The Endovascular Surgical Neuroradiology Milestone Project A Joint Initiative of The Accreditation Council for Graduate Medical Education
The American Board of Neurological Surgery The American Board of Psychiatry and Neurology The American Board of Radiology
July 2015
The Endovascular Surgical Neuroradiology Milestone Project
The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGMEaccredited residency or fellowship programs. The Milestones provide a framework for assessment of the development of the fellow in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context.
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Endovascular Surgical Neuroradiology Milestones Chair: B. Greg Thompson, MD Working Group
Advisory Group
Colin Derdeyn, MD Pam Derstine, PhD, MHPE Laura Edgar, EdD, CAE Muhammad Hussain, MD Alexander Khalessi, MD, MS Lawrence Wechsler, MD Robert Zimmerman, MD
Hunt Batjer, MD Gary Becker, MD Lawrence Davis, MD Larry Faulkner, MD Steven Lewis, MD Mary Lieh-Lai, MD Louis Ling, MD John Potts, MD
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Milestone Reporting This document presents milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each program’s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing. For each period, review and reporting will involve selecting Milestone levels that best describe a fellow’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty. Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v). Level 1: The fellow demonstrates milestones expected of an incoming fellow. Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level. Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship. Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target. Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level.
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Additional Notes
Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions. Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element. Some milestone descriptions include statements about performing independently. These activities must occur in conformity to the ACGME supervision guidelines, as well as to institutional and program policies. For example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight.
Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.
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The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be indicated by selecting the level that best describes that fellow’s performance in relation to those milestones.
Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated.
Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher level(s). v
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
MK1: Intracranial Aneurysm Level 1 Level 2 Demonstrates basic understanding of cerebral vascular anatomy and physiology Demonstrates understanding of clinical presentation/course of ruptured cerebral aneurysms Describes natural history of unruptured cerebral aneurysms Recognizes and appropriately classifies cerebral aneurysms based on location and imaging features using various diagnostic imaging modalities Appropriately classifies subarachnoid patients using established grading scales (e.g., Hunt and Hess, Fisher)
Demonstrates understanding of variant cerebral vascular anatomy and pathophysiology Lists indications, risks, benefits, contraindications, and alternatives of treatment (including no treatment) for intracranial aneurysm Recognizes and discusses complications of subarachnoid hemorrhage (e.g., hyponatremia, delayed neurological deficit, hydrocephalus, seizures) Demonstrates knowledge of risk factors for peri-procedural complications
Level 3
Level 4
Level 5
Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for intracranial aneurysm
Describes expected outcomes following endovascular therapy
Discusses advanced combined treatment for complex aneurysm (e.g., bypass)
Recognizes features on imaging to determine optimal method of endovascular treatment (e.g., use of adjuncts such as stent or balloon) Recognizes clinical and imaging features to determine optimal treatment modality (observation, endovascular, microsurgical)
Describes the indications for medical, endovascular, and microsurgical treatment of intracranial aneurysms
Contributes to the peerreviewed literature regarding cerebral aneurysmal disease and subarachnoid hemorrhage
Describes the indications for endovascular treatment of subarachnoid hemorrhage induced vasospasm Demonstrates a comprehensive understanding of available endovascular technologies for aneurysm treatment
Demonstrates knowledge of medical management adjuncts Demonstrates knowledge of intensive care for subarachnoid hemorrhage patients
Comments: Not yet achieved Level 1
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PC1: Intracranial Aneurysm Level 1
Level 2
Level 3
Level 4
Level 5
Performs a history and neurological examination in patients with cerebral aneurysm and/or subarachnoid hemorrhage
Effectively evaluates and establishes a treatment plan for patients with unruptured aneurysm in a supervised outpatient setting
Initiates appropriate management of complications of subarachnoid hemorrhage
Performs complex elements of endovascular aneurysm procedures independently
Uses patient quality data to improve patient outcomes
Safely and effectively performs a diagnostic cerebral angiogram with supervision
Recognizes complications of subarachnoid hemorrhage
Initiates appropriate management of complications of endovascular aneurysm treatment
Appropriately coordinates care for patients with aneurysmal subarachnoid hemorrhage
Recognizes complications of endovascular aneurysm treatment
Performs basic elements of intracranial endovascular procedures independently
Appropriately utilizes antiplatelets and antithrombotics in the periprocedural period
Performs complex elements of endovascular aneurysm procedures with supervision
Initiates the appropriate imaging evaluation of patients presenting with subarachnoid hemorrhage Performs basic elements of intracranial endovascular procedures with assistance
Leads multidisciplinary team in the management of complex aneurysmal disease
Establishes and executes plan for outpatient follow-up of treated and untreated patients
Manages vascular closure with devices, and manages complications of vascular access Performs basic elements of intracranial endovascular procedures with supervision Performs complex elements of endovascular aneurysm procedures with assistance
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 2
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
MK2: Vascular Malformation Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates basic understanding of cerebral and spinal vascular anatomy and physiology
Demonstrates understanding of pathophysiology of cerebral and spinal vascular malformations, including perfusion pressure breakthrough
Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for cerebral and spinal vascular malformation
Describes expected outcomes following endovascular therapy
Contributes to the peerreviewed literature on cerebral vascular malformations
Demonstrates understanding of clinical presentation/course of ruptured vascular malformations Describes natural history of unruptured cerebral and spinal vascular malformations Recognizes and appropriately diagnoses cerebral and spinal vascular malformations based on imaging features using various diagnostic imaging modalities
Lists indications, risks, benefits, contraindications, and alternatives of treatment for cerebral and spinal vascular malformations (observation, endovascular, microsurgical, radiosurgery, and combined) Demonstrates knowledge of risk factors for peri-procedural complications
Recognizes clinical and imaging features to determine optimal treatment modality (observation, endovascular, microsurgical, radiosurgery and combined) Recognizes features on imaging to determine optimal method of endovascular treatment (i.e., use of adjuncts)
Describes the indications for medical, endovascular, microsurgical, radiosurgical, and combined treatment of cerebral and spinal vascular malformations Demonstrates a comprehensive understanding of available endovascular technologies for cerebral and spinal vascular malformation treatment
Appropriately classifies cerebral and spinal vascular malformations using established grading scales (e.g., Spetzler-Martin for AVM, Borden, Cognard for dural fistulas)
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 3
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PC2: Vascular malformations Level 1
Level 2
Level 3
Level 4
Level 5
Performs a history and neurological examination in patients with cerebral and spinal vascular malformations
Effectively evaluates and establishes a treatment plan for patients with unruptured cerebral and spinal vascular malformations in a supervised outpatient setting
Initiates appropriate management of complications of endovascular vascular malformation treatment
Performs complex elements of intracranial and spinal endovascular procedures independently
Uses patient quality data to improve patient outcomes
Performs basic elements of intracranial and spinal endovascular procedures independently
Appropriately coordinates care for patients with ruptured cerebral vascular malformations
Performs complex elements of endovascular cranial and spinal procedures with supervision
Establishes and implements a plan for outpatient follow-up of treated and untreated patients
Safely and effectively performs diagnostic cerebral and spinal cerebral angiography with supervision Initiates the appropriate evaluation of patients presenting with ruptured cranial and spinal vascular malformations Performs basic elements of intracranial endovascular and intraspinal procedures with assistance
Recognizes complications of unruptured cerebral and spinal vascular malformations Recognizes complications of endovascular vascular malformation treatment
Leads multidisciplinary team in the management of cerebral and spinal vascular malformations
Appropriately utilizes antithrombotics in the periprocedural period Manages vascular closure with devices, and manages complications of vascular access Performs basic elements of intracranial and spinal endovascular procedures with supervision Performs complex elements of endovascular procedures with assistance
Comments:
Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 4
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
MK3: Arterial Occlusive Disease (AOD) Level 1
Level 2
Level 3
Level 4
Level 5
Understands pathogenesis of arterial occlusive disease, including Moya Moya, atherosclerosis, and dissection
Understands medical treatment options based on AOD etiology
Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for carotid disease and Internal Carotid Artery Dissection
Integrates clinical findings, imaging results, and pattern of collateralization to inform a plan of care
Publishes in the peer-reviewed literature on AOD
Understands symptoms of stroke and transient ischemic attack (TIA) Demonstrates knowledge of imaging features of different vascular modalities and selection of appropriate imaging based on clinical situation Understands patterns of vascular collateralization
Demonstrates knowledge of clinical syndromes associated with compromise of anatomic vascular distributions Understands the acquisition and utility of perfusion and other advanced imaging methods Identifies key clinical collaterals in AOD
Demonstrates knowledge of treatment options for AOD based on anatomic location, including risk and benefit profiles
Understands the range of procedure-related complications, their signs, symptoms, and management Demonstrates knowledge of long-term outcomes and need for surveillance imaging in AOD
Participates in the development of new devices for treatment of AOD, including participation in clinical trials Participates as a faculty member in the training of other physicians and learners in the management of AOD
Recognizes imaging findings associated with common AOD pathology, including Moya Moya, atherosclerosis, and dissection Understands physiologic responses to drive perfusion
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 5
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PC3: Arterial Occlusive Disease (AOD) Level 1
Level 2
Level 3
Level 4
Level 5
Diagnoses and provides appropriate medical management for extracranial carotid disease
Completes appropriate clinical and imaging work-up to identify patients benefiting from carotid endarterectomy (CEA) or carotid artery stenting (CAS)
Successfully performs diagnostic cerebral angiogram, macrovascular guide access for CAS procedure and postprocedure care
Successfully performs standard CAS procedure with distal embolic protection devices (DEPD) or balloon angioplasty
Leads a root-cause analysis for endovascular complications
Understands clinical and imaging factors that guide potential endovascular intervention or extracranial to intracranial (EC-IC) bypass
Performs uncomplicated intracranial angioplasty and stenting for intracranial atherosclerotic disease (ICAD)
Familiar with intensive medical therapy regimen (e.g., SAMMPRIS), and diagnoses intracranial atherosclerotic disease Applies diagnostic classification (e.g., Denver) to inform the management of carotid dissection Obtains relevant history, labs, and medications required for endovascular procedures Safely and effectively performs a diagnostic cerebral angiogram with supervision
Performs diagnostic angiogram and macrovascular access for carotid dissection procedure Manages medical complications of contrast nephropathy, embolic stroke, aspiration, and unstable arrhythmias
Obtains complex macrovascular guide access (e.g., Type III arch, brachial/radial approach) Provides peri-procedural blood pressure management in endovascular procedures (e.g., glycopyrrolate in CAS)
Recognizes and manages of common intra-procedural complications Performs complicated intracranial angioplasty and stenting involving tandem lesions Manages iatrogenic complications, including vessel dissection or extravasation Manage all phases of periprocedural sedation, including monitored anesthesia care (MAC) and conscious sedation
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 6
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
MK4: Acute Ischemic Stroke (AIS) Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates knowledge of signs and symptoms of AIS
Understands the anatomic substrate that corresponds with the clinical syndrome
Demonstrates knowledge of the clinical trial data regarding revascularization rate and clinical outcomes associated with iv-tPA vs. endovascular therapy for candidate occlusion
Understands range of medical and procedural complications associated with endovascular treatment of AIS, including identification of symptomatic intracranial hemorrhage (ICH), device-induced vasospasm, vessel dissection, and persistent occlusion
Contributes to the literature regarding clinical features and management of AIS
Demonstrates knowledge of the varying etiologies of stroke (e.g., structural vascular disease, cardioembolic) Demonstrates knowledge of inclusion and exclusion criteria for intravenous tissue plasminogen activator (iv-tPA) administration Demonstrates knowledge of imaging characteristics of acute infarction
Understands the medical therapies available for secondary prevention of stroke based on etiology Demonstrates knowledge of the indications for endovascular treatment Demonstrates knowledge of the progression of imaging findings in stroke over time
Demonstrates knowledge of clinical and imaging features, such as ASPECT score, location, patient age, and clot type, that impact clinical and technical success Demonstrates understanding of a range of mechanical thrombectomy devices and dosing of intra-arterial pharmacologic agents for endovascular therapy
Understands secondary mechanisms of injury including loss of blood-brain barrier, reperfusion injury, oxidative stress, and inflammation
Participates in teaching and training of residents in fellows concerning the management of acute stroke Contributes to the advancement of technology for the treatment of AIS
Understands strategic and treatment implications of tandem occlusions
Recognizes the imaging features of post-stroke treatment, including contrast staining
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 7
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PC4: Acute Ischemic Stroke (AIS) Level 1
Level 2
Level 3
Level 4
Level 5
Performs simple diagnostic cerebral angiogram
Performs ongoing patient assessment and manages possible complications of iv-tPA administration or cerebral edema (e.g., need for decompressive craniectomy)
Performs mechanical thrombectomy procedure in uncomplicated cases (i.e., simple anterior circulation)
Demonstrates proficiency in a range of mechanical thrombectomy devices and techniques, including aspiration system and stentrievers
Leads an interdisciplinary stroke team at a comprehensive stroke center (CSC)
Performs complete neurological exam, including NIHSS assessment Performs complete history to establish last known normal, medication history and contraindications Interprets parenchymal and vascular imaging to determine diagnosis and guide treatment decisions Identifies and coordinates stabilization of patients in extremitus (e.g., respiratory failure, acute hydrocephalus)
Determines whether stroke patient is candidate for endovascular intervention based on clinical and imaging criteria Performs complex diagnostic cerebral angiogram (e.g., Type III arch or tandem lesion) Manages intra-procedural sedation, hemodynamics, and rheology in simple cases
Manages common complications (e.g., groin hematoma, catheterinduced spasm) Coordinates post-procedural care, including blood pressure control, neurovascular checks, and interpretation of surveillance imaging Understands and applies indications for cerebral spinal fluid diversion or decompressive craniectomy
Contributes to peer-reviewed literature in AIS
Manages rare, serious complications (e.g., vessel dissection, perforation, or extravasation)
Serves as a faculty member for endovascular education
Performs complex stroke intervention, such as tandem carotid stenting with mechanical thrombectomy or posterior circulation occlusion
Participates in the development of new thrombectomy devices
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 8
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
MK5: Vascular Imaging (e.g., computed tomography [CT], magnetic resonance [MR], angiography, ultrasonography) Level 1
Level 2
Level 3
Level 4
Level 5
Differentiates normal from abnormal findings and identifies potential significance
Uses imaging findings in operative planning for basic procedures
Independently generates an accurate, concise, and organized report of imaging findings
Independently uses multidimensional imaging (e.g., 3-D computed tomography angiography [CTA])
Implements innovative imaging technology to enhance the care of the patient
Makes secondary observations and prioritizes differential diagnoses
Uses imaging findings in operative planning for intermediate procedures
Modifies imaging protocol to optimize data acquisition
Differentiates modalities based on comparative effectiveness and cost
Makes core observations, formulates differential diagnoses, and recognizes critical findings Recognizes need to modify imaging protocols based on patient comorbidities
Comments:
With supervision, generates an accurate, concise, and organized report of imaging findings
Teaches imaging interpretation to other learners
Uses imaging findings in operative planning for advanced procedures Observes and interprets subtle findings
Describes appropriate contrast dosing (e.g., for pediatric patients, renal disease)
Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 9
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PC5: Vascular Imaging Level 1
Level 2
Level 3
Level 4
Level 5
Recognizes and manages contrast reactions
Identifies patients at risk for complication of contrast administration and recommends appropriate management
Modifies protocols to minimize radiation exposure for neuroangiographic procedures
Educates others in issues related to contrast agent administration
Contributes to advancing the field of contrast agents
Evaluates patients at risk for complication of MRI and recommends appropriate management
Recognizes and manages radiation overexposure for neuroangiographic procedures
Describes the mechanisms of radiation injury and the ALARA (“as low as reasonably achievable”) concept Accesses resources to determine exam-specific average radiation dose information Describes risks of magnetic resonance imaging (MRI)
Communicates the relative risk of exam-specific radiation exposure to patients and practitioners
Contributes to advancing the field of radiation safety
Promotes radiation safety
Accesses resources to determine MRI safety in settings of implanted devices and retained metal Communicates MR safety of common implants and retained foreign bodies to patients and practitioners
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 10
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
SBP1: Radiation Safety Level 1
Level 2
Level 3
Level 4
Level 5
Describes the mechanisms of and risks for radiation injury
Recognizes signs of radiation injury Communicates the relative risk of exam-specific radiation exposure to patients
Consistently and independently employs ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality
Performs root cause analysis for recordable or reportable events
Describes the ALARA principle
With limited supervision, consistently employs ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality
With supervision, applies basic radiation protection and monitoring concepts
Develops methodologies to further decrease radiation exposure
Requires supervision when employing ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 11
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
SBP2: Patient Safety Level 1
Level 2
Level 3
Level 4
Level 5
Recognizes the importance of advocating for quality care and optimal patient care systems
Understands key concepts related to health care quality improvement
Advocates for optimal individual patient care in the endovascular environment
Understands and directs department protocols for patient safety in the endovascular environment
Participates in the development of national standards for safety in the endovascular environment
Recognizes potential sources of system failure in health care systems, such as medication errors
Recognizes and reports lapses in procedural and medication safety, procedural and medication errors, and near misses
Advocates for quality care and supports an environment of safety
Leads a team to evaluate medical errors and systemsbased failures and improve processes and systems
Acknowledges that medical errors and health care system failures are a significant cause of morbidity
Participates in a team-based approach to evaluate medical errors and systems-based failures
Comments: Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 12
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
SBP3: Systems-based Management Level 1 Identifies the members and roles of the endovascular team and CSC team
Level 2 Recognizes need for participation in a multidisciplinary care team
Participates in transitions of Understands principles of care, including stroke code procedure coding response Presents case analysis at quality improvement review
Level 3 Coordinates multidisciplinary care of the cerebrovascular patient
Level 4 Coordinates system resources and transitions of care for complicated cerebrovascular patients
Practices cost-effective care Understands the role of utilization review
Effectively manages the endovascular team
Level 5 Creates appropriate use criteria for endovascular therapy Participates in national decision-making for coding and reimbursement of endovascular therapy
Engages in utilization review Participates in the collection of CSC quality metrics
Comments:
Not yet achieved Level 1
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 13
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PBLI: Self-directed Learning Level 1
Level 2
Level 3
Level 4
Level 5
Acknowledges gaps in personal knowledge and frequently asks for feedback
Develops learning and improvement goals based on feedback
Performs ongoing selfassessment and implements individual learning plans
Creates novel ways to assess performance
Understands the importance of setting learning and improvement goals
Utilizes online data resources appropriately
Critically appraises scientific literature and applies evidencebased medicine principles for self-improvement as a clinician
Engages in performance improvement by incorporating feedback from multiple stakeholders (e.g., patients, members of the health care team, third-party payors) Demonstrates best clinical practice, including use of evidence-based pathways
Completes scholarly activity (e.g., scientific presentation, publication, research)
Participates in a quality improvement project
Applies results from selfdirected learning to educating others
Comments:
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 14
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
ICS1: Communication with Patients and Families Level 1
Level 2
Level 3
Level 4
Level 5
Recognizes the importance of effective communication with patients, families, and the public across a broad range of socioeconomic and cultural backgrounds
Demonstrates effective communication with patients and families
Educates patients and families regarding issues related to cerebrovascular disease
Obtains informed consent for participation in clinical trials
Consults on regional and national health care agencies
Engages in shared decision making when obtaining informed consent
Effectively communicates with vulnerable populations, including patients at risk and their families
Effectively communicates with patients and families regarding complications and adverse outcomes
Educates the public regarding cerebrovascular disease risks
Understands privileged communications and HIPPA compliance
Leads communication regarding end-of-life and withdrawal of care
Comments:
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 15
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
ICS2: Communication with Health Care Professionals Level 1
Level 2
Level 3
Level 4
Level 5
Recognizes the importance of effective, timely consultation and communication with the health care team
Demonstrates effective, timely consultation and communication with the health care team in routine clinical situations, including dictated reports
Provides effective, timely consultation and communication with the health care team in critical, timesensitive situations
Adapts communication strategies to resolve challenges with consultants and other health care professionals
Seeks leadership opportunities within professional organizations
Ensures transitions of care are accurately and efficiently communicated Ensures clear communication and respect among health care team members
Develops working relationships across specialties with other health care professionals
Provides education to the health care team (e.g., journal club)
Provides endovascular therapy education to other specialties within his or her own institution
Delivers talks to regional or national audiences
Participates in peer review
Comments:
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PROF1: Professional Values Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates behavior that conveys caring, honesty, genuine interest, and sensitivity when interacting with a diverse population of patients, families, and other members of the health care team
Engages in patient-centered care, including demonstrating compassion, integrity, respect, sensitivity, and responsiveness
Consistently manages own values and beliefs to optimize relationships and medical care
Develops and applies a consistent approach to evaluating appropriate care
Engages in shared decision making to develop alternate care plans when patients’ personal decisions/beliefs preclude the use of commonly accepted practices
Evaluates possible barriers to care, and creates strategies that consistently prioritizes the patient’s best interest
Develops institutional and organizational strategies to protect and maintain professional and bioethical principles
Consistently recognizes ethical issues in practice, including conflicts of interest
Effectively analyzes and manages ethical issues in challenging clinical situations (e.g., end-of-life, unexpected outcomes)
Comments:
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 17
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Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet
PROF2: Accountability to Patients, Society, Profession and Self Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates basic professional responsibilities, such as timely reporting for duty, responsiveness to consultation requests, appropriate dress/grooming, timely chart completion, and duty hour reporting
Identifies basic principles of physician wellness, including sleep, hygiene, and fatigue mitigation
Consistently recognizes limits of knowledge in uncommon and complicated clinical situations
Understands how to identify and confidentially report impairment in one’s self or a colleague
Develops institutional and organizational strategies for physician professional responsibilities
Consistently recognizes limits of knowledge in common and frequent clinical situations, and asks for assistance
Develops and implements plans for the best possible patient care
Manages medical errors consistent with principles of responsibility and accountability in accordance with institutional policy
Trains physicians and educators regarding responsibility, wellness, fatigue, and physician impairment
Maintains patient confidentially Uses social media ethically and responsibly Maintains current licensure, certification, and privileging as required by institutional and national governing bodies
Recognizes and avoids inappropriate influences of marketing and advertising Recognizes and acknowledges potential conflicts of interest
Serves as a role model for other physicians and health care providers Aware of institutional and national regulations regarding reporting of conflicts of interest
Comments:
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 18