Download 2YVA Nuclear Medicine

Goals and Objectives: VA Nuclear Medicine
(2 Year Curriculum-Nuclear Residency Program)
Description of Rotation or Educational Experience
The goal of the first year of rotations at the Ann Arbor VA Nuclear Medicine Service is to
provide the fundamentals of nuclear medicine practice in a setting that has similarities to
a private practice. There is intensive exposure to the principles of telenuclear medicine
and opportunity for hands-on experience.
For second year residents there will be increased familiarity with diagnostic imaging and
therapy studies in the VA patient population. Residents are expected to function largely
independently (with appropriate supervision) in directing, performing, assessing
adequacy, interpreting and reporting VA nuclear medicine imaging studies. Residents
pre-dictate all studies in the second year, forming independent opinions. These draft
reports are then reviewed and corrected by faculty members with appropriate feedback to
the residents.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health.
Objectives
First Year Residents are expected to:
1. Learn to care appropriately for patients while they are in the VA Nuclear
Medicine suite for nuclear imaging studies.
2. Communicate effectively with VA patients during the interview, so that an
appropriate history and physical examination can be obtained.
3. Obtain information from the VA electronic medical records and clinical
physicians.
4. Learn specialized skills for communication with VA nuclear medicine patients
(often elderly and indigent).
5. Know the contraindications for studies and modifications for VA patients and be
able to select appropriate procedures.
Second Year Residents are expected to:
1. In addition to all the above, become more sophisticated and independent in the
care of patients in the VA nuclear medicine laboratory.
2. Demonstrate more advanced skills in the care of VA patients (history, physical
examination, treatment of complications).
3. Demonstrate facility with the VA hospital computer and PACS systems (that
differ from U-M) for patient care.
4. In short, able to take responsibility for almost all routine patient management
while the patient is in the VA nuclear medicine department.
Medical Knowledge
Goal
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Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and cognate (e.g. epidemiological and social-behavioral) sciences, and
the application of this knowledge to patient care.
Objectives
First Year Residents are expected to:
1. Learn the main imaging modalities, planar, SPECT and PET and appropriate
radiopharmaceuticals as they apply to the VA (mostly elderly male)
population.
2. Acquire fundamental knowledge of normal and abnormal scintigraphic
appearance in the VA population.
3. Develop skills to interpret nuclear medicine studies, formulate differential
diagnoses and draft reports using VA-specific templates.
4. Gain familiarity with the principles of tele-nuclear medicine, the pros and
cons of this system and the quality control of images acquired off-site.
Second Year Residents are expected to:
1. Pre-dictate all VA studies, prior to faculty review (to allow independent
judgment and confidence to grow).
2.
Acquire increasingly sophisticated knowledge of the VA tele-nuclear
medicine network and be able to perform simple troubleshooting of computer
problems.
3. Acquire increasingly sophisticated knowledge and performance of procedures
and demonstrate facility with independently running the VA nuclear laboratory
(with reduced level of supervision).
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to perform practice-based learning and
improvement that involves investigation and evaluation of their own patient care,
appraisal and assimilation of scientific evidence, and improvements in patient care.
Objectives
First Year Residents are expected to develop skills and habits to be able to:
1. Utilize available information technology for access to the most recent scientific
data. Independently seek out new data.
2. Collect cases of interest, either due to unusual or classic presentations of disease
or due to difficulties in diagnoses. Present these at the nuclear medicine
correlation conferences.
3. Participate in VA conferences – Tumor Board and Cardiology Conference and
present cases as requested.
Second Year Residents are expected to:
1. As well as all the above, regularly explore the contemporary literature for the
most recent developments in nuclear medicine imaging.
2. Collect cases of interest and present them at conferences, now using sophisticated
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skills to analyze the findings and incorporate into their own practice.
Systems Based Practice
Goal
Residents must be aware of systems-based practice, as manifested by actions that
demonstrate an awareness of and responsiveness to the larger context and system of
health care, and the ability to call effectively on system resources to provide care that is
of optimal value.
Objectives
First year residents are expected to:
1. Gain basic knowledge of the role that the various nuclear medicine imaging
procedures play in the work up of patients relative to other complementary
/competing techniques.
2. Understand appropriateness criteria and the relative strengths and weaknesses
of the various procedures.
3. Demonstrate basic knowledge about the role of the telenuclear medicine
network at the VA and the role that telemedicine can play.
Second year residents are expected to:
1. Fully understand the relative merits of the different nuclear medicine imaging
studies and able to make recommendations to the clinical service concerning the
best imaging studies for detecting suspected pathology.
2. Be aware of the roles of the regulatory agencies that oversee VA Nuclear
Medicine practice, such as the VA Radiation Safety Service and the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO).
Professionalism
Goal
Residents must demonstrate professionalism, as manifested through a commitment to
carrying out professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population.
First year residents are expected to::
1. Dress appropriately at all times.
2. Interact on a professional level with their VA patients, demonstrating great
sensitivity toward their patient’s anxiety, and placing appropriate and
compassionate patient care above self-interest at all times.
3. Demonstrate strong ethical principles. This includes good work ethic with prompt
appearance on the service at appropriate times.
4. Establish professional relationships with the VA nuclear medicine technologists
and student technologists with whom they interact and progressively develop
team leader skills.
5. Demonstrate sensitivity to the needs of the diverse patient population, including
but not limited to cancer and dementia patients.
6. Not discriminate based on age, ethnicity, gender, disability or sexual orientation.
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Second year residents are expected to:
1. In addition to the professionalism demonstrated in the 1st year, act professionally
with a responsible work ethic and respect for all members of the team by directing
all aspects of the VA nuclear medicine laboratory efficiently and smoothly
throughout the day.
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in
effective information exchange and collaboration with patients, their families, and other
health professionals.
Objectives
First Year Residents are expected to (to be):
1. Able to dictate reports using VA templates with clear and concise language after
reviewing the images with a faculty member.
2. Able to verbally communicate the results of performed studies concisely and
clearly to inquiring VA referring physicians.
3. Develop the ability to communicate calmly and clearly about nuclear medicine
imaging studies to VA patients. Demonstrate appropriate patience and empathy
in this communication.
4. Play an active role in communicating with and instruction of medical students
rotating on the VA service.
5. Demonstrate appropriate communication skills with VA technologists with whom
they interact.
6. Demonstrate appropriate communication skills with VA clerical and
administrative personnel with whom they interact.
Second Year Residents are expected to:
1. Demonstrate proficiency in all the above skills, as well as gain mastery of report
dictation in a pre-review mode. Independently dictate study findings with
minimal direction.
2. Communicate effectively with VA patients, VA technologists, and VA clinical
physicians with whom they interact. This includes leadership skills and
demonstration of empathy/understanding for both patients and their primary
caretakers.
Teaching Methods
Individual teaching on cases
Tumor Board and Cardiology conferences
Teaching files on internet
Written material in textbooks in VA nuclear medicine library
Scientific articles provided by faculty
Self education is expected
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Assessment Method (residents)
Focused direct observation by the faculty (written quarterly evaluations)
Assessment of residents’ draft reports
Assessment Method (Program Evaluation)
Annual formal program evaluation
Quarterly meetings with the Program Director
Frequent informal discussions with the Associate Program Director
Level of Supervision
First Year: During the first six months supervision by the faculty is direct. During the
second six months, residents take on greater responsibility including quality control of
images. During the second year, responsibility on the nuclear medicine service continues
but all dictated reports are reviewed by the faculty.
Educational Resources
Textbooks in the VA Nuclear Medicine Library
VA Medical Library
VA Interesting Case Log
Access to Internet teaching files
Access to Medline Search and PubMed through VA portal
4/16/08
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