5 MRI SUPERVISOR: Dr. Paul Jeon, Health Sciences Centre The following is an outline of the goals and objectives of the MRI rotation during PGY 3 and 5, incorporated into CanMEDS format. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES: At the beginning of the rotation, the MR resident will inform the MR operating staff at the Janeway and HSC of his/her daily responsibility to help initiate, organize, protocol and report appropriate MR imaging tests. It is the duty of the resident to function at all times in a professional, mature and responsible manner, whether dealing with patients, colleagues, or health care workers. The MR resident must review all MR abdominal exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The junior MR resident is responsible only for the abdominal MR exams during his/her month. The senior MR resident should review selected MR MSK exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The senior MR resident may review selected MR CNS exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The MR resident will be responsible to prepare 2 MR cases, on PowerPoint (in ICR format) from a provided list, to the MR supervisor by the end of the rotation. The MR resident is responsible to review and read vigorously from the suggested reading list. An end of rotation exam will be given during the last week of the rotation to assess knowledge and where applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
SPECIFIC DAILY DUTIES Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible. Any holiday time taken during this rotation must have appropriate approval and follow the protocol outlined in the Radiology Resident Manual. The MR Resident will review at least 10 (total number) of Abdominal and/or MSK PF per day with the staff designated in either of the ER PF or MR slots contained in the Work Rota. When there is no staff designated in the ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot. The MR resident will check the daily MR patient list at both sites (Janeway and HSC) to ensure proper protocols are in place and to deal with any safety/contrast questions that may arise. The MR resident will present cases to staff in a prepared, organized fashion and subsequently dictate a timely concise, accurate report. A verbal report must be provided to the responsible attending physician for urgent findings that are detected; the details of this communication must be then acknowledged subsequently at the end of the generated report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
REQUIRED READING LIST It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Practical Guide to Abdominal and Pelvic MRI: John Leyendecker, Jeffrey Brown MSK MRI: Clyde Helms, Nancy Major
Recommended reading list: Body MRI : Evan Seigelman
Resource List : MRI Normal Variants and Pitfalls: Laura Bancroft, Mellena Bridges http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert OBJECTIVES PGY 3 :
After completing this rotation, the resident should be able to: 1. Identify and describe the basic MR anatomy of the abdomen/pelvis, Musculoskeletal and CNS systems.
2. Articulate the basic physics of MRI.
3. Describe and identify pertinent MR safety issues.
4. Determine indications for appropriate MR examinations in relation to the specific organ system, after reviewing pertinent background clinical information, and preceding diagnostic examinations.
5. Outline and discuss current MR imaging procedures/protocols after studying the accompanying MR Protocol Document and content structure/suggested readings:
6. Outline and discuss indications and contraindications of Gadolinium contrast agents as well as the following: a) Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast media excretion. b) Identify patients who are at risk from injection of intravascular radiographic contrast material. Comprehend the classification, symptoms, and signs of contrast reactions and clinical management including appropriate use of pharmacologic agents and their mode of administration and doses after appropriate patient assessment. i) Consult the ACR Manual for Contrast Media. ii) Be prepared to answer patient and staff questions concerning when contrast media should or should not be utilized and how to treat contrast reactions. c) Understand the indications for premedication and the appropriate regimen to premedicate contrast sensitive patients including dosages, and dose scheduling 7. Describe the major elements in the MR organ based medical knowledge objectives (curriculum) specifically in the Abdominal, MSK and CNS systems.
8. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
9. Effectively communicate simple instructions to technologists and significant findings to the referring physician staff and house staff.
10. Organize MR diagnostic imaging requests that are generated by the ordering clinicians.
OBJECTIVES PGY 5 : After completing this rotation, the resident should be able to: 11. Demonstrate a thorough understanding of the basic MR anatomy of the abdomen/pelvis , Musculoskeletal and CNS systems .(PGY 5)
12. Display a sound working knowledge of the physics of MRI.
13. Describe, identify and deal with pertinent MR safety issues.
14. Determine indications for, and implement appropriate MR examinations in relation to the specific organ system, after reviewing pertinent background clinical information, and preceding diagnostic examinations.
15. Outline and discuss and implement current MR imaging procedures/protocols after studying the accompanying MR Protocol Document and content structure/suggested readings:
16. Demonstrate a sound understanding of the indications and contraindications of Gadolinium contrast agents as well as the following: a) Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast media excretion. b) Identify patients who are at risk from injection of intravascular radiographic contrast material. Comprehend the classification, symptoms, and signs of contrast reactions and clinical management including appropriate use of pharmacologic agents and their mode of administration and doses after appropriate patient assessment. i) Consult the ACR Manual for Contrast Media. ii) Be prepared to answer patient and staff questions concerning when contrast media should or should not be utilized and how to treat contrast reactions. c) Understand the indications for premedication and the appropriate regimen to premedicate contrast sensitive patients including dosages, and dose scheduling 17. Describe the major elements in the MR organ based medical knowledge objectives (curriculum) specifically in the Abdominal, MSK and CNS systems.
18. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
19. Effectively communicate instructions to technologists and significant findings to the referring physician staff and house staff.
20. Initiate, organize/coordinate and screen/triage MR diagnostic imaging requests that are generated by ordering clinicians. a) Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology (recognition of imaging abnormalities with synthesis of clinical and radiological information to arrive at the correct diagnosis or differential diagnosis) b) Progressive increase in radiological knowledge base and continuous learning in MR Radiology during rotations and case based study. c) Acquire knowledge of principles of MR Physics d) Demonstrate the ability to use all relevant Resource Materials e) Knowledge of principles of research design and implementation. f) Demonstrates knowledge of MR imaging produces diagnostic information and their advantages and limitations. g) Have film reading ability of plain film (abdominal/MSK) examinations. h) Be able to recommend an appropriate MR imaging study in an emergent situation.
2. Communicator Communicate effectively with patients/families, referring physicians, and co-workers. Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management. Establish good relationships with peers and other health professionals while effectively providing and receiving information. Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management. Skills: a) Provide an accurate clear and informative radiologic report with a precise diagnosis when possible or a relevant differential diagnosis with recommendations for follow up or further imaging as appropriate b) Directly communicate urgent and unexpected findings with the referring physician or their representative. Document the communication in the report.
c) Demonstrate effective face to face skills with patients and their families, other physicians, nurses, technologists and support staff d) Demonstrate appropriate telephone and digital communication skills e) Demonstrate skills in obtained written and verbal informed consent f) Participate in multidisciplinary conferences and radiologic case presentations.
3. Collaborator Become an effective consultant of radiology. Interact effectively with health professionals by recognizing their roles and expertise. Collaborate effectively and constructively with other members of the health care team. Interact with house staff and referring physicians as “first contact”. Be active participants in inter and intra discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology. Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Make cost effective use of health care resources based on sound judgment. Set realistic priorities and use time effectively in order to optimize professional performance. Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5. Health Advocate Promote health of the population through the application of radiology. Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment including population screening. Understand the issues regarding screening (i.e. lung cancer and cardiac calcification). Recognize the burden of illness upon the patients served by Radiology.
Skills: a) Gather essential and accurate information about patients
b) Gather information from the patient folder, faculty, literature, digital textbooks and internet c) Develop an imaging plan based on the clinical presentation and available information d) Perform the appropriate examination with skill and knowledge. f) Demonstrate knowledge regarding the indications and contra-indications of MR imaging. g) Ascertain that the correct procedure is performed on the correct patient h) Explain the procedure and obtain consent if required. 6. Scholar Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this. Demonstrate an ability to be an effective teacher of radiology. See as many cases as possible during the days with follow-up reading performed at night. Residents are required to present and teach to other residents, medical students and house staff.
Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and improvement goals; use multiple sources, including information technology to optimize life- long learning and support patient care decisions. Incorporate formative evaluation feedback into daily practice.
7. Professional Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously. Demonstrate confidentiality with all information transmitted during a patient encounter. Demonstrate an understanding of broad principles of biomedical ethics.
Demonstrate positive work habits including punctuality and a professional appearance. Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance abuse) obligations for impaired physician reporting, and resources and options for care of self-impairment or impaired colleagues.
PGY2 Musculoskeletal Radiology (HSC) (The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS)
SUPERVISOR: Dr. John Hopkins, Health Sciences The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies with an emphasis on plain radiographs. 1. The minimum number of plain radiographs is 30 per day. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday & 15-20 studies on Tuesday). 2. All MSK CT exams for the week (average 1-2 per day).
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM. Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon, but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit) and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be assigned with technologist. Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility of resident until their return at end of rotation. 1. MSK Section of Brant & Helms 2. Arthritis in Black and White (St. Clare’s Rotation) 3. Musculoskeletal MRI: Chapters 1,2,10,15 (Introduction, Marrow, Shoulder, Knee) 4. The Requisites: Musculoskeletal Imaging: Chapters 1, 2, 29-37, 40, 41, 45, 48, 49 5. Orthopedic Imaging: Chapters 4-10 inclusive, 16, 29, 6. Arthrography: Chapter 7 (Shoulder) 7. Research Assigned Topics & Cases: Resnick & related journal articles
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system. Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton.
Demonstrate learning of normal MRI anatomy of the knee and shoulder.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions including systemic lupus. Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should know the features of aggressive and non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulites • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on knee and shoulder). Recognize and describe imaging features of internal derangements of joints with an emphasis on the knee and shoulder. The resident should have good understanding of at least the following: • ACL tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • OCD • Rotator cuff tear • Shoulder labral tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies • Lytic/radiolucent bony lesion (s) • Sclerotic bony lesion (s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
PGY3 Musculoskeletal Radiology (HSC) SUPERVISOR: Dr. John Hopkins, Health Sciences The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal rotation, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies. 3. The minimum number of plain radiographs is 40 per day. 4. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday & 15-20 studies on Tuesday). 5. All MSK CT exams for the week (average 1-2 per day).
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon, but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit) and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation. Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility of resident until their return at end of rotation. 8. Review Arthritis in Black and White 9. Musculoskeletal MRI: Infection, Tumor, Hip, Wrist & Review Chapters Shoulder, Knee, Infection, Tumor) 10. The Requisites: Musculoskeletal Imaging: Chapters 16-28, 50 11. Orthopedic Imaging: Chapters 17-23, 24-28 12. Research Assigned Topics & Cases: Resnick & related journal articles
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder. Demonstrate learning of normal MRI anatomy of the hip and wrist. Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate salient radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone lesions including biopsy approach and compartmental anatomy.
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulitis • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on hip and wrist) Recognize and describe imaging features of internal derangements of joints with an emphasis on the hip and wrist. The resident should have good understanding of at least the following: • ACL tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • Knee OCD • Rotator cuff tear • Biceps tendon rupture (proximal and distal) • Shoulder and hip labral tear • Hip AVN • Transient osteoporosis • Hip Fracture • Femoroacetabular Impingement • Kienbock’s • TFCC Tear • Tenosynovitis • Scapholunate/lunotriquetral ligament tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings: • Mono/poly arthropathies • Lytic/radiolucent bony lesion (s) • Sclerotic bony lesion (s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
2. Communicator Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. 4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness. Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY4 & PGY5 Musculoskeletal Radiology (HSC) SUPERVISOR: Dr. John Hopkins, Health Sciences The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal rotation during PGY 4 & 5, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES Become a near- independent provider of musculoskeletal interpretative services.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies. 1. The minimum number of plain radiographs is 50 per day. 2. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday & 15-20 studies on Tuesday). 3. All MSK CT exams for the week (average 1-2 per day). Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon, but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit) and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation. Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and second rotations.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility of resident until their return at end of rotation. 13. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee 14. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47 15. Research Assigned Topics & Cases: Resnick & related journal articles http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot. Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate salient radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone lesions including biopsy approach and compartmental anatomy. Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should know the features of aggressive and non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulitis • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Recognize radiologic findings and describe pathophysiology of endocrine disease including hyperparathyroidism, renal osteodystrophy, osteomalacia/rickets, hypophosphatasia, shypophosphatemia.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia, thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on elbow, ankle and foot) Recognize and describe imaging features of internal derangements of joints with emphasis upon elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should have good understanding of at least the following: • ACL tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • Knee OCD • Rotator cuff tear • Biceps tendon rupture (proximal and distal) • Shoulder and hip labral tear • Hip AVN • Transient Osteoporosis • Hip fracture • Femoroacetabular impingement • Transient osteoporosis • Kienbock’s • TFCC Tear • Tenosynovitis • Scapholunate/lunotriquetral ligament tear • Achilles tendon rupture • Medial, lateral and anterior ankle tendon injury • Ankle ligament tears • Tarsal tunnel syndrome • Sinus tarsi syndrome • Tarsal/carpal coalition • Talar OCD/osteochondral injury and AVN • Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies • Lytic/radiolucent bony lesion (s) • Sclerotic bony lesion (s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
2. Communicator Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management. Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY2 Musculoskeletal Radiology (SC) SUPERVISOR: Dr. Eric Pike, St. Clare’s The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2, incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience and would appreciate that any problems arising prior to, during or after your rotation be brought directly to my attention first. The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given within the last week and will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of fill-in-the- blank and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and procedures related to the musculoskeletal system. During each 4 week rotation the resident should: 1. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient areas.
2. Check each day for interventional procedures that are booked including arthrograms and biopsies, as well as joint injections and aspirations.
3. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases performed using these modalities should be forwarded to you. Effort should be made to be present for ultrasound studies particularly involving the shoulder and other tendons.
4. Review MRI cases performed under St. Clare’s. These studies are generally performed on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if desired but this is not mandatory. The Junior Resident should concentrate on the common exams of the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload for the week can be up to 25 cases.
5. At the end of your rotation, we are going to be administering a short oral exam of approximately 10 cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies with an emphasis on plain radiographs.
1. The minimum number of plain radiographs is 30 per day. 2. All adult MR examinations for the week performed on Wednesday, Thursday and Friday. 3. All MSK CT exams for the week (average 1-2 per day). 4. All risk Ultrasound exams (average 10 – 15 per week)
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled. Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be assigned with technologist. Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations. Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to the resident at the beginning of rotation and are the responsibility of the resident until their return at the end of the rotation. 16. MSK Section of Brant & Helms 17. Arthritis in Black and White (St. Clare’s Rotation) 18. Musculoskeletal MRI: Chapters 1,2,10,15 (Introduction, Marrow, Shoulder, Knee) 19. The Requisites: Musculoskeletal Imaging: Chapters 1, 2, 29-37, 40, 41, 45, 48, 49 20. Orthopedic Imaging: Chapters 4-10 inclusive, 16, 29, 21. Arthrography: Chapter 7 (Shoulder) 22. Research Assigned Topics & Cases: Resnick & related journal articles 23. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005 24. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier 2009 25. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition) 26. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004 27. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004 28. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006 29. Musculoskeletal Imaging: A Teaching File, F. Chew, 2nd Edition, 2005
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton.
Demonstrate learning of normal MRI anatomy of the knee and shoulder.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions including systemic lupus. Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should know the features of aggressive and non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Chondrosarcoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulitis • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on knee and shoulder). Recognize and describe imaging features of internal derangements of joints with an emphasis on the knee and shoulder. The resident should have good understanding of at least the following: • ACL tear and PCL tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • OCD • Rotator cuff tear • Shoulder labral tear and Variants (Spectrum of labral injury)
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies • Lytic/radiolucent bony lesion(s) • Sclerotic bony lesion(s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
2. Communicator Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report. Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously. PGY3 Musculoskeletal Radiology (SC) SUPERVISOR: Dr. Eric Pike, St. Clare’s The following is an outline of the goals and objectives of the Musculoskeletal rotation, incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I would appreciate that any problems arising prior to, during or after your rotation be brought directly to my attention first. The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given within the last week and will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of fill-in-the- blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and procedures related to the musculoskeletal system. During each 4 week rotation the resident should: 6. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient areas.
7. Check each day for interventional procedures that are booked including arthrograms, biopsies as well as joint injections and aspirations.
8. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases performed using these modalities should be forwarded to you. Effort should be made to be present for ultrasound studies particularly involving the shoulder and other tendons.
9. Review MRI cases performed under St. Clare’s each week. These studies are generally performed on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if desired but this is not mandatory. The Junior Resident should concentrate on the common exams of the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier caseload.
10. At the end of your rotation, we are going to be administering a short oral exam of approximately 10 cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies.
6. The minimum number of plain radiographs is 40 per day. All adult MR examinations for the week performed on Wednesday, Thursday and Friday. 7. All MSK CT exams for the week (average 1-2 per day). 8. All risk Ultrasound exams (average 10 – 15 per week)
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation. Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to the resident at beginning of the rotation and are the responsibility of the resident until their return at the end of rotation. 30. Review Arthritis in Black and White 31. Musculoskeletal MRI: Infection, Tumor, Hip, Wrist & Review Chapters Shoulder, Knee, Infection, Tumor) 32. The Requisites: Musculoskeletal Imaging: Chapters 16-28, 50 33. Orthopedic Imaging: Chapters 17-23, 24-28 34. Research Assigned Topics & Cases: Resnick & related journal articles 35. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005 36. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier 2009 37. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition) 38. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004 39. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004 40. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006 41. Musculoskeletal Imaging: A Teaching File, F Chew, 2nd Edition, 2005 http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder.
Demonstrate learning of normal MRI anatomy of the hip and wrist.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar spine. Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis. Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate salient radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone lesions including biopsy approach and compartmental anatomy.
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should know the features of aggressive and non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Chondrosarcoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulitis • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on hip and wrist). Recognize and describe imaging features of internal derangements of joints with an emphasis on the hip and wrist. The resident should have good understanding of at least the following: • ACL tear and PCL tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • Knee OCD • Rotator cuff tear • Biceps tendon rupture (proximal and distal) • Shoulder and hip labral tear • Hip AVN • Transient osteoporosis • Hip Fracture • Femoroacetabular Impingement • Kienbock’s • TFCC Tear • Tenosynovitis • Scapholunate/lunotriquetral ligament tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies • Lytic/radiolucent bony lesion (s) • Sclerotic bony lesion (s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
2. Communicator Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file. Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY4 & PGY5 Musculoskeletal Radiology (SC) SUPERVISOR: Dr. Eric Pike, St. Clare’s The following is an outline of the goals and objectives of the Musculoskeletal rotation incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I would appreciate that any problems arising prior to, during or after your rotation be brought directly to my attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and procedures related to the musculoskeletal system. During each 4 week rotation the resident should: 11. Concentrate first & foremost on seeing as many plain radiographs related to MSK imaging. This should include daily films from the Emergency Department, Orthopedic Clinics & Out Patient areas.
12. Check each day for interventional procedures that are booked including arthrograms, biopsies as well as joint injections and aspirations.
13. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases performed using these modalities should be forwarded to you. Effort should be made to be present for ultrasound studies particularly involving the shoulder and other tendons.
14. Review MRI cases performed under St. Clare’s each week. These studies are generally performed on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if desired but this is not mandatory. The Junior Resident should concentrate on the common exams of the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier caseload.
15. At the end of your rotation, we are going to be administering a short oral exam of approximately 10 cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching sessions on various MSK topics.
Become a near- independent provider of musculoskeletal interpretative services.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal system and to be able to interpret and report associated imaging studies. 9. All adult MR examinations for the week performed on Wednesday, Thursday and Friday. 10. All MSK CT exams for the week (average 1-2 per day). 11. All risk Ultrasound exams (average 10 – 15 per week)
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation. Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and second rotations.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST Textbooks will be provided; assigned to the resident at the beginning of the rotation and are the responsibility of the resident until their return at the end of rotation. 42. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee 43. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47 44. Research Assigned Topics & Cases: Resnick & related journal articles 45. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005 46. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier 2009 47. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition) 48. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004 49. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004 50. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006 51. Musculoskeletal Imaging: A Teaching File, F Chew, 2nd Edition, 2005 http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Learn the musculoskeletal anatomy and the normal variations. Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton, and know potential complications associated with them.
Review recognition & description of fractures & dislocations of the cervical, thoracic & lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation & evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe & differentiate salient radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, & synovial chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone lesions including biopsy approach and compartmental anatomy. Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue & bone tumors. The resident should know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging studies. Should know radiology, pathology, presentation and management of at least the following: • Fibrous dysplasia • Eosinophilic granuloma • Giant cell tumor • Non ossifying fibroma • Osteoid osteoma • Multiple myeloma • Metastatic disease • Aneurysmal bone cyst • Solitary bone cyst • Enchondroma • Ewing’s sarcoma • Chordoma • Pigmented villonodular synovitis • Chondroblastoma • Chondrosarcoma • Osteogenic sarcoma • Fibrosarcoma • Liposarcoma • Leiomyosarcoma • Malignant fibrous histiocytoma • Osteoblastoma • Hemangiomas • Osteochondroma (s) • Nerve sheath tumors • Adamantinoma
Recognize features of MSK infection on various imaging studies including: • Osteomyelitis • Septic arthritis • Cellulitis • Myositis • Tenosynovitis • Abscess Formation • Discitis • Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging studies especially related to orthopedic hardware. The resident should also recognize the appearance of various types of hardware. Know the physiology of bone formation and maintenance and be able to recognize abnormalities of this on imaging studies. Gain increased knowledge and understanding of various metabolic conditions affecting the MSK system and be able to recognize their manifestations on imaging studies including: • Renal osteodystrophy • Rickets • Scurvy • Paget’s disease • Avascular necrosis/infarct • Neuropathic joint • Osteoporosis Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Recognize radiologic findings and describe pathophysiology of endocrine disease including hyperparathyroidism, renal osteodystrophy, osteomalacia/rickets, hypophosphatasia, shypophosphatemia.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia, thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders (emphasis on elbow, ankle and foot) Recognize and describe imaging features of internal derangements of joints with emphasis upon elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should have good understanding of at least the following: • ACL tear and PLC tear • Meniscal injury • MCL tear • Lateral complex injury • Postero-lateral corner injury • Quadriceps/patellar tendon tear • Knee OCD • Rotator cuff tear • Biceps tendon rupture (proximal and distal) • Shoulder and hip labral tear plus variants (spectrum of labral injury) • Hip AVN • Transient Osteoporosis • Hip fracture • Femoroacetabular impingement • Transient osteoporosis • Kienbock’s • TFCC Tear • Tenosynovitis • Scapholunate/lunotriquetral ligament tear • Achilles tendon rupture • Medial, lateral and anterior ankle tendon injury • Ankle ligament tears • Tarsal tunnel syndrome • Sinus tarsi syndrome • Tarsal/carpal coalition • Talar OCD/osteochondral injury and AVN • Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings: • Mono/poly arthropathies • Lytic/radiolucent bony lesion (s) • Sclerotic bony lesion (s) • Osteopenia • Sacroillitis • Periosteal reaction • Soft tissue calcification • Soft tissue mass
2. Communicator Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease. Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management. Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds.
Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines. 6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY2 Neuroradiology
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Robert Heale, Health Sciences The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous system and to be able to interpret and report associated imaging studies with an emphasis on Computed Tomography.
Review and report all CT scans of head and spine performed at HSC site.
Where time allows, review some MRI studies to become familiar with this modality in preparation for the PGY3 rotation.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures such as lumbar puncture.
Review CT protocols for your CT list each day.
Submit (in power point format) 4 researched & prepared CNS cases as assigned by the end of the rotation.
Present 1 CNS case each Tuesday at ICR during your rotation. Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST 1. Neuroradiology: Anne Osborne 2. Statdx: Appropriate sections.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Know the gross anatomy of the central nervous system and review the pertinent aspects of functional neuroanatomy. Become exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow, the resident should strive to obtain proficiency in these examinations. Become familiar with the basic imaging sequences required in MRI scanning of the head and spine. Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Know the anatomy and pathology regarding the brain and spinal cord. Be able to read the following films: CT, MRI and myelogram.
Perform myelogram/lumbar punctures. Be able to protocol MRI/CT scan examinations.
Specific Learning Objectives: Normal Variants: Brain: Aging Brain, Arachnoid Granulations, Cavum Septi Pellucidi (CSP), Cavum Velum Interpositum (CVI), Enlarged Perivascular Spaces. Spine: Conjoined Nerve Roots Spine, Incomplete Fusion of Posterior Element Spine, Limbus Vertebra Spine. Congenital/Genetic in the Adult: Brain Aqueductal Stenosis, Chiari Malformation, Dandy Walker Continuum, Lipoma. Spine: Scheuermann Disease, Schmorl Node, Vertebral Segmentation Failure Trauma: Brain Brain Death, Calvarium Fracture, Cerebral Contusion, Cerebral Edema, Diffuse Axonal Injury (DAI), Epidural Hematoma, Herniation Syndromes, Missile and Penetrating Injury, Pneumocephalus, Subarachnoid Hemorrhage, Subdural Hematoma. Spine: Plain radiograph and CT of spinal trauma is covered in MSK, but reinforced in Neuroradiology. Vascular Disease: Arteriolosclerosis, Carotid Cavernous Fistula, Cerebral Infarction, Cerebral Venous Sinus Thrombosis, Hypertensive Hemorrhage, Small Vessel Ischemia, Spontaneous Intracranial Hemorrhage, Aneurysmal Subarachnoid Hemorrhage, Nonaneurysmal Perimesencephalic SAH Vascular Disease, Malformations: Arteriovenous Malformation, Cavernous Malformation Brain, Developmental Venous Anomaly (DVA) Infection: Brain: Abscess, Extra-Axial Empyema, Herpes Encephalitis, Meningitis. Spine: Epidural abscess. Metabolic: Acute Hypertensive Encephalopathy (PRES), Hepatic Encephalopathy, Hypoglycemia, Osmotic Demyelination Syndrome Degenerative: Brain: Alzheimer Dementia, Multi-Infarct Dementia, Normal Pressure Hydrocephalus, Obstructive Hydrocephalus, Porencephalic Cyst. Spine: Acquired Lumbar Canal Stenosis, Cervical Facet Arthropathy, Degenerative Disc Disease, Degenerative Endplate Changes, Disc Herniation, DISH, Spondylolisthesis, Spondylolysis, Synovial Cyst, Toxic: Alcoholic Encephalopathy, CO Poisoning, Drug Abuse, Idiopathic Intracranial Hypertension, Neoplasm, Benign: Brain Hemangioblastoma, Meningioma, Neurofibroma, Pilocytic Astrocytoma, Pituitary Adenoma, Schwannoma. Spine: Hemangioma, Neoplasm, Malignant: Brain: Metastases: Astrocytoma, Low Grade, Glioblastoma Multiforme, Primary CNS Lymphoma, Oligodendroglioma. Spine: Metastatic Lesions, Multiple Myeloma, Cysts, Non-neoplastic: Brain: Arachnoid Cyst, Colloid Cyst, Dermoid Cyst, Epidermoid Cyst. Pineal Cyst. Spine: Perineural Root Sleeve Cyst, Treatment-Related Lesions: CSF Shunts and Complications Idiopathic/Miscellaneous: Empty Sella, Paget Disease, Thick Skull
2. Communicator Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call and the date and time of the discussion in the report. Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file. Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY3 Neuroradiology Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Robert Heale, Health Sciences The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY3, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous system and to be able to interpret and report associated imaging studies with an emphasis on Magnetic Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and/or CT from the HSC site. In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures such as lumbar puncture.
Review MRI protocols for your list each day.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the rotation.
Present 1 CNS case each Tuesday at ICR during your rotation. Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic. REQUIRED READING LIST 1. Neuroradiology: Anne Osborne 2. Statdx: Appropriate sections.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Know the gross anatomy of the central nervous system and to review the pertinent aspects of functional neuroanatomy. To be proficient in the interpretation of imaging studies in the evaluation of patients with neurological and neurosurgical diseases. To be exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow, the resident should strive to obtain proficiency in these examinations. To be familiar with the basic and advanced imaging sequences required in MRI scanning of the head and spine. (Diffusion imaging) Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Know the anatomy and pathology regarding the brain and spinal cord. Be able to read the following films: CT, MRI and myelogram.
Perform myelogram/lumbar punctures. Be able to protocol MRI/CT scan examinations.
Specific Learning Objectives: All of the objectives in the PGY2 rotation, plus: Congenital/Genetic in the Adult:Brain Callosal Dysgenesis, Frontoethmoidal Cephalocele, Coloboma, Congenital Vermian Hypoplasia, Heterotopic Gray Matter, Dehiscent Jugular Bulb, Pachygyria-Polymicrogyria, Persistent Trigeminal Artery, Pituitary Stalk Anomalies, Schizencephaly, Tuber Cinereum Hamartoma Spine: Anterior Sacral Meningocele, Connective Tissue Disorders, Diastematomyelia, Klippel-Feil Spectrum, Myelomeningocele, Neurenteric Cyst, Tethered Spinal Cord, Ventriculus Terminalis. Congenital/Genetic, Neurocutaneous Syndromes: HHT, Neurofibromatosis 1, Neurofibromatosis 2, Sturge-Weber Syndrome, Tuberous Sclerosis Complex, von Hippel Lindau Trauma: Brain CSF Leak, Diffuse Axonal Injury (DAI), Extracranial Dissection, Intracranial Dissection, Intracranial Hypotension Spine: Central Spinal Cord Syndrome, Contusion-Hematoma, Post-Traumatic Syrinx, Vascular Disease: CADASIL, Carotid Cavernous Fistula, Cerebral Amyloid Disease, Cerebral Ischemia-Infarction/ Diffusion Imaging, Dural A-V Fistula, Hypertensive Encephalopathy, Hypotensive Cerebral Infarction, Moyamoya, Persistent Trigeminal Artery, Primary Arteritis of the CNS, Vascular Loop Syndrome (CPA-IAC), Vasculitis, Vertebrobasilar Insufficiency. Spine: Spinal Cord Infarction, Vascular Disease, Aneurysms: Fusiform Aneurysm, Pseudoaneurysm, Saccular Aneurysm, Superficial Siderosis Vascular Disease, Malformations: Capillary Telangiectasia, Dural A-V Fistula, Vein of Galen Malformation Infection: Brain: AOM with Complication, Apical Petrositis, Encephalitis, Fungal Diseases, Fungal Sinusitis, HIV Encephalitis, Lyme Disease, Neurocysticercosis, Opportunistic Infection, AIDS, Tuberculosis, Ventriculitis Spine: Epidural abscess, Viral Myelitis, Osteomyelitis/discitis. Inflammation: Brain:ADEM, Cerebral Amyloid Angiopathy, Lymphocytic Hypophysitis, Mucocele, Multiple Sclerosis, Neurosarcoid, Optic Neuritis, Sinonasal Polyposis, Pseudotumor, Radiation Vasculopathy, Ramsay Hunt Syndrome, Sarcoidosis, Subacute Sclerosing Panencephalitis. Spine: Acute Transverse Myelopathy, Guillain-Barre Syndrome, Hypertrophic Neuropathy, Lumbar Arachnoiditis, Metabolic: Canavan Disease, Fahr Disease, Huntington Disease, Krabbe, Leigh Syndrome, MELAS, Metachromatic Leukodystrophy (MLD), Paraneoplastic Disorders, Wilson Disease X-Linked Adrenoleukodystrophy Degenerative: Brain: Amyotrophic Lateral Sclerosis (ALS), Hypertrophic Olivary Degeneration, Frontotemporal Dementia, Hypertrophic Olivary Degeneration, Creutzfeldt-Jakob Disease (CJD)
Mesial Temporal Sclerosis, Multiple System Atrophy, Parkinson Disease, Pituitary Apoplexy Wallerian Degeneration. Spine: Anular Tear, OPLL Spine, Ossification Ligamentum Flavum, Toxic: Radiation and Chemotherapy, Status Epilepticus
Neoplasm, Benign: Brain Central Neurocytoma, Chordoma, Choroid Plexus Papilloma, Craniopharyngioma, DNET, Endolymphatic Sac Tumor, Ganglioglioma, Glomus Tumor (Paraganglioma), Hemangioblastoma, Osteoma, Pineocytoma,Subependymal Giant Cell Astrocytoma, Subependymoma. Spine: Angiolipoma, Chordoma, Hemangioblastoma, Meningioma, Neurofibroma, Paraganglioma, Schwannoma Neoplasm, Malignant: Brain: Anaplastic Astrocytoma, Chondrosarcoma, Choroid Plexus Carcinoma, Ependymoma, Esthesioneuroblastoma, Optic Glioma, Gliomatosis Cerebri, Hemangiopericytoma, Medulloblastoma (PNET-MB), Ocular Melanoma, Nasopharyngeal Carcinoma, Pineoblastoma, Sinonasal SCCa, Supratentorial PNET, Teratoma Spine: Astrocytoma, Ependymoma, Leukemia, Lymphoma, Metastatic. Tumor-like Lesions: Fibrous Dysplasia, Idiopathic Orbital Inflammatory Disease (Pseudotumor), Langerhans Histiocytosis, Paget Disease Cysts, Non-neoplastic: Brain: Choroid Plexus Cyst, Ependymal Cyst, Neurenteric Cyst, Neuroglial Cyst, Rathke Cleft Cyst Spine: Syrinx, Arachnoid Cyst Treatment-Related Lesions: CSF Leak, Failed Back Surgery Syndrome, Hardware Failure. Idiopathic/Miscellaneous: Migraine, Osteopetrosis,
2. Communicator Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease. Communicate all unexpected or significant findings to the ordering provider and document the call and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY4 & PGY5 Neuroradiology
Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Robert Heale, Health Sciences The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY5, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous system and to be able to interpret and report associated imaging studies with an emphasis on both CT and Magnetic Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and or CT from the HSC site.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures such as lumbar puncture.
Review CT and MRI protocols for your list each day.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the rotation.
Present 1 CNS case each Tuesday at ICR during your rotation. Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff. Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic. REQUIRED READING LIST 1. Neuroradiology: Anne Osborne 2. Statdx: Appropriate sections.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert To know the gross anatomy of the central nervous system and to review the pertinent aspects of functional neuroanatomy. To be proficient in the interpretation of imaging studies in the evaluation of patients with neurological and neurosurgical diseases. To be exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow, the resident should strive to obtain proficiency in these examinations. To be familiar with the basic and advanced imaging sequences required in MRI scanning of the head and spine. (Diffusion imaging) Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast. Specific Learning Objectives: Review all of the objectives in the PGY2 and PGY3 rotations. Elaborate on differential diagnosis with reference to the specific case rather than repeating a standard list. The resident should be able to function as a consultant by the end of this rotation.
2. Communicator Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease. Communicate all unexpected or significant findings to the ordering provider and document the call and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
3. Collaborator Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. To recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7. Professional Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY3 NEURO/ENT Objectives
Supervisor: Dr. Nicole Myers, St. Clare's Mercy Hospital Goals and Objectives for CT in Neuro/ENT
Preamble:
The ENT CT experience at Memorial mainly includes time at the St. Clare’s site. This is mainly considered part of Neuro Imaging and fulfills Royal College requirement for training in: Neuroimaging Vascular and Interventional Radiology
Upon completion of this rotation, the resident is expected to be able to independently manage the daily activities of a CT section and MRI.
Evaluation: Assessed on a daily basis by staff assigned to ENT, as well as during education rounds. Formal ITER at end of 4-week rotation. PLEASE ARRANGE A TIME FOR THIS WITH SUPERVISOR! There is an end of rotation exam that will also contribute to assessment of the student. Preparing for this exam will entail performing everyday ENT cases, reading the suggested readings, and utilizing the practice ENT questions available on D2L.
In addition to the standard Professional Objectives, after completion of all of the Neuro CT rotations, a resident should show competence in the following CanMEDS fields:
Medical Expert:
Understand the anatomy of the central and peripheral nervous system and know how the normal anatomy will appear on CT scans. Use of “bread and butter” imaging protocols. Know the physics of multidetector CT (MDCT) scanning and be able to choose the scan appropriate for any given clinical question. Know the effects of slice thickness, windowing and centering on image quality. Be familiar with basis CT parameters and MRI pulse sequences and their clinical applications Understand MDCT scanning and image reconstruction. Understand the factors which influence image contrast and resolution in CT. Know the various protocols for imaging the brain, head and neck and spine. Understand the artifacts unique to CT and methods to reduce or eliminate them. Know the iodinated contrast agents including pharmacology, dose, and how they work as a contrast agent. Know the symptoms and signs, prevention and urgent treatment of contrast reaction. Know the gross pathology of the central and peripheral nervous system and how the diseases will appear on CT. Recognize pathology and be able to discuss the signal and enhancement characteristics of commonly seen pathologies of the above-mentioned systems Basic concepts of benign and malignant neck masses, head and neck cancer and patterns of tumor spread, and staging, infectious or inflammatory diseases of the neck Understand the differential diagnoses of the patterns of abnormal density on CT. Become comfortable with reading plain film studies such as sinuses, facial bones, mastoids, orbits and soft tissues of the neck. Know the indications and contraindications for CT of the nervous system. Understand the advantages and disadvantages of CT when compared to other modalities such as MRI, angiography and plain films. Know the indications, technical factors and limitations of CT angiography of the neck and circle of Willis. Know the technique of CT guided spine biopsy and disc aspiration including the potential adverse effects, pain management and the importance of informed consent. Understand the principles of CT perfusion.
Scholar: Utilize critical appraisal of the literature to positively impact patient care and outcomes. Demonstrate intellectual curiosity and enthusiasm with clinical cases and problem solving. Attendance at designated rounds is expected. To set up personal learning goals and objectives during rotation. To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotations, elective students and off-service residents. Health Advocate Understand the implications of resource limitations on patient care. Be familiar with the role of radiologists in advocating for appropriate diagnostic imaging equipment for their patients. Recognize and consider consent issues, patient comfort and other patient-related issues, when supervising ENT CT and MRI examinations.
Professional: Deal with patients and families in an appropriate and professional manner. Demonstrating integrity, honesty, and compassion Demonstrate a collegial, professional attitude to other hospital, medical and teaching staff. To practice understanding ethical and medical-legal requirements of radiologists. To demonstrate awareness of own limitations. Communicator Be able to dictate concise radiological reports documenting methodology, findings, appropriate differential diagnosis and recommendations for further management in a timely fashion. Understand and be able to obtain informed consent as it applies to CT related procedures. Provide appropriate interpretations for referring clinicians. Demonstrate effective communication skills when dealing with patients, staff and referring clinical services. Collaborator Interact appropriately with clinicians, technologists and other members of the health care team. To demonstrate good consulting skills when interacting with other physicians & health team members.
Manager: Understand the organization of the radiology department. Have an appreciation of workflow issues in CT as they impact on patient care. Understand the concept of scarce medical resources and wait times. Know the indications for neuro CT and MRI scans and appropriately protocol examinations. Consider advantages and disadvantages of each imaging study Have an appreciation for patient wait times and issues around prioritization for CT scanning
Resident Responsibilities: a) As is appropriate, interview patient, review patient charts, lab data and previous imaging history, in order to provide appropriate information for the involved technologists and study interpretation. b) Provide supervision/guidance to the technologist for cases requiring a modified CT or MR scanning protocol. c) Report all cases he/she has been involved with (supervising or reviewing). All cases need to be read out in conjunction with the assigned staff radiologist. d) Administer or supervise sedatives to patients parenterally as needed. e) Prepare in PowerPoint, one ENT case per week for review with staff for teaching. f) MRI ENT with Assigned Staff that week g) ENT CT with staff assigned CT that day
TEACHING: a) The resident is encouraged to bring interesting cases to resident rounds every Tuesday. b) Supervision/teaching of elective medical students or off-service residents, along with assigned radiologist. c) Teaching of CT and MR technologists and students, as appropriate
ROUNDS: Bring interesting ENT cases to combined ENT-radiology rounds as well as to the weekly ENT rounds given by the ENT staff.
Suggested resources: Temporal Bone Imaging of the Temporal Bone, Swartz & Harnsberger. CT/MRI .Head and Neck Imaging, 5th ed., Peter M. Som, Hugh D. Curtin .Head and Neck Imaging Cases, Osamu Sakai Miscellaneous Handbook in Radiology: Head and Neck Imaging.2nd Edition, Harnsberger, Radiology Clinics of North America. Diagnostic and Surgical Imaging Anatomy. Harnsberger, Osborn, Macdonald and Ross. The Requisites 2nd Edition, Neuroradiology, Grossman, RI, Yousem, DM Additional resources: CT/MRI teaching file Internet including STATDX paid subscription for the residents Departmental/Hospital journals
PGY4 & PGY5 Obstetrical Ultrasound (OBS) SUPERVISOR: Dr. Stephanie Jackman, Janeway GOAL: To become competent in the interpretation and technical aspects of Obstetrical Ultrasound. The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
PGY 4 MEDICAL EXPERT TOPICS
Supervise and review obstetrical ultra sonographic examinations.
Recognize sonographic anatomy of the uterus, ovary, corpus luteum, placenta, normal fetal anatomy and development.
Perform and interpret obstetrical ultrasound, first trimester ultrasound, second trimester ultrasound, late pregnancy ultrasound, fetal MRI
Detect and describe a variety of complications in pregnancy including: Leiomyoma in pregnancy Cervical incompetence Cervical length Funneling Postpartum uterus
Recognize and describe abnormalities of placenta, membranes and umbilical cord including Placenta previa Vasa previa Placental abruption Abnormal placental villous adherence (accrete/increta/percreta) Circumvallate placenta Chorioangioma Amniotic band syndrome Battledore placenta Chorioamnionitis Enlarged placenta Small placenta Short umbilical cord Two-vessel umbilical cord Cord around neck
Recognize and describe abnormalities of amniotic fluid Amniotic fluid index Polyhydramnios Oligohydramnios Anhydramnios Amniotic fluid discordance
Recognize and interpret a normal first trimester ultrasound as well as a number of pathologies in first trimester including: Crown rump length Yolk sac Decidual reaction Double bleb sign Fetal heart rate Embryonal demise Sac position abnormal Subhorionic hemorrhage Threatened miscarriage Gestational trophoblastic disease
Recognize and interpret a normal second trimester ultrasound as well as a number of pathologies in second trimester including: Fetal anomaly (20 weeks anatomy scan) Recognize and interpret Ectopic pregnancy including subtypes Abdominal ectopic pregnancy Tubal ectopic pregnancy Ovarian ectopic pregnancy Scar ectopic pregnancy Corneal ectopic pregnancy Cervical ectopic pregnancy
Recognize and interpret Twin pregnancy Chorionicity and amnionicity Twin-to-twin transfusion syndrome
Recognize and interpret disorders and conditions of pregnancy Hydrops fetalis HELLP syndrome MCA artery dopplers
Recognize and interpret CNS anomalies Acrania Anencephaly Exencephaly Arnold chiari malformation Dandy Walker Syndrome Fetal Brain tumors Holoprosencephaly Mega cisternal magna Vetriculomegaly Choroid plexus cyst Hydranencephaly Vein of Galen malformation
Recognize and interpret Facial anomalies Cleft lip and cleft palate Absent nasal bone Cebocephaly Anopthalmia
Recognize and interpret Neck anomalies Cystic hygroma
Recognize and interpret Extra-cardiac thoracic anomalies Congenital high airway obstruction Hydrothorax (fetal) Tracheal stenosis Tracheal atresia CPAM Diaphragmatic hernia Pulmonary hypoplasia/aplasia Esophageal atresia Pleural effusion
Recognize and interpret Abdominal wall anomalies including Omphalocele Gastroschisis
Recognize and interpret Renal anomalies PUJ anomaly Renal agenesis Multicystic dysplastic kidneys Autosomal recessive polycystic kidneys Fetal neuroblastoma
Recognize and interpret Ureter and bladder anomalies Megaureter PUV
Recognize and interpret Gastrointestinal anomalies Duodenal atresia Echogenic bowel Fetal ascites Fetal bowel dilatation
Recognize and interpret Spinal anomalies (including neural tube defects) Spinal bifida Encephalocele Meningocele Meningomyelocele Lemon sign and banana sign
PGY5
Fetal Echo
Recognize and interpret Limb anomalies Arthrogryposis multiplex congenital Clinodactyly Polydactyly Brachydactyly Camptodactyly CTEV (clubfoot)
Recognize and Interpret Miscellaneous anomalies Hemolytic disease of newborn Limb body wall complex Down’s syndrome Turner’s syndrome Fetus in fetu Fetal macrosomia
Recognize and Interpret Cardiac Anomalies Cardiomegaly (fetal) Cardiomyopathy (fetal) Congenital heart defects Ectopia cordis Echogenic intracardiac focus Fetal cardiac tumors Pericardial effusion Pericardial teratoma Sinus bradycardia Sinus tachycardia Supraventricular tachycardia
Recognize and Interpret a normal third trimester ultrasound as well as a number of pathologies in third trimester including:
Fetal biophysical profile Uterine Art dopplers Fetal presentation TYPE I IUGR TYPE II IUGR Abnormal ductus venosus waveforms Absent umbilical artery end diastolic flow Middle cerebral arterial Doppler TORCH infection Abrupto placentae Spalding sign Umbilical cord prolapse
2. Communicator Breaking bad news. Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis, investigation and management. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management. Develop techniques for communication of adverse outcomes with pregnant patients.
3. Collaborator Establish good relationships with peers and other health professionals, particularly the Antenatal Assessment Unit. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities. 5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pregnant patient. Recognize the burden of illness upon the patients served by Radiology. Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Work up cases for the teaching file.
Identify potential research project with supervisors.
7. Professional
Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY2 Pediatrics: Introductory Month SUPERVISOR: Dr. Nicole Hughes, Janeway The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be included in the ITER evaluation sheet. This will also include nursing staff. A printout of the complete required modules from the online curriculum will be required. DUTIES AND RESPONSIBILITIES Daily review and reporting of Emergency X-rays.
Daily fluoroscopy lists.
Daily review of neonatal ICU films and general reporting.
As time permits, limited ultrasound exposure, particularly with regard to normal cranial sonography.
Completion of online curriculum.
Radiology rounds for pediatric residents/interns/clerks: when arranged
Selective Pediatric radiology subspecialty rounds: Thursdays: 4:15 pm – 5:00 pm
Medical, surgical or other rounds if requested by supervisor
Working up cases and coding them for the teaching file. Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper Airway Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to Karen. The website can be accessed at: https://www.cchs.net/onlinelearning/default.htm * All examinations must be checked with a radiologist prior to reporting.
REQUIRED READING LIST Introduction to Radiology in Clinical Pediatrics – Haller/Slovis
Appropriate sections from some of the following: 1. Practical Pediatric Imaging – Kirks 2. Emergency Radiology of the Acutely Ill or Injured Child – Swischuk 3. Imaging of the Newborn, Infant and Young Child – Swischuk 4. Caffey’s Pediatric Diagnosis 5. Neurosonography section, “ Pediatric Sonography” – Siegel 6. Ultrasound of Infants and Children – Teele
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Become competent in interpreting plain films and performing basic procedures; namely, barium swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy. Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of radiation dosage and individual exposure in pediatrics. Learn contrast dosage and treatment of reaction in the pediatric population. Increase knowledge of anatomy and pathology related to organ systems with specific attention to the pediatric population. Start to familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related protocols. Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT). Be able to read plain film studies of pediatric patients including the chest and musculoskeletal system. Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper Airway Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to Karen. The website can be accessed at:
https://www.cchs.net/onlinelearning/cometvs10/pedrad/default.htm
2. Communicator Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis, investigation and management. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management. Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities. 4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits & risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. Recognize the burden of illness upon the patients served by Radiology. Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.Scholar Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Work up cases for the teaching file.
Identify potential research project with supervisors.
7. Professional Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness. Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY4 & PGY5 Pediatrics SUPERVISOR: Dr. Nicole Hughes, Janeway The assessment tools utilized during the rotations include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be included in the ITER evaluation sheet. This will also include nursing staff. A print out of the complete required modules from the online curriculum will be required.
DUTIES AND RESPONSIBILITIES Report emergency films daily early a.m. Fluoroscopy list 2 days per week minimum.
Ultrasound approximately 2 days per week minimum. The resident should be capable of scanning independently and obtaining diagnostic images. The resident should provide an image of a normal appendix scanned personally by the end of the rotation. The resident is responsible for reporting the majority of ultrasounds on scheduled ultrasound days. At least one morning per week (minimum) hands-on scanning. CT approximately 2 days per week. The resident will review all CT requisitions and decide on protocols with the staff person. The resident will supervise and subsequently report all a.m. CT’s on scheduled days. MRI – the resident will review and report the majority of pediatric MRI’s performed during the rotation. Report non-emergent/ICU general radiology as time permits. The resident will be responsible for the same rounds and teaching file responsibilities as in the PGY2 rotation. Completion of online curriculum.
REQUIRED READING LIST 1. As per PGY2 rotation 2. Appropriate sections on pediatric and obstetrical ultrasound – Rumack and Wilson 3. Appropriate sections in CT book – Lee, Sagal and Stanley 4. Pediatric Body CT – Daneman 5. Pediatric Neuroimaging – Barkovich 6. MRI in Pediatric Neuroradiology – Walpert, Barnes 7. Imaging of the Pediatric Head, Neck and Spine – Castillo Mukherji 8. Pediatric Sonography – Siegel 9. Other departmental reference texts
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Become competent in interpreting plain films and performing basic procedures; namely, barium swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy. Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of radiation dosage and individual exposure in pediatrics. Learn contrast dosage and treatment of reaction in the pediatric population. Increase knowledge of anatomy and pathology related to organ systems with specific attention to the pediatric population. Familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related protocols. Complete Pediatric Radiology online curriculum sections for Senior Resident, as well as Upper Airway Inflammation, and Inflammatory Neck Lesions and pediatric brain tumor sections in Barkovich. Provide print out of completed courses. The website can be accessed at: https://www.cchs.net/onlinelearning/default.htm Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT). Be able to read plain film studies of pediatric patients including the chest and musculoskeletal system.
2. Communicator Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis, investigation and management. Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management. Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations. The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds. Consult effectively with other physicians and health care professionals. Contribute effectively to other interdisciplinary team activities.
4. Manager Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Learn to set realistic priorities and use time effectively in order to optimize professional performance. Understand the fundamentals of quality assurance. Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population. Recognize the burden of illness upon the patients served by Radiology. Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6. Scholar Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy. Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to Radiology. Demonstrate an ability to be an effective teacher of radiology. Work up cases for the teaching file and identify a potential research project with supervisors.
7. Professional Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY4 Rural Rotation ROTATION CO-ORDINATOR: Dr. Brent Pilgrim, WMRH
ROTATION SUPERVISORS: Dr. Ed Mercer, WMRH Dr. Jen Lombard, WMRH Dr. Chris Cousens, WMRH Dr. Andrea Reid, WMRH Dr. Bob Cook, WMRH Dr. Gavin White, WMRH Dr. Christina Pacquette, WMRH
The following is an outline of the goals and objectives of the Rural rotation during PGY4, incorporated into CanMEDS format. The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES Function as a community radiologist with exposure to all imaging modalities and subspecialties offered at the WMRH. Interpret and report all studies assigned to the supervising staff person. The supervising staff person will change on a weekly basis. This will include plain films, GI/barium studies, mammography, CT, MRI and US. Echocardiography and nuclear medicine are only reported by certain staff persons and exposure to these modalities can be arranged if requested. To perform, interpret and report procedures assigned to the supervising staff person. This includes GI procedures, breast biopsies, thyroid biopsies, CT and US-guided biopsies and drainages. Complex procedures are performed by the interventional staff person and exposure to higher-level interventional procedures can be arranged if requested. All “stat” studies should be reviewed and reported the day they are performed. Non-stat studies performed during any given week should be reviewed and reported by Monday evening of the following week. The resident is not expected to report any studies performed on the Friday of the last week of the rotation. Friday AM the exam will be administered and all remaining studies should be reviewed, reported and signed during the remainder of the day. To attend interesting case rounds when scheduled.
REQUIRED READING LIST This is a general rotation and, as such, there are no specific reading requirements. One suggestion for reading during this rotation would be to re-read Brant & Helms “Fundamentals of Diagnostic Radiology” in preparation for exam-oriented study.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert Become competent in interpreting plain films and performing basic procedures; namely, barium studies, basic US- and CT-guided procedures. Be aware of how to tailor any general examination to answer the specific clinical concerns. Be aware of radiation dosage and individual exposure. Learn contrast dosage and treatment of adverse reactions. Increase knowledge of anatomy, physiology and pathology related to all organ systems. Learn common ultrasound/CT/MRI examination protocols for all organ systems and be able to tailor this appropriately for specific clinical concerns.
2. Communicator Communicate effectively with patients/families, referring physicians, and co-workers. Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management. Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
3. Collaborator Become an effective consultant of radiology. Interact effectively with health professionals by recognizing their roles and expertise. Collaborate effectively and constructively with other members of the health care team. Interact with house staff and referring physicians as “first contact”.
Be active participants in inter- and intra-discipline rounds.
4. Manager Understand the effective use of allocation and utilization of health care resources with specific attention to radiology. Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology. Make cost effective use of health care resources based on sound judgment. Set realistic priorities and use time effectively in order to optimize professional performance. Understand the principles of practice management. Understand the fundamentals of quality assurance.
5. Health Advocate Promote health of the population through the application of radiology. Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs. Understand and communicate the benefits and risks of radiological investigation and treatment including population screening. Understand the issues regarding screening (i.e. lung cancer and cardiac calcification). Recognize the burden of illness upon the patients served by Radiology.
6. Scholar Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community. Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this. Demonstrate an ability to be an effective teacher of radiology. See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior. Demonstrate integrity, honesty, compassion and respect for diversity. Fulfill medical, legal and professional obligations of a Diagnostic Radiologist. Demonstrate reliability and conscientiousness. Understand the principles of ethics and apply these in critical situations. Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.
PGY2 Ultrasound Introductory Month (HSC) Daily Performance Cards are required for this rotation. SUPERVISOR: Dr. Eric Sala, Health Sciences Centre The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES All emergency patients and inpatients are to be checked with the resident by the technologist, and should be scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary during the course of the rotation, the resident should participate in the evaluation of other cases during the work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be reviewed with attending staff.
REQUIRED READING LIST . Ultrasound: The Requisites, by Middleton . Learning How to Scan, the Text: Ultrasound Scanning Principles and Protocols by Tempkin
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity. Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of the first level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Gallbladder: (gallstones/acute cholecystitis) . Liver: (masses) . Kidney: (hydronephrosis and stones) . Transabdominal/Endovaginal Pelvis: (mass/cyst/free fluid) . Testes: torsion/epididyimitis . Lower Extremity: (DVT Study) . Abdominal Aorta: (aneurysm) . Pleural Effusion and Ascites . Normal and Abnormal Intrauterine Early Pregnancy . Thyroid Gland, specifically overall size and echogenicity . Ultrasound guided procedures: basic techniques
ULTRASOUND PHYSICS . Define ultrasound, including the relationship of sound waves using imaging. . Transducer choice: curvi-linear, linear, sector, vector . Generation and detection of ultrasound waves. . Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone, Frown Hopper Zone. . Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction, absorption, acoustic impudence pulse echo principles . Straight and narrow sound beams, suprareflection constant sound speed . Beam shape: linear, sector, curved ray. . Probes: transabdominal and endocavitary . Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler. . Image orientation . Image optimization: power output, gain, time gain compensation . Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures . Tissue characteristics: acoustic shadowing and enhancement . Focal zone
CLINICAL APPLICATIONS . Liver: normal echotecture, size and shape (including anatomic variants), diffuse disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema), focal masses, metastasis, granuloma . Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall thickening, polyp . Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation . Pancreas: normal anatomy, pancreatic duct, mass . Spleen: normal echotexture, size and shape (including anatomic variants), focal masses, cystic versus solid, lymphoma, abscess, infarction, granuloma . Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated) . Pleural effusion
GENITOURINARY SYSTEM . Normal kidney cortical echotexture, size and shape, medical renal disease, simple renal cyst . Ureters: hydronephrosis and pylenephrosis . Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY . Uterus: normal size, shape, position, echogenicity, fibroid identification . Endometrium: normal appearance during phases of menstrual cycle and thickness measurement (premenopausal, postmenopausal, effects of hormone replacement), IUD, fluid . Ovary: normal size, shape, echogenicity, physiologic variation during phases of the menstrual cycle (follicles, corpus luteum, hemorrhagic ovarian cyst) . Free pelvic fluid . First trimester ultrasound: normal gestational sac appearance, size, gestational sac growth, yolk sac, embryo, cardiac activity including normal embryonic heart rate, normal early fetal anatomy/growth, crown rump link measurement, correlation with beta HCG levels and menstrual dates THYROID/NECK . Normal thyroid echotexture, size and shape . Thyroid disease: diffuse and focal disease . Multinodular thyroid, evaluation of neck lymph nodes
VASCULAR/DOPPLER . Abdominal Aorta: normal appearance and measurement, aneurysm . Inferior vena cava: normal appearance, thrombosis . Lower extremity DVT . Hematoma . Pseudoaneurysm SCROTUM . Testes: normal echotexture and shape and size . Epididymis . Testicular mass . Hydrocele
MUSCULOSKELETAL . Mass . Hematoma, Baker’s cyst, incomplete rupture . Abscess
INTERVENTIONAL . Informed consent . Sterile technique . Localization of fluid for paracentesis or thoracentesis, with ultrasound guided aspiration of same . Techniques for ultrasound guided invasive procedures: understanding important landmarks and pit falls of percutaneous procedures including recognition of critical structures . Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies Development effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behaviour when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self-learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism). Demonstrate accountability to the patients, society and the profession. The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care.
PGY3 Ultrasound (HSC) Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Eric Sala, Health Sciences The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound rotation during PGY3, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES . In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed consent and assisting attending staff with all ultrasound guided procedures.
. Weekly contribution to interesting case rounds with a case specifically pertaining to the role of sonography is expected. Also, a contribution of at least one case per rotation to the departmental teaching file is also expected.
REQUIRED READING LIST . The two volume set: Diagnostic Ultrasound, by Rumack and Wilson Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained within the first volume. . Supplementary reading with the case review series, and both the general ultrasound, as well as the obstetrical gynecological ultrasound volumes is recommended.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity. Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of each level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Pancreas: (pancreatitis and mass) . Biliary Tree: (common bile duct and ductal dilatation) . Abdominal Mass/Adenopathy . Kidney: (mass/cyst) . Basic Doppler: (portal vein, pseudoaneurysm and AV fistula) . Early Pregnancy: (failed pregnancy) . Adnexal Mass: (ovarian and non ovarian) . Testes: (pain and masses) . Thyroid Nodules . Continue to refine ultrasound guided procedural skills
ULTRASOUND PHYSICS . Define ultrasound, including the relationship of sound waves using imaging. . Transducer choice: curvi-linear, linear, sector, vector . Generation and detection of ultrasound waves. . Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone, Frown Hopper Zone. . Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction, absorption, acoustic impudence pulse echo principles . Straight and narrow sound beams, suprareflection constant sound speed . Beam shape: linear, sector, curved ray. . Probes: transabdominal and endocavitary . Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler. . Image orientation . Image optimization: power output, gain, time gain compensation . Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures . Tissue characteristics: acoustic shadowing and enhancement . Focal zone
CLINICAL APPLICATIONS . Liver: hematoma, biloma, abscess . Post liver transplantation/surgery collections: hematoma, biloma, abscess . Gallbladder: hyperplastic cholecystosis, carcinoma . Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia . Pancreas: neoplasm, cysts . Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic pancreatitis . Peritoneal cavity: abscess, hemorrhage, omental mass, metastases, carcinocmatosis . Spleen: varices GENITOURINARY SYSTEM . Abscess/pyelonephritis, perinephric fluid . Post renal transplant collections: hematoma, uronoma, abscess, lymphocele . Complex renal cyst, adult polycystic kidney disease, acquired kidney cystic disease, renal cell carcinoma, angiomyelolypoma . Bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction, diverticulae, urethrocele . Transabdominal prostate . Ureters: hydroureter
GYNECOLOGY . Uterus: congenital anomalies, endometrial polyp, endometrial hyperplasia, endometrial carcinoma, endometritis, pyelometrium, fibroid localization (submucosal, intramural and subsurrousal) adenomyosis . Ovarian cyst: hemorrhagic/ruptured cyst, endometrioma, polycystic ovarian disease, over and hyper stimulation syndrome . Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid, fibroma, germ cell tumor, Doppler evaluation . Ovarian torsion: pelvic inflammatory disease, tube ovarian abscess . Cervix: mass, stenosis, endometrial obstruction . Fallopian tube: hydrosalpinx, pyosalpinx . Posthysterectomy . Early obstetrics: spontaneous complete/incomplete abortion, ectopic pregnancy, blighted ovum, embryonic death, subcryonic hematoma, gestational tripoblastic disease
THYROID/NECK . Thyroid nodule characterization: echotexture, calcifications including microcalcifications, margins, recommendations for aspiration biopsy . Hashimoto’s thyroiditis/Graves disease
VASCULAR/DOPPLER . Peripheral aneurysm, including iliac and popliteal arteries . Hepatic vasculature: post and color Doppler imaging of the portal veins, splenic vein, hepatic arteries and hepatic veins, including normal direction of flow . Hemodynamics of cirrhosis, portal hypertension and varices, portal vein . Thrombosis . Upper extremity DVT . Renal vein thrombosis
SCROTUM . Epididymitis, orchitis . Testicular torsion . Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma, metastases . Cystic ectasia of mediastinum testes . Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head cyst . Varicocele . Trauma
MUSCULOSKELETAL . Normal tendon appearance . Foreign body . Soft tissue gas . Joint fluid . Muscle tear . Rotator cuff tear
INTERVENTIONAL . Biopsy of soft tissue masses as well as focal solid visceral masses . Aspiration of fluid collections, cysts and catheter placement for abscess and fluid drainage . Postprocedural evaluation: radiographic studies, patient monitoring, management of complications . Fine needle biopsy versus core biopsy and specific applications, including focal, liver and renal masses, thyroid lesions and retroperitoneal adenopathy
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies. Develop effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self-learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs. Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism). Demonstrate accountability to the patients, society and the profession. The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care.
PGY4 & PGY5 Ultrasound (HSC) Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Eric Sala, Health Sciences Centre The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound rotation during PGY4 & 5, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES . At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the entire working of the department during the day. This includes reviewing all cases, as well as obtaining informed consent for all ultrasound guided procedures.
. Assisting the attending staff as well as independently performing these procedures is expected.
. Continued weekly contribution to the interesting case rounds as well as the preparation of a case for the departmental teaching file is also expected.
REQUIRED READING LIST . The two volume set: Diagnostic Ultrasound, by Rumack and Wilson Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained within the first volume. . Supplementary reading with the case review series, and both the general ultrasound, as well as the obstetrical gynecological ultrasound volumes is recommended.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity. Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of each level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Parathyroid, paracarotid artery and Doppler . Advanced Abdominal Doppler: (visceral organs and organ transplant) . Peripheral Vessels
ULTRASOUND PHYSICS In addition to the knowledge acquired in prior ultrasound rotations: . Doppler phenomenon, Doppler formula . Beam formation and focusing . Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler imaging . Beam width, side load, slice thickness artefacts . Multiple reflection artefacts: mirror image/reverberation . Refractive artefacts . Doppler artefacts: pulse wave, color imaging including ileising . Gray scale versus Doppler: (trade off of penetration and resolution) . 3D volumetric imaging . Thermal/nonthermal effects on tissues: (biological health risks) . Image optimization . Hermonic imaging . Ultrasound contrast agents . Equipment quality assurance: phantoms, special/contrast resolution
CLINICAL APPLICATIONS . Liver: trauma . Bile ducts: neoplasm (cholangiocarcinoma) . Spleen: trauma . Chest: pericardial effusion, mass, atelectasis, pneumonia . Organ transplants . Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease . Peritoneal cavity: free air . Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM . Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney, medullary nephrocalcinosis . Adrenal glands: mass . Retroperitoneum: adenopathy and mass . Ureters: ureteral stone . Bladder: ectopic ureterocele . Renal artery stenosis, renal vein thrombosis
GYNECOLOGY . Peritoneal inclusion cyst . Ovarian cancer staging . Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary horn)
THYROID/NECK . Parathyroid mass . Congenital cyst: brachial cleft cyst . Lymph nodes: benign and malignant characterization . Post thyroidectomy recurrence . Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER . Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion . AV fistula . Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein thrombosis, renal infarction, post biopsy complications, renal artery stenosis . Liver transplants, including hepatic artery stenosis or thrombosis, portal vein thrombosis, post biopsy complications, IVC stenosis . Pancreas transplant . TIPS evaluation and complications . Arterial bypass graft, hemodialysis graft/fistula . Vertebral artery: subclavian steal syndrome . Mesenteric ischemia . Renal artery stenosis
SCROTUM . Hernia . Non descended testes . Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies. Develop effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self-learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs. Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism). Demonstrate accountability to the patients, society and the profession. The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care. PGY2 Ultrasound (SC) Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s The following is an outline of the goals and objectives of the ultrasound rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations & will remain consistent throughout residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES All emergency patients and inpatients are to be checked with the resident by the technologist, and should be scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary during the course of the rotation, the resident should participate in the evaluation of other cases during the work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be reviewed with attending staff.
REQUIRED READING LIST . Ultrasound: The Requisites, by Middleton . Learning How to Scan, the Text: Ultrasound Scanning Principles and Protocols by Tempkin http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound , there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize & give the differential diagnosis of a lesion based on its anatomical location & echogenicity Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of the first level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Gallbladder: (gallstones/acute cholecystitis) . Liver: (masses) . Kidney: (hydronephrosis and stones) . Transabdominal/Endovaginal Pelvis: (mass/cyst/free fluid) . Testes: torsion/epididyimitis . Lower Extremity: (DVT Study) . Abdominal Aorta: (aneurysm) . Pleural Effusion and Ascites . Normal and Abnormal Intrauterine Early Pregnancy . Thyroid Gland, specifically overall size and echogenicity . Ultrasound guided procedures: basic techniques
ULTRASOUND PHYSICS . Define ultrasound, including the relationship of sound waves using imaging. . Transducer choice: curvi-linear, linear, sector, vector . Generation and detection of ultrasound waves. . Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone, Frown Hopper Zone. . Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction, absorption, acoustic impudence pulse echo principles . Straight and narrow sound beams, suprareflection constant sound speed . Beam shape: linear, sector, curved ray. . Probes: transabdominal and endocavitary . Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler. . Image orientation . Image optimization: power output, gain, time gain compensation . Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures . Tissue characteristics: acoustic shadowing and enhancement . Focal zone
CLINICAL APPLICATIONS . Liver: normal echotecture, size and shape (including anatomic variants), diffuse disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema), focal masses, metastasis, granuloma . Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall thickening, polyp . Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation . Pancreas: normal anatomy, pancreatic duct, mass . Spleen: normal echotexture, size and shape (including anatomic variants), focal masses, cystic versus solid, lymphoma, abscess, infarction, granuloma . Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated) . Pleural effusion
GENITOURINARY SYSTEM . Normal kidney cortical echotexture, size and shape, medical renal disease, simple renal cyst . Ureters: hydronephrosis and pylenephrosis . Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY . Uterus: normal size, shape, position, echogenicity, fibroid identification . Endometrium: normal appearance during phases of menstrual cycle and thickness measurement (premenopausal, postmenopausal, effects of hormone replacement), IUD, fluid . Ovary: normal size, shape, echogenicity, physiologic variation during phases of the menstrual cycle (follicles, corpus luteum, hemorrhagic ovarian cyst) . Free pelvic fluid
THYROID/NECK . Normal thyroid echotexture, size and shape . Thyroid disease: diffuse and focal disease . Multinodular thyroid, evaluation of neck lymph nodes
VASCULAR/DOPPLER . Abdominal Aorta: normal appearance and measurement, aneurysm . Inferior vena cava: normal appearance, thrombosis . Lower extremity DVT . Hematoma . Pseudoaneurysm
SCROTUM . Testes: normal echotexture and shape and size . Epididymis . Testicular mass . Hydrocele
MUSCULOSKELETAL . Mass . Hematoma, Baker’s cyst, incomplete rupture . Abscess
INTERVENTIONAL . Informed consent . Sterile technique . Localization of fluid for paracentesis or thoracentesis, with ultrasound guided aspiration of same . Techniques for ultrasound guided invasive procedures: understanding important landmarks and pit falls of percutaneous procedures including recognition of critical structures . Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies. Develop effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident reviewing cases & performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self-learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self-interest (altruism). Demonstrate accountability to the patients, society and the profession. The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care.
PGY3 Ultrasound (SC) Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s The following is an outline of the goals and objectives of the ultrasound rotation during PGY3, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES . In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed consent and assisting attending staff with all ultrasound guided procedures.
. Weekly contribution to interesting case rounds with a case specifically pertaining to the role of sonography is expected. Also, a contribution of at least one case per rotation to the departmental teaching file is also expected.
REQUIRED READING LIST . The two volume set: Diagnostic Ultrasound, by Rumack and Wilson The chapters relevant to the rotation are contained within the first volume. . Supplementary reading with the case review series, and both the general ultrasound, as well as the obstetrical gynecological ultrasound volumes is recommended.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity. Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of each level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Pancreas: (pancreatitis and mass) . Biliary Tree: (common bile duct and ductal dilatation) . Abdominal Mass/Adenopathy . Kidney: (mass/cyst) . Basic Doppler: (portal vein, pseudoaneurysm and AV fistula) . Early Pregnancy: (failed pregnancy) . Adnexal Mass: (ovarian and non ovarian) . Testes: (pain and masses) . Thyroid Nodules . Continue to refine ultrasound guided procedural skills
ULTRASOUND PHYSICS . Define ultrasound, including the relationship of sound waves using imaging. . Transducer choice: curvi-linear, linear, sector, vector . Generation and detection of ultrasound waves. . Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone, Frown Hopper Zone. . Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction, absorption, acoustic impudence pulse echo principles . Straight and narrow sound beams, suprareflection constant sound speed . Beam shape: linear, sector, curved ray. . Probes: transabdominal and endocavitary . Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler. . Image orientation . Image optimization: power output, gain, time gain compensation . Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures . Tissue characteristics: acoustic shadowing and enhancement . Focal zone
CLINICAL APPLICATIONS . Liver: hematoma, biloma, abscess . Gallbladder: hyperplastic cholecystosis, carcinoma . Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia . Pancreas: neoplasm, cysts . Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic pancreatitis . Peritoneal cavity: abscess, hemorrhage, omental mass, metastases, carcinocmatosis . Spleen: varices
GENITOURINARY SYSTEM . Abscess/pyelonephritis, perinephric fluid . Post renal transplant collections: hematoma, uronoma, abscess, lymphocele . Complex renal cyst, adult polycystic kidney disease, acquired kidney cystic disease, renal cell carcinoma, angiomyelolypoma . Bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction, diverticulae, urethrocele . Transabdominal prostate . Ureters: hydroureter
GYNECOLOGY . Uterus: congenital anomalies, endometrial polyp, endometrial hyperplasia, endometrial carcinoma, endometritis, pyelometrium, fibroid localization (submucosal, intramural and subsurrousal) adenomyosis . Ovarian cyst: hemorrhagic/ruptured cyst, endometrioma, polycystic ovarian disease, over and hyper stimulation syndrome . Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid, fibroma, germ cell tumor, Doppler evaluation . Ovarian torsion: pelvic inflammatory disease, tube ovarian abscess . Cervix: mass, stenosis, endometrial obstruction . Fallopian tube: hydrosalpinx, pyosalpinx . Posthysterectomy . Early obstetrics: spontaneous complete/incomplete abortion, ectopic pregnancy, blighted ovum, embryonic death, subcryonic hematoma, gestational tripoblastic disease
THYROID/NECK . Thyroid nodule characterization: echotexture, calcifications including microcalcifications, margins, recommendations for aspiration biopsy . Hashimoto’s thyroiditis/Graves disease
VASCULAR/DOPPLER . Peripheral aneurysm, including iliac and popliteal arteries . Hepatic vasculature: post and color Doppler imaging of the portal veins, splenic vein, hepatic arteries and hepatic veins, including normal direction of flow . Hemodynamics of cirrhosis, portal hypertension and varices, portal vein . Thrombosis . Upper extremity DVT . Renal vein thrombosis
SCROTUM . Epididymitis, orchitis . Testicular torsion . Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma, metastases . Cystic ectasia of mediastinum testes . Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head cyst . Varicocele . Trauma
MUSCULOSKELETAL . Normal tendon appearance . Foreign body . Soft tissue gas . Joint fluid . Muscle tear . Rotator cuff tear
INTERVENTIONAL . Biopsy of soft tissue masses as well as focal solid visceral masses . Aspiration of fluid collections, cysts and catheter placement for abscess and fluid drainage . Postprocedural evaluation: radiographic studies, patient monitoring, management of complications . Fine needle biopsy versus core biopsy and specific applications, including focal, liver and renal masses, thyroid lesions and retroperitoneal adenopathy
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies. Develop effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs. Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism). Demonstrate accountability to the patients, society and the profession. The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care.
PGY4 & PGY5 Ultrasound (SC) Daily Performance Cards are required for this rotation.
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s The following is an outline of the goals and objectives of the ultrasound rotation during PGY4 & 5, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the entire working of the department during the day. This includes reviewing all cases, as well as obtaining informed consent for all ultrasound guided procedures.
Assisting the attending staff as well as independently performing these procedures is expected.
Continued weekly contribution to the interesting case rounds as well as the preparation of a case for the departmental teaching file is also expected.
REQUIRED READING LIST . The two volume set: Diagnostic Ultrasound, by Rumack and Wilson The chapters relevant are contained within the first volume. . Supplementary reading with the case review series, and both the general ultrasound, as well as the obstetrical gynecological ultrasound volumes is recommended.
http://www.med.mun.ca/Radiology/Residents/Curriculum/Physics.aspx
1. Medical Expert In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed. Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis. Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system. Know the role of ultrasound in situations of trauma. Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity. Perform an ultrasound guided biopsy and ultrasound guided drainage. a. “Hands On” Scanning: By the end of each level of training, the resident should be able to scan most clinical scenarios listed below in each training category. . Parathyroid, paracarotid artery and Doppler . Advanced Abdominal Doppler: (visceral organs and organ transplant) . Peripheral Vessels
ULTRASOUND PHYSICS In addition to the knowledge acquired in prior ultrasound rotations: . Doppler phenomenon, Doppler formula . Beam formation and focusing . Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler imaging . Beam width, side load, slice thickness artefacts . Multiple reflection artefacts: mirror image/reverberation . Refractive artefacts . Doppler artefacts: pulse wave, color imaging including ileising . Gray scale versus Doppler: (trade off of penetration and resolution) . 3D volumetric imaging . Thermal/nonthermal effects on tissues: (biological health risks) . Image optimization . Hermonic imaging . Ultrasound contrast agents . Equipment quality assurance: phantoms, special/contrast resolution
CLINICAL APPLICATIONS . Liver: trauma . Bile ducts: neoplasm (cholangiocarcinoma) . Spleen: trauma . Chest: pericardial effusion, mass, atelectasis, pneumonia . Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease . Peritoneal cavity: free air . Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM . Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney, medullary nephrocalcinosis . Adrenal glands: mass . Retroperitoneum: adenopathy and mass . Ureters: ureteral stone . Bladder: ectopic ureterocele . Renal artery stenosis, renal vein thrombosis
GYNECOLOGY . Peritoneal inclusion cyst . Ovarian cancer staging . Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary horn)
THYROID/NECK . Parathyroid mass . Congenital cyst: brachial cleft cyst . Lymph nodes: benign and malignant characterization . Post thyroidectomy recurrence . Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER . Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion . AV fistula . Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein thrombosis, renal infarction, post biopsy complications, renal artery stenosis . Liver transplants, including hepatic artery stenosis or thrombosis, portal vein thrombosis, post biopsy complications, IVC stenosis . TIPS evaluation and complications . Arterial bypass graft, hemodialysis graft/fistula . Vertebral artery: subclavian steal syndrome . Mesenteric ischemia . Renal artery stenosis
SCROTUM . Hernia . Non descended testes . Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator Dictate prompt, accurate and concise reports for ultrasound studies. Develop effective communication skills with patients, patient families, physicians and other members of the health care team. Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report. Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.
3. Collaborator Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary. If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.
4. Manager Use information technology to manage information, to access online medical information and for self learning. Understand how medical decisions affect patient care within a larger system. Know how types of ultrasound practice and delivery systems differ from one another. Effectively prioritize patients requiring ultrasound studies. Use information technology to support patient care decisions. Participate in quality assurance programs for sonographers and physicians. Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.
5. Health Advocate Understand the bio effect and safety issues in diagnostic ultrasound.
6. Scholar Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge and application of the principles of evidence based medicine in practice. Facilitate teaching of medical students, stenographers, other residents and other health care professionals. Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
7. Professional Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism). Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time. In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care. Appendix One Policy
Office of Accountability: Postgraduate Medical Education
Office of Administrative Postgraduate Medical Education Responsibility:
Approver: Postgraduate Medical Studies Committee
Overview Resident education must occur in a physically safe environment (Royal College of Physicians and Surgeons of Canada, standard A.2.5; College of Family Physicians of Canada). The collective agreement between the Professional Association of Interns and Residents of NL (PAIRN) states that residents are postgraduate trainees registered in university programs as well as physicians employed by the hospitals. The agreement states that the residents must have secure and private rooms with secure access between call room facilities and the service area; maximum duty hours are defined; uniforms and protective equipment standards; as well as access to and coverage for Occupational Health services. Memorial University is committed to provide and maintain healthy and safe working and learning environments for all employees, trainees (including postgraduate trainees), volunteers and visitors. This is achieved by observing best practices which meet or exceed the standards to comply with legislative requirements as contained in the NL Occupational Health and Safety Act, Environmental Protection Act, Nuclear Safety and Control Act and other statutes, their regulations, and the policy and procedures established by the University.
Purpose To demonstrate the commitment of Postgraduate Medicine, Faculty of Medicine, to health, safety and protection of its postgraduate medical trainees.
To minimize the risk of injury and promote a safe and healthy environment on the university campus and affiliated teaching sites
To provide a procedure to report hazardous or unsafe training conditions and injury along with a mechanism to take corrective action
Policy PERSONAL SAFETY Memorial University, Faculty of Medicine strives for a safe and secure environment for postgraduate trainees to train in its facilities and training sites through maintenance of affiliation agreements. Affiliated hospitals are responsible for ensuring the safety and security of postgraduate trainees training and supervision in their facilities in compliance with their existing employee safety and security policies/procedures as well as the requirements outlined in the PAIRN – Eastern Health collective agreement. It is expected that the Postgraduate Trainee, the Residency Program and the Postgraduate Medical Education Office will work together with the affiliated teaching hospitals and community training sites to ensure the personal safety of all Postgraduate trainees. Accommodation When trainees rotate in sites that are out of town accommodations should have adequate security and lighting, safe locks and security personnel available to accompany the trainee to their residence after dark. Responsibility 1. Postgraduate Trainee It is the responsibility of the trainee to participate in required safety sessions, which include Workplace Hazardous Materials Information and Safety (WHMIS), Fire Safety (as required), etc. and abide by the Safety codes of the designated area where s / he is training. This includes dress codes, particularly as they relate to safety. The Postgraduate trainee must report any situation where personal safety is threatened (see Faculty Protocol below).
2. Residency Program and the Postgraduate Medical Education Office It is a responsibility of each Residency Program and the Postgraduate Medical Education Office to ensure that appropriate educational safety sessions are available to all Postgraduate Trainees e.g., generic WHMIS and safety training. In addition to WHMIS, the Residency Program must ensure that there is an initial, specialty, site-specific orientation available to the Postgraduate trainee. It is the responsibility of the Residency Program to ensure that individual clinics or practice settings develop a site specific protocol to deal with:
patient(s) who may represent a safety risk and policies working alone working in isolated areas or situations e.g., medivac transports or any other situation that may be a safety issue to the Postgraduate Trainee The protocol must be communicated to the Postgraduate Trainee at the beginning of the rotation. The Postgraduate Medical Education Office will work, in conjunction with the affiliated Newfoundland and Labrador teaching hospitals to ensure that hospital areas are in compliance with the requirements as outlined in the PAIRN – Eastern Health collective agreement.
Site Specific Protocol The protocol should include the following:
identify potential risks to the Postgraduate Trainee include how the Postgraduate Trainee is seeing a patient after hours in clinic. This would encounter, identification of potentially problematic patients at the beginning of the encounter so they could be monitored a supervisor* or co-worker must be available
a. while the Postgraduate Trainee is seeing a patient after hours in clinic. This would not apply if the patient is being seen in an emergency room / hospital based urgent care clinic, nursing home and hospice b. when the Postgraduate Trainee does home visits c. at the end of office hours if the Postgraduate Trainee is still with patients *The supervisor as defined by the Occupational Health and Safety Act – “a person who has charge of a workplace or authority over any worker.” It can be a physician (including another Postgraduate Trainee), midwife, nurse practitioner or social worker depending on the encounter.
Faculty Protocol Postgraduate Trainees identifying a personal safety or security breach: 1. If a Postgraduate Trainee identifies a personal safety or security breach, it must be reported to their immediate supervisor and/or Program Director to allow resolution of the issue at the local level. 2. If a Postgraduate Trainee feels that his / her own personal safety is threatened, s/he should seek immediate assistance and remove themselves from the situation in a professional manner. The Postgraduate Trainee should ensure that their immediate supervisor has been notified and/or Program Director, as appropriate. 3. The Postgraduate Medical Education Office is available for consultation during regular work hours, particularly if the Program Director is not available. If an issue arises after regular office hours, where the clinical supervisor and/or Program Director may not be available, contact Security of the institution where the Postgraduate trainee is based.
Travel If in the residents’ estimation, it would not be safe to travel because of weather, the resident may elect not to attend their academic half day, clinic, etc., but must inform the appropriate people as soon as possible in a professional manner.
Training Outside North America Postgraduate Trainees must complete the Field Trips and Electives Planning and Approval process when planning to do an elective outside of North America to ensure compliance with standards and best practices for the safety of all Postgraduate Trainees WORKPLACE ENVIRONMENTAL HEALTH AND SAFETY (e.g. hazardous material (biological or chemical agent named in the Occupational Health and Safety Act), indoor air quality, chemical spills)
OCCUPATIONAL HEALTH (e.g. immunization policies, blood borne pathogens, respiratory protection) Both Memorial University and its employees are jointly responsible for implementing and maintaining an Internal Responsibility System directed at promoting health and safety, preventing incidents involving occupational injuries and illnesses or adverse effects upon the natural environment. The University is responsible for the provision of information, training, equipment and resources to support the Internal Responsibility System and ensure compliance with all relevant statutes, this policy and internal health and safety programs. Managers, Supervisors, Deans, Directors, Chairs, Research Supervisors are accountable for the safety of postgraduate trainees who work/study within their area of jurisdiction. Postgraduate trainees are required by University policy to comply with all University health, safety and environmental programs such as Workplace Hazardous Materials Information and Safety (WHMIS). The Faculty of Medicine and the teaching hospitals each are responsible for ensuring that postgraduate trainees are adequately instructed in infection prevention and control as it relates to communicable diseases. The Faculty and the teaching hospitals will provide an introductory program on routine practices / standard precautions, infection protection and control that is consistent with current guidelines and occupational health and safety. In addition, the Faculty and the teaching hospitals will inform postgraduate trainees as to their responsibilities with respect to infection prevention and control and occupational health and safety. Affiliated teaching hospitals are required to comply with the Communicable Disease Surveillance Protocols for Newfoundland and Labrador Hospitals. Compliance with these Protocols requires the hospitals, in liaison with the University’s academic programs, to provide instruction in infection prevention and control and occupational health and safety. The Faculty Postgraduate Medical Education Office collects the immunization data on all Postgraduate Trainees on behalf of the teaching hospitals. If an injury occurs while working, the injury must be reported as follows (Refer to Chart 1 on page 7)
During daytime hours, while working at one of the Newfoundland and Labrador hospitals:
The Postgraduate Trainee should go to the Employee Health Office at any of the teaching hospitals. An incident form will be provided by the Employee Health office to the Postgraduate Trainee. Reporting: All trainees are encouraged to submit a copy of the incident form to their home program for notification. The home program will send a copy to the Postgraduate Medical Education Office for University records. Non-Ministry of Health funded trainees: (e.g., foreign sponsored Residents and all Clinical Fellows *) must submit a copy of the incident form to the Postgraduate Medical Education Office, in order for the PGME Office to notify their sponsor and ensure proper follow-up. Occupational Health & Safety Office of the University will be notified.
Postgraduate Medical Education Office (PGME) Phone: 709-864-6331
During the evening or on the weekend at one of the Newfoundland and Labrador teaching hospitals or if working at a training site outside of the Newfoundland and Labrador area
The Postgraduate Trainee should go to the nearest Emergency Room and identify themselves as a Resident / Clinical Fellow and request to be seen on an urgent basis. The Postgraduate Trainee must complete, within 24 hours, an Injury/Incident Report (forms should be available in the local Emergency Room).
The injury/incident form should be submitted to the hospital where the injury took place. That hospital will be responsible for administering the claim.