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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 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