American Urological Association Educational Linkages Worksheet Hands-On Ultrasound Urologic Course
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American Urological Association Educational Linkages Worksheet Hands-on Ultrasound Urologic Course Identified Practice Gaps Several external forces are requiring reassessment of the mechanisms by which non-radiologists gain and maintain skills involving diagnostic and therapeutic imaging. As such, there is momentum for the development of standards for physicians interpreting imaging studies and applying this knowledge in clinical practice. To address this issue in urology, the Board of Directors of the American Urological Association (AUA) created the Urologic Diagnostic and Therapeutic Imaging Task Force (UDTIF) in 20061. The initial charge of the Task Force was to inventory current image based practice in urology; investigate new educational mechanisms that could be developed for imaging and image based therapy in urology and developed possible mechanisms for credentialing and verification of skills. The inventory generated the following: Diagnostic Urologic Procedures Image Guided Urologic Procedures Prostate, Renal. Scrotal, Bladder, Penile Ultrasound Prostate Biopsy Retrograde Urethrogram/Pyelogram Renal Cryoablation/RF Ablation Cystogram Prostate Cryoablation IVP Prostate LDR Brachytherapy or HDR Dexascan for bone density Prostate HIFU Cavernosagram Percutaneous Renal/Retroperitoneal CT/MRI evaluation of the urinary tract Biopsy/Drainage Nuclear Medicine Imaging (bone, renal Radiosurgery and PET scanning) The Task Force inventoried the current use of imaging in urologic practice through clinical experience, peer discussions and review of major urologic texts1. A survey2 was also conducted to assess current use of imaging in urology practice. Areas assessed included ultrasound, CT, MRI, plain film/fluoroscopy based imaging and image guided procedures (percutaneous renal access, image guided ablation). Surveys were sent to 4000 urologists with 1042 responding (26%), the following were the results of the various modalities: Modality Urologist Radiologist Both Retroperitoneal Ultrasound 45% 30% 25% Scrotal Ultrasound 36% 38% 26% MRI 0.3% 73.7% 26% CT 1% 52% 47% Cystography 33% 19% 48% Pyelography 56% 7% 37% Image Guided Ablation 10% 65% 25% Percutaneous Renal Access 19% 36% 45% The survey documents that all aspect of diagnostic urologic imaging are practiced by AUA membership. In well over half of ultrasound and x-ray studies, urologists are the primary or integral partner in interpreting findings. Interpretation of axial imaging, especially MRI, is dependent on radiologists. For image-guided procedures, urologists are involved in less than half of the cases. This low rate of involvement in these procedures indicates a gap in the practice of urologists’ ability to provide point of service diagnostic and therapeutic imaging modalities to patients.3 1 UDTIF Report to the AUA Board of Directors, October 2006 2 Attachment 1 3 Rukstalis DB, Simmons J. Urologic Residency Curriculum in Ultrasound Augments Resident Competency in Urologic Ultrasound. J Urol. Sup. 2008 May 21;179(4):622 G:\EDUCATION\~CME\CRITERIA 2-6-NEEDS ASSESSMENT-PLANNING\NEEDS POOL\HANDS-ON ULTRASOUND\LINKAGE FORM HOW-TO-US 2008.DOC American Urological Association Educational Linkages Worksheet Hands-on Ultrasound Urologic Course Expected Results After this activity, participants should be able to: • Apply the physical principles of ultrasonography to urologic ultrasound • Employ the various ultrasound probes and machine settings to optimize imaging • Describe the indications for ultrasound for the kidney, bladder, scrotum and prostate • Identify normal ultrasound d anatomy and the most common abnormal findings of the kidney, bladder, scrotum and prostate • Successfully perform and document examinations of the kidneys, bladder, scrotum and prostate Target Audience A) Urologists, urology residents and sonologists Activity Format The Education Council, the Urologic Diagnostic and Therapeutic Imaging Committee, together with the Office of Education, using the adult learning principles, determined that the practice gaps found in the escalation of clinical skills requirements of urologists in providing point of service diagnostic and therapeutic imaging modalities before these services can be fully reimbursed, would be best addressed by interactive didactic and hands-on training in urologic ultrasound and for urologists to demonstrate proficiency in performing and documenting studies the AMA Verification of Skills Level II. Professional Practice Improvement The Education Council and the Office of Education, and using adult learning principles, determined that the following evaluation methods would be the most effective in analyzing the effectiveness of the activity: A. Pre and post test and verification of skills by faculty B. Evaluation immediately following activity C. Follow-up evaluation on implemented changes and barriers faced D. Evaluation information will be compiled and shared with the Chair of Education, Director of Education, course director and faculty and the Live Activities Committee for use in planning future activities. G:\EDUCATION\~CME\CRITERIA 2-6-NEEDS ASSESSMENT-PLANNING\NEEDS POOL\HANDS-ON ULTRASOUND\LINKAGE FORM HOW-TO-US 2008.DOC American Urological Association Educational Linkages Worksheet Hands-on Ultrasound Urologic Course Physician Competencies Physician competencies incorporated into the activity through the planning process American Board of Urology/AUA Core Curriculum AGCME Core Competencies 1) Patient Care – Provide patient care that is compassionate, appropriate, and effective 2) Medical Knowledge – established and evolving biomedical, clinical, and cognate sciences, and the application of this knowledge to patient care 3) Practice-based Learning and Improvement – investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve patient care practices. 4) Interpersonal and Communication Skills – Interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates 5) Professionalism – A commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population 6) Systems-based Practice – Awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value IOM 1) Provide patient-centered care 2) Work in interdisciplinary teams 3) Employ evidence-based practice 4) Apply quality improvement techniques 5) Utilize informatics Urologic competencies needed to provide point of service diagnostic and therapeutic imaging Patient-centered care Medical knowledge Practice-based learning and improvement/ Employ evidence-based practice Interpersonal and communication skills G:\EDUCATION\~CME\CRITERIA 2-6-NEEDS ASSESSMENT-PLANNING\NEEDS POOL\HANDS-ON ULTRASOUND\LINKAGE FORM HOW-TO-US 2008.DOC .