UMMC INTERVENTIONAL RADIOLOGY ROTATION DESCRIPTION R OTATION OVER VIEW

This one month rotation in Interventional Radiology at the University of Minnesota generally occurs in the second month of the radiology residency. Prior to the start of this rotation, all residents have completed at least one month in Interventional Radiology at the VAMHS. The goal of this rotation is to further develop procedural skills and insure exposure to different IR cases not commonly sees at the VAMHS. • •

•

Residents participate in the pre- and post-procedure discussions of the cases. They are responsible for pre-procedural evaluation and consenting of patients. In general, residents work one-on-one with faculty and fellows in performing procedures. They are allowed to be primary operators under the direct supervision of faculty based on complexity of cases and mastery of skills. Residents are responsible for writing post procedures orders, making appropriate follow up appointments, and admitting patients to the IR service, if indicated. They are expected to round on IR admissions and discharges. They are responsible for communicating pertinent findings and complications to primary clinicians/teams.

The basic objectives listed below are the same for other months in Interventional Radiology, but residents are expected to show greater proficiency and take greater responsibility during this rotation – that is, volume of experience is important in mastering the skills required by these procedures. Requirements are progressive and cumulative over time. That is, a resident in the 2nd or 3rd month of the rotation is assumed to continue to meet all the goals and objectives of the 1st month of rotation. The responsibilities and privileges that apply at the end of the 1st month rotation will continue to apply in subsequent months.

D IDACTICS • •

Complete minimum reading requirements specified in the UMIR Duty Sheet. Participate in conferences and rounds as described in the UMIR Duty Sheet. All residents will be responsible for presenting cases in conference.

CLINICAL ACTIVITIES

• • •

Participation in wide range of diagnostic and image-guided procedures, as noted in the specific objectives listed below under the core competencies. Active participation in patient management, pre- and post-procedure. IR Call – one day per week and one weekend per month.

ROTATION GOALS Upon completion of the UMIR rotation, resident will: • • •

Demonstrate mastery of the Body of Knowledge, as defined in the Section Curriculum Description for Interventional Radiology. Achieve “Competency” in each category evaluated by faculty evaluations through RMS system. Consistently meet the expectation outlined in the UMIR Duty Sheet.

COMPETENCIES & OBJECTIVES Goals are listed as bullets under each competency below. Each goal is followed by a list of objectives for each year (unit) of the complete rotation, along with the appropriate assessment tool for each objective. Evaluation codes, A, B, C, etc. refer to the Evaluation Methods and are described in more detail in the Appendix.

A: Global Faculty Evaluation; B: Case/Procedure Logs; C: 360 Degree Evaluation; D: Objective Test; E: Resident Learning Portfolio; F: Document participation in Department Activities; G: Evaluation quality of reports; H: Direct Observation and I: Journal Club PATIENT CARE  DEVELOP A MANAGEMENT PLAN BASED ON RADIOLOGIC FINDINGS AND CLINICAL INFORMATION MO OBJECTIVE DESCRIPTION

EVALUATION METHOD

1

• •

2

• •

Understands the indications and risks associated with diagnostic and interventional procedures. Aware of best practices for managing complications associated with procedures. Understand pros and cons of interventional radiology vs. surgical treatments. Provide post-procedure patient management: follow-up studies and patient care.

A,B,H

A,B,H

 DEMONSTRATE PROPER TECHNIQUE IN PLANNING AND PERFORMING IMAGE-GUIDED PROCEDURES MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

2

• •

Learn the indications, contradictions, and possible complications associated with common procedures. Understand strategies for minimizing radiation exposure, and reactions to contrast agents. Understand pros and cons of interventional radiology vs. surgical treatments. Correctly perform common procedures, including imageguided biopsy, abscess drainage, paracentesis, thoracentesis, and basic angiography.

A,B,H

A,B,H

MEDICAL KNOWLEDGE (Residents should be knowledgeable, scholarly and committed to lifelong learning)  RECOGNIZE AND DESCRIBE RELEVANT RADIOLOGIC ABNORMALITIES MO OBJECTIVE DESCRIPTION ALL

•

Understand normal (including normal variants) and abnormal patient anatomy as they pertain to interventional procedures.

 SYNTHESIZE RADIOLOGIC AND CLINICAL INFORMATION AND FORM AN IMPRESSION MO OBJECTIVE DESCRIPTION

EVALUATION METHOD A,D

EVALUATION METHOD

ALL

• •

Know the role of comorbidity, life expectancy, and referring clinician input in the “impression”. Articulate the risks and benefits of procedures.

A,D,H

 UTILIZE INFORMATION TECHNOLOGY TO INVESTIGATE CLINICAL QUESTIONS AND FOR CONTINUOUS SELFLEARNING. MO OBJECTIVE DESCRIPTION EVALUATION METHOD

ALL

• •

Demonstrate use of internet to find pertinent information to add to current cases and teaching file cases. Demonstrate case based computer initiated biomedical library and internet information access.

A,D,H,I

INTERPERSONAL/COMMUNICATION SKILLS (Residents should communicate and teach effectively)  RECOGNIZE AND DESCRIBE RELEVANT RADIOLOGIC ABNORMALITIES MO OBJECTIVE DESCRIPTION 1

• •

2

• •

Interactions with team members are in accordance with the UMIR Duty Sheet. Residents interact effectively and appropriately with both patients and families. Articulate the radiologist’s role, and the role for image-guided procedures, in conjunction with other clinical areas (e.g., surgery, oncology, and gynecology). Understand and effectively manage areas of shared responsibility, particularly with IR nursing staff.

 APPROPRIATELY OBTAIN INFORMED CONSENT MO OBJECTIVE DESCRIPTION 1

•

2

• •

Demonstrate knowledge of principles of informed consent, and appropriate documentation of such. Clearly explain the risks and benefits of procedures, as well as alternative procedures. Consistently obtain appropriate informed consent with appropriate documentation

EVALUATION METHOD A,C,G,H

A,C,G,H

EVALUATION METHOD A,C,G,H A,C,G,H

 RECOGNIZE, APPROPRIATELY COMMUNICATE, AND DOCUMENT IN THE PATIENT RECORD URGENT OR UNEXPECTED RADIOLOGIC FINDINGS

MO

OBJECTIVE DESCRIPTION

EVALUATION METHOD

1

•

2

• •

Consistently contacts the clinician after procedures to report any complications and recommend post-procedure patients management. Write clear orders for post-procedure patients’ management. Understand the role of the radiologist in treatment planning.

A,C,G,H

A,C,G,H

 PRODUCE RADIOLOGIC REPORTS THAT ARE ACCURATE, CONCISE, AND GRAMMATICALLY CORRECT. MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

2

•

Effectively communicate the radiological findings in both oral and written format, observing report standards in the UMIR Duty Sheet. Clearly indicate recommendations for procedures based on the impression, including post-procedure patient management. Demonstrate awareness of medicolegal aspects of reporting.

A,C,G,H

A,C,G,H

 EFFECTIVELY TEACH RESIDENTS, MEDICAL STUDENTS AND OTHER HEALTH CARE PROFESSIONALS. MO OBJECTIVE DESCRIPTION EVALUATION METHOD ALL

• •

Produce one teaching file per rotation and give case conferences as scheduled. Effective in teaching previously mastered competencies to medical students and more junior residents.

A,C,G,H

PRACTICE-BASED LEARNING AND IMPROVEMENT (Residents should investigate and evaluate patient care practices, and appraise and assimilate scientific evidence in order to improve their practices)  PARTICIPATE IN QI (QUALITY IMPROVEMENT)/QA (QUALITY ASSURANCE) ACTIVITIES MO OBJECTIVE DESCRIPTION

EVALUATION METHOD

1 2

• • •

Demonstrate understanding of Quality Assurance process. Log cases in the tracking sheet in a timely manner. Actively participate in identifying errors, improving quality of the image and its interpretation, and forwarding the results to the Quality Assurance Committee.

 RECOGNIZE AND CORRECT PERSONAL ERRORS MO OBJECTIVE DESCRIPTION

A,E A,E,H

EVALUATION METHOD

ALL

•

Consistently use personal errors and feedback on errors to improve performance.

A,E,H

• •

Apply strategies for elimination of errors recognized by Quality Assurance Committee. Use printed and electronic resources to access information that can further the individual’s knowledge and further the care of the patient.

PROFSSIONALISM (Residents should be altruistic and accountable, and adhere to principles of medical ethics by respecting and protecting patient’s best interest)  DEMONSTRATE A RESPONSIBLE WORK ETHIC WITH REGARD TO CONFERENCE ATTENDANCE AND WORK ASSIGNMENTS

MO ALL

OBJECTIVE DESCRIPTION • • •

Comply with UMIR Duty Sheet requirements for conferences and teaching files. Uphold work ethic described on the UMIR Duty Sheet. Demonstrate respect for patient privacy and confidentially.

 DEMONSTRATE ACCEPTABLE PERSONAL DEMEANOR AND HYGIENE MO OBJECTIVE DESCRIPTION 1

•

2

•

Comply with standards for professional appearance and conduct as outlined in the UMIR Duty Sheet. Assume greater responsibility, in interactions with personnel in the work environment, for maintaining a respectful work environment.

EVALUATION METHOD A,C,H

EVALUATION METHOD A,C,H

SYSTEMS-BASED PRACTICE (Residents should understand healthcare practice)  DEMONSTRATE KNOWLEDGE OF AND APPLY APPROPRIATENESS CRITERIA AND OTHER COST-EFFECTIVE HEALTHCARE PRINCIPLES TO PROFESSIONAL PRACTICE

MO

OBJECTIVE DESCRIPTION

1

• • • •

2

• •

Attend interdisciplinary conferences. Demonstrate understanding of electronic medical records. Know the ACR standards of appropriate criteria. Demonstrate understanding of and consistent practice of radiation safety. Correctly apply ACR standards/appropriateness criteria. Develop understanding of cost effective algorithms for patient care.

EVALUATION METHOD A,E,F

A,E,F

VA INTERVENTIONAL RADIOLOGY ROTATION DESCRIPTION

ROTATI ON OVERVI EW

Residents have a one-month rotation in interventional radiology during their first and second years of radiology residency In general, residents will work one-on-one with faculty, senior residents, and fellows during the performance of procedures. During the first month, they observe and assist in cases. With more experience, they serve as primary operators under the direct supervision of faculty. In the second month of this rotation, residents help to teach first year residents so as to solidify knowledge gained during the first month of the rotation. In many cases, the basis objectives listed below are the same for both months, but residents are expected to show greater proficiency and take greater responsibility in the second month of the rotation—that is, volume of experience is important in mastering the skills required by these procedures. During this rotation, residents receive training in the following subspecialties: •

Interventional Radiology

Requirements are progressive and cumulative over time. That is, a resident in the 2nd or 3rd month of the rotation is assumed to continue to meet all the goals and objectives of the 1st month of rotation. The responsibilities and privileges that apply at the end of the 1st month rotation will continue to apply in subsequent months.

D I DACTI CS • •

Complete minimum reading requirements specified in the VAIR Duty Sheet. Participate in conferences and rounds as described in the VAIR Duty Sheet. All residents will be responsible for presenting cases in conference.

CLINICAL ACTIVITIES

• •

Participation in wide range of diagnostic and image-guided procedures, as noted in the specific objectives listed below under the core competencies Active participation in patient management, pre- and post-procedure

ROTATION GOALS Upon completion of the VAIR rotation, residents will: •

Demonstrate mastery of the Body of Knowledge, as defined in the Section Curriculum Description for Abdominal Imaging

• •

Achieve “Competency” in each category evaluate by faculty evaluations through the RMS system Consistently meet the expectations outlined in the VAIR Duty Sheet

COMPETENCIES & OBJECTIVES Goals are listed as bullets under each competency below. Each goal is followed by a list of objectives for each year (unit) of the complete rotation, along with the appropriate assessment tool for each objective. Evaluation codes, A, B, C, etc. refer to the Evaluation Methods and are described in more detail in the Appendix.

A: Global Faculty Evaluation; B: Case/Procedure Logs; C: 360 Degree Evaluation; D: Objective Test; E: Resident Learning Portfolio; F: Document participation in Department Activities; G: Evaluation quality of reports; H: Direct Observation and I: Journal Club PATIENT CARE  DEVELOP A MANAGEMENT PLAN BASED ON RADIOLOGIC FINDINGS AND CLINICAL INFORMATION MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

2

• • •

Understands the indications and risks associated with diagnostic and interventional procedures Aware of best practices for managing complications associated with procedures Understand pros and cons of interventional radiology vs. surgical treatments Provide pre-procedure patient management, including appropriate orders for medications and other patient preparation Provide post-procedure patient management: follow-up studies and patient care

A,B,H

A,B,H

 DEMONSTRATE PROPER TECHNIQUE IN PLANNING AND PERFORMING IMAGE-GUIDED PROCEDURES MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

2

• •

Learn the indications, contraindications, and possible complications associated with common procedures, including most vascular procedures. Understand strategies for minimizing radiation exposure, and reactions to contrast agents Understand pros and cons of interventional radiology vs. surgical treatments Correctly perform common vascular procedures, including drainages, angiography, image-guided biopsy, and central venous access

A,B,H

A,B,H

MEDICAL KNOWLEDGE

(Residents should be knowledgeable, scholarly and committed to lifelong learning)

 RECOGNIZE AND DESCRIBE RELEVANT RADIOLOGIC ABNORMALITIES MO OBJECTIVE DESCRIPTION ALL

•

Understand normal (including normal variants) and abnormal patient anatomy as they pertain to interventional procedures

 SYNTHESIZE RADIOLOGIC AND CLINICAL INFORMATION AND FORM AN IMPRESSION MO OBJECTIVE DESCRIPTION ALL

• •

Know the role of comorbidity, life expectancy, and referring clinician input in the “impression”. Articulate the risks and benefits of procedures

EVALUATION METHOD A, D

EVALUATION METHOD A, D , H

 UTILIZE INFORMATION TECHNOLOGY TO INVESTIGATE CLINICAL QUESTIONS AND FOR CONTINUOUS SELF-LEARNING. MO OBJECTIVE DESCRIPTION EVALUATION METHOD

ALL

• •

Demonstrate use of internet to find pertinent information to add to current cases and teaching file cases Demonstrate case based computer initiated biomedical library and internet information access

A, D

INTERPERSONAL/COMMUNICATION SKILLS (Residents should communicate and teach effectively)

 SHOW SENSITIVITY TO AND COMMUNICATE EFFECTIVELY WITH ALL MEMBERS OF THE HEALTH CARE TEAM

MO 1

OBJECTIVE DESCRIPTION • •

2

• •

EVALUATION METHOD

A,C,G,H Interactions with team members are in accordance with the VAIR Duty Sheet. Residents interact effectively and appropriately with both patients and parents. A,C,G,H Articulate the radiologist’s role, and the role of imageguided procedures, in conjunction with other clinical areas (e.g., surgery, oncology, gynecology). Understand and effectively manage areas of shared responsibility, particularly with IR nursing staff

 APPROPRIATELY OBTAIN INFORMED CONSENT MO OBJECTIVE DESCRIPTION 1

•

2

• •

Demonstrate knowledge of principles of informed consent, including what information is needed and when, and appropriate documentation of such. Clearly explain the risks and benefits of procedures, as well as alternative procedures Consistently obtain appropriate informed consent with appropriate documentation

EVALUATION METHOD A,C,G,H

A,C,G,H

 RECOGNIZE, APPROPRIATELY COMMUNICATE, AND DOCUMENT IN THE PATIENT RECORD URGENT OR UNEXPECTED RADIOLOGIC FINDINGS

MO 1

OBJECTIVE DESCRIPTION • •

2

•

Consistently contacts the clinician after procedures to report any complications and recommend postprocedure management Write clear orders for post-procedure patient management Understand the role of the radiologist in treatment planning

EVALUATION METHOD A,C,G,H

A,C,G,H

 PRODUCE RADIOLOGIC REPORTS THAT ARE ACCURATE, CONCISE, AND GRAMMATICALLY CORRECT. MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

2

•

Effectively communicate the radiological findings in both oral and written format, observing report standards in the VAIR Duty Sheet Clearly indicate recommendations for procedures based on the impression, including pre- and post-procedure patient management Demonstrate awareness of medicolegal aspects of reporting

A,C,G,H

A,C,G

 EFFECTIVELY TEACH RESIDENTS, MEDICAL STUDENTS AND OTHER HEALTH CARE PROFESSIONALS. MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

• •

Produce on teaching file per rotation and give case conferences as scheduled Effective in teaching previously mastered competencies to medical students and more junior residents

PRACTICE-BASED LEARNING AND IMPROVEMENT

A,C,G,H

(Residents should investigate and evaluate patient care practices, and appraise and assimilate scientific evidence in order to improve their practices)

 PARTICIPATE IN QI (QUALITY IMPROVEMENT)/QA (QUALITY ASSURANCE) ACTIVITIES MO OBJECTIVE DESCRIPTION EVALUATION METHOD

1

•

2

•

Demonstrate understanding of Quality Assurance process Actively participate in identifying errors, improving quality of the image and its interpretation, and forwarding the results to the Quality Assurance Committee

 RECOGNIZE AND CORRECT PERSONAL ERRORS MO OBJECTIVE DESCRIPTION ALL

• • •

Consistently use personal errors and feedback on errors to improve performance. Apply strategies for elimination of errors recognized by the Quality Assurance Committee Use printed and electronic resources to access information that can further the individual’s knowledge and further the care of the patient.

A, E A,E,H

EVALUATION METHOD A,E,H

PROFSSIONALISM

(Residents should be altruistic and accountable, and adhere to principles of medical ethics by respecting and protecting patient’s best interest)

 DEMONSTRATE A RESPONSIBLE WORK ETHIC WITH REGARD TO CONFERENCE ATTENDANCE AND WORK ASSIGNMENTS

MO ALL

OBJECTIVE DESCRIPTION • • •

Comply with VAIR Duty Sheet requirements for conferences and teaching files. Uphold work ethic described on the VAIR Duty Sheet. Demonstrate respect for patient privacy and confidentially.

 DEMONSTRATE ACCEPTABLE PERSONAL DEMEANOR AND HYGIENE MO OBJECTIVE DESCRIPTION 1

Comply with standards for professional appearance and conduct as outlined in the VAIR Duty Sheet. 2 • Assume greater responsibility, in interactions with personnel in the work environment, for maintaining a respectful work environment. SYSTEMS-BASED PRACTICE •

EVALUATION METHOD A,C,H

EVALUATION METHOD A,C,H A,C,H

(Residents should understand healthcare practice)

 DEMONSTRATE KNOWLEDGE OF AND APPLY APPROPRIATENESS CRITERIA AND OTHER COST-EFFECTIVE HEALTHCARE PRINCIPLES TO PROFESSIONAL PRACTICE

MO 1

OBJECTIVE DESCRIPTION • • • •

2

• •

Attend interdisciplinary conferences Demonstrate understanding of electronic medical records, including PACS and its integration Know the ACR standards of appropriate criteria. Demonstrate understanding of and consistent practice of radiation safety. Correctly apply ACR standards/appropriateness criteria. Develop understanding of cost effective algorithms for patient care.

EVALUATION METHOD A,E,F

A,E,F