Download Medical Imaging and Anatomy - Course Manual and Syllabus

Medical Imaging and Anatomy - Course Manual and Syllabus
COURSE SYLLABUS
Course Title: Interdisciplinary Science Course in Medical Imaging & Anatomy
Course Directors: Cari Buckingham, MD, Lillian Nanney, Ph.D, Erin Kinney, MD
[email protected]; [email protected],
Contact Information: [email protected]
Asma Ahmed, MD; Chris Baron, MD; Jake Block, MD; Peter Bream,
Additional Faculty Instructors: MD; Jeff Creasy, MD; Lori Deitte, MD; Katherine Frederick-Dyer,
MD; Art Fleischer, MD; Martin Jordanov, MD, Mary Keenan, Ph.D.;
Allen Newton, Ph.D; Kim Sandler, MD; David Taber, MD; Jill Trotter;
Geoffrey Wile, MD; Jennifer Williams, MD; Phillip K. Williams
Additional Resident Karen Ayers, MD; Adam Militana, MD; Eddie Hyatt, MD; Dave
Instructors: Johnson, MD; Allison Johnsen, MD;
Minimum/Maximum 4 minimum 10 maximum
Enrollment
Course Duration: (weeks) 4 weeks - Sessions offered August, October, January, March
Number of Contact Hours + Approx 40/week on-site + 10-15/week outside preparation
self-study hours
Course at a Glance
Course Overview & Welcome
The Medical Imaging and Anatomy Immersion Course is designed to build on the foundational
knowledge of anatomy and radiology constructed during your FMK and FCC experiences. Students
will be challenged to learn additional basic sciences (primarily anatomy) while advancing their
clinical skills at applying this knowledge to medical imaging. This course will provide a broad
multidisciplinary approach to medical imaging aspects in order to promote competent use of and
interaction with medical imaging and those professionals who provide imaging during your future
training. Each student will also participate in selective reading room experiences, dissection
demonstrations and oral presentations that are based on their future career directions.
The use of radiology in patient care is pervasive. Essentially every patient will interact with
medical imaging in one form or another during his/her care. Medical Imaging services are
provided by multiple disciplines. This course will focus on both inpatient and outpatient services
provided by a hospital-based radiology department. Immersion students are expected to emerge
from this course with a) an expanded hands-on knowledge of generalized and specialized anatomy
useful for interpreting medical imaging b) a more thorough understanding of appropriate
ordering , national guidelines and the limitations of imaging c) a working knowledge of basic
radiation physics and safety d) hands-on experience with image guided procedures and basic
sonographic skills e) improved competency in communicating imaging-related information to
patients. Learners will have an adequate foundation to proceed into the various advanced clinical
electives that will contain more details and focused diagnostic or interventional radiology.
Medical Imaging and Anatomy - Course Manual and Syllabus
Course Description
Imaging is an essential component of the diagnosis and treatment of disease across all fields of
medicine. Every physician interacts with medical imaging both in emergent and non-emergent
settings. Therefore, this course is built on the premise that each physician-in-training requires
knowledge of the utility, indications, acquisition, interpretation, limitations, and risks of medical
imaging. Physicians are expected to understand how imaging affects patient care and
management and how these diagnostic and interventional tools fit into the larger healthcare
delivery system. This course will strengthen and expand upon prior learning in anatomy,
embryology, pathophysiology, endocrinology, neuroscience, and pathology and introduce
students to radiobiology and radiation effects, imaging physics, imaging ethics, radiologic and
pharmacology. The course will consist of a “general” portion for all students as well as a secondary
“selective” portion with activities in one of the following: neurologic imaging, cardiothoracic
imaging, body imaging, or musculoskeletal imaging. Self-paced didactic podcasts and case series as
well as interactive lectures, small group discussions based around cases in the various regions, and
student presentation will be offered. Each student will have 5 clinical exposures to medical
imaging in diagnostic, interventional, and therapeutic settings and be expected to reflect and
discuss his/her experiences from the perspective of the radiology technologist and the patient.
Students will learn and be evaluated in basic ultrasound scanning technique. In the selective
portion of the course, students will complete checklists in the reading room. In the gross anatomy
lab students will prosect and demonstrate anatomic regions to peers. Students will work to
compare and label anatomic structures on cadaveric cross-sections with corresponding CT scans.
Students will reinforce their anatomic knowledge as they practice their technical skills with
ultrasound scanning on stimulated patients in CELA. Additionally, each student will make an oral
presentation to peers/faculty on a "selective" based topic. After completing this course, students
will feel confident with key anatomy, will be well practiced in their reading skills, be able to make
numerous “do-not-miss” imaging diagnoses, have increased ultrasound skills and will be able to
use imaging in a safer and more appropriate manner. A primary focus will be on having a student
emerge with an entrustable professional activity/competent in the realm of Appropriate Ordering
of Radiologic Procedures.
Course Learning Objectives & Goals:
1)
2)
3)
4)
5)
6)
7)
8)
9)
Reinforce and expand on anatomic knowledge (learned in previous foundational
experiences) as it pertains to the structures commonly evaluated in medical imaging
Develop a systematic approach to evaluating and interpreting images
Learn to make several “do not miss” diagnoses commonly encountered in the inpatient
setting
Gain in-depth anatomic and imaging experience in the area most appropriate to future
training/career plans
Develop and prioritize differential diagnoses based on common imaging
findings and patient history.
Learn tools to request/perform the most appropriate and safe imaging
examination
Learn basic mechanisms of image generation and imaging safety
Understand the “patient experience” of common imaging examinations and
interventional radiology procedures, and how the radiology “team” cares for
patients
Anticipate and inform discussions with patients and family regarding
Medical Imaging and Anatomy - Course Manual and Syllabus
medical imaging
10) Gain basic hands-on US scanning experience and anatomic recognition in a simulated
environment with normal patients.
11) Gain dexterity with the use of imaging tools (PACS)
12) Contribute to fellow students’ learning through case discussions, prosections and
demonstrations, and an end of course presentation
13) Gain practice with accessing the radiology literature and using online
radiologic resources.
Course Logistics:
You may expect to find these components on VSTAR/Learn
a) Learning materials (powerpoint slides)
b) Monthly Excel calendar, daily VSTAR calendar, rotation assignments
c) Course Syllabus containing Standard Assessment Expectations for Interdisciplinary Science
Courses and Milestones that will be assessed in this course
d) Course Director Announcements posted on the Forum
e) Student Forum for questions and announcements from students. Students are
encouraged to post questions to course directors at this site so all students can benefit
from the answers. But e-mails are appropriate for personal matters
f) Weekly Learning Objectives
g) Checklists for reading room, for clinical rotations
h) Weekly quizzes will become available at 5:00 pm on Friday and must be completed by
Monday morning at 8:00 am
i) Milestone based assessment assignments will be posted on VSTAR/Portfolio.
If you experience technical difficulties with while taking a quiz or completing an
activity in VSTAR/Learn or VSTAR/Portfolio, please notify Lillian Nanney by email. Do
not panic. We will fix the glitch at our earliest convenience. Your assignment or quiz
will not be judged late. We will consult with the IT team and work out a solution.
Locations for Learning Activities:
Group activities/Lectures: R1303 (mostly) or D-1116 (occasionally), Radiology Dept, 1st floor
Medical Center North
Gross Anatomy Activities: 10th Floor VIIS, 24/7 access with your ID Card
Individual Rotations for Clinical Activities and Reading Room Locations will be posted on
VSTAR/Learn
Ultrasound Skills taught in CELA with SPs: 3rd floor or 4th floor (check schedule)
Course Faculty
Asma Ahmed, MD – Assistant Professor of Radiology & Radiological Sciences
Rochelle Andreotti, MD, Professor of Radiology & Radiological Sciences, Associate Professor of
Clinical OB/GYN, [email protected]
Chris Baron, MD – Interventional Radiology, Assistant Professor of Radiology & Radiological
Sciences, [email protected]
Jake Block, MD, Associate Professor of Radiology and Radiological Sciences, Chief Musculoskeletal
Service, [email protected]
Medical Imaging and Anatomy - Course Manual and Syllabus
Peter Bream, MD, Assistant Professor of Radiology & Radiological Sciences,
[email protected]
Jeff Creasy, MD, Professor of Radiology & Radiological Sciences, [email protected]
Taylor Davis, MD – Neuroradiology, Clinical Instructor
Lori Deitte, MD – Body Radiology & Ultrasound, Associate Professor of Radiology & Radiological
Sciences, Vice Chair Education
Edwin Donnelly, MD, Ph.D., Program Director, Associate Professor of Radiology & Radiological
Sciences. [email protected]
Art Fleischer, MD, Professor of Radiology & Radiological Sciences,
[email protected]
Katherine C. Frederick-Dyer, Instructor, Radiology and Radiological Sciences, [email protected]
Martin Jordanov, MD – Musculoskeletal Imaging, Assistant Professor of Radiology & Radiological
Sciences, [email protected]
Mary Keenan, Ph.D. Medical Physicist, [email protected]
Victoria Morgan, MD, Associate Professor of Radiology & Radiological Sciences,
[email protected]
Allen T. Newton, Ph.D. Sr. Research Imaging Specialist
Vanderbilt University Institute of Imaging Science, [email protected]
Kim Sandler, MD – Cardiothoracic Radiology, Assistant Professor of Radiology & Radiological
Sciences, [email protected]
Jill Trotter, Program Director, School of Diagnostic Sonography, [email protected]
Geoffrey Wile – Medical Director for Computed Tomography, Assistant Professor of Radiology and
Radiological Sciences, [email protected]
Phil Williams – Supervisor of Diagnostic Sonography, [email protected]
Jennifer Williams, MD - Assistant Professor of Radiology & Radiological Sciences,
[email protected]
Selective Faculty you are likely to work with in the reading room:
Body/Abdominal Area – Lori Deitte, Asma Ahmed
Cardiothoracic Area – Kim Sandler, Jennifer Williams
Musculoskeletal Area – Jake Block, Kate Heartley, Marty Jordanov, David Taber
Neuroanatomy Area - Cari Buckingham, Jeff Creasy, Taylor Davis
Instructional Components
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Clinical Experience (interpretation in the reading room, experience with imaging in the
imaging suites)
Ultrasound scanning - CELA, clinical experiences
Self-directed learning (case modules, reading, podcasts, cases to review from reading
room)
Experiential learning with Dissections, labeling of Cross-Sectional Anatomy on actual
cadaver sections and on CTs, bones
Group discussions, case presentations, informal team-based learning
End of Course presentation to peers/faculty (oral topic, prosection review)
Course Assessments (Pretest, weekly quizzes, end of course written & practical GA
exam, ultrasound checkoff, reading room checkoffs)
Medical Imaging and Anatomy - Course Manual and Syllabus
Course Requirements and Modes of Assessment:
All ISCs will use qualitative (VUSM competency milestones) and quantitative measures (quizzes,
examinations, presentations, reflections) when determining final grades (Honors, High Pass, Pass
or Fail). Questions on the weekly and final exam assessment will be comprised of questions taken
from the national vetted bank of student radiology exam questions (similar to a national shelf
exam) as well questions designed by your instructors. To pass an ISC Course, each student
must pass both the quantitative and qualitative measures. To obtain honors, a student
should demonstrate excellent performance in all aspects of the course. Mid-course
feedback will be provided as follows: Green light, Yellow light, Red light. It will be based on 2
weeks of quizzes, mid-course reading room checkoff activity, quality of engagement in activities
(labs, classroom discussions) and the checklist from the clinical rotations. At the end of the
course, Course directors will synthesize milestone input from faculty, residents, staff) and make
one final assessment for each competency, which will be considered when determining a final
grade.
Quantitative assessments in Medical Imaging and Anatomy will be weighted and determined as
follows:
Component
Quantitative Scores on 3 weekly quizzes
Quantitative performance on GA Lab
practical
Performance and Knowledge on an end-ofcourse ultrasound checkoff
MCQ & Essay Final Exam
Percentage
36%
12%
12%
40%
The following competency domains and milestones (qualitative aspects) are required
for student assessment in all ISCs Courses: https://medschool.vanderbilt.edu/ume/iscmilestones.
MEDICAL KNOWLEDGE
Integration
Depth
Analysis
Inquiry
Use of info resources
PATIENT CARE
Thought process
Self-knowledge
INTERPERSONAL COMMUNICATION
Content of presentations to colleagues
PRACTICE-BASED LEARNING & IMPROVEMENT
Receptivity to feedback
MK2a
MK2b
MK7a
MK7b
MK7c
PC2a
PC7a
IPCS7b.1
PBLI3a
Medical Imaging and Anatomy - Course Manual and Syllabus
SYSTEMS BASED PRACTICE
Initiative and contribution to group efforts
PROFESSIONALISM
Professional duty
SBP2a
PR1b
Qualitative (Milestones) Assessments will be determined in Medical Imaging & Anatomy by
the following activities:

Oral Presentation of Topic (Communication: IPCS7b, Medical Knowledge:
especially Inquiry, use of info resources, integration)
Includes peer assessment & faculty assessment

Oral Demonstration/Presentation in GA Lab (Communication, Medical
Knowledge, Systems-Based Practice: SBP2a: Initiative & contribution to group efforts)
Includes peer assessment and faculty assessment

Verbal contributions to peer discussion during the course such as in UNKNOWNS
Case conference or daily classroom interactions (Professional Duty: PR1b, Medical
Knowledge MK7a Analysis, MK7B Inquiry, Practice-based Learning & Improvement:
PBLI3a)
 Reading Room Activities (Patient Care: PC2a, PC7a Thought process and selfknowledge; Medical Knowledge: MK7b or MK7c Inquiry, Use of info resources)
 Clinical Observations during rotations from checkoff sheet and group discussions
(Patient Care: PC2a: thought processes; Medical Knowledge: MK7b Inquiry;
Systems based practice: SBP2a Initiative and contribution to group efforts)
 Peer Assessments of GA Labs and Oral Presentations:; Professional duty PR1b
Milestone assessments will accumulate individually into the portfolio from these activities. The
course directors will make an overall milestone assessment based on the accumulation of
datapoints and observed behaviors throughout the course. All ISCs will assign final grades based
on the following criteria:
Final Grade
Quantitative Score
Risk of Failure
(course director
discretion)
Pass
<70%
High Pass
At least 80%
Honors
At least 90%
At least 70%
Summative Competency Ratings (Qualitative Score)
(6 domains assessed)
Any Sub-Threshold
OR
>2 Thresholds
No more than 2 Thresholds
All others at Target or above
At least 3 Reaches
All others at Target
Nothing below Target
5 Reaches
Student grievance concerning grades
Students can seek redress of a problem with a grade no later than four weeks after the
grade is released. Students with a grievance should confer directly with the ISC Director.
Every effort should be made to resolve the problem fairly and promptly at this level. If the
Medical Imaging and Anatomy - Course Manual and Syllabus
student and ISC Director cannot resolve the problem through discussion, the student can
formally request an appeal, within two weeks of talking with the course director, from the
Associate Dean for Medical Student Affairs (ADMSA). Appeal will prompt a review of the
course’s assessment practices by the Standing Assessment Committee, as well as a review
of the individual student’s situation by the ADMSA, the Associate Dean for Undergraduate
Medical Education, and a neutral faculty reviewer. If resolution is still not achieved, the
ADMSA will make a recommendation to the Senior Associate Dean for Health Sciences
Education, who will make the final decision.
Key learning resources:
Throughout the month, you will be issued a hardback copy of a basic radiology book Radiology
101: The basics and Funcamental of Imaging by WE Erkonen & WL Smith. In addition William
Herring’s Learning Radiology: Recognizing the Basics (2nd edition) is also available electronically
available through Eskind Digital Library.
Books
1. Essential Radiology (Book, 2nd edition, 2006) Thieme Medical Publishers. This
introduction to basic radiology is organized around the major organ systems; it situates
imaging within the larger context of the patient's clinical presentation, the
pathophysiology of the disease or injury, the analysis and differential diagnosis of imaging
findings, and the integration of each into patient management.
2. Radiology Fundamentals (Book, 4th edition, 2012) Springer LINK. This book is an
introduction to the field of radiology for medical students, non-radiology house staff,
physician assistants, nurse practitioners, radiology assistants, and other allied health
professionals.
3. Learning Radiology: Recognizing the Basics (Book, 2nd edition, 2012) ClinicalKey. This is an
image-filled, practical, and clinical introduction to this integral part of the diagnostic
process, covering everything needed to effectively interpret medical images.
4. Getting Started in Clinical Radiology (Book, 2006) Thieme Medical Publishers. This text for
students presents case studies and images of radiology via the device of a story: four
students in their final year of medical school are involved in active discussion of the cases,
so that the reader also feels a part of the diagnostic process.
5. Essentials of Radiology: Expert Consult (Book, 3rd edition, 2014) ClinicalKey. This text
clearly explains the basic principles and clinical applications of plain film, CT, MRI, and
nuclear medicine.
6. Abdominal Ultrasound: Step by Step (Book, 2nd ed, 2012) This text provides a logical,
structured foundation for performing a successful ultrasound examination and confidence
in interpreting ultrasound findings. Abdominal Ultrasound: Step-By-Step by
Berthold Block, 2nd Edition, 2012 at www.mc.vanderbilt.edu/diglib; Search for
Thieme Medical Publishers; Select Thieme Medical Publishers,
7. RadCases: Ultrasound Imaging. Azar N, Donaldson CK. Thieme Medical Publishers, 1st ed:
2015).
Web pages
Online tutorials, lectures, and case files
Medical Imaging and Anatomy - Course Manual and Syllabus
1. http://learningradiology.com Lectures, cases, and links to other sites.An excellent
resource geared toward medical students
2. http://3s.acr.org/CIP/ (ACR’s Case in Point) Daily unknown cases with excellent brief
teaching.The historical database contains hundreds of cases
3. http://www.radiologyeducation.com/ Excellent portal to educational websites in all
imaging subspecialties.
4. http://www.mypacs.net/mpv4/hss/casemanager Multiple cases in different categories
(MSK, pediatric radiology, neurological imaging, chest imaging)
5. http://www.evaluation.idr.med.uni-erlangen.de/Ecomparetitlepage.htm Excellent
teaching site from Germany. Teaching cases in chest, neuro, angiography, and abdominal
imaging
6. http://www.radquiz.com/gi-brighamrad.htm Another great portal.Links to a number of
great teaching sites in all imaging subspecialties (MSK, neuro, body, chest, cardiothoracic,
etc.).A list of cases is available as well but did not work the last time I tried to use it
7. http://www.chestx-ray.com Chest imaging teaching site
8. http://www.bidmc.org/MedicalEducation/Departments/Radiology/MedicalStudents.aspx
Excellent teaching modules developed by Dr. Lieberman from Harvard.
9. http://www.ob-ultrasound.net/ Introduction to OB ultrasound.Very good site for medical
students
10. http://www.pediatricradiology.com A site discussing common pediatric radiology imaging
problems and protocols.Multiple links to other pediatric radiology sites
11. http://mycourses.med.harvard.edu/vp_view.asp?frame=Y&case_id=%7BA05B20FA-F648468F-BB4C-F6FE9ED09438%7D Beth Israel nuclear medicine tutorial
12. http://gamma.wustl.edu/home.html Nuclear medicine teaching cases from Mallinckrodt
13. http://chorus.rad.mcw.edu Very large database of conditions indexed by condition.
Images with findings, diagnosis and differentials are provided.
14. http://www.med.umich.edu/lrc/breastcancerdetective Mammography teaching site
15. http://www.med-ed.virginia.edu/courses/rad/index.html
Eskind Digital Library Resources
1. Accident & Emergency Radiology: A Survival Guide Third Edition, 2015, Raby,
Berman, Morley, Lacey,https://www-clinicalkeycom.proxy.library.vanderbilt.edu/#!/search/Accident%2520and%2520Emergency
%2520Radiology%253A%2520A%2520Survival%2520Guide
Anatomy
1. http://www.dartmouth.edu/~anatomy Excellent cross-sectional anatomy teaching
modules
2. http://www.lumen.luc.edu/lumen/meded/grossanatomy/x_sec/mainx_sec.htm Crosssectional anatomy teaching site.
3. http://www.fmhs.auckland.ac.nz/sms/anatomy/atlas/intro.aspx Cross-sectional anatomy
(cadaver, MRI, CT) and teaching modules from the University of Auckland
4. http://anatomy.hsc.wvu.edu/eStudyGuide/SecondLevel/Radiologic/P2index.swf
Extremities and spine anatomy on radiographs
5. http://ect.downstate.edu/courseware/neuro_atlas/mri_horizontal.html Neuroanatomy
atlas
6. http://uwmsk.org/RadAnatomy.html Skeletal anatomy on radiographs Excellent teaching
site
Medical Imaging and Anatomy - Course Manual and Syllabus
7. Imaging atlas of human anatomy Jamie Wier and Peter Abrahams.
Eskind Digital Library has free books: type LWW Health Library into the search
box. These 3 electronic books are available
8. Clinically Oriented Anatomy, 7e Keith Moore, Arthur Dalley, Anne Agur
9. Grant’s Atlas of Anatomy, 13e Anne Agur, Arthur Dalley
10. Neuroanatomy: An Atlas of Structure, Sections and Systems 8e, Duane Haines
Other sites of interest
1. http://www.acr.org/Quality-Safety/Appropriateness-Criteria Evidence-based guidelines to
assist referring physicians in making the most appropriate imaging or treatment decision
for a specific clinical condition
2. http://www.medicalstudent.com Award-winning site for medical students with a huge
number of links to other websites (all subspecialties, basic sciences, journals, etc.)
Content Areas Covered within Medical Imaging and Anatomy
Disciplinary Threads: (check all that applies)
X
Anatomy-Gross
Anatomy-Microscopic
☐
Biostatistics
☐
Biochemistry
☐
Biomechanics
☐
Biomedical Informatics
x
Cell & Developmental Biology
☐
Communication
x
Cultural Competence
☐
Embryology
☐
Epidemiology/Clinical Epidemiology
x
EBM + Clinical Care-Diagnosis
x
Diagnostic Imaging
x
Laboratory Diagnosis
x
Physical Diagnosis
☐
EBM + Clinical Care-Therapeutics
☐
Behavioral
☐
Pharmacologic
x
Procedural skills (diag/thera)
x
Interdisciplinary Threads: (check all that applies)
Asthma
☐
Cancer
x
Chronic Illness
x
Critical Thinking, Reasoning
x
Developmental Disabilities
☐
Diabetes
☐
Gender-Based Medicine
☐
Global Health
☐
☐
x
☐
x
☐
x
☐
☐
x
☐
x
☐
x
x
x
☐
x
☐
X
Genetics
Healthcare Policy & Economics
Human Development
Infection, Immunology and Inflammation
Leadership
Learning & Teaching
Microbiology
Nutrition
Pathology
Pathophysiology
Pharmacology
Physiology
Professional Formation
Research & Scholarship
Safety and Quality Improvement
Social sciences (Psych, Soc, Anthro)
Systems of Care
Toxicology
Physics
☐
X
☐
X
☐
☐
☐
X
Healthcare Disparities
Heart Disease
HIV/AIDS
Obesity
Pain
Palliative Care
Sexuality
Trauma
Medical Imaging and Anatomy - Course Manual and Syllabus
Interprofessional Skills
Wellness & Prevention
☐
☐
Other: [please list any other disciplinary threads not included above]
The following Vanderbilt Clinical Core Curriculum (VC3) Presenting
Problems are covered during Medical Imaging and Anatomy
X
X
☐
X
X
X
☐
X
X
X
X
X
X
Abdominal Pain
Abnormal Vaginal Bleeding
Abnormal Vaginal Discharge
Abnormalities of Mood
Altered Mental Status
Back Pain
Breast Complaints
Chest Pain
Cough
Dysuria
Fever
GI Bleeding
Headache
X
X
X
X
☐
X
X
X
☐
☐
X
X
Jaundice
Loss of Consciousness
Obesity
Pelvic Pain
Rash
Seizure
Shock
Shortness of Breath
Sore Throat
Substance Abuse
Trauma
Unexplained Weight Loss
The following Entrustable Professional Activities are assessed:
Recommend and Interpret Common diagnostic and Screening Tests
Assessed on weekly quizzes and by the Reading Room Checkoffs